Impact of psychosocial factors on fibromyalgia: A systematic review

OBJECTIVE: This systematic review examined the influence of psychosocial factors on pain intensity, functionality, psychological distress, and quality of life in fibromyalgia (FM), with particular attention to emotional distress, social support, and coping-related variables. METHODS: Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched for studies published between 2020 and 2026 in English, Portuguese, or Spanish. Twenty-nine empirical studies met the inclusion criteria, comprising 20.929 adults with FM (predominantly women). Most studies were cross-sectional (75.9%), followed by longitudinal (13.8%) and experimental or quasi-experimental designs (10.3%). Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. RESULTS: Depression, anxiety, pain catastrophizing, and social support were the most frequently examined psychosocial factors. Higher levels of emotional distress and maladaptive pain-related beliefs were consistently associated with greater pain intensity, poorer functional outcomes, and reduced quality of life. In contrast, social support and self-efficacy emerged as protective factors. Studies with multivariate analyses indicated that depressive and anxiety symptoms showed moderate-to-strong associations linking pain and functional impairment, with pain catastrophizing emerging as the strongest predictor. CONCLUSIONS: The findings highlight the central role of psychosocial processes in shaping the clinical experience of FM. Interventions integrating psychological and social components alongside medical care may contribute to improved functional adaptation and quality of life in this population.