Onset and temporal sequencing patterns of comorbidity between lifetime major depression, panic disorder and fibromyalgia

Abstract

Objective Fibromyalgia (FM) is a syndrome of unknown aetiology characterised by chronic widespread musculoskeletal painand associated with high rates of psychiatric comorbidities, mainly mood and anxiety disorders. This study aims to determine the age at onset (AAO) and temporal sequencing patterns of FM and its frequent and distinguishable psychiatric comorbidities, the major depressive episode(s) (MDE), and panic disorder (PD). Methods Diagnosis of MDE and PD were assigned using the Structured Clinical Interview for Diagnostic and StatisticalManual of Mental Disorders fourth edition (DSM-IV). The AAO of FM, MDE, and PD was defined using the event history calendar. All patients completed a sociodemographic data form, self-report questionnaires measuring FM-related symptoms and function, and the Childhood Trauma Questionnaire-28 (CTQ-28). Results (83%) of the 118 recruited patients with FM had at least one psychiatric comorbidity. Two main temporal patternswere identified among the 83 patients (70.3 %) who could reliably report the age at onset of FM and psychiatric comorbidities. In the concurrent comorbidity pattern (CCP), MDE and/or PD co-occurred with the onset of FM. In the sequential pattern (SP), the patients first developed PD, then MDE, and finally FM. FM patients with SP are overweight and younger than those with a CCP (FM concurrent with MDE and PD) and reported more childhood adversities, mainly sexual abuse. AAO of psychiatric comorbidities significantly differed between the two patterns. ConclusionThe presence of different temporal comorbidity patterns may suggest prevention/early treatment interventions, especially in patients with childhood adversities and early-onset PD.

The impact of psychiatric comorbidities associated with depression: a literature review

“…The comorbidity between panic and depression was found to be the most significant in a population study [ 18 ]. Using data from the Initial Study of National Comorbidity, Roy-Byrne et al (2000) found a strong lifetime and current comorbidity between panic and depression [ 19 ].…”

Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required

“…For example, poor psychological outcomes include an increased risk of self-harm and/or suicidality, instability in mental health and the transfer of addictions to other substances. 9,10 Poor physical outcomes include weight regain or failure to lose weight; chronic nausea and/or vomiting; and acid reflux. [11][12][13] 1.1 | Common considerations for people living with obesity A significant number of bariatric surgery-seeking patients present with complex psychopathology.…”

“…Studies have consistently demonstrated that poor mental health and unresolved psychological difficulties are significant predictors of a less successful physical and psychological outcome from surgery. For example, poor psychological outcomes include an increased risk of self‐harm and/or suicidality, instability in mental health and the transfer of addictions to other substances 9,10 . Poor physical outcomes include weight regain or failure to lose weight; chronic nausea and/or vomiting; and acid reflux 11–13 …”