Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study.
BACKGROUND
Headache disorders, anxiety and depression - the major disorders of the brain - are highly comorbid in the western world. Whether this is so in South Asia has not been investigated, but the question is of public-health importance to countries in the region. We aimed to investigate associations, and their direction(s), between headache disorders (migraine, tension-type headache [TTH] and headache on ≥15 days/month) and psychiatric manifestations (anxiety, depression and neuroticism), and how these might affect quality of life (QoL).


METHODS
In a nationwide, cross-sectional survey of the adult Nepalese population (N = 2100), trained interviewers applied: 1) a culturally-adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire to diagnose headache disorders; 2) a validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) to detect anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD); 3) a validated Nepali version of the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N); and 4) the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Associations with headache types were analysed using logistic regression for psychiatric caseness and linear regression for neuroticism. Adjustments were made for age, gender, household consumption, habitat, altitude and use of alcohol and marijuana.


RESULTS
HADS-A was associated with any headache (p = 0.024), most strongly headache on ≥15 days/month (AOR = 3.2) followed by migraine (AOR = 1.7). HADS-cAD was also associated with any headache (p = 0.050, more strongly among females than males [p = 0.047]) and again most strongly with headache on ≥15 days/month (AOR = 2.7), then migraine (AOR = 2.3). Likewise, neuroticism was associated with any headache (p < 0.001), most strongly with headache on ≥15 days/month (B = 1.6), followed by migraine (B = 1.3). No associations were found between HADS-D and any headache type, or between TTH and any psychiatric manifestation. Psychiatric caseness of any sort, when comorbid with migraine or TTH, aggravated the negative impact on QoL (p < 0.001).


CONCLUSIONS
Headache disorders are highly comorbid with anxiety and show associations with neuroticism in Nepal, with negative consequences for QoL. These findings call for reciprocal awareness, and a holistic coordinated approach to management and in the health service. Care for common headache and common psychiatric disorders should be integrated in primary care.
Department of Neuroscience, Norwegian University of Science and Technology, Nevrosenteret Øst, St Olavs Hospital, 7006, Trondheim, Norway.|Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Ajay
A
Risal
Department of Neuroscience, Norwegian University of Science and Technology, Nevrosenteret Øst, St Olavs Hospital, 7006, Trondheim, Norway.|Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Kedar
K
Manandhar
Department of Neuroscience, Norwegian University of Science and Technology, Nevrosenteret Øst, St Olavs Hospital, 7006, Trondheim, Norway.|Pain Unit, St Olavs University Hospital, Trondheim, Norway.
Are
A
Holen
Department of Neuroscience, Norwegian University of Science and Technology, Nevrosenteret Øst, St Olavs Hospital, 7006, Trondheim, Norway.|Division of Brain Sciences, Imperial College London, London, UK.
Timothy J
TJ
Steiner
Department of Neuroscience, Norwegian University of Science and Technology, Nevrosenteret Øst, St Olavs Hospital, 7006, Trondheim, Norway. mattias.linde@ntnu.no.|Norwegian Advisory Unit on Headache, St Olavs University Hospital, Trondheim, Norway. mattias.linde@ntnu.no.
Mattias
M
Linde
D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D020773:Headache Disorders / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D000075384:Neuroticism; D015995:Prevalence; D011320:Primary Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires
Anxiety; Comorbidity; Depression; Global campaign against headache; Headache disorders; Holistic care; Nepal; Neuroticism; Primary care; Questionnaire; South Asia