Depression, Anxiety Associated With Poor Illness Perception Rather Than Pain, Study Finds

Depression, Anxiety Associated With Poor Illness Perception Rather Than Pain, Study Finds

Depression and anxiety in patients with fibromyalgia are associated with poor illness perception rather than pain severity, a study has found.

Fibromyalgia syndrome (FMS) is associated with depression and anxiety with prevalence reaching 60 percent and 70 percent, respectively. Although previous studies have shown an association between pain, coping and illness perception with depression and anxiety in chronic pain patients, no such associations have been investigated in FMS.

This was therefore the main focus of the study “Poor Illness Perceptions Are a Risk Factor for Depressive and Anxious Symptomatology in Fibromyalgia Syndrome: A Longitudinal Cohort Study,” published in the journal Frontiers in Psychiatry.

The study involved 280 patients diagnosed with FMS by a certified rheumatologist in The Netherlands. The patients completed a baseline questionnaire at the beginning of the study and a follow-up questionnaire after 18 months.

In the questionnaires, anxiety, depression, pain severity, coping style and illness perceptions all were assessed using standard scales.

Mean age of the participants was 42.6 years and 95.4 percent of them were female.

At the 18-month interval, 68 patients had signs of depression and 80 of anxiety.

Overall, the results showed that patients who believed their illness impacted their mental status and who had high levels of depression were more likely to suffer from depression in the future. Patients who suffer from anxiety and think that the treatment will not be effective also are more likely to suffer from more anxiety in the future.

Although the team expected pain to be among the risk factors associated with depression and anxiety in FMS patients, the association found in this patient group was not significant.

The findings are consistent with some previous studies showing that patients with chronic widespread pain who believe their illness affects their mental status are more likely to suffer from depression and anxiety.

However, the findings are not consistent with a previous study that found a link between coping and the risk of depressive and anxiety symptoms in FMS patients, possibly due to the fact that a different assessment method was used in the current study.

“Our data suggest that not pain severity or maladaptive coping, but poor illness perceptions are important in elevated depressive and anxious symptomatology. Patients with fibromyalgia who think their illness negatively affects their mental well-being are at increased risk for more depressive symptoms, and those who think treatment of their illness will not be effective are at increased risk for more anxiety symptoms” the researchers wrote.

The identification of risk factors that can affect depression and anxiety in FMS patients is important, because it can offer the opportunity to tackle the risk factors before they impact the mental well-being of patients.

“Strengthening illness beliefs and reducing catastrophic thinking seem to be important factors in the treatment of patients with FMS, allowing them to improve their health. Future research should further explore the effects of such interventions” the team concluded.

5 comments

  1. Heather J says:

    This tells us… what?

    I don’t think our emotional responses can be so simplified. Chronic pain patients would be better served by the acknowledgement that our illness may cause physical limitations or that symptoms wax and wane. I’ve experienced a grief process but I resist being labeled as being depressed. Instead, I’ve been able to explain to my doctors that when my symptoms worsen, I face more obstacles that interfere with things I enjoy doing or things I used to take for granted so sometimes I become depressed.

    In the past, doctors assigned me the “depressed” label and then started restricting my access to treatments that reduced my other symptoms — which only compounded my emotional distress and harmed my trust in doctors! There are very real implications for patients when their doctors can’t see past that “depression” or “anxiety” label. At that point, some doctors STOP listening to their patients at all.

    Hrm, if only doctors had the time to talk to their patients instead of rushing through appointments on to the next patient. We have complex health issues, and that fact is being devalued in the current medical system. It’s a real disservice and it causes harm to the patient… and frankly, it’s got to be compounding the stresses faced by physicians too!

    What if cancer patients were denied treatments because physicians got stuck with labeling them as depressed or anxious? That’s an extreme example but how about we start designing programs that validate some of the experiences of the chronic pain patients — that normalize frustrations, sadness, grief that comes from very real limitations. The next step would be to offer adaptation strategies like teaching patients how to pace their activities (using a timer or counting the number of dishes they do and evaluating their energy levels after 5 dishes, 10 dishes… decide when they need to rest). Rate physical and mental daily activities as less or more demanding and show them how to be flexible enough to work on less demanding activities on high symptom days. Teach them the value of PROGRESS rather than watching them beat themselves up because they can never FINISH a project. Teach them that their pain will vary from day to day, build a “toolkit” of symptom management strategies and a crisis plan (if needed) that can involve family, friends, healthcare providers.

    Use management models like those developed for diabetes, cancer, pregnancy… whatever. Don’t just slap diagnoses on patients and let them try to figure out what their expectations should be, what the course of the illness is likely to be. Can you blame them when they are forced to seek support from fellow sufferers who are at various stages of coping or failing to cope? People get stuck… because they do NOT get support from doctors. And then doctors blame these same patients for failing to cope.

    Provide structure, support, resources. Not diagnosis, labels and judgement. The current system creates a self-fulfilling prophesy. I feel like I am battling the healthcare system for the help I deserve and it takes energy that could better be spent on self-care.

    A chronic illness diagnosis *IS* life-changing. I had to come to many realizations on my own and seek my own validation. If cancer patients or diabetic patients received the same level of treatment as chronic pain patients, then their disease courses would inevitably decline.

    The medical system has created a self-fulfilling prophesy. They don’t support patients and then they wonder why patients are coping poorly.

  2. Sandra G. says:

    I couldn’t put any better than Heather J. did. Sha is SPOT ON.
    Heather, with your permission, may I print, or post your reply, to share with family, friends, doctors, and fellow support group members coping with this illness?
    Thank you!! 💜

  3. Bron says:

    Thank you very much Heather; You have stated the views of ALL of us. I know that I find my appointments very disappointing, for as you say “we have a 10 minute allocation ” (for which I have to pay $60 ) to just get my prescription repeats. These medications I, too, have had to find from our own research/fellow Fibro patients. I have made this point on various occasions regarding our dismissal because either our Doctors don’t understand Fibromyalgia, or our Health Systems don’t want to recognise it ?? To me this is the same/more than the suffering of Life-threatening conditions, as we know we will have it with us for Many years. I also know that we do deteriorate with Fibro, (slowly but surely).
    I agree that we would all benefit from All-round support services, as Heather has stated, like Diabetes, without us having to search/pay for these services ourselves.
    I also agree that I know I am not depressed/anxious. I get angry when others try to tell me that I ” am capable of doing whatever I want”: Little do they know. I know that I have good days and bad days, and if I push through, when I shouldn’t push through, then It Hits Hard, but no-one can see that, for We All Look Normal to others.

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