title: Recurrent headache and interpersonal violence in adolescence: the roles of psychological distress, loneliness and family cohesion: the HUNT study.
abstract: BACKGROUND
  Recurrent headache is the most common and disabling pain condition in adolescence. Co-occurrence of psychosocial adversity is associated with increased risk of chronification and functional impairment. Exposure to interpersonal violence seems to constitute an important etiological factor. Thus, knowledge of the multiple pathways linking interpersonal violence to recurrent headache could help guide preventive and clinical interventions. In the present study we explored a hypothetical causal model where the link between exposure to interpersonal violence and recurrent headache is mediated in parallel through loneliness and psychological distress. Higher level of family cohesion and male sex is hypothesized to buffer the adverse effect of exposure to interpersonal violence on headache.
  
  
  METHODS
  The model was assessed using data from the cross-sectional, population-based Young-HUNT 3 study of Norwegian adolescents, conducted from 2006-2008. A cohort of 10 464 adolescents were invited. The response rate was 73% (7620), age ranged from 12 and 20 years, and 50% (3832) were girls. The study comprised self-report measures of exposure to interpersonal violence, loneliness, psychological distress and family cohesion, in addition to a validated interview on headache, meeting the International Classification of Headache Disorders criteria. Recurrent headache was defined as headache recurring at least monthly during the past year, and sub-classified into monthly and weekly headache, which served as separate outcomes.
  
  
  RESULTS
  In Conditional Process Analysis, loneliness and psychological distress consistently posed as parallel mediating mechanisms, indirectly linking exposure to interpersonal violence to recurrent headache. We found no substantial moderating effect of family cohesion or sex.
  
  
  CONCLUSIONS
  Loneliness and psychological distress seem to play crucial roles in the relationship between exposure to interpersonal violence and recurrent headache. To facilitate coping and recovery, it may be helpful to account for these factors in preventive and clinical interventions. Trauma-informed, social relationship-based interventions may represent a major opportunity to alter trajectories of recurrent headache.
authors.affiliation: Norwegian Centre for Violence and Traumatic Stress Studies, University of Oslo, P,B, 181, Nydalen 0409 Oslo, Norway. synne.stensland@nkvts.unirand.no.
authors.forename: Synne Oien
authors.initials: SO
authors.lastname: Stensland
authors.forename: Siri
authors.initials: S
authors.lastname: Thoresen
authors.forename: Tore
authors.initials: T
authors.lastname: Wentzel-Larsen
authors.forename: John-Anker
authors.initials: JA
authors.lastname: Zwart
authors.forename: Grete
authors.initials: G
authors.lastname: Dyb
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005195:Family Relations; D005260:Female; D006261:Headache / Q000209:etiology* / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D008132:Loneliness / Q000523:psychology*; D008297:Male; D012008:Recurrence; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology; D014754:Violence / Q000523:psychology*; D055815:Young Adult