Poor Illness Perceptions Are a Risk Factor for Depressive and Anxious Symptomatology in Fibromyalgia Syndrome: A Longitudinal Cohort Study

Abstract

BackgroundPatients with widespread pain, such as in fibromyalgia, are vulnerable for depression and anxiety, which composes a relevant public health problem. Identifying risk factors for the onset of depression and anxiety is therefore warranted. Objective of this study was to determine whether severe pain, maladaptive coping, and poor illness perceptions are associated with depressive and anxious symptomatology in fibromyalgia.MethodConsecutive patients referred to an outpatient clinic completed sets of physical and psychological questionnaires at baseline and at 18-month follow-up. A total of 452 patients with fibromyalgia syndrome (FMS) were eligible for inclusion, and subsequently, 280 patients returned the baseline questionnaire. Depressive and anxious symptomatology was measured with the Hospital Anxiety and Depression Scale. To measure pain severity, coping style, and illness perceptions, the Fibromyalgia Impact Questionnaire, Pain Coping Inventory, and the Illness Perception Questionnaire-Revised (IPQ-R) were used, respectively. Multivariable logistic regression analyses, bootstrapping and calibration, were performed to examine the association of pain severity, pain coping, and illness perception with depressive and anxiety symptoms at follow-up, adjusted for sociodemographic variables. Initial level of depressive and anxiety symptoms was selected as covariates.ResultsMean age was 42.6 years and 95.4% were female. At 18-month follow-up, 68 (of the 195) patients were depressed and 80 (of the 197) were anxious. Only the IPQ-R subscale “emotional representations” showed a significant positive association with depressive symptoms at follow-up (OR = 1.10), next to the initial level of depressive symptoms (OR = 1.30). In case of anxiety, only the IPQ-R subscale “treatment control” showed a significant negative association with anxiety symptoms at follow-up (OR = 0.87), next to the initial level of anxiety symptoms (OR = 1.45).ConclusionOur 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. Strengthening illness beliefs and reducing catastrophic thinking, therefore, seem crucial factors in the treatment of patients with FMS.

Mapping of predictors of the disengagement of the descending inhibitory pain modulation system in fibromyalgia: an exploratory study

“…This result is aligned with what we observe in a clinical setting, where the severity of psychological symptoms is a factor associated with the severity of the disease, and it has been demonstrated that it can be a predictive factor of treatment response. [51][52][53] The multivariate model showed that these symptoms are positively correlated to dysfunction in the DPMS. Thus, this result confirms our hypothesis that the severity of fibromyalgia symptoms, related to psychological characteristics, may indicate the failure of DPMS.…”

Illness Perception and Job Satisfaction in Patients Suffering from Migraine Headaches: Trait Anxiety and Depressive Symptoms as Potential Mediators

“…In addition, anxious patients exhibited worse perceptions about consequences, sense of control, and symptoms. 48 A recent longitudinal study 49 has described the role of some dimensions of illness perception (emotional representations, control over the treatment, and perceived consequences of the disease), as well as level of anxiety and depressive symptoms which may predict a possible/probable anxiety disorder at 18-month follow-up. Lastly, an additional study in patients with chronic widespread pain has suggested that higher impact of the disease on emotional and physical well-being is linked to the presence of increased levels of anxiety.…”

“…Specifically, the label someone gives to his/her illness (Identity), the control perceived over his/her treatment, how much the illness is understood, and the emotional impact of the disease seem to be predictors of depressive symptoms. 51 Further studies have shown that other dimensions of illness perception can predict the onset of depressive symptoms: 49 duration and negative consequences of the illness. 52 Moreover, in another study on chronic heart failure, results indicated that patients who perceive their illness to be burdensome and threatening and experience low personal control over it contribute to increased depressive symptoms and anxiety.…”

Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study

“…Previous research has found that IPs are predictive for and associated with psychological factors, such as depression and anxiety, in patients with fibromyalgia [ 14 ], chronic back pain [ 15 ] systemic lupus erythematosus [ 16 ] and informal carers of patients with depression [ 17 ]. Therefore, overlap may exist between the domains included in the 4DSQ and in the Brief IPQ.…”