Impact of the disease and mental health in Mexican women with fibromyalgia

Abstract

Introductions

A bidirectional relationship exists between fibromyalgia and anxiety and depression, sharing pathophysiological mechanisms that profoundly influence clinical outcomes and disease management.

Objective

To evaluate the impact of fibromyalgia on the mental health status and functional capacity of a cohort of Mexican women.

Methodology

A cross-sectional study was conducted including female patients diagnosed with fibromyalgia according to the 2016 ACR criteria, recruited from outpatient rheumatology and psychology clinics. Sociodemographic characteristics and current disease parameters were recorded. Specialized psychologists administered the following instruments: Widespread Pain Index (WPI), Symptom Severity Score (SSS), Visual Analog Scale (VAS) for pain, Fibromyalgia Impact Questionnaire (FIQ), Impairment and Functioning Inventory (IFI), Coping with Chronic Pain Questionnaire (CAD), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI-S/T), and the Montreal Cognitive Assessment (MoCA). Statistical analyses comprised descriptive metrics, comparative group evaluations stratified by the median age, and univariable and multivariable logistic regression analyses to assess factors associated with disease impact (mild/moderate versus severe).

Results

The study sample comprised 23 women with a median age of 54 years (IQR 48–59). Demographically, 47.8% were single, 65.2% had attained an educational level exceeding upper secondary education, and 65.2% were employed. The median time since formal diagnosis was 1 year (IQR 1–7), whereas the median duration of clinical symptoms was 6 years (IQR 2–14). Prior psychological intervention was reported by 56.5% of the cohort.

Comparative analysis based on the median age (<54 versus ≥54 years) revealed that younger patients exhibited significantly higher widespread pain scores (median 10 versus 3; $p = 0.009$), whereas older patients demonstrated higher VAS pain scores (median 7 versus 6; $p = 0.04$). Other clinical characteristics did not differ significantly between age groups. Furthermore, no significant correlation was observed between elevated widespread pain scores (above the median) and VAS scores ($p = 0.09$).

Psychological and functional profiles indicated that 52.2% of patients experienced severe disease impact, 73.9% exhibited severe or very severe functional impairment, and 56.5% presented with mild cognitive impairment. Regarding affective symptoms, severe depression was identified in 34.8% of the sample, and moderate anxiety was present in 47.8%. BDI scores above the median showed no significant associations with widespread pain ($p = 0.7$), disease severity ($p = 0.2$), tender points ($p = 0.6$), or VAS scores ($p = 0.2$). In the univariable analysis, WPI scores were significantly associated with severe disease impact (OR 1.3; 95% CI 1.1–1.6); however, this association was attenuated and lost statistical significance after adjusting for age in the multivariable model (OR 1.3; 95% CI 0.9–1.1).

Conclusions

In this cohort of Mexican women, fibromyalgia demonstrated a high burden of severity, characterized by profound functional impairment, mild cognitive deficits, and elevated rates of depression and anxiety. Although widespread pain initially correlated with increased disease impact, the overall clinical complexity underscores the necessity of a multidisciplinary management paradigm that integrates somatic, psychological, and cognitive interventions. These findings provide regional evidence supporting the systematic implementation of comprehensive psychiatric and functional assessments within routine fibromyalgia care.