More than half of those with fibromyalgia experienced major depressive disorder (MDD) within their lifetimes, and the point prevalence was estimated at 25%. MDD has shown a very high prevalence among individuals with fibromyalgia, according to a meta-analysis recently published in the Journal of Affective Disorders.
This systematic review included 11 studies drawn from PsycINFO, Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE that included research on MDD comorbidity with fibromyalgia. Eligibility criteria included more than 30 individuals in the study sample, participants aged at least 18 years, a primary diagnosis of fibromyalgia, a lack of other rheumatic comorbidities that could interfere with results, and either a current or lifetime incidence of MDD. Structured clinical interviews were used to estimate MDD lifetime prevalence and point prevalence, while point prevalence was also estimated using self- and clinician-administered screening symptom scales. Depression prevalence among individuals with fibromyalgia was estimated using a random effects meta-analysis.
Structured clinical interviews yielded a pooled point prevalence of 25% (95% confidence interval [CI], 19%-31%) and a lifetime prevalence of 65% (95% CI, 59%-71%). Clinician-administered screening symptom scales yielded a point prevalence of 23% (95% CI, 10%-41%), whereas those self-administered by participants yielded a much higher result of 45% (95% CI, 32%-59%), though this had high inconsistency (I2=92.13%). Structured clinical interviews had low inconsistency (I2=42.36%), whereas screening symptom scales exhibited moderate inconsistency.
Limitations to this analysis include a smaller number of studies than was expected for the use of structured clinical interviews vs screening symptom scales, varying classifications of the 2 disorders, modifications of the original PROSPERO protocol, and a lack of assessment for risk of bias.
The study researchers conclude that “[a] fourth of all [fibromyalgia] patients had [major depressive disorder], and more than half experienced [major depressive disorder] during their life-time according to clinician-administered instruments. Prevalence of [major depressive disorder] was almost twice as high when using self-administered symptom scales and may be likely to overestimate the co-occurrence.”
Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia: systematic review and meta-analysis [published online December 3, 2018]. J Affect Disord. doi: 10.1016/j.jad.2018.12.001