In a groundbreaking retrospective observational study published in BMC Psychiatry in 2025, researchers delve into the intricate psychiatric landscape of fibromyalgia patients within a major American healthcare system. This extensive analysis focuses on the prevalence and interplay of three critical psychiatric comorbidities—posttraumatic stress disorder (PTSD), depression, and anxiety—among individuals diagnosed with fibromyalgia, a chronic condition characterized by widespread musculoskeletal pain and often accompanied by fatigue and cognitive disturbances. Despite the well-documented coexistence of psychiatric disorders in fibromyalgia, this study provides one of the first large-scale, systematic evaluations of these mental health conditions within a single-network healthcare setting, leveraging data from HCA Healthcare facilities.
Fibromyalgia is increasingly recognized not merely as a pain disorder but as a complex systemic condition with multifaceted associations, including significant psychiatric comorbidities. The researchers examined electronic health records for 1,516 fibromyalgia patients aged 18 and older, collected over a two-year span from January 2022 to December 2023. This data-driven investigation aimed to unravel the demographic and clinical nuances of psychiatric disorders in this population, shedding light on how PTSD, depression, and anxiety manifest and diverge across age, sex, and racial groups, as well as how these conditions impact hospital length of stay (LOS).
The demographic profile of the cohort reveals a predominantly middle-aged white female population, with an average age of 52.2 years, 96% female, and approximately 78% identifying as white. These characteristics reflect established fibromyalgia epidemiology, which disproportionately affects women. The study’s demographic depth allowed for robust statistical analyses, employing chi-square tests to ascertain associations between psychiatric outcomes and demographic variables, while hospital LOS was assessed using non-parametric Kruskal–Wallis tests, accommodating the skewed nature of LOS distributions in clinical data.
Results highlight the high prevalence of anxiety and depression within fibromyalgia patients, recorded at 61% and 40% respectively, illustrating the psychiatric burden these individuals carry. Contrastingly, PTSD presented in a smaller subset, affecting roughly 9% of patients. Intriguingly, the researchers observed distinct age-related prevalence patterns: PTSD markedly clustered in younger patients, particularly those aged 30-39, suggesting potential links between acute trauma exposure or heightened vulnerability in this age group. Depression, conversely, showed a positive correlation with advancing age, peaking among patients older than 65, possibly reflecting cumulative psychosocial and health stressors.
Anxiety demonstrated a bell-shaped distribution, with the highest prevalence in middle-aged patients between 40 and 52 years old. This finding provides fresh insight into the age dynamics of psychiatric comorbidities in fibromyalgia and may inform targeted intervention strategies. Notably, racial background did not significantly influence the prevalence of PTSD, depression, or anxiety, indicating that these psychiatric conditions cut across racial lines within this clinical population.
Sex differences were statistically significant only for anxiety, where females exhibited higher rates (62%) compared to males (48%), reinforcing prior observations of sex disparities in anxiety disorders generally and among fibromyalgia patients specifically. This finding underscores the need for sex-sensitive approaches in screening and treating anxiety within this group. Regarding hospital outcomes, the mean length of stay was relatively brief at 1.93 days, yet significant differences emerged when stratifying patients by psychiatric comorbidity profiles.
Patients with isolated anxiety diagnoses tended to have shorter hospital stays compared to those with isolated depression or multiple psychiatric comorbidities. This gradient suggests that the complexity of psychiatric comorbidity exacerbates clinical severity or complicates inpatient management, extending hospitalization durations. The researchers applied Bonferroni correction to ensure that these pairwise comparisons met stringent statistical thresholds, reinforcing the robustness of their findings.
Beyond prevalence data, this study illuminates the potential clinical significance of psychiatric comorbidities in fibromyalgia management. The interplay between psychological distress and somatic symptoms may contribute to increased healthcare utilization and may complicate diagnostic as well as therapeutic pathways. Recognizing these psychiatric patterns is pivotal for healthcare providers aiming to deliver integrated care that addresses both the physical and mental health dimensions of fibromyalgia.
The study’s findings advocate for comprehensive screening protocols within hospital settings to identify and stratify psychiatric comorbidities effectively. Early detection of anxiety, depression, and PTSD could trigger multidisciplinary treatment plans, potentially improving patient outcomes and reducing healthcare burdens. Given the observed impact on hospitalization length, integrated psychiatric support might also optimize resource allocation and patient flow in inpatient units.
In synthesizing data from a sizable, diverse patient population within a unified healthcare framework, this research contributes a vital perspective to the growing acknowledgment of mental health’s role in chronic pain syndromes. It also underscores the heterogeneity of psychiatric presentations in fibromyalgia, shaped by age, sex, and comorbidity profiles, thereby resisting one-size-fits-all approaches in clinical practice.
Future investigations may expand upon these insights by exploring longitudinal trajectories of psychiatric comorbidities, their causal relationships with fibromyalgia symptoms, and response to targeted interventions. The nuances of PTSD’s prevalence in younger patients warrant particular attention to explore trauma histories, coping mechanisms, and potential preventive strategies.
In conclusion, Rahangdale and Ferraro’s study establishes a compelling evidence base revealing that psychiatric comorbidities are not ancillary features but integral components influencing the clinical course and healthcare outcomes of fibromyalgia patients. Their comprehensive analysis serves as a clarion call for advancing integrated care models that concurrently address the psychological and somatic dimensions of this burdensome condition.
Subject of Research: Psychiatric comorbidities (PTSD, depression, anxiety) in fibromyalgia patients
Article Title: Assessing comorbid PTSD, depression, and anxiety in fibromyalgia patients: a retrospective observational study
Article References:
Rahangdale, A., Ferraro, J. Assessing comorbid PTSD, depression, and anxiety in fibromyalgia patients: a retrospective observational study. BMC Psychiatry 25, 444 (2025). https://doi.org/10.1186/s12888-025-06708-4
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