Work stress and incidence of newly diagnosed fibromyalgia: Prospective cohort study
Introduction
Fibromyalgia is a functional somatic syndrome, which cannot be explained in terms of a conventionally defined medical disease. It is characterized by widespread muscle pain, tenderness, fatigue, and sleep disturbances [1], [2], [3]. Although the aetiology of fibromyalgia is not well understood, stress has been hypothesized to be one of the provoking factors for this syndrome [4], [5], [6].
Prior studies have reported cross-sectional associations among life stress, emotional trauma, and fibromyalgia [6]. Retrospective and prospective studies suggest that stress and psychosocial factors are predictive of major symptoms of fibromyalgia, such as chronic widespread body pain [7], [8], [9] and chronic fatigue [10], [11], [12]. However, no prospective evidence is available to confirm that stress actually precedes the onset of fibromyalgia.
The present paper reports a prospective study to examine the association between stress and incidence of newly diagnosed fibromyalgia in a working population. High workload and low decision latitude at work are common sources of chronic stress and health problems among employees [13], [14], [15]. In addition to these two work stressors, we studied workplace bullying, a situation in which someone is subjected to social isolation or exclusion, his or her work and efforts are devaluated and he or she is threatened or otherwise worn down or frustrated. Exposure to workplace bullying has been shown to be a strong predictor of subsequent stress-related health problems, such as increased sickness absenteeism and clinical depression [16], [17]. To test the specificity of the association between work stress and fibromyalgia, we also examined the contribution of work stressors to other musculoskeletal disorders.
Section snippets
Study population
A postal questionnaire on stress at work and musculoskeletal disorders including fibromyalgia was sent to all 10,968 employees (1713 men and 9255 women) aged 18–63 years working in 12 Finnish hospitals in 1998; 8107 employees (74%) responded to the survey. The mean age of the respondents was 43.3 years, 88% were women, 77% had a permanent job contract, and the mean income was 1858 euros per month. The corresponding figures for the eligible population were 42.9 years, 84%, 75%, and 1895 euros
Results
Of the remaining 4791 respondents who did not report diagnosed fibromyalgia at baseline, 47 reported newly diagnosed fibromyalgia during the follow-up. Thus, the 2-year incidence for diagnosed fibromyalgia was 0.98%.
Table 1 shows the associations of demographic characteristics, obesity, and smoking with incident fibromyalgia. Obese employees, older employees, and smokers were more likely than others to have had a new fibromyalgia during the follow-up. Increased but statistically nonsignificant
Discussion
This study provides prospective evidence that stress at work is predictive of newly diagnosed fibromyalgia. High workload, low decision latitude, and experience of being bullied at work were associated with a two- to fourfold risk of new fibromyalgia. These stress exposures did not, however, predict osteoarthritis or sciatica. Previous studies have shown cross-sectional and retrospective associations between life stress and fibromyalgia [6] and prospective associations between psychosocial
Acknowledgements
This study was supported, in part, by the Academy of Finland (projects #105195 and #77560) and the Finnish Work Environment Fund. We thank Dr Tony Cleare for his comments on an earlier version of the paper.
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