To the best of our knowledge, this is the first national survey conducted to evaluate the prevalence of depression among patients with FM in Syria.
A National Health Interview Survey conducted in the US in 2012 showed that in a population of people aged 18 years and older, only 1.75% satisfied study-specific criteria for fibromyalgia.[12]
Our study demonstrated a much higher FM prevalence rate of 8%.
This finding of such a high occurrence rate of FM in participants corresponds to a previous study conducted in Damascus, Syria, which revealed one of the highest incidence rates of FM (11.8%) in a general population according to the ACR 2010 modified criteria for FM diagnosis.[1] Numerous studies have shown a strong relationship between psychological distress and an increased prevalence of FM.[13, 14] Thus this high rate can be attributed to the effects of the decade-long war in Syria, which has caused the Syrian people to experience severe psychological distress due to poverty, the nation's economic collapse, and internal displacement.[15]
We found the prevalence of depressive symptoms among research participants to be 77%, exceeding the 3.9% WHO prevalence estimates from 2015 [20]. This percentage corresponds to a previous study conducted in Syria during the war and the COVID-19 pandemic, which reported the prevalence of depressive symptoms to be 83.4%.[15]
Given that a strong correlation between the presence of depressive symptoms and a diagnosis of FM has been demonstrated in previous literature, this high percentage of depressive symptoms is of concern as there is growing evidence of a possible link between the two.[16, 17] One study showed that 83.3% of FM subjects had clinically significant depressive symptoms, while another demonstrated prevalence rates of up to 40%.[18, 19] Our study showed a much higher rate of depressive symptoms among FM patients (90.5%). This could be attributed to the effect of war on the spread of FM. A study on Syrian refugee women in Jordan showed a 30% acute FM dissemination, demonstrating the impact of the war on FM propagation.[20]
The significance of demonstrating this correlation lies in the importance of identifying depressive symptoms among FM patients, as they can contribute to the morbidity of FM and decrease the quality of life among patients. Disseminated pain is the hallmark of FM, and over time, this pain can contribute to psychological issues as both a result of the physical disorder and as a separate psychiatric condition.[21]
A US study indicated that females with FM were more at risk of developing depression and anxiety.[22] Our study offers important information on the incidence and severity of depression in FM patients. FM is associated with a high burden of illness on patients and the healthcare system, which results in significant disability and undiagnosed comorbidities. We support a general awareness campaign aimed at the public and healthcare professionals to aid in the early detection of depressive symptoms associated with FM to ensure proper treatment and improve patients' quality of life.
Limitations:
There are some noteworthy limitations. Young women were over-represented in our sample, and our findings can only be generalized to young Syrians from Damascus. As such, reaching out to these populations should be prioritized in future studies.