ORIGINAL PAPER
Psychological factors and health-related quality of life in fibromyalgia patients
1
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
2
Polytechnic University of Cávado and Ave, Barcelos, Portugal
Submission date: 2023-05-26
Final revision date: 2024-04-02
Acceptance date: 2024-04-17
Online publication date: 2024-08-19
Corresponding author
Ricardo P. Campos
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Rúa Xosé María Suárez Núñez, s/n. Campus Vida, 15782 Santiago de Compostela, Spain
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Rúa Xosé María Suárez Núñez, s/n. Campus Vida, 15782 Santiago de Compostela, Spain
Health Psychology Report 2024;12(4):352-367
KEYWORDS
TOPICS
ABSTRACT
Background:
Fibromyalgia (FM) has been associated with decreased health-related quality of life (HRQoL), which has been linked to psychological variables such as anxiety, depression, coping, and social support. This study aimed to simultaneously analyse the association of these variables with HRQoL in FM patients and explore their mediating role in the relationship between somatic symptoms and HRQoL.
Participants and procedure:
A cross-sectional sample of 134 FM patients (97% women) with no other rheumatologic diseases followed in specialized healthcare services completed self-report questionnaires to evaluate pain, fatigue, sleep, anxiety, depression, coping, social support, and HRQoL.
Results:
The results indicated that FM patients experienced a negative impact on all dimensions of HRQoL, with anxiety primarily affecting the mental dimensions, and depression and social support affecting both physical and mental dimensions. Anxiety, depression, dysfunctional coping, and low social support were independent predictors of HRQoL and mediated the effect of somatic symptoms in the mental component of HRQoL.
Conclusions:
FM patients experience a negative impact on HRQoL, and anxiety, depression, coping and social support play an important role as independent predictors of this decrease, and as mediators of the effect of somatic symptoms in the mental dimen-sions of HRQoL. This underscores the importance of considering these psychological variables in the therapeutic approach to FM and suggests the need for interventions targeting anxiety, depression, dysfunctional coping, and low social support to improve HRQoL in FM patients.
Fibromyalgia (FM) has been associated with decreased health-related quality of life (HRQoL), which has been linked to psychological variables such as anxiety, depression, coping, and social support. This study aimed to simultaneously analyse the association of these variables with HRQoL in FM patients and explore their mediating role in the relationship between somatic symptoms and HRQoL.
Participants and procedure:
A cross-sectional sample of 134 FM patients (97% women) with no other rheumatologic diseases followed in specialized healthcare services completed self-report questionnaires to evaluate pain, fatigue, sleep, anxiety, depression, coping, social support, and HRQoL.
Results:
The results indicated that FM patients experienced a negative impact on all dimensions of HRQoL, with anxiety primarily affecting the mental dimensions, and depression and social support affecting both physical and mental dimensions. Anxiety, depression, dysfunctional coping, and low social support were independent predictors of HRQoL and mediated the effect of somatic symptoms in the mental component of HRQoL.
Conclusions:
FM patients experience a negative impact on HRQoL, and anxiety, depression, coping and social support play an important role as independent predictors of this decrease, and as mediators of the effect of somatic symptoms in the mental dimen-sions of HRQoL. This underscores the importance of considering these psychological variables in the therapeutic approach to FM and suggests the need for interventions targeting anxiety, depression, dysfunctional coping, and low social support to improve HRQoL in FM patients.
REFERENCES (65)
1.
Abraira, V., & Pérez de Vargas, A. (1996). Métodos multivariantes en bioestadística [Multivariate methods in biosta-tistics]. Centro de Estudios Ramón Areces.
2.
Asbring, P., & Närvänen, A. L. (2002). Women’s experiences of stigma in relation to chronic fatigue syndrome and fibromyalgia. Qualitative Health Research, 12, 148–160. https://doi.org/10.1177/104973....
3.
Ataoglu, S., Ozcetin, A., Yazici, S., Koçer, E., & Içmeli, C. (2003). Effects of depression and anxiety on quality of life in patients with rheumatoid arthritis, knee osteoarthritis and fibromyalgia syndrome. Düzce Tip Fakültesi Dergisi, 3, 20–28.
4.
Bertolazi, A. N., Fagondes, S. C., Hoff, L. S., Dartora, E. G., Miozzo, I. C., de Barba, M. E., & Barreto, S. S. (2011). Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Medicine, 12, 70–75. https://doi.org/10.1016/j.slee....
5.
Boehm, A., Eisenberg, E., & Lampel, S. (2011). The contribution of social capital and coping strategies to function-ing and quality of life of patients with fibromyalgia. The Clinical Journal of Pain, 27, 233–239. https://doi.org/10.1097/AJP.0b....
6.
Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213. https://doi.org/10.1016/0165-1....
7.
Campos, R. P., Vázquez, I., & Vilhena, E. (2021). Clinical, psychological and quality of life differences in fibromyal-gia patients from secondary and tertiary healthcare. European Journal of Pain, 25, 558–572. https://doi.org/10.1002/ejp.16....
8.
Campos, R. P., & Vázquez, M. I. (2012). Health-related quality of life in women with fibromyalgia: clinical and psy-chological factors associated. Clinical Rheumatology, 31, 347–355. https://doi.org/10.1007/s10067....
9.
Campos, R. P., & Vázquez, M. I. (2013). The impact of fibromyalgia on health-related quality of life in patients according to age. Rheumatology International, 33, 1419–1424. https://doi.org/10.1007/s00296....
10.
Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the brief COPE. Interna-tional Journal of Behavioral Medicine, 4, 92–100. https://doi.org/10.1207/s15327....
11.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383. https://doi.org/10.1016/0021-9....
12.
Cohen, J. (1988). Statistical power analisys for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associate.
13.
Consoli, G., Marazziti, D., Ciapparelli, A., Bazzichi, L., Massimetti, G., Giacomelli, C., Rossi, A., Bombardieri, S., & Dell’Osso, L. (2012). The impact of mood, anxiety, and sleep disorders on fibromyalgia. Comprehensive Psy-chiatry, 53, 962–967. https://doi.org/10.1016/j.comp....
14.
Coolidge, F. L., Segal, D. L., Hook, J. N., & Stewart, S. (2000). Personality disorders and coping among anxious older adults. Journal of Anxiety Disorders, 14, 157–172. https://doi.org/10.1016/s0887-....
15.
Cruz, J., Jácome, C., Oliveira, A., Paixão, C., Rebelo, P., Flora, S., Januário, F., Valente, C., Andrade, L., & Marques, A. (2021). Construct validity of the brief physical activity assessment tool for clinical use in COPD. The Clinical Respiratory Journal, 15, 530–539. https://doi.org/10.1111/crj.13....
16.
Da Costa, D., Dobkin, P. L., Fitzcharles, M. A., Fortin, P. R., Beaulieu, A., Zummer, M., Senécal, J. L., Goulet, J. R., Rich, E., Choquette, D., & Clarke, A. E. (2000). Determinants of health status in fibromyalgia: a comparative study with systemic lupus erythematosus. The Journal of Rheumatology, 27, 365–372.
17.
del Pozo-Cruz, J., Alfonso-Rosa, R. M., Castillo-Cuerva, A., Sañudo, B., Nolan, P., & del Pozo-Cruz, B. (2017). De-pression symptoms are associated with key health outcomes in women with fibromyalgia: a cross-sectional study. International Journal of Rheumatic Diseases, 20, 798–808. https://doi.org/10.1111/1756-1....
18.
Ferreira, P. L. (2000a). Criação da versão portuguesa do MOS SF-36. Parte I: adaptação cultural e linguística [De-velopment of the Portuguese version of the MOS SF-36. Part I: Cultural and linguistic adaptation]. Acta Médica Portuguesa, 13, 55–66.
19.
Ferreira, P. L. (2000b). Criação da versão portuguesa do MOS SF-36. Parte II: testes de validação [Development of the Portuguese version of MOS SF-36. Part II: Validation tests]. Acta Médica Portuguesa, 13, 119–127.
20.
