The association between illness representations, body image and death anxiety in women with Fibromyalgia: The mediating role of coping strategies and the moderating role of perceived social support

Objective: Studies show association between the failure of vital physical functions, as experienced among women with fibromyalgia (FM), and the experience of aging and death, so that those dealing with diseases with these symptoms may develop death anxiety. Recognizing the presence of death anxiety among women with FM may expand the variety of interventions and their effectiveness in treatment for FM. The aim of this study is to examine the existing knowledge and to test an integrative model of  illness representations, body image, coping strategies, and perceived social support and death anxiety in women diagnosed with FM. The study was based on the Common Sense Model as a theoretical framework.

Methods: A total of 310 patients with FM completed online questionnaires concerning illness representations, body image, coping strategies, perceived social support and death anxiety. Data regarding socio-demographic characteristics and FM symptoms and treatment was also collected. The following questionnaires were used: Dependent Death anxiety was measured with the Death Anxiety Questionnaire (Carmel, 2001; Carmel & Mutran, 1997); illness perceptions were measured with the Brief Illness Perception Questionnaire )Broadbent et al., 2006(; coping strategies were measured with the CERQ- The Cognitive Emotion Regulation Questionnaire )Garnefski et al., 2001), body image was measured with the Body-Esteem Scale- Mendelson (Mendelson et al., 2001), perceived social support was measured with the Perceived Social Support Questionnaire (The Multidimensional Scale of Perceived Social Support - MSPSS; Zimet et al., 1988).

Results: Statistically significant correlations were in the expected direction. Negative illness perceptions, body image and coping strategies were associated with higher death anxiety. In hierarchical regression analysis, illness representations, body image, coping strategies, and perceived social support explained the variance in death anxiety (28%). Additionally, level of education explained variance in death anxiety (3%).

Conclusion: This study shows that illness representations, body image and negative coping strategies play an independent role in self-reported death anxiety in women diagnosed with FM. Clinicians are advised to take these psychosocial factors into account when they provide care to women with FM.