Assessing Comorbid PTSD, Depression, and Anxiety in Fibromyalgia Patients: A Retrospective Study

Assessing Comorbid PTSD, Depression, and Anxiety in Fibromyalgia Patients: A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessing Comorbid PTSD, Depression, and Anxiety in Fibromyalgia Patients: A Retrospective Study Aneesh Rahangdale, Jeffrey Ferraro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5374501/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 May, 2025 Read the published version in BMC Psychiatry → Version 1 posted 4 You are reading this latest preprint version Abstract Background Fibromyalgia frequently coexists with psychiatric disorders, creating complex challenges in managing the health and quality of life for affected individuals. Existing literature points to significant overlap between fibromyalgia and conditions like posttraumatic stress disorder (PTSD), anxiety, and depression, but no large-scale analysis within a single American healthcare system has yet been conducted. Methods This retrospective study analyzed 1,516 fibromyalgia patients from HCA Healthcare facilities from January 1, 2022, to December 31, 2023, including only patients aged 18 and older with at least one psychiatric comorbidity. Chi-square tests examined associations between psychiatric outcomes (PTSD, depression, anxiety) and demographic factors such as age, sex, and race. Hospital length of stay (LOS) was analyzed among comorbidity groups using the Kruskal-Wallis test, with Bonferroni correction applied for pairwise comparisons. Results The sample had a mean age of 52.51 years, was predominantly female (89.38%) and white (78.96%). Anxiety (60.75%) and depression (53.76%) were highly prevalent, while PTSD was less common (7.52%). Significant age differences emerged for PTSD and anxiety, with younger patients exhibiting higher rates. Sex differences were significant for anxiety only (p = .028), showing higher rates among females. Mean LOS was 4.56 days, with significant differences across comorbidity groups (p = .0009), although pairwise comparisons revealed no specific group differences. Conclusions Psychiatric comorbidities, especially anxiety and depression, are common in fibromyalgia patients and correlate with certain demographic factors. These findings can inform clinical practice by emphasizing the need for comprehensive, age-appropriate, and gender-sensitive approaches to holistic fibromyalgia management that address both physical symptoms and mental health concerns. Fibromyalgia Psychiatric comorbidities Posttraumatic stress disorder Depression Anxiety Hospital length of stay Background Fibromyalgia often coexists with psychiatric disorders, forming a complex web of symptoms and challenges for those affected. The relationship between fibromyalgia and psychiatric conditions has been a subject of research and clinical interest, shedding light on the interplay between physical and mental health. Amir et al. (1997) explored the connection between fibromyalgia and posttraumatic stress disorder (PTSD), as well as tenderness. 1 Their study revealed a significant association between PTSD and fibromyalgia, suggesting that trauma and stress can contribute to the development or exacerbation of fibromyalgia symptoms. Moreover, the presence of tenderness, a hallmark of fibromyalgia, was also linked to PTSD, indicating a potential overlap in physiological responses and sensitivities. The systematic review by Kleykamp et al. (2021) delved into the prevalence of psychiatric comorbidities in fibromyalgia, drawing from a comprehensive analysis. They found a high prevalence of psychiatric disorders such as anxiety, depression, and PTSD among individuals with fibromyalgia. 2 This underscores the importance of addressing not only the physical symptoms but also the psychological well-being of patients with fibromyalgia to provide comprehensive care. Buskila and Cohen (2007) highlighted the comorbidity of fibromyalgia with various psychiatric disorders beyond PTSD. Their review encompassed conditions like major depressive disorder, generalized anxiety disorder, and somatoform disorders. 3 The overlap between fibromyalgia and these psychiatric conditions suggests shared pathophysiological mechanisms or a bidirectional relationship where one condition can influence the other, leading to a more complex clinical presentation. A large-scale retrospective study from a single hospital system has not been conducted to our knowledge at the time of this writing. Methods This study examined fibromyalgia patients across HCA Healthcare facilities from January 1, 2022 to December 31, 2023. Inclusion criteria were patients aged 18 years and older with fibromyalgia listed among their top three diagnoses and at least one psychiatric-related condition. This yielded 1647 patients, but 131 were removed for only keeping the first encounter of each patient. As such, the total sample size was 1,516 patients. Data analysis began with a descriptive overview of all variables, including demographics, comorbidities, and the top 30 diagnosis codes associated with fibromyalgia. Chi-square tests were then employed to examine associations between categorical variables, specifically analyzing outcomes (PTSD/Depression/Anxiety) by age group, race (White vs. Non-white), and sex (Male vs. Female). For significant chi-square results, pairwise comparisons were conducted to identify specific group differences, with Bonferroni corrections applied to adjust p-values for multiple comparisons. To analyze differences in hospital length of stay (LOS) among comorbidity groups, the Kruskal-Wallis test was used due to the non-parametric nature of the data. Following significant Kruskal-Wallis test results, post-hoc pairwise comparisons were performed, again applying Bonferroni corrections to adjust p-values. Throughout the analysis, a p-value of less than 0.05 was considered statistically significant. This comprehensive approach allowed for a thorough examination of the relationships between fibromyalgia, psychiatric comorbidities, demographic factors, and hospital length of stay, while accounting for potential confounding factors and multiple comparisons. Results Table 1. Demographic Characteristics, Comorbidities, and