120 Fatigue and pain leading to the diagnosis of depression. Diagnostic procedure experienced by patients with fibromyalgia. A qualitative study

Objectives Fibromyalgia is a functional syndrome characterized by pain, fatigue and many other somatic symptoms. The lifetime prevalence of psychiatric comorbidities, such as depression, among patients with diagnosed fibromyalgia is high. It has been suggested that the reason for this phenomenon could result from similar pathophysiological mechanisms. Furthermore, the diagnostic criteria of these conditions are partly overlapping. The aim of this study was to explore experiences of fibromyalgia patients on diagnostic procedures using a qualitative analysis method. Method The study is based on the data from fibromyalgia patients of the city of Nokia, Finland. All the fibromyalgia patients who had been treated in the primary health care were identified from the electronic patient records of the heath care center of Nokia. 96 patients filling the diagnostic criteria (ACR2010) of fibromyalgia were identified. Further, 18 fibromyalgia patients (15 female and 3 male) were selected using the purposive sampling method into focus group interviews. Altogether, four sessions (4–5 participants per each) were carried out before the saturation of the data was reached. A semi-structured interview was used. The main focus of the interviews was to explore patients’ experiences and perspectives on diagnostic process of fibromyalgia. All the interviews were recorded, transcribed verbatim and analyzed through the inductive content analysis based on the phenomenological theory. The particular interest was focused on the diagnostic process of depression as a comorbidity. Results The data analysis revealed two main themes among the interviews. First, the patients had experienced that their fibromyalgia symptoms were frequently explained as depressive symptoms by the physicians. They described that the diagnosis of depression was based on the feeling of pain and fatigue rather than how they experienced their mood. Patients repeatedly pointed out that their own perception of their mental health differed from the physicians’ opinions. They did not feel themselves depressed even though they reported symptoms common with depression. Nevertheless, psychological interventions aiming to improve the management of pain and other symptoms of fibromyalgia were found useful by the patients. One participant described her perception on psychological intervention as follows: ‘I guess it would be worth prioritizing how to cope with the pain. Maybe it’s more psychological, but I think it’s the most important thing in this’. Conclusions Based on our findings from this qualitative analysis, setting the diagnosis of depression for fibromyalgia patients who do not regard their mood as low, does not seem to be useful. Psychological interventions aiming at to cope with the symptoms of fibromyalgia better could be included in the treatment instead.