Sense of Coherence in the Trauma-Fibromyalgia Relationship: Mediation and Moderation Findings from a 2099-Participant...

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.

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.

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.

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.

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.