Ferreira, P. L., Ferreira, L. N., & Pereira, L. N. (2012). Medidas sumário física e mental de estado de saúde para a população portuguesa [Physical and mental summary measures of health state for the Portuguese popula-tion]. Revista Portuguesa de Saúde Pública, 30, 163–171. https://doi.org/10.1016/j.rpsp....
21.
Ferreira, P. L., & Santana, P. (2003). Percepção de estado de saúde e de qualidade de vida da população activa: contributo para a definição de normas portuguesas [Perception of health status and quality of life of the active population: contribution to the definition of Portuguese standards]. Revista Portuguesa de Saúde Pública, 21, 15–30.
22.
Freitas, R. P. A., Andrade, S. C., Spyrides, M. H. C., Micussi, M. T. A. B. C., & Sousa, M. B. C. (2017). Impacto do apoio social sobre os sintomas de mulheres brasileiras com fibromialgia [Impact of social support on the symptoms of Brazilian women with fibromyalgia]. Revista Brasileira de Reumatologia, 57, 197–203.
23.
Galvez-Sánchez, C. M., Montoro, C. I., Duschek, S., & Reyes Del Paso, G. A. (2020a). Pain catastrophizing medi-ates the negative influence of pain and trait-anxiety on health-related quality of life in fibromyalgia. Quality of Life Research, 29, 1871–1881. https://doi.org/10.1007/s11136....
24.
Galvez-Sánchez, C. M., Montoro, C. I., Duschek, S., & Reyes Del Paso, G. A. (2020b). Depression and trait-anxiety mediate the influence of clinical pain on health-related quality of life in fibromyalgia. Journal of Affective Disor-ders, 265, 486–495. https://doi.org/10.1016/j.jad.....
25.
Gündüz, N., Üşen, A., & Atar, E. (2019). The impact of perceived social support on anxiety, depression and severi-ty of pain and burnout among turkish females with fibromyalgia. Archives of Rheumatology, 34, 186–195. https://doi.org/10.5606/ArchRh....
26.
Häuser, W., Biewer, W., Gesmann, M., Kühn-Becker, H., Petzke, F., Wilmoswky, H.v, Langhorst, J., & Glaesmer, H. (2011). A comparison of the clinical features of fibromyalgia syndrome in different settings. European Jour-nal of Pain, 15, 936–941. https://doi.org/10.1016/j.ejpa....
27.
Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neurosci-ence, 20, 53–62. https://doi.org/10.31887/DCNS.....
28.
Hayes, A. F., & Little, T. D. (2018). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford Press.
29.
Heidari, F., Afshari, M., & Moosazadeh, M. (2017). Prevalence of fibromyalgia in general population and patients: a systematic review and meta-analysis. Rheumatology International, 37, 1527–1539. https://doi.org/10.1007/s00296....
30.
Hoffman, D. L., & Dukes, E. M. (2008). The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. International Journal of Clinical Practice, 62, 115–126. https://doi.org/10.1111/j.1742....
31.
Jiao, J., Davis Iii, J. M., Cha, S. S., Luedtke, C. A., Vincent, A., & Oh, T. H. (2016). Association of rheumatic diseases with symptom severity, quality of life, and treatment outcome in patients with fibromyalgia. Scandinavian Journal of Rheumatology, 45, 49–56. https://doi.org/10.3109/030097....
32.
Katz, J., & Melzack, R. (2011). The McGill Pain Questionnaire: Development, psychometric properties, and useful-ness of the long form, short form, and short form-2. In D. C. Turk & R. Melzack (Eds.), Handbook of pain as-sessment (pp. 45–66). Guilford Press.
33.
Kishi, A., Natelson, B. H., Togo, F., Struzik, Z. R., Rapoport, D. M., & Yamamoto, Y. (2010). Sleep stage transitions in chronic fatigue syndrome patients with or without fibromyalgia. Proceedings of the 2010 Annual Internation-al Conference of the IEEE Engineering in Medicine and Biology Society, 5391–5394. https://doi.org/10.1109/IEMBS.....
34.
Kremer, E. F., Atkinson, J. H., Jr., & Ignelzi, R. J. (1982). Pain measurement: The affective dimensional measure of the McGill Pain Questionnaire with a cancer pain population. Pain, 12, 153–163. https://doi.org/10.1016/0304-3....
35.
Krupp, L. B., LaRocca, N. G., Muir-Nash, J., & Steinberg, A. D. (1989). The Fatigue Severity Scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123. https://doi.org/10.1001/archne....
36.
Lacasse, A., Bourgault, P., & Choinière, M. (2016). Fibromyalgia-related costs and loss of productivity: a substantial societal burden. BMC Musculoskeletal Disorders, 17, 168. https://doi.org/10.1186/s12891....
37.
Laranjeira, C. A. (2012). Translation and adaptation of the Fatigue Severity Scale for use in Portugal. Applied Nurs-ing Research, 25, 212–217. https://doi.org/10.1016/j.apnr....
38.
Laursen, B. S., Bajaj, P., Delmar, C., & Arendt-Nielsen, L. (2005). Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. European Journal of Pain, 9, 267–275. https://doi.org/10.1016/j.ejpa....
39.
Lee, J. W., Lee, K. E., Park, D. J., Kim, S. H., Nah, S. S., Lee, J. H., Kim, S. K., Lee, Y. A., Hong, S. J., Kim, H. S., Lee, H. S., Kim, H. A., Joung, C. I., Kim, S. H., & Lee, S. S. (2017). Determinants of quality of life in patients with fi-bromyalgia: a structural equation modeling approach. PLoS One, 12, e0171186. https://doi.org/10.1371/journa....
40.
Marshall, A. L., Smith, B. J., Bauman, A. E., & Kaur, S. (2005). Reliability and validity of a brief physical activity assessment for use by family doctors. British Journal of Sports Medicine, 39, 294–297. https://doi.org/10.1136/bjsm.2....
41.
Martins, H. G. C. (1999). Apresentação do MPQ adaptado à língua portuguesa (questionário Melzack da dor) [Presentation of the MPQ adapted to the Portuguese language (Melzack Pain Questionnaire)]. Dor, 4, 21–26.
42.
McInnis, O. A., Matheson, K., & Anisman, H. (2014). Living with the unexplained: Coping, distress, and depression among women with chronic fatigue syndrome and/or fibromyalgia compared to an autoimmune disorder. Anxiety, Stress, & Coping, 27, 601–618. https://doi.org/10.1080/106158....
43.
Mease, P., Arnold, L. M., Choy, E. H., Clauw, D. J., Crofford, L. J., Glass, J. M., Martin, S. A., Morea, J., Simon, L., Strand, C. V., Williams, D. A., & OMERACT Fibromyalgia Working Group (2009). Fibromyalgia syndrome module at OMERACT 9: Domain construct. The Journal of Rheumatology, 36, 2318–2329. https://doi.org/10.3899/jrheum....
44.
Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–299. https://doi.org/10.1016/0304-3....
45.
Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191–197. https://doi.org/.
47.
Montoya, P., Larbig, W., Braun, C., Preissl, H., & Birbaumer, N. (2004). Influence of social support and emotional context on pain processing and magnetic brain responses in fibromyalgia. Arthritis & Rheumatism, 50, 4035–4044. https://doi.org/10.1002/art.20....
48.
Oncu, J., Basoglu, F., & Kuran, B. (2013). A comparison of impact of fatigue on cognitive, physical, and psychoso-cial status in patients with fibromyalgia and rheumatoid arthritis. Rheumatology International, 33, 3031–3037. https://doi.org/10.1007/s00296....
49.
Pais-Ribeiro, J. L. (1999). Escala de Satisfação com o Suporte Social (ESSS) [Satisfaction with Social Support Scale (ESSS)]. Análise Psicológica, 17, 547–558.
50.
Pais-Ribeiro, J. L., & Rodrigues, A. P. (2004). Questões acerca do coping: a propósito do estudo de adaptação do Brief COPE [Questions about coping: Regarding the Brief COPE adaptation study]. Psicologia, Saúde & Doenças, 5, 3–15.
51.
Pais-Ribeiro, J. L., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225–235. https://doi.org/10.1080/135485....
