Journal of Psychosomatic Research

Objective: To characterise the symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Method: 1028 adults with ME/CFS completed The Index of ME Symptoms (TIMES) online. Raw ordinal data were Rasch transformed into interval data so parametric statistics were used. Results: Mean TIMES score was 57.2/100 (sd 5.4) indicating a severe symptom burden affecting multiple body systems. The correlations between symptom burden, age and duration were negligible, and moderate with ME/CFS severity. Women had a greater symptom burden than men. All participants experienced fatigue, neurological symptoms and dysautonomia. The mean Fatigue Scale score was severe (67.7 (sd 19.9)) and moderate for the Neurological Scale (mean 45.11 (sd 9.45)) and Dysautonomia Scale (43.98 (sd 8.42)). Over 90% experienced cognitive, pain, motor-sensory, sleep, cardio-respiratory, cranial nerve and gastro-intestinal symptoms to some degree. They were mild-moderately troublesome overall, except cognitive symptoms which were severe. Conclusions. ME/CFS causes a heavy multi-system symptom burden. Although most individual symptoms were mild-moderately troublesome, the cumulative effect was severe or very severe. Fatigue was the most common and troublesome problem followed by cognitive symptoms, sleep disturbance and pain. Women experienced a greater symptom burden than men, and there was a moderate relationship between symptom burden and disease severity.

PurposeSurvivors of severe COVID-19 commonly experience post-intensive care syndrome (PICS), which includes depression and fatigue. Fatigue is far more common and may inflate depression severity given overlapping symptoms. We sought to disentangle fatigue from depression in PICS. MethodsWe conducted a cross-sectional analysis of the RAFT COVID study, a national multicenter longitudinal cohort of severe prolonged COVID-19 survivors. We included participants who completed validated surveys at 1-year from hospitalization for depression (PHQ-9) and fatigue (FACIT-Fatigue). We described correlation of FACIT-fatigue with the PHQ9, and separately with PHQ-2 and PHQ-7, which both omit the two items we hypothesized are influenced by fatigue--tiredness and sleeping. Using a MIMIC model, we performed differential item functioning to evaluate the impact of fatigue on depression directly through these two questions and indirectly with the latent depression construct. We then compared PHQ-7 to PHQ-9 scores by fatigue status. ResultsAmong 82 participants, 61.0% reported fatigue (reverse-scored FACIT-Fatigue [&ge;]9), and 15.9% moderately severe depression (PHQ-9 [&ge;]10). FACIT-fatigue was strongly correlated with PHQ-9 (r=.87, p<.001), but less so for PHQ-2 (r=.76, p<.001) and PHQ-7 (r=.82, p<.001). The MIMIC model identified significant direct effects on tiredness ({lambda}=.89, p<.001) and sleep ({lambda}=.52, p<.001). Among fatigued participants, the rescaled PHQ-7 was lower than the PHQ-9 (median of 4.5, IQR 1.50-9.75, vs 7, IQR 4-9.75). ConclusionsFatigue significantly inflated depression symptoms in severe COVID-19 survivors through tiredness and sleeping PHQ-9 items. PHQ-2 may better screen for true depressive symptoms in PICS, minimizing the risk of misdiagnosis and overtreatment. PLAIN ENGLISH SUMMARYSurvivors of severe COVID-19 illness commonly experience post-intensive care syndrome (PICS), which includes depression and fatigue. Fatigue is far more common and may inflate depression severity given overlapping symptoms. We sought to disentangle fatigue from depression in PICS. We found that the presence of fatigue inflated depression severity through symptoms of tiredness and difficulty sleeping, which are two of the nine items of a commonly used depression screening tool, known as the Patient Health Questionnaire-9 (PHQ-9). Depression screening tools that omit these two items, such as the PHQ-2, may better screen for depressive symptoms in PICS, minimizing the risk of overestimating depression symptoms and potentially misdiagnosis.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID are persistent multi-system illnesses affecting many patients. With no known effective FDA-approved treatments for either condition, patient-reported outcomes of treatments are invaluable for guiding management strategies in patient care and generating new avenues for research. Here, we present the results of an ME/CFS and Long COVID treatment survey with responses from 3,925 patients. We assessed the experiences of these patients with more than 150 treatments, as well as their demographics, symptoms, and comorbidities. Patients with each condition who participated in the study shared similar symptom profiles, including all the core symptoms of ME/CFS, e.g., 89.7% of ME/CFS and 79.4% of Long COVID reported post-exertional malaise (PEM). Treatments with the greatest perceived benefits were identified, which had varied effects on different core symptoms. In addition, treatment responses were significantly correlated (R{superscript 2} = 0.68) between the two patient groups. Patient subgroups with distinct profiles of symptoms and comorbidities showed varied responses to treatments, e.g., a POTS-dominant cluster benefiting from autonomic modulators and a cognitive-dysfunction cluster from CNS stimulants. This study underscores the symptomatic and therapeutic similarities between ME/CFS and Long COVID and highlights the commonalities and nuanced complexities of infection-associated chronic diseases and related conditions. Insights from patient-reported experiences, in the absence of approved treatments, provide urgently needed real-world evidence for targeted therapies in patient care and for developing future clinical trials. (Disclaimer: The findings presented in this paper are based on patient-reported information and are intended for research purposes only. They should not be interpreted as medical advice. Patients are advised to consult their healthcare provider before initiating or altering any treatment.)

