Background The use of health care services in patients with fibromyalgia is substantial. Besides the severity of the disease and psychological factors, the social environment will influence patients’ health care use. We hypothesized that solicitous responses of a partner, that reinforce pain and worse physical functioning, may be associated with more health care use. Moreover, punishing responses from the partner and invalidating responses (discounting and lack of understanding) from the close social environment are expected to be associated with more health care use, because such rejecting responses have been shown to aggravate pain and other symptoms.
Objectives To investigate whether perceived social responses of the partner and family are associated with health care use in patients with fibromyalgia.
Methods Cross sectional data of 167 recently diagnosed patients with fibromyalgia (95% female; mean age 43.1, SD= 11.8; 76% having a partner) from the rheumatology department of the Sint Maartenskliniek were used. Demographic variables, health care use, impact of fibromyalgia (FIQ), partner’s solicitous and punishing responses (MPI-Significant Other Response Scale), and invalidation (i.e., discounting and lack of understanding) by family (3*I) were assessed. Heath care uses was defined as number of visits to medical specialists and health professionals and number of different disciplines consulted (medical specialists and health professionals combined). Associations between psychosocial factors and health care use were examined using univariate and multivariate regression analyses.
Results In the past 6 months, 98% of the patients visited at least one medical specialist and 72% of the patients visited at least one health professional. Median number (interquartile range) of total health care visits was 14 (6-28) and median number of different disciplines consulted was 4 (2-5). Univariate analysis showed significant associations of visits to a medical specialist with being a woman, a higher impact of fibromyalgia, more solicitous responses from the partner, and higher discounting and lack of understanding by the family. In multivariate regression analyses, besides being a woman (β=.13) and impact of fibromyalgia (β=.13), solicitous responses from the partner (β=.16), discounting responses by the family (β=.23), and lack of understanding by the family (β=.20) were independently associated with visits to a medical specialist (p<0.05). Univariate analyses showed that more visits to a health professional were associated with less punishing responses from the partner (β=.14, p=0.03) and the number of different disciplines consulted was associated with more discounting by the family (β=.25, p<0.01); no other significant correlations were found.
Conclusions This study demonstrates that having a solicitous partner and perceiving more invalidating responses from family members are associated with more health care visits. This may suggest that therapeutic attention to patients’ close social environment might decrease health care use, for instance by involving the partner in therapy and by empowering patients to deal with invalidation by their close social environment.
Disclosure of Interest None Declared
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