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

## TL;DR

This study shows that a person's sense of coherence helps explain how trauma relates to fibromyalgia symptoms and can reduce their impact.

## Contribution

The study identifies sense of coherence as a key mediator and moderator in trauma-FM symptom relationships using a large cohort.

## Key findings

- Higher adversity predicts lower sense of coherence, which in turn predicts higher symptom burden.
- Sense of coherence weakens the effects of trauma on fatigue and global impact in fibromyalgia.
- Comorbidities like hypertension and stroke have smaller effects compared to sense of coherence.

## Abstract

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.