BackgroundFibromyalgia is characterised by chronic widespread pain. Quality of life is further reduced by autonomic and cognitive symptoms, including subjective brain-fog and dissociative experiences. Although an association with joint hypermobility suggests variant connective tissue is a factor in both fibromyalgia and dysautonomia, the mechanisms underlying the neuropsychiatric symptoms are poorly understood. Methods21 fibromyalgia patients and 21 healthy controls were assessed for joint hypermobility dissociative experiences, autonomic symptoms and interoceptive sensibility. Mediation analyses were conducted according to the method of Baron and Kenny. ResultsPatients with fibromyalgia reported greater dissociative experiences and autonomic symptoms. The relationship between fibromyalgia and dissociative experiences was fully mediated by symptoms of orthostatic intolerance. Fibromyalgia, dissociative experiences and orthostatic intolerance all were associated with joint hypermobility and interoceptive sensibility. ConclusionsThis exploratory investigation highlights the relationship between dissociative experiences in the context of fibromyalgia and subjective experience of aberrant physiological responses. These findings can enhance the recognition and management of neuropsychiatric symptoms in patients with fibromyalgia, wherein dissociative experiences reflect disturbance of self-representation that can arise through abnormalities in internal agency, autonomic (dys)control and interoceptive prediction errors.

Metacognitive beliefs and behavioural indices aligned with large-scale networks plausibly shape day-to-day psychosocial functioning, especially under conditions of persistent stress and fatigue. However, their joint structure and group-level comparability remain under-specified. In a cross-sectional multi-group design (men and women), we administered the MCQ-30, the Fatigue Severity Scale, behavioural proxies of fronto-parietal, salience and default-mode network tendencies, and the Index of Psychosocial Functioning (IPF). Note that the three neurocognitive instruments do not measure large-scale brain networks per se. They are behavioural proxies that characterise probable patterns of attention/control, self-referential processing, and cue detection/switching putatively linked to activity within the frontoparietal (executive), default-mode, and salience networks; accordingly, all inferences are at the level of behaviour/cognition rather than direct neurophysiology. Using multi-group exploratory structural equation modelling (ESEM) with target rotation, we specified a three-factor measurement solution for the metacognitive- behavioural indicators, tested configural, metric and partial scalar invariance across sex, and regressed a latent IPF outcome on the three factors while controlling for age and education. Missingness was handled with FIML and MLR; WLSMV sensitivity analyses and bootstrap confidence intervals were used where appropriate. The three-factor ESEM structure showed good fit in each group and supported metric and partial scalar invariance. A factor reflecting threat/uncontrollability beliefs displayed robust negative associations with psychosocial functioning, whereas executive confidence/goal-directedness was positively associated; self-focus/monitoring contributed little or inconsistently. Effects were robust to estimator choice and to freeing a small subset of intercepts for partial scalar invariance. Clean separation of predictors and outcome (IPF as a latent criterion) clarifies that metacognitions centred on perceived threat and loss of control undermine functioning, while executive confidence aligned with FPN-like behaviour supports it. Therapeutically, the findings prioritise dampening uncontrollability beliefs and strengthening executive stamina. Behavioural network indices should be interpreted as proxies rather than neural measurements.

