title: Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: a prospective cohort study in the general population.
abstract: Previous studies have associated depression and temporomandibular joint disorders (TMDs). The temporality, however, remains to be clarified. Most patient studies have selected subjects from treatment facilities, whereas in epidemiological studies a clinical examination has not been performed. In this study the 5-year follow-up data of the population-based Study of Health in Pomerania (SHIP) were analyzed. To estimate the effect of symptoms of depression and those of anxiety on the risk of TMD pain, the Composite International Diagnostic-Screener (CID-S) and a clinical functional examination with palpation of the temporomandibular joint and the masticatory muscles were used. After exclusion of subjects having joint pain at baseline, a sample of 3,006 Caucasian participants with a mean age of 49 years resulted. Of those, 122 participants had signs of TMD joint pain upon palpation. Subjects with symptoms of depression had an increased risk of TMD joint pain upon palpation (rate ratio: 2.1; 95% confidence interval: 1.5-3.0; P < .001). Anxiety symptoms were associated with joint and with muscle pain. The diagnosis, prevention, and therapy of TMD pain should also consider symptoms of depression and those of anxiety, and appropriate therapies if necessary.
  
  
  CONCLUSIONS
  Depressive and anxiety symptoms should be considered as risk factors for TMD pain. Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination. These findings may support decision-making in treating TMD.
authors.affiliation: Department of Oral and Maxillofacial Surgery/Plastic Surgery, University of Greifswald, Greifswald, Germany. kindlers@uni-greifswald.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Kindler
authors.forename: Stefanie
authors.initials: S
authors.lastname: Samietz
authors.forename: Mohammad
authors.initials: M
authors.lastname: Houshmand
authors.forename: Hans Jörgen
authors.initials: HJ
authors.lastname: Grabe
authors.forename: Olaf
authors.initials: O
authors.lastname: Bernhardt
authors.forename: Reiner
authors.initials: R
authors.lastname: Biffar
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
authors.forename: Georg
authors.initials: G
authors.lastname: Meyer
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Hans-Robert
authors.initials: HR
authors.lastname: Metelmann
authors.forename: Christian
authors.initials: C
authors.lastname: Schwahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D018771:Arthralgia / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult