Most Patients With Fibromyalgia Have Concomitant Psychiatric Disorders

In a cohort of Iranian female patients with fibromyalgia, 92% of cases were also diagnosed with 1 or more psychiatric disorder, including ones that affect sleep, mood, anxiety, and personality, according to a study published in Nursing Open.¹

The incidence of psychiatric disorders have been reported to be higher in patients with fibromyalgia when compared with the general population. These comorbidities can increase disability, decrease quality of life, and have been linked to higher rates of suicide attempts.²

“The exact pathology of fibromyalgia still remains unknown, since no evidence of inflammation or tissue injury is seen in the painful and affected areas of the body; this has led many clinicians to theorize that this disorder has a psychological and/or psychosomatic origin,” wrote Sara Sadr, MD, associated with the School of Medicine, Mazandaran University of Medical Sciences, in Sari, Iran, and colleagues. “The psychological and psychosomatic aspects of fibromyalgia have rarely been investigated in Iran, and the diagnosis of psychiatric disorders in previous studies has been mostly based on a questionnaire rather than a comprehensive unstructured interview by a psychiatrist.”

The cross-sectional study recruited newly diagnosed female patients with fibromyalgia who visited a private outpatient rheumatology clinic in Sari, Iran, from 2018 through 2019. Patients were given psychiatric assessments by a psychiatrist, which consisted of an unstructured 45-minute interview. Diagnosis of any psychiatric disorders was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), while sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).

Ultimately, 159 patients were enrolled in the study, with a mean age of 42.15 years. Most participants were married (87.42%), 61.01% reported having a high school diploma or below, and 68.55% were unemployed. Investigators discovered that 92.45% (n = 147) of patients were simultaneously diagnosed with at least 1 type of psychiatric disorder. These included sleep disorders (SDs; 90.57%), mood disorders (MDs; 52.83%), personality disorders (PDs; 40.25%), and anxiety disorders (ADs; 16.98%).

Most patients were diagnosed with 2 or more psychiatric disorders, with a concurrent diagnosis of MDs and SDs occurring in 20.13% (n = 32) patients and a concurrent diagnosis of PDs, MDs, and SDs reported in 15.72% (n = 25). Twenty-eight patients (17.61%) were simultaneously diagnosed with 1 type of Cluster-B PD, an MD, and a somatic symptom disorder (SSD).

The most common MDs were major depressive disorder (MDD) and persistent depressive disorder (PDD). Cluster-B PDs were the most common personality disorders (35.85%, n = 57). A logistic regression revealed that experiencing Cluster-B PDs was linked to a higher prevalence rate of SSDs (odds ratio [OR] 2.7, P = .019).

PDs were statistically significant higher in patients in the 30 – 39 age group (59.09%, n = 26; P = .011) compared with older patients. Obsessive compulsive disorder (OCD) was significantly higher in single women compared with married women (36.36% vs 9.35%, P = .030). No significant relationship was observed between place of residence, education, and employment status, and the prevalence of different psychiatric disorders (P >.05).

Investigators noted that the lack of control group limited the study. Further, as only a single interview was conducted, and it can be argued that certain psychiatric disorders may only be diagnosed after multiple sessions, it is a possibility that some disorders may not have been diagnosed.

“The study results combined with the reports in previous research showed that patients with FM were potentially suffering from a variety of psychiatric disorders that could exacerbate one another in a vicious cycle,” investigators concluded. “It was thus argued that each type of disorder needed to be addressed, which meant the fibromyalgia treatment in most cases was obliged to include thorough psychiatric assessments and multidisciplinary treatments.”

References

1. ^{Sadr S, Mobini M, Tabarestani M, Islami Parkoohi P, Elyasi F. The frequency of psychiatric disorder co-morbidities in patients with fibromyalgia: A cross-sectional study in Iran [published online ahead of print, 2023 Mar 22]. Nurs Open. 2023;10.1002/nop2.1731. doi:10.1002/nop2.1731}
2. ^{Bazzichi, L., Maser, J., Piccinni, A., Rucci, P., Del Debbio, A., Vivarelli, L., Catena, M., Bouanani, S., Merlini, G., & Bombardieri, S. (2005). Quality of life in rheumatoid arthritis: Impact of disability and lifetime depressive spectrum symptomatology. Clinical and Experimental Rheumatology, 23(6), 783–788.}