Statistical Comparisons in Fibromyalgia Patients. The data highlights the predominance of female and white patients, high prevalence of anxiety and depression, and the complex nature of comorbidity patterns in this population. Pairwise comparisons with Bonferroni correction were conducted for significant chi-square results. No significant pairwise differences were found for LOS among comorbidity groups despite overall significance. Characteristic Value PTSD Depression Anxiety Age χ²=26.35, p<.0001* χ²=5.26, p=.262 χ²=11.65, p=.020* Mean age 52.51 years 18-29 years 9.17% 9.78%, p=.041* - - 30-39 years 15.04% - - - 40-52 years 25.33% 11.2%, p<.0001* - 65.82%, p=.032* 53-64 years 30.54% 7.93%, p=.020* - - 65+ years 19.92% 2.42% (Reference) Reference 55.45% (Reference) Sex χ²=3.01, p=.083 χ²=0.09, p=.763 χ²=4.85, p=.028* Female 89.38% 62% Male 10.62% 48% Race χ²=0.58, p=.448 χ²=3.21, p=.073 χ²=0.01, p=.906 White 78.96% Non-white 21.04% Comorbidities PTSD 7.52% Depression 53.76% Anxiety 60.75% Length of Stay (LOS) Mean 4.56 days Median 3 days Standard Deviation 4.69 days Comorbidity Groups Kruskal-Wallis: χ²=20.82, p=.0009* No comorbidities 28.17% Median LOS: 3 days PTSD only 0.46% Median LOS: 2 days Depression only 5.54% Median LOS: 3 days Anxiety only 11.08% Median LOS: 3 days PTSD + Depression 0.46% Median LOS: 3 days PTSD + Anxiety 1.19% Median LOS: 3 days Depression + Anxiety 40.24% Median LOS: 3 days All three comorbidities 5.41% Median LOS: 3 days The sample had a mean age of 52.51 years, was predominantly female (89.38%) and white (78.96%). In terms of psychiatric comorbidities, anxiety (60.75%) and depression (53.76%) were highly prevalent, while PTSD was less common (7.52%). The most common comorbidity group was depression and anxiety (40.24%), followed by no comorbidities (28.17%). Only 5.41% have all three comorbidities. Significant age-related differences were found for PTSD (p<.0001) and anxiety (p=.020), with older patients generally showing lower rates. Sex differences were significant only for anxiety (p=.028), with females showing higher rates. No significant racial differences were found. The mean length of stay (LOS) was 4.56 days (median 3 days, SD 4.69 days) with significant differences among comorbidity groups (p=.0009), although pairwise comparisons revealed no specific group differences. Table 2. Top 30 Diagnosis Codes Associated with Fibromyalgia Patients. This table presents the most common comorbidities and associated conditions in the 1,516 fibromyalgia, highlighting the complex nature of fibromyalgia, with high rates of psychiatric disorders, pain syndromes, and various chronic health conditions co-occurring with the primary fibromyalgia diagnosis. The five most common comorbidities were major depression, generalized anxiety disorder, chronic pain syndrome, unspecified insomnia, and unspecified obesity. Rank ICD-10 Code Diagnosis Prevalence 1 M79.7 Fibromyalgia 100.00% 2 F33.2 Major depressive disorder, recurrent severe without psychotic features 28.96% 3 F41.1 Generalized anxiety disorder 28.56% 4 G89.4 Chronic pain syndrome 24.47% 5 G47.00 Insomnia, unspecified 21.97% 6 E66.9 Obesity, unspecified 21.77% 7 I10 Essential (primary) hypertension 21.24% 8 E78.5 Hyperlipidemia, unspecified 19.46% 9 F41.9 Anxiety disorder, unspecified 18.47% 10 M54.5 Low back pain 17.68% 11 E11.9 Type 2 diabetes mellitus without complications 15.96% 12 F32.9 Major depressive disorder, single episode, unspecified 15.70% 13 G43.909 Migraine, unspecified, not intractable, without status migrainosus 14.38% 14 K21.9 Gastro-esophageal reflux disease without esophagitis 13.85% 15 M25.50 Pain in unspecified joint 13.59% 16 F33.1 Major depressive disorder, recurrent, moderate 12.93% 17 M54.2 Cervicalgia 12.86% 18 M54.16 Radiculopathy, lumbar region 11.94% 19 M25.511 Pain in right shoulder 11.74% 20 F33.9 Major depressive disorder, recurrent, unspecified 11.48% 21 M25.512 Pain in left shoulder 11.41% 22 N95.1 Menopausal and female climacteric states 10.82% 23 M54.6 Pain in thoracic spine 10.62% 24 M54.17 Radiculopathy, lumbosacral region 10.49% 25 M25.551 Pain in right hip 10.42% 26 M25.552 Pain in left hip 10.29% 27 M25.561 Pain in right knee 10.22% 28 M25.562 Pain in left knee 10.16% 29 M79.606 Pain in leg, unspecified 9.96% 30 G47.33 Obstructive sleep apnea (adult) (pediatric) 9.83% Chi-square tests revealed significant differences across age groups for PTSD (χ²=26.35, p<.0001) and anxiety (χ²=11.65, p=.020), but not for depression (χ²=5.26, p=.262). Specifically, patients over 65 had the lowest PTSD rate at 2.42%, which was significantly lower than those aged 18-29 (9.78%, p=.041), 40-52 (11.2%, p<.0001), and 53-64 (7.93%, p=.020). For anxiety, patients over 65 had a rate of 55.45%, significantly lower than the 40-52 age group, which had a rate of 65.82% (p=.032). No significant differences were found when examining outcomes by race; white and non-white patients showed no differences in PTSD (χ²=0.58, p=.448), depression (χ²=3.21, p=.073), or anxiety (χ²=0.01, p=.906). In terms of sex, no significant differences were noted for PTSD (χ²=3.01, p=.083) or depression (χ²=0.09, p=.763); however, anxiety showed a significant difference (χ²=4.85, p=.028), with female patients experiencing higher rates of anxiety at 62% compared to 48% in male patients. The Kruskal-Wallis test (chosen due to the non-parametric nature of the data, allowing for comparison of multiple independent groups, ordinal variables, when the dependent variable is continuous) indicated significant differences in hospital length of stay among various comorbidity groups (χ²=20.82, df = 7, p=.0009). Additionally, the application of the Bonferroni correction ensured that the observed differences remained statistically significant after adjusting for multiple comparisons. Despite this overall significance, pairwise comparisons did not reveal specific differences between groups. The median length of stay was consistent across most groups at 3 days, except for the PTSD-only group, which had a median of 2 days. Discussion The study found high rates of psychiatric comorbidities among fibromyalgia patients, with anxiety (60.75%) and depression (53.76%) being particularly prevalent. This aligns with previous research highlighting the significant overlap between fibromyalgia and mood disorders. 4,5 The lower prevalence of PTSD (7.52%) is notable, though still higher than general population estimates, supporting the association between trauma-related disorders and fibromyalgia. 6 Significant age-related differences were observed for PTSD and anxiety, but not for depression. Older patients (65+) generally showed lower rates of PTSD and anxiety compared to younger age groups. This finding may reflect differences in life experiences, coping mechanisms, or reporting tendencies across age groups. It also suggests that targeted interventions and psychotherapeutic trauma processing modalities such as Eye Movement Desensitization and Reprocessing (EMDR) for younger fibromyalgia patients might be particularly beneficial in addressing PTSD and anxiety symptoms. 7 Additionally, the study population was predominantly female (89.38%), consistent with known fibromyalgia demographics. While no significant gender differences were found for PTSD or depression, females showed significantly higher rates of anxiety (62% vs. 48% in males). This gender disparity in anxiety prevalence warrants further investigation and may inform gender-specific treatment approaches. Nonetheless, there was a lack of significant differences in psychiatric comorbidities between white and non-white patients, but the predominance of white patients (78.96%) in the sample calls for further research with more diverse populations to confirm these findings. The most common comorbidity pattern was the co-occurrence of depression and anxiety (40.24%), highlighting the interconnected nature of these conditions in fibromyalgia patients. The finding that only 5.41% of patients had all three comorbidities (PTSD, depression, and anxiety) suggests that while psychiatric comorbidities are common, the simultaneous presence of all three is relatively rare. Moreover, comorbidities have a significant overall effect on hospital length of stay for fibromyalgia patients, but the specific nature of these differences is not clearly defined between individual comorbidity groups. The top 30 diagnosis codes associated with fibromyalgia patients reveal a complex clinical picture, encompassing not only psychiatric disorders but also chronic pain conditions, sleep disorders, and metabolic issues. These findings underscore the complex nature of fibromyalgia and its impact on healthcare utilization and that these differences are subtle and not clearly defined and calls for a multispecialty approach to fibromyalgia management. Limitations and Future Directions: The study's retrospective nature and focus on a single healthcare system may limit its generalizability. Additionally, investigating the temporal relationship between fibromyalgia onset and the development of psychiatric comorbidities with longitudinal studies could provide valuable insights into disease progression and management strategies. In conclusion, this study highlights the significant burden of psychiatric comorbidities, particularly anxiety and depression, and associated conditions in fibromyalgia patients and identifies important demographic factors influencing their prevalence. These findings can inform clinical practice by emphasizing the need for comprehensive, age-appropriate, and gender-sensitive approaches to holistic fibromyalgia management that address both physical symptoms and mental health concerns. Abbreviations PTSD – Post Traumatic Stress Disorder LOS – Length of Stay SD - Standard Deviation CI - Confidence Interval p - p-value (probability value) Z - Z-score (standard score) HCA - Hospital Corporation of America F - ICD-10 codes for mental and behavioral disorders Phi - Phi Coefficient (measure of association) Cramer’s V - Measure of association strength N - Sample size Declarations Ethics approval and consent to participate The views expressed in this publication represent those of the authors and do not necessarily represent the official views of Hospital Corporation of America (HCA) Healthcare or any of its affiliated entities. Research was conducted with respect to principles of the Belmont Report and Declaration of Helsinki. This research was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. This study protocol was reviewed and approved HCA Healthcare PUBCLEAR, Project #24-1742, determined as non-human subject research with ethics approval waived not requiring IRB oversight by Centralized Algorithms for Research Rules on IRB Exemption Submission ID #: 2024−519. We extracted anonymized data from HCA Healthcare electronic health records for all initial encounters meeting the inclusion criteria. All patients had accepted the possibility of their results being deidentified prior to this record being created. Acknowledgements: We would like to acknowledge the contributions of the UCF/HCA research team, including Melissa Moreno and Katy Robinson, for guidance and assistance in project planning. Author contributions: AR – Conceptualization, Methodology, Software, Validations, Formal Analysis, Investigation, Data Curation, Writing Original Draft, Review and Editing; JF – Review and Editing, Supervision. Funding: HCA Healthcare and/or affiliated entities did not financially support this research work. There are no funders to report for this submission. Data availability: The datasets used and/or analyzed during the current study are from the HCA Healthcare national database and available from the corresponding author on reasonable request. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. References Amir, M., Kaplan, Z., Neumann, L., Sharabani, R., Shani, N., & Buskila, D. (1997). Posttraumatic stress disorder, tenderness and fibromyalgia. Journal of psychosomatic research, 42(6), 607–613. https://doi.org/10.1016/s0022-3999(97)000093 Kleykamp, B. A., Ferguson, M. C., McNicol, E., Bixho, I., Arnold, L. M., Edwards, R. R., Fillingim, R., Grol-Prokopczyk, H., Turk, D. C., & Dworkin, R. H. (2021). The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: An ACTTION systematic review. Seminars in Arthritis and Rheumatism, 51(1), 166-174. https://doi.org/10.1016/j.semarthrit.2020.10.006 Buskila, D., & Cohen, H. (2007). Comorbidity of fibromyalgia and psychiatric disorders. Current pain and headache reports, 11(5), 333–338. https://doi.org/10.1007/s11916-007-02144 Kudlow, P. A., Rosenblat, J. D., Weissman, C. R., Cha, D. S., Kakar, R., McIntyre, R. S., & Sharma, V. (2015). Prevalence of fibromyalgia and co-morbid bipolar disorder: A systematic review and meta-analysis. Journal of affective disorders , 188 , 134–142. https://doi.org/10.1016/j.jad.2015.08.030 Maugars, Y., Berthelot, J.