Interpersonal violence and health in adolescents: Violence, sexual abuse and bullying in relation to recurrent headache & overweight, psychosocial & lifestyle factors, in a population-based cohort of adolescents

Stensland, S. (2015). Interpersonal violence and health in adolescents: Violence, sexual abuse and bullying in relation to recurrent headache & overweight, psychosocial & lifestyle factors, in a population-based cohort of adolescents. (Doktorgradsavhandling).

Violence, sexual abuse and bullying in relation to recurrent headache & overweight, psychosocial & lifestyle factors, in a population-based cohort of adolescents.

Recurrent headache and overweight are among the most prevalent health problems in adolescence. Environmental stress seems to impact on onset or exacerbations of both recurrent headache and excessive weight gain, in interplay with genetic susceptibility. Frequency and severity of headache, greater body fatness and coinciding psychosocial adversity is related to chronification of headache and overweight, functional impairment affecting school performance, absenteeism, leisure activities and relations to family and peers, and persistence of complaints into adulthood. Exposure to interpersonal violence, such as witnessing violence, violence, sexual abuse and bullying, could fuel the onset and persistence of recurrent headache and pathological weight gain in adolescents.

In this study we aimed to investigate the relationships between interpersonal violence, recurrent headache and overweight in a large population-based cohort of adolescents. More specifically, we aimed to examine the associations between exposure to interpersonal violence and migraine and tension-type headache. Further we investigated the potential impact of psychological distress and posttraumatic stress reactions on the relationships between interpersonal violence and recurrent headache, by type and frequency. Thereafter we explored a theoretical model of two potential parallel pathways linking interpersonal violence to recurrent headache through loneliness and psychological distress. Male sex and a high level of family cohesion were hypothesized to buffer the effect of interpersonal violence on headache. Last, we assessed the relationship between interpersonal violence and overweight, adjusting for a comprehensive range of inter-related risk-factors, including pubertal development, socioeconomic and psychosocial adversity and unfavorable lifestyle.

The Young-HUNT 3 study, 2006-2008, is a population-based, cross-sectional, cohort study of Norwegian youth that includes self-report data on exposure to interpersonal violence; pubertal status and timing; socioeconomic, psychosocial, and lifestyle factors; a validated headache interview and clinical measures of height and weight. A cohort of 10464 adolescents, aged 12–20 years from Nord-Trøndelag County, was invited to participate. Recurrent headache, by type and frequency, served as outcome in logistic regression analyses. Weekly recurrent headache served as the main outcome in assessment of the hypothesized model, using conditional PROCESS analysis. Body mass index (BMI) served as outcome in linear regression analyses.

Interpersonal violence was experienced by a substantial minority of adolescents, and recurrent headache and overweight constituted prevalent somatic conditions in the population. Robust relationships were found between interpersonal violence and both recurrent headache and higher BMI, remaining significant in adjusted regression models. Findings indicated that psychological distress and loneliness may pose as potential parallel mediators of the relationship between interpersonal violence and headache in adolescents.

Consistent associations between exposure to interpersonal violence, recurrent headache and higher BMI in adolescents may indicate that such exposure represent an important risk factor for onset or chronification of headache and overweight. A trauma-informed approach, accommodating adolescents’ somatic and psychological health needs, may be helpful in public health strategies targeting recurrent headache and overweight in adolescents. In clinical practice, when adolescents struggle with headache or overweight assessment of interpersonal violence, psychosocial adversity and unfavorable lifestyle may guide interventions and facilitate coping.