BackgroundAround one in five persons globally reports experiencing chronic pain. Chronic pain can lead to sleep disturbances, reduced resilience to chronic stressors, and quality of life. Exposure to childhood maltreatment is a risk factor for chronic pain that also reduces resilience abilities. However, the relationship between childhood maltreatment, resilience and sleep disturbance on quality of life in people with chronic pain remain poorly understood. MethodsTwo hundred and forty-one participants were included in this study, including 157 people with and 84 without chronic pain (controls). All participants responded to an online survey that included measures of childhood maltreatment, resilience, sleep disturbances and quality of life. A moderated serial mediation model tested how resilience and sleep disturbances mediate the relationship between group and quality of life, and how the severity of childhood maltreatment moderates the group difference in resilience. ResultsParticipants with chronic pain reported significantly lower quality of life than controls. This group difference in quality of life was significantly mediated by the level of resilience and sleep disturbance when people reported being exposed to low and average, but not high levels of childhood maltreatment. ConclusionsThe study found that exposure to childhood maltreatment reduced resilience abilities leading to more severe sleep problems and lower quality of life in participants with chronic pain. These findings suggest that interventions targeting childhood maltreatment and resilience may be beneficial to improve quality of life, through increased sleep quality, in individuals with chronic pain.

Depression represents a significant and prevalent challenge among individuals with multiple sclerosis (MS) substantially impacting their quality of life (QoL). This study explores the mediating role of psychological resilience in the relationship between depression and QoL in a sample of patients with multiple sclerosis (PwMS). This online cross-sectional study involves 179 Relapsing-Remitting Multiple Sclerosis (RRMS) patients. The PwMS completed three questionnaires: the Chicago Multiscale Depression Inventory, the Connor-Davidson Resilience Scale, and the Multiple Sclerosis Quality of Life (MSQOL-29). The results confirmed that higher levels of depression were associated with lower QoL in RRMS patients. However, the inclusion of psychological resilience as a mediator attenuated this direct effect, suggesting that resilience plays a crucial role in mitigating the negative impact of depression on QoL.

Burnout Syndrome (BOS), a pervasive occupational phenomenon stemming from unmanaged chronic workplace stress, leading to physical, psychological and cognitive impairment, represents a major challenge for preventive medicine. Indeed, the worldwide increasing incidence of BOS and the importance of its early management points to the unmet need for early BOS diagnosis. Whilst biomarkers of chronic stress have been explored with the description of the allostatic load, BOS lacks a consistent physiological signature, which would contribute to an early and comprehensive identification of persons at risk. This systematic review synthesizes current evidence on BOS-related biomarkers, aiming to identify potential physiological correlates. We conducted a comprehensive search of PubMed and EMBASE, yielding 111 studies evaluating 36 biomarkers in adult populations. Our analysis revealed inconsistent associations across most physiological systems, including the hypothalamic-pituitary-adrenal axis (e.g., cortisol, DHEA), immune system, cardiovascular parameters. While some biomarkers like HbA1c, blood glucose, or comorbidities like irritable bowel syndrome showed more consistent positive correlations with BOS, the overall findings are largely inconclusive. We conclude that the current biological evidence is insufficient for establishing a definitive BOS biosignature for routine clinical diagnosis. Future research should prioritize a more unified and comprehensive definition of BOS, potentially integrating emerging assessment tools to advance the objective identification and early intervention of burnout.