-M., Le Goff, B., & Darrieutort-Laffite, C. (2021). Fibromyalgia and associated disorders: From pain to chronic suffering, from subjective hypersensitivity to hypersensitivity syndrome. Frontiers in Medicine, 8, 666914. https://doi.org/10.3389/fmed.2021.666914 Raphael, K. G., Janal, M. N., & Nayak, S. (2004). Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women. Pain Medicine, 5(1), 33–41. https://doi.org/10.1111/j.1526-4637.2004.04003.x Gainer, D., Alam, S., Alam, H., & Redding, H. (2020). A FLASH OF HOPE: Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Innovations in clinical neuroscience, 17(7-9), 12–20. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 May, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 04 Nov, 2024 Editor assigned by journal 04 Nov, 2024 Submission checks completed at journal 04 Nov, 2024 First submitted to journal 01 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5374501","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":373964662,"identity":"f0304c3b-4c45-4e64-b8b0-b53cfd43f24e","order_by":0,"name":"Aneesh Rahangdale","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYHCCxIcfeP7x8ANZHxgYmInS8thYQuaAjGQDA+MMIrUwPhPgsTlgY3CAWC38s5vTGCRy7vAY30h+2MBQYZ3YQEiLxJ1jaQ8KzjzjMbuRZtjAcCadsBaGGznpBpI9zEAtOewPGNsOE9YifyP/mwTvP2Ye4xk5jA2M/4jQYnAjIU2Ch+cwj4EESEsDEVoMbyQkG0vwpPFInHlm2JBwLN2YoBa5GwmgqLSx528HhtiHGmtZglpQQQJpykfBKBgFo2AU4AIAv3ZBvldkkNsAAAAASUVORK5CYII=","orcid":"","institution":"HCA Florida Capital Hospital","correspondingAuthor":true,"prefix":"","firstName":"Aneesh","middleName":"","lastName":"Rahangdale","suffix":""},{"id":373964663,"identity":"bf5ed890-13d3-4c34-80ca-8bec8fb878e6","order_by":1,"name":"Jeffrey Ferraro","email":"","orcid":"","institution":"HCA Florida Capital Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jeffrey","middleName":"","lastName":"Ferraro","suffix":""}],"badges":[],"createdAt":"2024-11-01 16:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5374501/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5374501/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-06708-4","type":"published","date":"2025-05-01T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81988279,"identity":"e4da6fed-a369-4e5c-bc6e-69bca49db88d","added_by":"auto","created_at":"2025-05-05 16:08:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":750755,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5374501/v1/5e3d4c4e-d9da-4469-b1aa-ac0fe8aff2f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing Comorbid PTSD, Depression, and Anxiety in Fibromyalgia Patients: A Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eFibromyalgia often coexists with psychiatric disorders, forming a complex web of symptoms and challenges for those affected. The relationship between fibromyalgia and psychiatric conditions has been a subject of research and clinical interest, shedding light on the interplay between physical and mental health.\u003c/p\u003e \u003cp\u003eAmir et al. (1997) explored the connection between fibromyalgia and posttraumatic stress disorder (PTSD), as well as tenderness.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Their study revealed a significant association between PTSD and fibromyalgia, suggesting that trauma and stress can contribute to the development or exacerbation of fibromyalgia symptoms. Moreover, the presence of tenderness, a hallmark of fibromyalgia, was also linked to PTSD, indicating a potential overlap in physiological responses and sensitivities. The systematic review by Kleykamp et al. (2021) delved into the prevalence of psychiatric comorbidities in fibromyalgia, drawing from a comprehensive analysis. They found a high prevalence of psychiatric disorders such as anxiety, depression, and PTSD among individuals with fibromyalgia.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e This underscores the importance of addressing not only the physical symptoms but also the psychological well-being of patients with fibromyalgia to provide comprehensive care. Buskila and Cohen (2007) highlighted the comorbidity of fibromyalgia with various psychiatric disorders beyond PTSD. Their review encompassed conditions like major depressive disorder, generalized anxiety disorder, and somatoform disorders.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe overlap between fibromyalgia and these psychiatric conditions suggests shared pathophysiological mechanisms or a bidirectional relationship where one condition can influence the other, leading to a more complex clinical presentation. A large-scale retrospective study from a single hospital system has not been conducted to our knowledge at the time of this writing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study examined fibromyalgia patients across HCA Healthcare facilities from January 1, 2022 to December 31, 2023. Inclusion criteria were patients aged 18 years and older with fibromyalgia listed among their top three diagnoses and at least one psychiatric-related condition. This yielded 1647 patients, but 131 were removed for only keeping the first encounter of each patient. As such, the total sample size was 1,516 patients.\u003c/p\u003e \u003cp\u003eData analysis began with a descriptive overview of all variables, including demographics, comorbidities, and the top 30 diagnosis codes associated with fibromyalgia. Chi-square tests were then employed to examine associations between categorical variables, specifically analyzing outcomes (PTSD/Depression/Anxiety) by age group, race (White vs. Non-white), and sex (Male vs. Female). For significant chi-square results, pairwise comparisons were conducted to identify specific group differences, with Bonferroni corrections applied to adjust p-values for multiple comparisons.