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Comorbid Depression and Anxiety in Fibromyalgia Syndrome: Relationship to Somatic and Psychosocial Variables

From the Department of Anesthesiology, University of Washington, Seattle, Washington (K.T., D.C.T.); and the Department of Neuropsychology (K.T., H.F.), University of Heidelberg, Central Institute of Mental Health Mannheim, Mannheim, Germany.

Address correspondence and reprint requests to Kati Thieme, PhD, Department of Anesthesiology at the University of Washington, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195-6540. E-mail: thiemek{at}u.washington.edu

OBJECTIVE: The prevalence as well as predictors of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV] axis I and II) in patients with fibromyalgia syndrome (FMS) was evaluated.

METHOD: One-hundred fifteen patients with FMS participated in the Structured Clinical Interview for DSM-IV to assess current mental disorders. In addition, patients completed standardized questionnaires regarding pain, pain impact, anxiety, depression, posttraumatic stress disorder-like symptoms, and sexual and physical abuse.

RESULTS: Patients were grouped into one of three psychosocial subgroups based on responses to the Multidimensional Pain Inventory (MPI)–Dysfunctional (DYS), Interpersonally Distressed (ID), and Adaptive Copers (AC). Axis I diagnoses were present in 74.8% of the participants overall with the DYS subgroup mainly reporting anxiety and the ID group mood disorders. The AC group showed little comorbidity. Axis II diagnoses were present in only 8.7% of the FMS sample.

CONCLUSION: These results suggest that FMS is not a homogeneous diagnosis, but shows varying proportions of comorbid anxiety and depression dependent on psychosocial characteristics of the patients. The results demonstrate the importance of not treating patients with FMS as a homogeneous group. Assessment should not only examine the presence of widespread pain and the number of tender points, but also the presence of affective distress. Treatment should focus both on physical and emotional dysfunction.

Key Words: fibromyalgia, • comorbidity, • DSM-IV, • SCID, • MPI subgroups.

Abbreviations: FMS = fibromyalgia syndrome;; MPI = Multidimensional Pain Inventory;; DYS = dysfunctional;; ID = interpersonally distressed;; AC = adaptive copers;; SCID = Structured Clinical Interview for DSM-IV;; CES-D = Center for Epidemiologic Studies Depression Scale;; STAI-T = State-Trait Anxiety Inventory–Trait scale;; PRSS = Pain-Related Self-Statements Scale.

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