Migraine, Depressive Symptoms, and Maternal Quality of Life in the Postpartum Period: The Role of Comorbidity, Disengagement, and Social and Economic Disadvantage

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PROJECT SUMMARY/ABSTRACT Migraine affects one in three women of childbearing age in the United States (U.S.). Women with migraine have up to a five-fold increased risk for comorbid depression. The postpartum period is an especially challenging time for women with migraine, as rapid hormonal shifts, fatigue, exhaustion, and increased external stressors are known triggers for both migraine and postpartum depressive symptoms. If women's migraine self-management style (MSMS) primarily involves disengagement (i.e. social withdrawal, avoidance, wishful thinking), the implications for developing depressive symptoms and synergistically worsening symptoms across conditions may be more significant. These risks may be exponentially more harmful to socially and/or economically disadvantaged (SED) women, as they experience the greatest burden from migraine and postpartum depressive symptoms. A syndemic is characterized by the (1) higher prevalence of these co-occurring disorders, and (2) synergism that exists across symptoms and self-management strategies of one condition (migraine) that facilitates developing a comorbid condition (depression) are influenced by (3) social contextual factors (social and/or economic disadvantage in the face of postpartum demands). Despite the high prevalence of these disorders individually, the increased risk for comorbid migraine-depressive symptoms in the postpartum period, and the potential impact on women and their families, there is a paucity of research in this area. The proposed study will use a syndemics framework to understand the relationships, mechanisms, and interactions among migraine and depressive symptoms, disengagement, and social or economic disadvantage over the first 3 months postpartum. This will be accomplished by the following: Aim 1: Examine the relationships among (a) migraine symptom severity, (b) depressive symptom severity, (c) level of disengagement as a migraine self-management style, and (d) social and/or economic disadvantage, over time. Aim 1a: Test the extent to which disengagement mediates the relationship between migraine symptom severity and depressive symptom severity. Aim 1b: Determine whether social and/or economic disadvantage moderates the extent to which disengagement mediates the migraine-depressive symptom relationship. Aim 2: Compare maternal quality of life among women who develop the syndemic factor (comorbid migraine and moderate-to-severe postpartum depressive symptoms) and women who do not. The applicant has outlined a comprehensive training plan to be completed under this award. Outcomes of the study and training plan will provide the applicant with skills and data to pursue a career development award on prevention-oriented interventions targeting syndemic conditions that may be useful in disrupting the development of postpartum depressive symptomatology among women with migraine.