The Structural Relationship of Adverse Childhood Experiences and Pain Catastrophizing Tendency in Patient with Migraine by the Mediation of Depression and Anxiety

Document Type : Research Paper

Authors

1 PhD student, Department of Psychology, Faculty of Educational Sciences and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran

2 Department of Psychology, Faculty of Educational Sciences and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran

10.22034/jmpr.2025.67935.6723

Abstract

The present study aimed to investigate the structural relationship between adverse childhood experiences and pain catastrophizing in individuals with migraine, with depression and anxiety serving as mediating variables. This research employed a correlational design within the framework of structural equation modeling (SEM). The study population consisted of migraine patients aged 20 to 30 who sought treatment at pain clinics in Mashhad during 2024–2025. A total of 204 participants, all of whom had been clinically diagnosed with migraine by a board-certified neurologist and provided informed consent, were selected through purposive sampling. The research instruments included the Pain Catastrophizing Scale (Sullivan et al., 1995), the Adverse Childhood Experiences Questionnaire (Dong et al., 2004), the Beck Depression Inventory-II (1996), and the Beck Anxiety Inventory (1988). Data analysis was conducted using SPSS and AMOS software. The findings revealed that adverse childhood experiences exerted a statistically significant indirect effect on pain catastrophizing through depression (P < 0.01); however, the mediating effect of anxiety was not significant. Among the mediators, depression demonstrated the strongest effect, with a path coefficient of 0.531. These results underscore the critical role of early-life adversity and negative emotional states—particularly depression—in shaping pain perception and pain catastrophizing among migraine patients.