BackgroundPersistent Somatic Symptoms (PSS) are common, functionally disruptive, multifactorial, and often remain stable over time. Understanding how symptoms interact may clarify transdiagnostic patterns and inform treatment. This study investigated symptom networks in a transdiagnostic sample to identify central symptoms and assess temporal stability. MethodsPatients (n=1134; 63.7% female; mean age 50.6{+/-}16.3 years) from the transdiagnostic SOMACROSS research unit were analysed with the Patient Health Questionnaire-15 (PHQ-15), modified Pain Disability Index (PDI), and two global items on overall symptom severity and impairment due to symptoms (EURONET-SOMA) at baseline and 6-month follow-up. Networks were estimated with regularised partial correlations (EBICglasso). Network stability and change were tested with bootstrap procedures and the Network Comparison Test (NCT). ResultsAt baseline, four symptom clusters were identified: gastrointestinal, musculoskeletal pain, cardio-autonomic, and fatigue-sleep. Fatigue/low energy was a central symptom linking different network domains. Global symptom severity and impairment (EURONET-SOMA items) showed the strongest connectivity, reflecting their broad influence. Functional disability in home responsibilities and recreation (PDI items) acted as bridging nodes, connecting somatic symptoms with daily functioning. The follow-up network closely resembled the baseline structure. NCT confirmed temporal stability (global strength p=.815, structure invariance p=.180). Thus, both symptom clusters and central nodes remained consistent over six months. ConclusionFatigue, overall symptom severity, impairment, and functional disability emerged as central drivers within network. Their stable centrality highlights them as possible intervention targets, suggesting that reducing fatigue and disability may interrupt self-reinforcing symptom cycles. These findings support a transdiagnostic view on PSS as a stable, interconnected system. HighlightsO_LISymptom clusters: gastrointestinal, musculoskeletal pain, cardio-autonomic and fatigue-sleep C_LIO_LIFatigue and functional impairment were central symptom nodes across time points C_LIO_LIGlobal impairment and global symptom severity ratings were connected to somatic symptoms C_LIO_LIPSS network remained stable over 6 months, with no changes in strength or configuration C_LI

Myalgic Encephalomyelitis (ME) /Chronic Fatigue Syndrome (CFS) is a severely debilitating and complex illness of uncertain aetiology, affecting the lives of millions and characterised by prolonged fatigue. The initiating factors and mechanisms leading to chronic debilitating muscle fatigue in ME/CFS are unknown and are complicated by the time required for diagnosis. Both mitochondrial dysfunction and inflammation have been proposed to be central to the pathogenesis of ME/CFS. This original and extensive study demonstrated that although there was little dysfunction evident in the muscle mitochondria of patients with ME/CFS, particular blood plasma and skeletal muscle cytokines, when adjusted for age, gender and cytokine interactions could predict both diagnosis and a number of measures common to patients with ME/CFS. These included MVC and perceived fatigue as well as cognitive indices such as pattern and verbal reaction times. We employed advanced multivariate analyses to cytokine profiles that leverages covariation and intrinsic redundancy to identify patterns of immune signaling that can be evaluated for their predictions of disease phenotype. The current study identified discriminatory cytokine profiles that can be sufficiently used to distinguish HCs from patients with ME/CFS and provides compelling evidence that a limited number of cytokines are associated with diagnosis and fatigue. Moreover, this study demonstrates significant potential of using multiplex cytokine profiles and bioinformatics as diagnostic tools for ME/CFS, potentiating the possibility of not only diagnosis, but also being able to individually personalise therapies. SignificanceMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex, chronic, debilitating and potentially life-changing medical condition affecting children and adults of all ages, races and socio-economic groupings. Clinical presentation includes fluctuating fatigue of varying severity, with other symptoms, including myalgia, arthralgia, post-exertional fatigue, unrefreshed sleep, headache, upper respiratory tract symptoms, and cognitive impairment. With no biomarkers, or diagnostic tests, aetiology, epidemiology and pathophysiology remain unclear. This extensive study employed advanced multivariate analyses that leveraged covariation and intrinsic redundancy and identified discriminatory cytokine profiles that can be used to distinguish Healthy Controls (HCs) from patients with ME/CFS and a limited number of cytokines were associated with physical and cognitive fatigue. These findings are relevant to the potential of increasing numbers of patients developing chronic fatigue following Coronavirus disease 2019.

