Illness perceptions, coping and outcomes in fibromyalgia

Background: The self-regulatory model proposes cognitive representations of illness influence illness coping strategies and, in turn illness outcomes [1,2]. There is evidence illness representations affect outcomes in RA [3] but not for the mediating effect of coping [2,3]. To further explore this model, the impact of illnessperceptions on coping and outcomes in fibromyalgia (FM) were investigated. Methods: Following ethical approval, people diagnosed with FM were identified from records at one General Practice. People completed questionnaires including the SF-36, Chronic Pain Grade scale, Illness Perceptions (IPQ-R) and Coping Scales Questionnaires (CSQ). Relationships between IPQ-R, CSQ, SF-36 andPain were analysed using Pearson correlations.Results: A total of 58 people were identified: 31 women and 2 men consented, average age 51.16 (S.D. 8.41) years and FM duration of 4.54 (S.D. 3.44) years. Average scores were: SF-36 Physical Function 16.06 (S.D. 4.28); Physical Role Limitations 7.58 (S.D. 3.11); Mental Health 24.62 (S.D. 5.57) and Chronic Pain 6.03(2.19). Due to the high number of correlations P_0.01* was considered significant. Illness Perceptions and Illness Outcomes: Of the 8 IPQ-R subscales Timeline (acute/chronic), Timeline (cyclical) and Treatment Control did not correlate with any outcomes. There were significant correlations between: higher Illness Identity andhigher pain (r¼0.46*); more severe Consequences with higher pain (r¼0.41*) and worse SF-36 mental health (r¼_0.47*; lower Personal Control with higher pain scores (r¼_0.46*), worse Physical Function (r¼0.44*) and greater Role Limitations (r¼0.47*); poorer Illness Coherence (understanding) with worse SF-36 Mental Health (r¼_0.48*); and higher Emotional Representations with worseSF-36 Mental Health (r¼_0.57*). Illness Perceptions and Coping: there were very few significant correlations. CSQ Catastrophising correlated with severe Consequences and (r¼0.51*) andhigher Emotional Representations (r¼0.58*). Coping and Outcomes: only the CSQ Catastrophising scale correlated withoutcomes: SF36 Role Limitations (r¼_0.49*), SF36 Mental Health (r¼_0.68*) and Pain (r¼0.57*).Conclusions: This pilot study identified significant relationships with illness perceptions and outcomes, but with only one coping strategy (catastrophizing). As in other studies, there was little correlation between perceptions and coping [2,3]. As a cross-sectional study it is difficult to identify if perceptions influence outcomes or vice versa. However, an implication is that enhancing condition understanding and psychological interventions addressing perceptions are important prior to coping or therapy interventions. In particular, those using Catastrophising as a coping strategy should be identified early and referral for cognitive-behavioural therapy considered.References1. Leventhal H In: Petrie K, Weinman J. Perceptions of Health & Illness. 1997 Harwood Press.2. Carlisle A B J Health Psychol 2005;10:571–587;3. Scharloo J Psych Res 1998;44:573–585