Keywords

Main Subjects

References

Agosti, R. (2024). Migraine burden of disease: From the patient's experience to a socio‐economic view. Headache: The Journal of Head and Face Pain, 58, 17-32. https://doi.org/10.1111/head.13301
Al-Hassany, L., Boucherie, D. M., Creeney, H., van Drie, R. W., Farham, F., Favaretto, S., ... & European Headache Federation School of Advanced Studies (EHF-SAS). (2023). Future targets for migraine treatment beyond CGRP. The Journal of Headache and Pain, 24(1), 76. https://doi.org/10.1186/s10194-023-01567-4
Alvarez-Astorga, A., García-Azorín, D., Hernández, M., de la Red, H., Sotelo, E., Uribe, F., & Guerrero, A. L. (2021). Pain catastrophising in a population of patients with migraine. Neurología (English Edition), 36(1), 24-28. https://doi.org/10.1016/j.nrleng.2018.10.021
Amone-P’Olak, K., & Letswai, N. K. (2020). The relationship between adverse childhood experiences and depression: A cross-sectional survey with university students in Botswana. South African Journal of Psychiatry, 26. http://www.sajp.org.za/index.php/sajp/pages/view/policies#part_4
Babad, S., Zwilling, A., Carson, K. W., Fairchild, V., & Nikulina, V. (2022). Childhood environmental instability and social-emotional outcomes in emerging adults. Journal of interpersonal violence, 37(7-8), NP3875-NP3904. https://doi.org/10.1177/08862605209481
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol, 56(6), 893-7. DOI: 10.1037//0022-006x.56.6.893. PMID: 3204199.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychological Review, 1, 77-100.
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory (2nd Ed). San Antonio: The Psychological Corporation.
Cuciureanu, D. I., Bistriceanu, C. E., Vulpoi, G., Cuciureanu, T., Antochi, F., & Roceanu, A. (2024). Migraine Comorbidities. Life (Basel), 14(1), 74. https://doi.org/10.3390/life14010074
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., ... & Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child abuse & neglect, 28(7), 771-784. https://doi.org/10.1016/j.chiabu.2004.01.008
Elston Lafata, J., Moon, C., Leotta, C., Kolodner, K., Poisson, L., & Lipton, R. B. (2004). The medical care utilization and costs associated with migraine headache. Journal of general internal medicine, 19(10), 1005-1012.  https://doi.org/10.1111/j.1525-1497.2004.30021.x
Felitti, V. (1998). The relationship of adverse childhood experiences to adult health: Turning gold into lead.
Fox, J., Gaul, C., Ohse, J., et al. (2025). Psychological transdiagnostic factors and migraine characteristics as predictors of migraine-related disability. The Journal of Headache and Pain, 26, 167.
Jette, N., Patten, S., Williams, J., Becker, W., & Wiebe, S. (2008). Comorbidity of migraine and psychiatric disorders—a national population‐based study. Headache: The Journal of Head and Face Pain, 48(4), 501-516.  https://doi.org/10.1111/j.1526-4610.2007.00993.x
Kaviani, H., & Mousavi, A. S. (2008). Psychometric properties of the Beck Anxiety Inventory across age and gender clusters in an Iranian population. Journal of the Faculty of Medicine, 66(2), 126–140. Retrieved from https://sid.ir/paper/38866/fa
Kaviani, H., & Mousavi, A. S. (2008). Psychometric properties of the Beck Anxiety Inventory across age and gender groups in an Iranian population. Tehran University Medical Journal, 66(2), 136–140. Retrieved from http://tumj.tums.ac.ir/article-1-641-fa.html
Kline, R. B. (2023). Principles and practice of structural equation modeling. Guilford publications. https://books.google.comi9ph1ko96rE777y3bR-MddH4_GA
Kocsel, N., Galambos, A., Szőke, J., & Kökönyei, G. (2024). The moderating effect of resting heart rate variability on the relationship between pain catastrophizing and depressed mood: an empirical study. Biologia Futura, 75(1), 29-39. https://doi.org/10.1007/s42977-023-00190-3
Lake III, A. E., Rains, J. C., Penzien, D. B., & Lipchik, G. L. (2005). Headache and psychiatric comorbidity: historical context, clinical implications, and research relevance. Headache: The Journal of Head and Face Pain, 45(5), 493-506.  https://doi.org/10.1111/j.1526-4610.2005.05101.x
Ligthart, L., Hottenga, J. J., Lewis, C. M., Farmer, A. E., Craig, I. W., Breen, G., ... & Nyholt, D. R. (2014). Genetic risk score analysis indicates migraine with and without comorbid depression are genetically different disorders. Human genetics, 133, 173-186. https://doi.org/10.1007/s00439-013-1370-8
Lotfi, M., Pourshahriari, M., & Rezaeian, H. (2023). Psychometric properties of the international adverse childhood experience questionnaire in Mashhad. Journal of Psychological Science, 22(125), 865-880. 10/52547/JPS.22/125/865
Lu, S. R., Fuh, J. L., Juang, K. D., & Wang, S. J. (2000). Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache. Headache: The Journal of Head and Face Pain, 40(9), 724-729.  https://doi.org/10.1046/j.1526-4610.2000.00126.x