BackgroundThere is no accurate data on the epidemiology of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS) in Canada. The aims of the study were to describe the epidemiology of confirmed ME/CFS cases and their health-related quality of life (HRQoL). MethodsThis is a cross-sectional study with British Columbia Generations Project (BCGP) participants who self-reported having CFS and population-based controls with no fatiguing illness. Participants completed the Symptoms Assessment Questionnaire, RAND 36-item Health Survey, and Phenotyping Questionnaire Short-form. These assessments enabled the identification and characterization of "confirmed cases" of ME/CFS. Those with self-reported diagnoses who did not meet study diagnosis of ME/CFS were subcategorized as "non-ME/CFS cases." ResultsWe included 187 participants, 45.5% (n=85) self-reported cases and 54.5% (n=102) controls; 34% (n=29) of those who self-reported ME/CFS fulfilled diagnostic criteria for ME/CFS. The population prevalence rates were 1.1% and 0.4% for self-reported and confirmed ME/CFS cases respectively. Participants displayed significantly lower scores in all eight SF-36 domains compared to the other groups. Mental component scores were similar between ME/CFS and non-ME/CFS groups. The main risk factor for low HRQoL scores was fatigue severity ({beta} = - 0.6, p<0.001 for physical health; {beta} = -0.7, p<0.001 for mental health). ConclusionsThe majority of self-reported cases do not meet diagnostic criteria for ME/CFS, suggesting that self-reported CFS may not be a reliable indicator for a true ME/CFS diagnosis. HRQoL indicators were consistently lower in ME/CFS and non-ME/CFS cases compared to controls, with ME/CFS cases having lower scores in most domains. Having higher symptom severity scores and perceived poorer health were the significant affecting factors of lower HRQoL. Although self-report can be used as screening to identify cases in populations, we suggest studies of ME/CFS should include appropriate medically confirmed clinical diagnosis for validity. Further large-scale population-based studies with simultaneous medical assessment are suggested to further characterize validity parameters of self-reported diagnosis.

While progress has been made toward understanding physical and mental fatigue, chronic fatigue has been under-studied and stigmatized. Unlike other fatigue states that can be relieved by rest, chronic fatigue is a common, debilitating symptom of many chronic conditions. Utilizing deidentified patient data from the Yale-New Haven Hospital System, we analyzed the overlap between diagnosed fatigue and 14 chronic conditions. Our results revealed a significantly lower overlap with fatigue than previous reports in all but one of the current diagnoses fields. The underreporting of disabling fatigue across chronic conditions restricts the translation between medical and basic scientific research. Accurate reporting of the prevalence of chronic fatigue can result in researchers refocusing their efforts toward uncovering targetable mechanisms and physicians consistently reporting and treating chronic fatigue.

BackgroundThe management of the long-term sequelae of COVID-19 infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely due to a significant gap in the understanding of its aetiology, diagnosis and effective treatment. AimTo examine general practitioners (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement. Design and settingThis study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs (N=31) from across Germany. MethodInterviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis. ResultsPatients with persistent symptoms after SARS-CoV-2 infection often consult their GPs as the first point of contact, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients functioning, social participation, and the substantial time required for patient care. GPs coordinate diagnosis and treatment, but face difficulties because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care. ConclusionThe findings confirm the high functional limitations and psychosocial burden of PCS on patients and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments. How this fits inPost-COVID-19 syndrome has garnered attention in research and healthcare, but limited evidence on its causes and effective treatment challenges clinicians. This study illustrates the symptom-driven approaches to diagnosis and treatment adopted by general practitioners and their concerns about referring patients to specialist clinics. Greater collaboration and communication across sectors and disciplines is needed to meet the identified need for interprofessional care. Research should also focus on developing comprehensive differential diagnostic protocols, and health policy should address barriers to accessing specific outpatient services.