\u003c/p\u003e \u003cp\u003eTo analyze differences in hospital length of stay (LOS) among comorbidity groups, the Kruskal-Wallis test was used due to the non-parametric nature of the data. Following significant Kruskal-Wallis test results, post-hoc pairwise comparisons were performed, again applying Bonferroni corrections to adjust p-values.\u003c/p\u003e \u003cp\u003eThroughout the analysis, a p-value of less than 0.05 was considered statistically significant. This comprehensive approach allowed for a thorough examination of the relationships between fibromyalgia, psychiatric comorbidities, demographic factors, and hospital length of stay, while accounting for potential confounding factors and multiple comparisons.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Demographic Characteristics, Comorbidities, and Statistical Comparisons in Fibromyalgia Patients.\u003c/strong\u003e The data highlights the predominance of female and white patients, high prevalence of anxiety and depression, and the complex nature of comorbidity patterns in this population. Pairwise comparisons with Bonferroni correction were conducted for significant chi-square results. No significant pairwise differences were found for LOS among comorbidity groups despite overall significance.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eValue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=26.35, p\u0026lt;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=5.26, p=.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=11.65, p=.020*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e52.51 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e18-29 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.78%, p=.041*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e30-39 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e15.04%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e40-52 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e25.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.2%, p\u0026lt;.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e65.82%, p=.032*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e53-64 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e30.54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7.93%, p=.020*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e65+ years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e19.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.42% (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e55.45% (Reference)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=3.01, p=.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.09, p=.763\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=4.85, p=.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e89.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e48%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.58, p=.448\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=3.21, p=.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.01, p=.906\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e78.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-white\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.04%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7.52%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e53.76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e60.75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of Stay (LOS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.56 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4.69 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eKruskal-Wallis: \u0026chi;\u0026sup2;=20.82, p=.0009*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28.17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.54%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety only\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.08%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD + Depression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD + Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1.19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression + Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll three comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS: 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe sample had a mean age of 52.51 years, was predominantly female (89.38%) and white (78.96%). In terms of psychiatric comorbidities, anxiety (60.75%) and depression (53.76%) were highly prevalent, while PTSD was less common (7.52%). The most common comorbidity group was depression and anxiety (40.24%), followed by no comorbidities (28.17%). Only 5.41% have all three comorbidities. Significant age-related differences were found for PTSD (p\u0026lt;.0001) and anxiety (p=.020), with older patients generally showing lower rates. Sex differences were significant only for anxiety (p=.028), with females showing higher rates. No significant racial differences were found. The mean length of stay (LOS) was 4.56 days (median 3 days, SD 4.69 days) with significant differences among comorbidity groups (p=.0009), although pairwise comparisons revealed no specific group differences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Top 30 Diagnosis Codes Associated with Fibromyalgia Patients.\u003c/strong\u003e This table presents the most common comorbidities and associated conditions in the 1,516 fibromyalgia, highlighting the complex nature of fibromyalgia, with high rates of psychiatric disorders, pain syndromes, and various chronic health conditions co-occurring with the primary fibromyalgia diagnosis. The five most common comorbidities were major depression, generalized anxiety disorder, chronic pain syndrome, unspecified insomnia, and unspecified obesity.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eRank\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eICD-10 Code\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM79.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFibromyalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMajor depressive disorder, recurrent severe without psychotic features\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eGeneralized anxiety disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28.56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eG89.