European journal of investigation in health, psychology and education · 2026
Sense of Coherence in the Trauma-Fibromyalgia Relationship: Mediation and Moderation Findings from a 2099-Participant Cohort.
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Caumo Wolnei, Bueno Graziele Borges, Freitas Giordano Mayer De, Lopes Guilherme Teixeira, Coelho Mariana Lentino, Gomes Julia, Venturini Caroline Leffa, Louzada Maria Eduarda, Peres Sara Machado, Torres Iraci L S, Janz Moreira Andrea Cristiane, Fregni Felipe
Аннотация
BACKGROUND: The biopsychosocial model positions fibromyalgia (FM) as the result of altered pain modulation shaped by trauma, psychological vulnerability, and structural stressors. The Sense of Coherence (SOC) may be a key resilience factor explaining differences in symptom severity after similar hardships.
OBJECTIVES: To evaluate whether SOC mediates and/or moderates associations between trauma-related adversity and symptom burden in FM and whether comorbidities, medication use, healthcare factors, or treatment engagement modify these relationships.
METHODS: In this cross-sectional study, 2099 women with FM completed an online survey assessing adversity, psychosocial factors, core symptoms, healthcare support, treatment engagement, and medication use. A theory-driven SOC composite followed Antonovsky's model (comprehensibility, manageability, meaningfulness) using the proxy SOC composite derived from a theory-driven framework that underwent internal construct validation, including discriminant validity analyses and latent structure evaluation, but it was not benchmarked against a gold-standard SOC questionnaire. Linear regression evaluated adversity-symptom associations, SOC mediation, and moderation by SOC and medication classes.
RESULTS: Higher adversity predicted lower SOC (e.g., cumulative abuse: B = -0.25), and lower SOC predicted higher symptom burden (e.g., Fibromyalgia Impact Questionnaire (FIQ): B = -6.77), producing significant indirect effects (cognitive symptoms: 0.22; FIQ: 1.69). SOC also moderated the effects of adversity on fatigue and global impact, weakening associations at higher SOC. Comorbidities showed modest influence: hypertension had minor indirect effects (ab = 0.27), scheduled consultation produced small interactions (cognition β = -0.38 to -0.46; fatigue β = ~0.05-0.06), and stroke showed the only clinically meaningful moderation (β ≈ 4.9-5.2), all far smaller than SOC effects.
CONCLUSIONS: SOC functions as a central psychosocial pathway and resilience-related factor in the association between trauma and FM symptoms. Targeting SOC-related processes may help reduce symptom burden and improve outcomes.
OBJECTIVES: To evaluate whether SOC mediates and/or moderates associations between trauma-related adversity and symptom burden in FM and whether comorbidities, medication use, healthcare factors, or treatment engagement modify these relationships.
METHODS: In this cross-sectional study, 2099 women with FM completed an online survey assessing adversity, psychosocial factors, core symptoms, healthcare support, treatment engagement, and medication use. A theory-driven SOC composite followed Antonovsky's model (comprehensibility, manageability, meaningfulness) using the proxy SOC composite derived from a theory-driven framework that underwent internal construct validation, including discriminant validity analyses and latent structure evaluation, but it was not benchmarked against a gold-standard SOC questionnaire. Linear regression evaluated adversity-symptom associations, SOC mediation, and moderation by SOC and medication classes.
RESULTS: Higher adversity predicted lower SOC (e.g., cumulative abuse: B = -0.25), and lower SOC predicted higher symptom burden (e.g., Fibromyalgia Impact Questionnaire (FIQ): B = -6.77), producing significant indirect effects (cognitive symptoms: 0.22; FIQ: 1.69). SOC also moderated the effects of adversity on fatigue and global impact, weakening associations at higher SOC. Comorbidities showed modest influence: hypertension had minor indirect effects (ab = 0.27), scheduled consultation produced small interactions (cognition β = -0.38 to -0.46; fatigue β = ~0.05-0.06), and stroke showed the only clinically meaningful moderation (β ≈ 4.9-5.2), all far smaller than SOC effects.
CONCLUSIONS: SOC functions as a central psychosocial pathway and resilience-related factor in the association between trauma and FM symptoms. Targeting SOC-related processes may help reduce symptom burden and improve outcomes.