Increases in Psychiatric Symptoms Lead to Greater Disease Activity in Fibromyalgia


As fibromyalgia impact increased, self-stigmatization scores increased proportionally.

Increases in Psychiatric Symptoms Lead to Greater Disease Activity in Fibromyalgia

Erhan Onalan, MD

Credit: Firat University

Results of a recent study revealed patients with fibromyalgia had more somatization symptoms compared with healthy subjects. Further, an increase in psychiatric symptoms was linked to increased levels of fibromyalgia symptoms in these patients, according to data published in European Review for Medical and Pharmacological Sciences.1

Previous data have shown the rates of major depression range from 62% - 86% in patients with fibromyalgia, with a lifetime prevalence of depressive symptoms reported in as high as 90%. The combination of pain and depression has been linked to treatment failure, an increased use of pain medication, and higher suicidal ideation frequency and intensity. Luckily, both pharmacological (anti-depressants) and non-pharmacological (cognitive behavioral therapy) treatment have been shown to successfully manage these symptoms.2

“Considering the positive effects of antidepressant drugs on pain and sleep, it is evident that getting psychiatric help in patients with fibromyalgia is important in treatment and symptom control,” wrote investigator Erhan Onalan, MD, associated with the Department of Internal Medicine, Firat University Medical School, Turkey, and colleagues. “Despite this, our clinical experience has shown that although fibromyalgia patients apply to branches other than psychiatry, the rate of admission to psychiatry outpatient clinics for treatment is much lower.”

The cross-sectional prospective study, conducted between February and July 2020, assessed psychiatric symptoms in these patients, as well as their concerns about stigma and their beliefs about seeking psychological help. The possible link between stigma concerns and not seeking psychiatric treatment was also evaluated.

Fibromyalgia symptoms were measured using the Symptom Screening Questionnaire, Revised 90 Items (SCL-90-R), and quality-of-life was assessed using the Fibromyalgia Impact Questionnaire (FIQ). Feelings towards seeking help were determined using the Self-Stigma in the Process of Seeking Psychological Help Scale (SSPSPHS), Intention to Seek Psychological Help Inventory (ISPHI), Attitude Towards Seeking Psychological Help Scale-Short Form (ATSPPHSF), and the Social Stigma Due to Seeking Psychological Help Scale (SSDSPHS). In addition to this, demographic data including age, gender, economic status, smoking and alcohol use, and education level were collected.

A total of 50 adult patients with fibromyalgia and 50 age- and sex-matched controls were included in the study. The fibromyalgia affect scale score in the patient cohort was 46.01±15.92.

Although all patients reported positive attitudes towards seeking psychiatric help, the self-stigmatization scores of seeking help were higher in patients with fibromyalgia compared with controls. Additionally, as fibromyalgia impact increased, self-stigmatization scores increased proportionally.

Patients with fibromyalgia reported higher somatization (P = .001), phobic anxiety (P = .015), and psychoticism (P = .045) when compared with controls. The SSPSPHS and ATSPPH-SF scale scores were also higher in this patient population (P = .043; P = .002, respectively). A significant positive correlation between FIQ and SSPSPHS (P = .043) and between the SCL-90 overall (P <.001) and all subscales scores was observed.

Most patients (n = 30, 60%) had a low active psychotic symptom level, defined as a score <1 according to the SCL-90. Compared with subjects with low psychotic symptom levels, those with high or very high levels had higher fibromyalgia impact scale scores and SCL-90 overall scores (P <.001). Five (25%) patients with high active psychotic symptom levels attempted suicide at transition, while none of those with low levels had a history of suicide attempt (P = .007).

Investigators noted the small number of participants as a limitation. Additionally, the SCL-90 screening was given to all participants to assess psychiatric symptoms; however, the severity of depression or anxiety is evaluated using the scales for the disease, not the symptoms.

“Self-stigmatization behavior may be one of the barriers to getting psychiatric help in this patient group,” investigators concluded.


  1. Bulu A, Onalan E, Korkmaz S, et al. Attitude towards seeking psychological help regarding psychiatric symptoms and stigma in patients with fibromyalgia. Eur Rev Med Pharmacol Sci. 2023;27(21):10661-10668. doi:10.26355/eurrev_202311_34346
  2. Tzadok R, Ablin JN. Current and emerging pharmacotherapy for fibromyalgia. Pain Res Manag 2020; 2020: 6541798.
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