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Objective: Stress perception depends on cultural and social aspects that vary from one country to another. One of the most widely disseminated methods of assessing psychological stress is the Perceived Stress Scale (PSS-4). Therefore, in order to identify these factors and their impact on mental health, the present study compares the PSS-4 results among three European countries (Great Britain, France and Spain). This study focuses on PSS-4 results within a Spanish sample to determine: (1) normative data, reliability and validity of PSS-4 in a Spanish sample and (2) how stress perception changes depending on cultural and social factors.Methods: The data were obtained from a website representing a service of a smoking cessation program, the study represented a service that was open to all individuals. The number of participants were 37,451. They reported their age, gender, nationality, marital status, education and employment status, and completed two psychological questionnaires (PPS-4 and the anxiety and depression scales of the Symptom Checklist-90-Revised, SCL 90-R).Results: The PSS-4 scores could differentiate between relevant sociodemographic variables (such as sex, age, nationality, marital status, education, parental status, employment status, and income class). The PSS-4 scores showed a positive correlation with the SCL 90-R anxiety and depression scales. The normed values for interpreting the PSS-4 scores are presented. The PSS-4 showed adequate internal consistency and reliability.Conclusions: The PSS-4 is a useful instrument for assessing stress perception levels in the general population in different countries. Its internal consistency is sufficient for a 4-item scale.

Objective. To our knowledge, the impact of the COVID-19 pandemic on fibromyalgia (FM) patients has not been studied before. FM patients often experience clinical impairment with stress. The aim of this study was to determine whether severity of FM increases because of confinement by the COVID-19 pandemic. Methods. This prospective study includes patients from the Combined Index of Severity of Fibromyalgia (ICAF) cohort who met the 2010 ACR FM criteria. In this cohort, all patients have a periodical evaluation of their quality of life through two questionnaires, the ICAF, which assesses the ability to perform daily living activities, anxiety and depression, and through the Patient Global Impression of Change (PGIC), which assesses overall change after a therapeutical intervention. Pre-and post-confinement measurements were analysed. Inferential statistical analysis and ANOVA for repeated measurements were used. Results. A total of 93 patients received a phone consultation, (95.5% females), mean (SD) age of 48.23 (8.38) years. Four patients were excluded as presenting COVID-19 and 51 (57%) completed the post-confinement ICAF. Following confinement, 25 (49%) patients got worse (group-worse) and 26 (51%) patients experienced no change or improved (group-stable). Comparisons between pre-and post-confinement ICAF did not show significant differences in both groups. Passive coping was significantly different in groupworse in pre-confinement evaluation. In the 80% of patients with passive coping predominance there were no changes in coping strategy. Conclusion. No clinical impairment due to COVID-19 confinement oc-curred. The perceived worsening among FM patients relies primarily on how patients cope with their disease, without a real impact on clinical manifestations.

Objectives To determine the prevalence and characteristics of post-COVID-19 (PC) in fibromyalgia (FM) patients. Methods Retrospective, multi-centric, observational study, comparing a group of FM patients (FM group) with another group of patients with other rheumatic diseases (RD group). COVID-19 diagnosis was established by positive polymerase chain reaction or antigen during acute infection or by positive antibodies thereafter. We considered PC diagnosis when symptoms remain after COVID-19. We collected the principal characteristics of COVID-19, the severity of fatigue, waking unrefreshed and cognitive impairment, and persistent symptoms. The American College of Rheumatology (ACR) criteria and the Combined Index of Severity in Fibromyalgia (ICAF) were collected in the FM group. Results RD group (n = 56) had more pneumonia (p = 0.001) and hospital admissions (p = 0.002), but the FM group (n = 78) had a higher number of symptoms (p = 0.002). The percentage of patients with PC was similar between groups (FM group 79.5%; RD group 66.1%, p = 0.081). FM group had more PC symptoms (p = 0.001), more impairment after COVID-19 (p = 0.002) and higher severity of fatigue, waking unrefreshed and cognitive impairment (p <  0.0001). Only loss of smell was more frequent in the FM group (p = 0.005). The FM group with PC (n = 29) showed more severity of the Combined Index of Severity in Fibromyalgia (ICAF) total score and physical factor after COVID-19, while emotional, coping factors and the ACR criteria did not change. Conclusions The prevalence of PC in FM patients is similar to RD patients. In FM patients, the presence of PC does not appear to impact the severity of FM.

The results of this study confirm the digital divide, with lower participation among people with a lower educational level. No association was observed between stress, anxiety or depression and cigarette consumption.