BackgroundWhen studying health-related quality of life (QOL), disease-specific instruments have the advantage of measuring the unique effects of particular medical conditions. Almost every disease-specific QOL instrument uses its own metric, and measures QOL in its own content areas. The unfortunate result is that scores from different disease-specific QOL instruments cannot be compared. In contrast, the seven-item Quality of Life Disease Impact Scale (QDIS-7) has response choices on only one scale (one metric) and its content is standardized. Thus, the QDIS-7 should allow disease-specific QOL to be compared across different diseases. We therefore tested whether, unlike scores from the traditional mutually-incompatible metrics, those from the single-metric QDIS-7 are comparable across diseases. MethodsResponses to the QDIS-7 questions (regarding global QOL, physical functioning, role functioning, social functioning, vitality, mental health, and health outlook) were used to compute a single score, based on an item-response model. When the QDIS-7 was completed by respondents with different diseases, the content of the question-items was the same, and the only difference was the name of the disease to which the respondents explicitly attributed any impact on their QOL. In an online survey, 2,627 adults who had sought care for headache, low-back pain, asthma, or diabetes, each responded to the QDIS-7 and to a previously-validated disease-specific QOL instrument ("legacy scale") that was developed to measure QOL in their specific disease. We examined the slopes from four regressions of legacy-scale scores on QDIS-7 scores. Similarity of those slopes would support the hypothesis that the QDIS-7 enables quantitative comparisons of disease-specific QOL across those four different medical conditions. ResultsFor all four groups, the regression-line slopes were nearly the same: 0.12 to 0.14 legacy-scale standard deviations per 1-point difference in QDIS-7 score. Thus, each 10-point difference in QDIS-7 scores is equal to slightly more than one standard-deviation difference in legacy-scale scores, for all four groups. ConclusionsThe relationships of score differences on the legacy measures to score differences on the QDIS-7 (i.e., the slopes) were similar across the four groups, which is consistent with the idea that the QDIS-7 enables comparisons of disease-specific QOL across different medical conditions.

BackgroundPersistent Postural-Perceptual Dizziness (PPPD) is a prevalent long-term functional neurological disorder characterised by non-spinning vertigo, perceived instability, and visual motion sensitivity. Current diagnostic criteria inadequately incorporate psychological variables widely associated with PPPD symptom onset and maintenance. ObjectivesThis study explored PPPD-specific psychological variables to differentiate PPPD patients from healthy controls and, exploratorily, from Bilateral Vestibulopathy (BVP) patients. We evaluated these variables as potential treatment targets through mediation analysis. Our aim was to inform more precise diagnostic criteria and guide targeted interventions for PPPD. MethodsWe conducted a cross-sectional study with 164 participants, including 59 diagnosed cases of PPPD, 16 cases of BVP, and 89 healthy controls. Participants completed a series of questionnaires assessing negative illness perception, balance vigilance, anxiety, visual sensitivity, dizziness and other related metrics. ResultsPsychological variables, particularly anxiety, cognitive fusion, and justice appraisal significantly mediated the relationship between key PPPD symptoms (dizziness, visual sensitivity, and balance vigilance) and PPPD diagnosis compared to healthy controls. Logistic regression suggested psychological differences between PPPD and BVP, but limited BVP sample size constrained generalisability. Between PPPD and healthy controls, psychological variables significantly improved classification accuracy compared to measures of dizziness alone. ConclusionIncorporating psychological variables in the diagnosis and management of PPPD could enhance the understanding of the disorder and may aid in developing better-targeted interventions. The study supports revising existing diagnostic criteria to include validated psychological assessments and highlights the potential of treatments addressing cognitive and emotional aspects of PPPD to improve patient outcomes.

