Silvia M. Bigatti

Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression

OBJECTIVE This study is an examination of sleep, pain, depression, and physical functioning at baseline and 1-year followup among patients with fibromyalgia syndrome (FMS). Although it is clear that these symptoms are prevalent among FMS patients and that they are related, the direction of the relationship is unclear. We sought to identify and report sleep problems in this population and to examine their relationship to pain, depression, and physical functioning. METHODS Patients diagnosed with fibromyalgia were recruited from a Southern California health maintenance organization and evaluated according to American College of Rheumatology criteria in the research laboratory. Six hundred patients completed the baseline assessment and 492 completed the 1-year assessment. Measures included the Center for Epidemiologic Studies Depression Scale, the McGill Pain Questionnaire, the Pittsburgh Sleep Quality Index, and the Fibromyalgia Impact Questionnaire. RESULTS The majority of the sample (96% at baseline and 94.7% at 1 year) scored within the range of problem sleepers. Path analyses examined the impact of baseline values on 1-year values for each of the 4 variables. No variable of interest predicted sleep, sleep predicted pain (beta = 0.13), pain predicted physical functioning (beta = -0.13), and physical functioning predicted depression (beta = -0.10). CONCLUSION These findings highlight the high prevalence of sleep problems in this population and suggest that they play a critical role in exacerbating FMS symptoms. Furthermore, they support limited existing findings that sleep predicts subsequent pain in this population, but also extend the literature, suggesting that sleep may be related to depression through pain and physical functioning.

Prevalence, Severity, and Correlates of Sleep-Wake Disturbances in Long-Term Breast Cancer Survivors

CONTEXT Current evidence shows that sleep-wake disturbances are a persistent problem linked to poor quality of life in women surviving breast cancer. Information regarding correlates of sleep-wake disturbances in long-term survivors is sparse. OBJECTIVES The objective of this study was to refine knowledge regarding prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors (BCS) compared with age-matched women without breast cancer (WWC). METHODS The cross-sectional convenience sample included 246 BCS and 246 WWC who completed a quality-of-life study and were matched within +/-5 years of age. RESULTS BCS were a mean of 5.6 years beyond completion of cancer treatment (range = 5.6-10.0 years). Based on Pittsburgh Sleep Quality Index (PSQI) scores, BCS had significantly more prevalent sleep-wake disturbances (65%) compared with WWC (55%) (P < 0.05). BCS also had significantly higher PSQI global scores indicating poorer sleep quality compared with WWC (P < 0.05). Significant correlates of prevalence of poor sleep for BCS included hot flashes, poor physical functioning, depressive symptoms, and distress, and for WWC, these included hot flashes, poor physical functioning, and depressive symptoms. Significant correlates (P < 0.05) of severity of poor sleep for BCS included presence of noncancer comorbidities, hot flashes, depressive symptoms, and residual effects of cancer treatment. For WWC, these included hot flashes, poor physical functioning, depressive symptoms, and impact of a life event. CONCLUSION Knowledge of prevalence, severity, and correlates of sleep-wake disturbances provides useful information to health care providers during clinical evaluations for treatment of sleep-wake disturbances in BCS.

An examination of the physical health, health care use, and psychological well-being of spouses of people with fibromyalgia syndrome.

The present study compared the physical and mental health and the health care use of spouses of patients with fibromyalgia syndrome (FS group; n = 135) with that of spouses of healthy individuals (n = 153). FS group participants reported lower health and affective states and scored higher on depression, loneliness, and subjective stress than comparison group participants (p < .017). Husbands in the FS group who reported more illness impact and whose wives reported worse sleep quality and less self-efficacy had more psychological difficulties. No differences were found in health care costs between groups. These findings suggest that chronic illness in a partner may negatively affect an individuals physical and mental health.

Research to Encourage Exercise for Fibromyalgia (REEF): Use of Motivational Interviewing Design and Method

Fibromyalgia (FM), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, is an illness associated with major personal and societal burden. Supervised aerobic exercise is an important treatment modality to improve patient symptoms. Unfortunately, adherence to an exercise regimen after a structured supervised program is disappointingly low. Since FM is a chronic illness, studies are needed to test strategies that would enhance exercise adherence in these individuals. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. The objective of this paper was to describe the protocol of the Research to Encourage Exercise for Fibromyalgia (REEF). REEF is a randomized attention-controlled trial that seeks to test the efficacy of 6 sessions of telephone delivered motivational interviewing (MI) that targets exercise adherence to improve FM-relevant clinical outcomes (i.e., physical function and pain severity). The trial has recently completed enrolling 216 subjects, and randomization has resulted in well-balanced groups. Details on the study design, MI program, and treatment fidelity are provided in the paper. Outcome assessments at week 12, week 24 and week 36 will test the immediate, intermediate and long-term effects of exercise-based MI on adherence (as measured by the Community Health Activities Model Program for Seniors/CHAMPS and accelerometer) and clinical outcomes. When completed, REEF will determine whether exercise-based MI could be utilized as a management strategy to sustain the clinical benefits of exercise for FM.

