Fibromyalgia (FM) is a stress-related functional somatic syndrome consisting of musculoskeletal pain and tenderness, and additional symptoms such as fatigue and difficulty concentrating. Factors such as ill-being, often assessed as negative affectivity, may follow, increasing the risk of unhealthy and dysfunctional lifestyles.
The term 'eudaimonic' roots in Aristotle's philosophy, and identifies well-being in the actualization of human potentials and virtue. It is opposed to hedonic well-being based on the pursuit of pleasure and happiness. In Ryff's approach, eudaimonic well-being, measured via the Scales of Psychological Well-Being (PWB), posits on the extent to which people feel they are in control of their lives, feel that what they do is meaningful, and have good relationships with others.
This study wants to evaluate whether PWB predicts not only disability but also negative affectivity in FM, and whether the association of PWB with disability remains when ill-being and other potential confounds are controlled. Cases were 48 FM females consecutively presenting at the Pain Treatment Centre or at the Rheumatological Clinic of the Santa Chiara Hospital (Pisa, Italy) over a 9-month period.
Controls were 48 women matched for age with cases, and recruited among undergraduate students (18.7%) and their relatives (81.2%). Psychological well-being was measured by the 18-item version of the PWB, a self-administered inventory measuring 6 constructs (Autonomy, Environmental Mastery, Personal Growth, Positive Relations with others, Purpose in Life and Self-Acceptance).
Negative affectivity was measured via the Hospital Anxiety and Depression Scale, a 14-item self-administered rating scale counting 2 subscales (i.e. depression, anxiety).
Functional impairment was assesses by the Daily Living and Functioning Skills subscale of the Behavior and Symptom Identification Scale. Item 4 of the EQ-5D was used to measure perceived intensity of pain. Controlling for educational level, cases showed significantly higher scores on depression, functional impairment, and pain than controls.
Results from the stepwise regression analyses indicated that Purpose in Life and Positive Relationships significantly predicted functional impairment in FM, beyond several potential confounds. Disability, in turn, as well as anxiety, predicted depression, and Self-Acceptance predicted anxiety. Interestingly, a different pattern of predictors was found among controls. While Autonomy predicted functional impairment, both Environmental Mastery and Purpose in Life predicted depression.
Taken together, findings from this study are consistent with psychological research suggesting that goal-engagement and environmental mastery play a major role in determining psychological adjustment in general population samples. However, these findings suggest that in FM patients other psychological processes and/or relationships among the variables here considered seem to come into play. In particular, 3 PWB processes appear to be related to depression in FM females, but all these relationships seem mediated by disability and anxiety.
Thus, having a sense of directedness and intentionality as well as warm and trust relating to others would prevent a diminished daily functioning, which in turn would prevent for depression. Moreover, holding positive attitudes towards oneself would prevent anxiety symptoms, thus protecting from depression.
On the basis of the biopsychosocial model of FM suggesting that stress has a possible etiology in FM and that stress-related factors, such as anxiety, may contribute to the perpetuation of symptoms and disability, the results of this study suggest that Self-Acceptance, Positive Relationships, and Purpose in Life might buffer the effects of the adversity on ill-being in FM. Since the Well-being Therapy is useful to modify PWB, FM patients might benefit from it to strengthen the mentioned PWB areas, thus diminishing anxiety, enhancing daily functioning and, in turn, preventing depression.