The association between [QoL] and psychological flexibility, depressive, anxiety or insomnia symptoms in patients with persistent... 2025 Selinheimo+

Full title: The association between quality of life and psychological flexibility, depressive, anxiety or insomnia symptoms in patients with persistent indoor environment-related symptoms or chronic fatigue

Abstract

Background
Persistent physical symptoms (PPS) can significantly impair health-related quality of life (HRQoL) and are often accompanied by psychiatric comorbidity. Psychological flexibility (PF), characterized by the ability to adapt functionally and congruently to diverse situations based on personal values, may play a crucial role in determining HRQoL. This study aims to examine the associations between symptoms of depression, anxiety or insomnia or PF and HRQoL among individuals with PPS associated with (i) the indoor environment (IE), (ii) chronic fatigue, or (iii) both.

Methods
We utilized the baseline data (n = 103) from a randomized controlled trial focused on improving the HRQoL of individuals (mean age 46.1, SD 7.8, 86% women) experiencing PPS associated with IE or chronic fatigue. Self-report questionnaires were administered to evaluate symptoms of depression, anxiety, insomnia, and dimensions of PF, including acceptance, cognitive fusion, and thought suppression. The primary outcome was HRQoL, assessed using a 15D questionnaire. The association between symptoms, PF dimensions, and HRQoL was examined using Pearson’s correlation and ANCOVA.

Results
Symptoms of depression, anxiety, and insomnia were negatively associated with HRQoL (p <.001) across all participants. Among individuals with PPS associated with IE, higher PF was significantly associated with higher HRQoL. No association was found between PF and HRQoL in those with chronic fatigue-associated PPS or both conditions.

Conclusions
PF associated with positive outcomes in HRQoL in individuals with PPS associated with the indoor environment, but not in those with chronic fatigue. Further research on the differences between these groups is warranted to enhance treatment targeting.

Open access

 

"Chronic fatigue-associated PPS involve a marked reduction in activity levels, post-exertional malaise, and persistent symptoms like pain or cognitive difficulties [12, 13]. While these conditions share similarities in symptom profiles and duration, it’s essential to note that not all individuals with PPS fit into one diagnostic category [4]. Thus, it is crucial to understand the factors that perpetuate symptoms.

Individuals with PPS share mutual bodily reactivity and behavioral patterns in symptom control and management. Approaches include avoiding triggers (e.g., events, environments) linked to symptom manifestation, attributing somatic causes to symptoms, and focusing on signs of symptoms and catastrophic thoughts [1, 4, 14, 15, 16]. Such behavioural patterns impact well-being and social connectedness, potentially conflicting with long-term goals for wellbeing. This creates a detrimental cycle where rigid pursuits hinder acceptance of the prolonged condition, restricting daily lives [17]. Consequently, avoidant strategies, meant to control distress, may inadvertently worsen functional impairments by reducing adaptability to different situations [18]."