Women with fibromyalgia have a high prevalence of post-traumatic stress disorder (PTSD), major depressive disorder (MDD), bipolar, and panic disorders, which can have a negative impact on their quality of life, according to a study.
The study, “The impact of fibromyalgia syndrome and the role of comorbidity with mood and post-traumatic stress disorder in worsening the quality of life,” appeared in the International Journal of Social Psychiatry.
Studies have found that PTSD and mood disorders are highly prevalent in fibromyalgia patients, but the strength of these associations have differed between studies.
For PTSD, research has used only rating scales for symptoms, rather than reliable diagnoses with international classification systems. Previous research on the link between fibromyalgia and psychiatric disorders also did not use semi-structured interviews — which allows for some deviation from a list of predefined questions — conducted by psychiatrists, which the authors consider the best methodological approach.
Accounting for coexisting conditions in fibromyalgia patients with psychiatric disorders is of key importance, because antidepressants are routinely used for these patients, which can have implications for those with bipolar disorder. Determining if PTSD in fibromyalgia is because of the high prevalence of mood disorders, or if it’s independent, is also relevant.
Assessing whether the lower quality of life in fibromyalgia patients is derived from a psychiatric disorder is also of importance to clinicians. Fibromyalgia patients often complain that their condition is minimized by clinicians, viewed as being psychological rather than physical in nature, caused by emotional or mental problems and lacking an objective origin.
In this study, a research team from Italy and Brazil intended to determine the correlation between PTSD and mood disorders in fibromyalgia patients. They also evaluated the extent to which fibromyalgia lowers quality of life and the impact of coexisting conditions with psychiatric disorders.
The study included 71 women with fibromyalgia attending a rheumatology outpatient service at an Italian hospital and 284 healthy individuals used as controls.
Psychiatric diagnosis was conducted with a semi-structured clinical interview called the Advanced Neuropsychiatric Tools and Assessment Schedule. Quality of life in the month prior to evaluation was assessed with the Short Form Health Survey (SF-12), which explores physical activity, limitations due to health conditions, emotional life, pain, general health, vitality, social network, and mental health.
Lifetime prevalence of PTSD, MDD, bipolar disorder, panic disorder, and generalized anxiety were assessed in all participants.
Results showed that the prevalence of PTSD (8.4% vs. 1.4%), MDD (43.7% vs. 8.1%), bipolar disorder (21.1% vs. 0.7%), and panic disorder (28.2% vs. 5.6%) were higher in women with fibromyalgia than in controls. People with fibromyalgia had lower scores on the SF-12 survey, indicating a worse quality of life.
Of note, the prevalence of MDD was almost double what was reported in previous studies that did not conduct interviews, the team noted. The frequency of bipolar disorder was also higher than in studies using rigidly structured interviews.
Women with both MDD and bipolar disorder had worse mean SF-12 scores than those without any mood disorder, although this difference was not statistically significant.
Data further revealed that the impact of fibromyalgia on quality of life was comparable to that of chronic diseases such as multiple sclerosis and MDD, and higher than eating and panic disorders. However, if associated with a mood disorder, fibromyalgia worsens the quality of life more than multiple sclerosis.
“Both mood disorders and PTSD appear to be factors that significantly increase the [quality of life] impairment in [fibromyalgia],” the researchers wrote.
Because the association between PTSD and mood disorders was stronger in fibromyalgia patients than in controls, the scientists believe that the increased PTSD prevalence in fibromyalgia cannot be a mere consequence of mood disorders. They hypothesized that vulnerability to chronic stress may underlie the link between mood disorders and fibromyalgia.
“The findings have important clinical significance: the physician must interpret in the right dimension and with dignity the suffering of the people with [fibromyalgia],” they said.
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