Headache and Depression: Confounding Effects of Transdiagnostic Symptoms

Abstract

A link between headache and depression has been noted in the literature for over 30 years. To date, however, studies investigating this relationship have ignored the potential impact transdiagnostic symptoms (i.e., symptoms indicative of both depression and headache) may have on correlations between measures of depression and measures of headache activity. The present study examined this issue using the Beck Depression Inventory in a large sample of recurrent headache sufferers who had presented for treatment at one of two university-based clinics. Factor analysis identified two distinct, albeit correlated, factors reflecting cognitive/affective symptoms and somatic symptoms. Correlational analyses found consistent relationships between the somatic symptom factor and measures of headache activity, but not between the cognitive/affective factor and headache activity. We suggest that the BDI items comprising the somatic factor identified in this study may not be appropriate indicators of depression in recurrent headache samples. Key words: headache, depression, diagnosis, measurementAbbreviations: BDI Beck Depression Inventory (Headache 1994; 34:418-423) INTRODUCTIONAlthough a large literature supports the existence of a link between chronic headache and depression, 1-16 studies have generally failed to address problems inherent when diagnosing depression in medical populations. 17-19 Somatic symptoms/concerns are an important component in many theoretical conceptualizations of depression. 18 The presence of this somatic component in our conceptualization of depressive syndromes complicates the task of diagnosing depression in pain populations as the overlapping symptoms of depression and pain must be disentangled. Thus, Beck, Steer, and Garbin 20 argue that it would be useful to have a scoring system that would enable one to exclude symptoms that are transdiagnostic (i.e., symptoms indicative of both depression and a given sample's medical disorder) when assessing specific medical populations such as headache.At least three studies have found that cognitive/ affective symptoms are better indicators of depressive severity in medical populations than somatic/ vegetative symptoms. 17,21,22 For example, Cavanaugh and colleagues 17 reported that as depression increased for the medically-ill so did both the number and severity of cognitive/affective symptoms on the Beck Depression Inventory (BDI). The number of somatic symptoms, however, was not associated with depressive severity in this population. These studies suggest that in screening for depression with self-report instruments, such as the BDI, the presence of somatic symptoms alone is a poor predictor of depressive severity in the medically-ill.Factor-analytic investigations have also supported distinguishing between subsets of BDI items (for a review of these studies see Beck et al.,20 ). Although the number of factors extracted has ranged from three to seven, recent studies suggest one general broad-band factor 21 that might be decomposed into three narrow...

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