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eChronic pain syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24.47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eG47.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eInsomnia, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.97%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eE66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eObesity, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.77%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eI10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eEssential (primary) hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21.24%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eE78.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHyperlipidemia, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e19.46%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAnxiety disorder, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18.47%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM54.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eLow back pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e17.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eE11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eType 2 diabetes mellitus without complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e15.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF32.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMajor depressive disorder, single episode, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e15.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eG43.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMigraine, unspecified, not intractable, without status migrainosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14.38%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eK21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eGastro-esophageal reflux disease without esophagitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in unspecified joint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13.59%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMajor depressive disorder, recurrent, moderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12.93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eCervicalgia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12.86%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM54.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eRadiculopathy, lumbar region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.94%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in right shoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.74%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eF33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMajor depressive disorder, recurrent, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in left shoulder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.41%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eN95.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMenopausal and female climacteric states\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.82%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in thoracic spine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.62%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM54.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eRadiculopathy, lumbosacral region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.551\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in right hip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.42%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in left hip\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.29%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in right knee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.22%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM25.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in left knee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10.16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eM79.606\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePain in leg, unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eG47.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eObstructive sleep apnea (adult) (pediatric)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.83%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eChi-square tests revealed significant differences across age groups for PTSD (\u0026chi;\u0026sup2;=26.35, p\u0026lt;.0001) and anxiety (\u0026chi;\u0026sup2;=11.65, p=.020), but not for depression (\u0026chi;\u0026sup2;=5.26, p=.262). Specifically, patients over 65 had the lowest PTSD rate at 2.42%, which was significantly lower than those aged 18-29 (9.78%, p=.041), 40-52 (11.2%, p\u0026lt;.0001), and 53-64 (7.93%, p=.020). For anxiety, patients over 65 had a rate of 55.45%, significantly lower than the 40-52 age group, which had a rate of 65.82% (p=.032). No significant differences were found when examining outcomes by race; white and non-white patients showed no differences in PTSD (\u0026chi;\u0026sup2;=0.58, p=.448), depression (\u0026chi;\u0026sup2;=3.21, p=.073), or anxiety (\u0026chi;\u0026sup2;=0.01, p=.906). In terms of sex, no significant differences were noted for PTSD (\u0026chi;\u0026sup2;=3.01, p=.083) or depression (\u0026chi;\u0026sup2;=0.09, p=.763); however, anxiety showed a significant difference (\u0026chi;\u0026sup2;=4.85, p=.028), with female patients experiencing higher rates of anxiety at 62% compared to 48% in male patients.\u003c/p\u003e\n\u003cp\u003eThe Kruskal-Wallis test (chosen due to the non-parametric nature of the data, allowing for comparison of multiple independent groups, ordinal variables, when the dependent variable is continuous) indicated significant differences in hospital length of stay among various comorbidity groups (\u0026chi;\u0026sup2;=20.82, df = 7, p=.0009). Additionally, the application of the Bonferroni correction ensured that the observed differences remained statistically significant after adjusting for multiple comparisons. Despite this overall significance, pairwise comparisons did not reveal specific differences between groups. The median length of stay was consistent across most groups at 3 days, except for the PTSD-only group, which had a median of 2 days.