Fibromyalgia and Depression in Egyptian Medical Students: A Cross-sectional Study of Impact on Physical Functional Status

Background: Fibromyalgia (FM) patients experience depression at a higher rate than healthy subjects. FM patients with comorbid depression tend to have worse functional status. Aim: To determine the impact of FM, depression and their comorbidity on the physical functional status. Methods: Egyptian medical students (undergraduates and interns) were screened for FM using FM Rapid Screening Tool (FiRST), and for depression with the Beck Depression Inventory II (BDI-II). Physical functional status was assessed using Health Assessment Questionnaire II (HAQ-II). Results: Among 430 medical students, the frequency of FM was 13.3% (12.3% in undergraduates, 16.2% in interns) and of depression was 38.4% (37.8% in undergraduates, 40.0% in interns). Female sex, the presence of any psychiatric comorbidity and the presence of depression were predictors of FM. Depressed medical students had higher frequency of FM compared to the non-depressed (24.2 vs. 6.4%, p<0.001). Medical students with FM had higher frequency of depression than those without (70.2% vs. 33.5%, p<0.001). Median (interquartile range) HAQ-II scores were higher in medical students with FM compared to those without (0.4(0.6) vs. 0.1(0.3), p<0.001) and in depressed medical students compared the non-depressed (0.3(0.5) vs. 0.1(0.3), p<0.001). HAQ-II scores were higher in medical students with comorbid FM and depression than in those free from both (0.4(0.54) vs 0.09(0.3), p<0.001), those with isolated depression (0.2(0.5), p<0.001) and those with isolated FM (0.18(0.43), p=0.049). Conclusions: FM and depression negatively impact physical function in medical students. The comorbidity of both results in greater functional impairment than either condition in isolation.