BackgroundLongitudinal data on the course of somatic symptom disorder (SSD) in ulcerative colitis (UC) and irritable bowel syndrome (IBS) are lacking. Understanding SSD trajectories and predictors in IBS and UC may clarify clinical relevance and guide psychological treatment decisions. This study examined the 12-month course and biopsychosocial predictors of interview-based SSD in patients with UC or IBS. MethodsLongitudinal data from a randomised controlled trial were analysed. SSD was assessed using DSM-5-based structured interviews at baseline and 12 months. SSD Criteria A (Somatic symptom severity) and B (symptom-related distress) were measured with the Patient Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder - B Criteria Scale-12 (SSD-12), respectively. Further variables included gastrointestinal symptom severity, inflammatory markers, depression severity, illness perceptions, and neuroticism. Logistic and linear regression models identified baseline predictors of SSD diagnosis and Criteria A and B at 12 months. ResultsThe sample included 213 patients (73.7% female; Mage=40.5, SD=13.98) with UC (n=110) or IBS (n=103). SSD was present in 42.3% (95%CI: 35.2-49.3) at baseline and in 15.5% (95%CI: 11.3- 20.7) at follow-up. Baseline SSD and depression severity predicted follow-up SSD. Criterion A was predicted by somatic symptom severity, female gender, and neuroticism; the B criterion by symptom-related distress, somatic symptom severity, neuroticism, and negative illness perceptions. Inflammatory markers and gastrointestinal symptom severity showed no predictive value. ConclusionStructured interview-based SSD was frequent in patients with UC or IBS at baseline and declined over time. Psychosocial rather than disease-related variables predicted SSD, highlighting modifiable targets for early detection and tailored interventions. Results should be interpreted in light of the studys interventional context.

BackgroundEarly research on the impact of the COVID-19 pandemic found persistent related anxiety in the general population. We hypothesised that this anxiety will be associated with increased pain in chronic pain patients diagnosed with fibromyalgia (FM). MethodsTo study this, we carried out a 10-day online survey with 58 female participants, diagnosed with FM and no other pain condition. We identified which aspects of the COVID-19 pandemic evoked anxiety. We then asked participants to provide daily ratings of both anxiety and pain on 101-point visual analogue scales (VAS). Key participant characteristics were included as mediators in a mixed-effects analysis, where the primary outcome was pain VAS. ResultsWe found that participants were most often anxious about "impact on relationships", "a family member contracting COVID-19", and "financial hardships", but on average rated "financial hardship", "access to medication", and "home loss/eviction" as evoking the strongest anxiety. Mixed-effects modelling showed that an increase in pain was significantly associated with an increase in anxiety, when taking into account individual variance and daily caffeine intake. Age and intake of some mild analgesics were also linked to stronger pain. ConclusionOur results extend the initial findings from the literature about the effects of COVID-19 pandemic on chronic pain sufferers. We found that not only is pandemic anxiety in FM patients present, but it is associated with amplified self-assessed chronic pain. SignificanceThe long-term support of fibromyalgia patients is challenging for healthcare professionals due to the nature of the condition. The new normal introduced by the pandemic particularly hinders pain management, which is the leading request from this patient group. Our study demonstrates that mental health decline during the COVID-19 pandemic is directly related to the worsening of pain in fibromyalgia. Core stressors that evoke the strongest anxiety were identified thus providing guidance for where to focus patient support.

