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a limitation of the study is the use of a self-report instrument to assess childhood maltreatment, which may be subject to recall bias. the self-report may have a higher sensitivity than the interview-based method, but lower specificity. however, self-report of childhood maltreatment may also reflect a disposition to admit to childhood maltreatment and thus may be more accurate than report by others [ 56 ].

the study did not include a group of people without a history of childhood trauma. therefore, it is difficult to identify the effect of the trauma, without the effect of the sociodemographic factors. the low number of patients with a history of childhood trauma may be the reason for the lack of a significant result. to assess whether the results are true in the general population, a study including a large sample of people without a history of childhood trauma is necessary. finally, the mini-suicide risk measure is a screening measure and not a diagnostic tool. therefore, a detailed diagnostic classification of psychiatric disorders may be necessary to validate the mini-suicide risk measure.

the patient health questionnaire-9 (phq-9) is a short and concise self-rating screening tool to assess the severity of depressive symptoms. it consists of nine items that cover all symptoms of a major depressive episode according to dsm-4 criteria [ 29 ]. responses are given by participants on a four-point likert scale (0 not at all to 3 almost every day), indicating their symptom severity for the past 2weeks. total scores can range from 0 to 27, with higher values indicating symptom severity. an overall score>10 indicates the presence of depression. cut-off values for symptoms severity are as following: minimal (29), mild (1014), moderate (1519), and severe (20). for the arabic translation of the phq-9, a discriminant, factorial, and convergent validity and high reliability (0.86 0.88) have been shown [ 30 ].




We examined the degree to which anxiety and depression symptoms occurred in participants with and without migraine. We also aimed to explore the influence of the severity of migraine and of their characteristics, and its interactions on the severity of depressive and anxiety symptoms. Information concerning patients’ characteristics, such as the severity of migraine, was obtained through questionnaires administered during an office visit and/or a telephone interview. In this study, the severity of migraine was measured using the headache impact test (HIT-6). This questionnaire consists of six questions designed to assess the impact of headache on the respondents daily life (one point for yes, two points for no, and three points for not sure). The HIT-6 has been widely used as a sensitive and reliable measure of perceived impact of migraine [ 39 ]. The severity of depression was assessed using the Beck Depression Inventory-II (BDI-II). The BDI-II is a short and easy to use screening instrument for depression. The BDI-II consists of 21 items, which can be answered on a 0 to 3 scale (0 no symptom, 1 mild symptom, 2 moderate symptom, 3 severe symptom). The sum of scores can then be converted to a 0 to 63 scale (0 normal, 1 mild, 2 moderate, 3 severe depression) [ 40 ]. The severity of anxiety was assessed using the State-Trait Anxiety Inventory (STAI), a widely used self-report measure for anxiety in adults [ 34 ]. The STAI is a well-validated instrument, and it consists of two scales: the state anxiety scale (STAI-S) and the trait anxiety scale (STAI-T). The STAI-S has 20 questions that determine the extent to which an individual feels state of anxiety. The STAI-T has 20 questions that measure how an individual feels at the moment of the test. Responses are provided on a 4-point Likert scale (0 not at all, 1 almost never, 2 sometimes, 3 often, and 4 almost always). The state and trait anxiety scale have good psychometric properties [ 41 ]. The original version of the MINI is not validated for Arabic, although the Arabic version of the M.I.N.I. was used in three other studies [ 25 ]. The MINI was translated into Arabic according to procedures recommended by the WHO [ 43 ]. The validity of the Arabic version of the MINI was assessed in a small sample of students in the United Arab Emirates, and it was found to have a strong agreement with the Diagnostic Interview for DSM-IV (DISC-IV) in terms of reliability (Cohen’s κ =.75) and validity (κ =.61) in a sample of prisoners [ 24 ]. In the present study, the internal consistency of the Arabic MINI was assessed, and the results showed a very strong internal consistency (alpha =.91). The internal consistency of the Arabic MINI was also investigated in the present sample (alpha =.87). 5ec8ef588b


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