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study found high rates of psychiatric comorbidities among fibromyalgia patients, with anxiety (60.75%) and depression (53.76%) being particularly prevalent. This aligns with previous research highlighting the significant overlap between fibromyalgia and mood disorders.\u003csup\u003e4,5\u003c/sup\u003e The lower prevalence of PTSD (7.52%) is notable, though still higher than general population estimates, supporting the association between trauma-related disorders and fibromyalgia.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eSignificant age-related differences were observed for PTSD and anxiety, but not for depression. Older patients (65+) generally showed lower rates of PTSD and anxiety compared to younger age groups. This finding may reflect differences in life experiences, coping mechanisms, or reporting tendencies across age groups. It also suggests that targeted interventions and psychotherapeutic trauma processing modalities such as Eye Movement Desensitization and Reprocessing (EMDR) for younger fibromyalgia patients might be particularly beneficial in addressing PTSD and anxiety symptoms.\u003csup\u003e7\u003c/sup\u003e Additionally, the study population was predominantly female (89.38%), consistent with known fibromyalgia demographics. While no significant gender differences were found for PTSD or depression, females showed significantly higher rates of anxiety (62% vs. 48% in males). This gender disparity in anxiety prevalence warrants further investigation and may inform gender-specific treatment approaches. Nonetheless, there was a lack of significant differences in psychiatric comorbidities between white and non-white patients, but the predominance of white patients (78.96%) in the sample calls for further research with more diverse populations to confirm these findings.\u003c/p\u003e\n\u003cp\u003eThe most common comorbidity pattern was the co-occurrence of depression and anxiety (40.24%), highlighting the interconnected nature of these conditions in fibromyalgia patients. The finding that only 5.41% of patients had all three comorbidities (PTSD, depression, and anxiety) suggests that while psychiatric comorbidities are common, the simultaneous presence of all three is relatively rare. Moreover, comorbidities have a significant overall effect on hospital length of stay for fibromyalgia patients, but the specific nature of these differences is not clearly defined between individual comorbidity groups. The top 30 diagnosis codes associated with fibromyalgia patients reveal a complex clinical picture, encompassing not only psychiatric disorders but also chronic pain conditions, sleep disorders, and metabolic issues. These findings underscore the complex nature of fibromyalgia and its impact on healthcare utilization and that these differences are subtle and not clearly defined and calls for a multispecialty approach to fibromyalgia management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Future Directions:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The study's retrospective nature and focus on a single healthcare system may limit its generalizability. Additionally, investigating the temporal relationship between fibromyalgia onset and the development of psychiatric comorbidities with longitudinal studies could provide valuable insights into disease progression and management strategies.\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study highlights the significant burden of psychiatric comorbidities, particularly anxiety and depression, and associated conditions in fibromyalgia patients and identifies important demographic factors influencing their prevalence. These findings can inform clinical practice by emphasizing the need for comprehensive, age-appropriate, and gender-sensitive approaches to holistic fibromyalgia management that address both physical symptoms and mental health concerns.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePTSD \u0026ndash; Post Traumatic Stress Disorder\u003c/p\u003e\n\u003cp\u003eLOS \u0026ndash; Length of Stay\u003c/p\u003e\n\u003cp\u003eSD - Standard Deviation\u003c/p\u003e\n\u003cp\u003eCI - Confidence Interval\u003c/p\u003e\n\u003cp\u003ep - p-value (probability value)\u003c/p\u003e\n\u003cp\u003eZ - Z-score (standard score)\u003c/p\u003e\n\u003cp\u003eHCA - Hospital Corporation of America\u003c/p\u003e\n\u003cp\u003eF - ICD-10 codes for mental and behavioral disorders\u003c/p\u003e\n\u003cp\u003ePhi - Phi Coefficient (measure of association)\u003c/p\u003e\n\u003cp\u003eCramer\u0026rsquo;s V - Measure of association strength\u003c/p\u003e\n\u003cp\u003eN - Sample size\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate The views expressed in this publication represent those of the authors and do not necessarily represent the official views of Hospital Corporation of America (HCA) Healthcare or any of its affiliated entities. Research was conducted with respect to principles of the Belmont Report and Declaration of Helsinki. This research was supported in whole or in part by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the authors and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities. This study protocol was reviewed and approved HCA Healthcare PUBCLEAR, Project #24-1742, determined as non-human subject research with ethics approval waived not requiring IRB oversight by Centralized Algorithms for Research Rules on IRB Exemption Submission ID #: 2024\u0026minus;519. We extracted anonymized data from HCA Healthcare electronic health records for all initial encounters meeting the inclusion criteria. All patients had accepted the possibility of their results being deidentified prior to this record being created.