BackgroundFibromyalgia is a chronic pain disorder, affecting 2-3% of the population, characterised by widespread pain, fatigue, sleep and cognitive symptoms. Despite symptom overlap between functional motor disorder (FMD) and fibromyalgia, the prevalence of fibromyalgia in FMD and its impact on health-related quality of life (HRQoL) remain unclear. ObjectivesTo assess the prevalence of fibromyalgia in FMD using the 2016 American College of Rheumatology diagnostic criteria and to evaluate its impact on HRQoL. MethodsA total of 139 consecutive patients with clinically established FMD (115 females, mean age 44.6 (SD 11.3) years) completed Fibromyalgia Survey Questionnaire, subjective motor symptoms and HRQoL assessments. Motor symptoms were objectively rated using the Simplified FMD Rating Scale (S-FMDRS). Major physical illnesses, neurological, and psychiatric comorbidities, and the use of centrally acting and nociceptive pain medication was recorded. ResultsFibromyalgia was present in 44.6% of FMD patients (95%CI: 36.2-53.3%). Those with fibromyalgia had higher S-FMDRS scores (p < 0.01), lower HRQoL (p < 0.001), more frequent use of centrally acting and nociceptive pain medication (p < 0.01). Fibromyalgia severity was positively correlated with both subjective motor symptom severity (p < 0.01) and S-FMDRS (p < 0.05). Higher fibromyalgia severity (p < 0.001), S-FMDRS (p < 0.001), and psychiatric comorbidity (p < 0.001) were independent predictors of lower HRQoL. ConclusionsIn this study, fibromyalgia was common in FMD and associated with more severe motor symptoms, greater medication use and reduced quality of life, highlighting the importance of recognising and managing fibromyalgia in FMD.

ObjectiveThe dynamic impact of chronic pain on attention can lead to impairments in overall cognitive functioning. Mindfulness is a practice often adopted for pain management that includes elements of attention training. It is thought to improve the experiential acceptance of pain, thus reducing pain-sensitivity and pain-related attentional biases. The aim of this study was to examine whether experience with mindfulness is associated with altered attentional functioning in participants with chronic pain. MethodsWe collected an online sample of 128 participants across four groups: 31 individuals with chronic pain who practice mindfulness (Pain-Meditators), 29 individuals with chronic pain who have not practiced mindfulness (PainNon-Meditators), 32 healthy individuals who practice mindfulness, and 36 healthy individuals who do not practice mindfulness. General attentional functioning was measured using the using the Short-Attention Network Task (short-ANT) and attention bias to pain was measured using the Pain Dot-Probe task. ResultsAn overall effect in reaction time (RT) was found across both (all p <.05), with post-hoc analyses finding that Pain-Meditators reacted faster on both the short-ANT (p = 0.014) and dot-probe attention tasks (p = < 0.001) compared to PainNon-meditators. PainNon-meditators showed higher alerting network scores on the short-ANT than all other groups (p = 0.005), indicating more reliance on cues to alert attention. No differences were found between the pain groups in attentional bias to pain-related words (p = 0.84). ConclusionThe results provide evidence that mindfulness practice is associated with altered attention performance in individuals with chronic pain and may mitigate the effects of chronic pain on attention functioning. Our results provide some of the only experimental research to investigate the effects of mindfulness training on attention processing in individuals with chronic pain.

IntroductionThe COVID-19 pandemic has been shown to have profound effects on both mental and physical health. Distress and widespread uncertainty about global events and personal risk are associated with increased worry and negative expectations that impact physical health. Thus, the current pandemic poses a possibility for the experience of nocebo effects. ObjectiveTo evaluate the likelihood of nocebo-induced COVID-19 symptoms in a US sample. MethodsAn online study on the mental health impact of COVID-19 asked participants to complete a set of biweekly surveys over a 6-month period between April 2020 and May 2021. We focus on responses from 3,027 individuals who reported never testing positive for COVID-19. We assessed the association between two types of worry and self-reported symptoms of COVID-19. We used multi-level models to examine variations across and within participants over time. We further investigated the effects of pre-existing health conditions and mental health status. ResultsThere was a positive association between symptoms and both general (b= 2.56, p<0.01) and personal worry (b=2.77, p<0.01). However, worry reported at one timepoint was not specifically associated with symptoms reported two weeks later (p = 0.63, p=0.56). We also found that a greater number of prior clinical comorbidities and greater mental health burden were significant predictors of symptom reporting. ConclusionsThese results suggest that increased worries during the COVID-19 pandemic were associated with greater symptoms. Further studies investigating worry and symptoms in populations with confirmed negative COVID-19 tests or isolated populations will be needed to isolate the occurrence of true nocebo effects during the pandemic.