Manouelian, A. C., & Azadekta, M. (2022). The relationship between adverse childhood experiences and depression: The mediating role of mindfulness. Journal of Psychological Methods and Models, 13(50), 107–118. https://doi.org/10.30495/jpmm.2023.30995.3710
Martinez, C. I. (2021). Pathology of Migraine Pain and Its Effect on Sensory Processing. Routledge. https://repository.arizona.edu/handle/10150/666671
Oláh, B., Fekete, Z., Kuritárné Szabó, I., & Kovács-Tóth, B. (2023). Validity and reliability of the 10-Item Adverse Childhood Experiences Questionnaire (ACE-10) among adolescents in the child welfare system. Front. Public Health, 11, 1258798. DOI: 10.3389/fpubh.2023.1258798
Olesen, J. (2018). Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia, 38(1), 1-211. DOI:10.1177/0333102417738202
Rahimi, C. (2014). Application of the Beck Depression Inventory-II among Iranian university students. Clinical and Personality Psychology, 12(1), 173–188.
Rahmati, N., Asghari Moghadam, M. A., Shaeiri, M. R., Paknejad, M., Rahmati, Z., Ghasemi, M., Maroufi, N., & Nayeb Aghaei, H. (2015). Psychometric properties of the Pain Catastrophizing Scale in Iranian patients with chronic pain. Scientific Journal of Ilam University of Medical Sciences, 25(1), 63–79.
Robinson, O. J., Vytal, K., Cornwell, B. R., & Grillon, C. (2013). The impact of anxiety upon cognition: perspectives from human threat of shock studies. Frontiers in human neuroscience, 7, 203. https://doi.org/10.3389/fnhum.2013.00203
Sadeghi, Sh., Montazeri, A., Reiss-Sadats, A., Shahgholi, L., Mokhberian Nejad, R., & Foroureshkhah, F. (2009). Cultural adaptation and psychometric validation of the Persian version of the Pain Catastrophizing Scale. Tehran, Iran: Academic Jihad Centers. Retrieved from https://sid.ir/paper/804528/fa
Sareen, J., Jacobi, F., Cox, B. J., Belik, S. L., Clara, I., & Stein, M. B. (2006). Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Archives of internal medicine, 166(19), 2109-2116. 10.1001/archinte.166.19.2109
Saunders, K., Merikangas, K., Low, N. C. P., Korff, M. V., & Kessler, R. C. (2008). Impact of comorbidity on headache-related disability. Neurology, 70(7), 538-547. https://doi.org/10.1212/01.wnl.0000297192.84581.
Sheffler, J. L., Piazza, J. R., Quinn, J. M., Sachs-Ericsson, N. J., & Stanley, I. H. (2019). Adverse childhood experiences and coping strategies: Identifying pathways to resiliency in adulthood. Anxiety, Stress, & Coping, 32(5), 594-609.  https://doi.org/10.1080/10615806.2019.1638699
Siego, C. V., Sanchez, S. E., Jimenez, M. L., Rondon, M. B., Williams, M. A., Peterlin, B. L., & Gelaye, B. (2021). Associations between adverse childhood experiences and migraine among teenage mothers in Peru. Journal of psychosomatic research, 147, 110507. https://doi.org/10.1016/j.jpsychores.2021.110507
Steinmetz, J. D., Seeher, K. M., Schiess, N., Nichols, E., Cao, B., Servili, C., ... & Atalell, K. A. (2024). Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23(4), 344–381. https://doi.org/10.1016/S1474-4422(24)00038-3
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524
T. Back, A., A. Steer, R., G. Carbin, M. (1998). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77-100.
Tan, H. J., Suganthi, C., Dhachayani, S., Mohd Rizal, A. M., & Raymond, A. A. (2007). The coexistence of anxiety and depressive personality traits in migraine. Singapore medical journal, 48(4), 307.
Tidmarsh, L. V., Harrison, R., Ravindran, D., Matthews, S. L., & Finlay, K. A. (2022). The influence of adverse childhood experiences in pain management: mechanisms, processes, and trauma-informed care. Frontiers in Pain Research, 3, 923866. https://doi.org/10.3389/fpain.2022.923866
Viudez-Martínez, A., Torregrosa, A. B., Navarrete, F., & García-Gutiérrez, M. S. (2024). Understanding the biological relationship between migraine and depression. Biomolecules, 14(2), 163.‏ https://doi.org/10.3390/biom14020163
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., ... & Bhutta, Z. A. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The lancet, 396(10258), 1204-1222. doi.10.1016%2FS0140-6736%2820%2930925-9&pii=S0140-6736%2820%2930925-9
Xu, R., Zhang, R., Dong, L., Xu, X., Fan, X., & Zhou, J. (2025). An analysis of the burden of migraine and tension-type headache across the global, China, the United States, India and Japan. Frontiers in Pain Research, 6, Article 1539344. https://doi.org/10.3389/fpain.2025.1539344
Zhang, Q., Shao, A., Jiang, Z., Tsai, H., & Liu, W. (2019). The exploration of mechanisms of comorbidity between migraine and depression. Journal of cellular and molecular medicine, 23(7), 4505-4513. https://doi.org/10.1111/jcmm.14390
Journal of Modern Psychological Researches
Volume 21, Issue 81
May 2026
Pages 44-55

Files

History

  • Receive Date: 11 August 2025
  • Revise Date: 29 October 2025
  • Accept Date: 03 November 2025

Share

How to cite

Statistics