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the contributions of the UCF/HCA research team, including Melissa Moreno and Katy Robinson, for guidance and assistance in project planning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAR \u0026ndash; Conceptualization, Methodology, Software, Validations, Formal Analysis, Investigation, Data Curation, Writing Original Draft, Review and Editing; JF \u0026ndash; Review and Editing, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHCA Healthcare and/or affiliated entities did not financially support this research work. There are no funders to report for this submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are from the HCA Healthcare national database and available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmir, M., Kaplan, Z., Neumann, L., Sharabani, R., Shani, N., \u0026amp; Buskila, D. (1997). Posttraumatic stress disorder, tenderness and fibromyalgia. Journal of psychosomatic research, 42(6), 607\u0026ndash;613. https://doi.org/10.1016/s0022-3999(97)000093\u003c/li\u003e\n\u003cli\u003eKleykamp, B. A., Ferguson, M. C., McNicol, E., Bixho, I., Arnold, L. M., Edwards, R. R., Fillingim, R., Grol-Prokopczyk, H., Turk, D. C., \u0026amp; Dworkin, R. H. (2021). The prevalence of psychiatric and chronic pain comorbidities in fibromyalgia: An ACTTION systematic review. Seminars in Arthritis and Rheumatism, 51(1), 166-174. https://doi.org/10.1016/j.semarthrit.2020.10.006\u003c/li\u003e\n\u003cli\u003eBuskila, D., \u0026amp; Cohen, H. (2007). Comorbidity of fibromyalgia and psychiatric disorders. Current pain and headache reports, 11(5), 333\u0026ndash;338. https://doi.org/10.1007/s11916-007-02144\u003c/li\u003e\n\u003cli\u003eKudlow, P. A., Rosenblat, J. D., Weissman, C. R., Cha, D. S., Kakar, R., McIntyre, R. S., \u0026amp; Sharma, V. (2015). Prevalence of fibromyalgia and co-morbid bipolar disorder: A systematic review and meta-analysis. \u003cem\u003eJournal of affective disorders\u003c/em\u003e, \u003cem\u003e188\u003c/em\u003e, 134\u0026ndash;142. https://doi.org/10.1016/j.jad.2015.08.030\u003c/li\u003e\n\u003cli\u003eMaugars, Y., Berthelot, J.-M., Le Goff, B., \u0026amp; Darrieutort-Laffite, C. (2021). Fibromyalgia and associated disorders: From pain to chronic suffering, from subjective hypersensitivity to hypersensitivity syndrome. Frontiers in Medicine, 8, 666914. https://doi.org/10.3389/fmed.2021.666914\u003c/li\u003e\n\u003cli\u003eRaphael, K. G., Janal, M. N., \u0026amp; Nayak, S. (2004). Comorbidity of fibromyalgia and posttraumatic stress disorder symptoms in a community sample of women. Pain Medicine, 5(1), 33\u0026ndash;41. https://doi.org/10.1111/j.1526-4637.2004.04003.x\u003c/li\u003e\n\u003cli\u003eGainer, D., Alam, S., Alam, H., \u0026amp; Redding, H. (2020). A FLASH OF HOPE: Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Innovations in clinical neuroscience, 17(7-9), 12\u0026ndash;20.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fibromyalgia, Psychiatric comorbidities, Posttraumatic stress disorder, Depression, Anxiety, Hospital length of stay","lastPublishedDoi":"10.21203/rs.3.rs-5374501/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5374501/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFibromyalgia frequently coexists with psychiatric disorders, creating complex challenges in managing the health and quality of life for affected individuals. Existing literature points to significant overlap between fibromyalgia and conditions like posttraumatic stress disorder (PTSD), anxiety, and depression, but no large-scale analysis within a single American healthcare system has yet been conducted.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed 1,516 fibromyalgia patients from HCA Healthcare facilities from January 1, 2022, to December 31, 2023, including only patients aged 18 and older with at least one psychiatric comorbidity. Chi-square tests examined associations between psychiatric outcomes (PTSD, depression, anxiety) and demographic factors such as age, sex, and race. Hospital length of stay (LOS) was analyzed among comorbidity groups using the Kruskal-Wallis test, with Bonferroni correction applied for pairwise comparisons.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe sample had a mean age of 52.51 years, was predominantly female (89.38%) and white (78.96%). Anxiety (60.75%) and depression (53.76%) were highly prevalent, while PTSD was less common (7.52%). Significant age differences emerged for PTSD and anxiety, with younger patients exhibiting higher rates. Sex differences were significant for anxiety only (p\u0026thinsp;=\u0026thinsp;.028), showing higher rates among females. Mean LOS was 4.56 days, with significant differences across comorbidity groups (p\u0026thinsp;=\u0026thinsp;.0009), although pairwise comparisons revealed no specific group differences.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePsychiatric comorbidities, especially anxiety and depression, are common in fibromyalgia patients and correlate with certain demographic factors. These findings can inform clinical practice by emphasizing the need for comprehensive, age-appropriate, and gender-sensitive approaches to holistic fibromyalgia management that address both physical symptoms and mental health concerns.\u003c/p\u003e","manuscriptTitle":"Assessing Comorbid PTSD, Depression, and Anxiety in Fibromyalgia Patients: A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 05:31:00","doi":"10.21203/rs.3.rs-5374501/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-04T15:53:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-04T11:49:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-04T11:44:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2024-11-01T16:01:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d1a10a3-f74f-43db-8a70-2ece976c096b","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T16:07:47+00:00","versionOfRecord":{"articleIdentity":"rs-5374501","link":"https://doi.org/10.1186/s12888-025-06708-4","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-05-01 15:57:42","publishedOnDateReadable":"May 1st, 2025"},"versionCreatedAt":"2024-11-15 05:31:00","video":"","vorDoi":"10.1186/s12888-025-06708-4","vorDoiUrl":"https://doi.org/10.1186/s12888-025-06708-4","workflowStages":[]},"version":"v1","identity":"rs-5374501","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5374501","identity":"rs-5374501","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}