Research to encourage exercise for fibromyalgia (REEF): Use of motivational interviewing, outcomes from a randomized-controlled trial

Objectives:Regular exercise is associated with important benefits in patients with fibromyalgia (FM). Unfortunately, long-term maintenance of exercise after a structured program is rare. The present study tested the efficacy of Motivational Interviewing (MI) to promote exercise and improve symptoms in patients with FM. Methods:A total of 216 patients with FM were randomized to 6 MI sessions (n=107) or an equal number of FM self-management lessons (education control/EC, n=109). Co-primary endpoints were an increase of 30 minutes in moderate-vigorous physical activity and improvement in the Fibromyalgia Impact Questionnaire (FIQ)-Physical Impairment score, assessed at pretreatment, posttreatment, and 3-month and 6-month follow-up. Secondary outcomes included clinically meaningful improvements in FIQ score, pain severity ratings, and a 6-minute walk test. Results:There were no significant treatment group differences in either co-primary endpoint at 6-month follow-up. However, more MI participants than controls exhibited meaningful improvements in FIQ score at 6-month follow-up (62.9% vs. 49.5%, P=0.06). Compared with EC participants, MI participants also displayed a larger increment in their 6-minute walk test (43.9 vs. 24.8 m, P=0.03). In addition, MI was superior to EC in increasing the number of hours of physical activity immediately postintervention and in reducing pain severity both immediately after the intervention and at 3-month follow-up. Conclusions:Despite a lack of benefits on long-term outcome, MI seems to have short-term benefits with respect to self-report physical activity and clinical outcomes. This is the first study in FM that explicitly addresses exercise maintenance as a primary aim. Clinical Trial Registration:NCT00573612.

The Effects of Maternal Depression on the Efficacy of a Literacy Intervention Program

The purpose of the present study was: (1) to determine whether depression was related to mother-child interactions in a group of low-income mothers participating in a literacy intervention; (2) to examine whether depression was related to retention; (3) to determine whether there were differential changes in depressed and non-depressed mothers in the intervention group. Participants included 488 ethnically diverse families. Depressed mothers engaged in fewer literacy enhancing behaviors with their children than non-depressed mothers and were more likely to drop out of the study. Depressed mothers were as likely to participate actively in the intervention, and benefited as much from the intervention as non-depressed mothers.

Depression in husbands of breast cancer patients: relationships to coping and social support

PurposeThe purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both.MethodsWe compared husbands of patients to husbands of women without chronic illness on depressive symptoms with the Center for Epidemiological Studies Depression Scale, social support with the Interpersonal Support Evaluation List, and coping with the Ways of Coping Questionnaire. Using the stress and coping model, we examined whether coping mediated social support and depression differently by group, as has been found in the literature.ResultsHusbands of patients reported higher scores on the measure of depression and lower use of problem-focused coping, while groups reported equivalent social support. Escape-avoidance coping emerged as a full mediator between social support and depression in husbands of patients, but only a partial mediator in comparison husbands. Accepting responsibility coping partially mediated social support and depression in both groups. Low social support appears particularly detrimental in husbands of patients as it is associated with ineffective coping and depression.ConclusionsFindings suggest that among husbands of patients, social support relates to depression only through its relationship with coping, indicating healthcare providers should direct attention and intervention to the coping strategies employed by husbands with low social support.

Cognitive Appraisals, Coping and Depressive Symptoms in Breast Cancer Patients

Depression in breast cancer patients and survivors is related to negative disease outcomes and worse quality of life. Factors that explain this depression can serve as targets of intervention. This study, guided by the Transactional Theory of Stress, examined the relationship between cognitive appraisals, coping strategies and depressive symptoms in a group of women with mostly advanced-stage breast cancer (N = 65), who scored mostly within the normal range for depressive symptoms. Path analysis was used to determine the relationships among variables, measured with the Cognitive Appraisals of Illness Scale, the Ways of Coping Questionnaire and the Center for Epidemiological Studies Depression Scale. The results of the path analysis showed that higher appraisals of harm/loss and greater use of escape-avoidance coping predicted higher depressive symptoms. These findings enhance the prediction of depression among breast cancer patients and suggest the need to examine cognitive appraisals when attempting to understand depressive symptoms.

Longitudinal relationships between fatigue and depression in cancer patients with depression and/or pain.

OBJECTIVE Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet relatively little is understood about its etiology. Recently, as researchers have begun to focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies, however, have examined directionality of the relationship between the two symptoms. Our aim was to evaluate the directionality of the association between depression and CRF. METHOD The study used a single-group cohort design of longitudinal data (N = 329) from a randomized controlled trial of an intervention for pain and depression in a heterogeneous sample of cancer patients. Participants met criteria for clinically significant pain and/or depression. Our hypothesis that depression would predict change in fatigue over 3 months was tested using latent variable cross-lagged panel analysis. RESULTS Depressive symptoms and fatigue were strongly correlated in the sample (baseline correlation of latent variables = 0.71). Although the model showed good fit to the data, χ(2) (66, N = 329) = 88.16, p = .04, SRMR = 0.030, RMSEA = 0.032, and CFI = 1.00, neither structural path linking depression and fatigue was significant, suggesting neither symptom preceded and predicted the other. CONCLUSIONS Our findings did not support hypotheses regarding the directionality of the relationship between depressive symptoms and fatigue. The clinical implication is that depression-specific treatments may not be sufficient to treat CRF and that instead, interventions specifically targeting fatigue are needed.

Predictors of pain and functioning over time in fibromyalgia syndrome: An autoregressive path analysis

Fibromyalgia is a disabling, chronic pain condition of unknown etiology. Although many factors have been recognized as important contributors to the pain experiences and functional abilities of fibromyalgia patients, the factors that are most impactful (and therefore represent optimal targets for intervention) are still unclear. The aim of the present study was to examine the pathways among depression, self‐efficacy, pain, and physical functioning in a large sample of fibromyalgia patients over a 1‐year timeframe.