52.
Pereira, M. G., & Duarte, S. (2010). Fadiga intensa em doentes com lupus eritematoso sistémico: estudo das características psicométricas da escala da intensidade da fadiga [Severe fatigue in patients with systemic lupus erythematosus: study of the psychometric characteristics of the fatigue intensity scale]. Psicologia, Saúde & Doenças, 11, 121–136.
53.
Queiroz, L. P. (2013). Worldwide epidemiology of fibromyalgia. Current Pain and Headache Reports, 17, 356. https://doi.org/10.1007/s11916....
54.
Sancassiani, F., Machado, S., Ruggiero, V., Cacace, E., Carmassi, C., Gesi, C., Dell’Osso, L., & Carta, M. G. (2017). The management of fibromyalgia from a psychosomatic perspective: an overview. International Review of Psy-chiatry, 29, 473–488. https://doi.org/10.1080/095402....
55.
Schetsche, C., Jaume, L. C., Caccia, P. A., Zelaya, M., & Azzollini, S. (2023). Is emotional support the key to im-proving emotion regulation? A machine learning approach. Health Psychology Report, 11, 295–308. https://doi.org/10.5114/hpr/15....
56.
Segura-Jiménez, V., Álvarez-Gallardo, I. C., Carbonell-Baeza, A., Aparicio, V. A., Ortega, F. B., Casimiro, A. J., & Delgado-Fernández, M. (2015). Fibromyalgia has a larger impact on physical health than on psychological health, yet both are markedly affected: The al-Ándalus project. Seminars in Arthritis and Rheumatism, 44, 563–570. https://doi.org/10.1016/j.sema....
57.
Soriano-Maldonado, A., Amris, K., Ortega, F. B., Segura-Jiménez, V., Estévez-López, F., Álvarez-Gallardo, I. C., Aparicio, V. A., Delgado-Fernández, M., Henriksen, M., & Ruiz, J. R. (2015). Association of different levels of depressive symptoms with symptomatology, overall disease severity, and quality of life in women with fi-bromyalgia. Quality of Life Research, 24, 2951–2957. https://doi.org/10.1007/s11136....
58.
Theadom, A., Cropley, M., & Humphrey, K. L. (2007). Exploring the role of sleep and coping in quality of life in fibromyalgia. Journal of Psychosomatic Research, 62, 145–151. https://doi.org/10.1016/j.jpsy....
59.
Ubago, M. C., Ruiz-Pérez, I., Bermejo-Pérez, M., Lima, O. L. A., Hernández-Torres, E., & Plazaola-Castaño, J. (2008). Analysis of the impact of fibromyalgia on quality of life: Associated factors. Clinical Rheumatology, 27, 613–619. https://doi.org/10.1007/s10067....
60.
Wagner, J. S., DiBonaventura, M. D., Chandran, A. B., & Cappelleri, J. C. (2012). The association of sleep difficul-ties with health-related quality of life among patients with fibromyalgia. BMC Musculoskeletal Disorders, 13, 199. https://doi.org/10.1186/1471-2....
61.
Ware, J. E. (2000). SF-36 health survey update. Spine, 25, 3130–3139. https://doi.org/10.1097/000076....
62.
Wolfe, F., Clauw, D. J., Fitzcharles, M. A., Goldenberg, D. L., Katz, R. S., Mease, P., Russell, A. S., Russell, I. J., Win-field, J. B., & Yunus, M. B. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research, 62, 600–610. https://doi.org/10.1002/acr.20....
63.
Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. L., Tugwell, P., Campbell, S. M., Abeles, M., & Clark, P. (1990). The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis and Rheumatism, 33, 160–172. https://doi.org/10.1002/art.17....
64.
Wu, Y. L., Chang, L. Y., Lee, H. C., Fang, S. C., & Tsai, P. S. (2017). Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. Journal of Psychosomatic Research, 96, 89–97. https://doi.org/10.1016/j.jpsy....
65.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600....
Copyright: © Institute of Psychology, University of Gdansk This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2353-5571 |
| ISSN: | 2353-4184 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
