title: Can a 10-Minute Questionnaire Identify Significant Psychological Issues in Patients With Temporomandibular Joint Disease?
abstract: OBJECTIVE
  For patients with disc displacement disorders (DDDs), psychiatric illness increases the risk of worsening postsurgical pain, postoperative delirium, postoperative incomplete recovery, and worse postoperative life quality. This study provides a fast and practical protocol to evaluate psychological conditions of patients with DDDs of the temporomandibular joint (TMJ) in clinical care.
  
  
  METHODS
  The populations under investigation in this cross-sectional study included patients with DDD who received treatment from October 2012 through June 2016. Variables included age, gender, education level, and TMJ (Axis I) and psychological (Axis II) evaluations. The 13-item protocol of Axis II evaluations contained a 5-item Brief Symptom Rating Scale (BSRS-5), a pain visual analog scale (VAS; 1 item), major life events (3 items), suicidal risk (3 items), and substance use (1 item). Analysis of variance, χ2test, and multivariate logistic regression were used for analyses.
  
  
  RESULTS
  Of 177 patients, 75.14% were women (mean age, 37.46 ± 14.06 yr). Pain VAS scores clearly supported the following ranking of psychosocial discomforts: disc displacement without reduction with limited opening (DDWORWLO) > disc displacement without reduction without limited opening > disc displacement with reduction. Pain VAS and BSRS-5 correlated with 5 variables in Axis I (trismus, acute TMJ pain, chronic awake bruxism, chronic sleep bruxism, and deep bite). The DDD study indicated that 9.6% of patients required urgent referrals to mental health resources (MHRs) for their moderate and high suicidal risk DDD and 77% required nonurgent referrals to MHRs for their psychiatric morbidity.
  
  
  CONCLUSIONS
  This study found that patients with DDD showed a prevalence of suicidal ideation and mean BSRS scores that were higher for anxiety, hostility, depression, interpersonal hypersensitivity, and insomnia than in the general population. Patients with trismus or acute TMJ pain could have a higher pain VAS score; chronic awake bruxism could involve greater hostility and lower depression; chronic sleep bruxism could increase sensitivity to interpersonal interactions; and deep bite could involve a higher anxiety level. DDWORWLO produced the highest pain VAS score in patients with DDD. The 13-item Axis II evaluations can offer useful clues for oral and maxillofacial surgeons and other specialists to collaborate with MHRs.
authors.affiliation: Attending Physician, Department of Psychiatry, Kaohsiung Armed Forces General Hospital Pingtung Branch, Pingtung, Taiwan; Graduate Student, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan; Lecturer, Department of Microelectronics Engineering, National Kaohsiung Marine University, Kaohsiung, Taiwan.
authors.forename: Shang-Lun
authors.initials: SL
authors.lastname: Lin
authors.affiliation: Associate Professor, School of Medicine, Griffith University, Gold Coast, Australia.
authors.forename: Shang-Liang
authors.initials: SL
authors.lastname: Wu
authors.affiliation: Director, Department of Psychiatry, Kaohsiung Armed Forces General Hospital Pingtung Branch, Pingtung, Taiwan; Lecturer, Nursing Department, Meiho University, Pingtung, Taiwan.
authors.forename: Hsien-Te
authors.initials: HT
authors.lastname: Huang
authors.affiliation: Superintendent, Calo Hospital, Pingtung, Taiwan; Superintendent, Taiwan Suicide Prevention Center, Taipei, Taiwan; Professor, Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.
authors.forename: For-Wey
authors.initials: FW
authors.lastname: Lung
authors.affiliation: Assistant Professor, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan.
authors.forename: Tzong-Cherng
authors.initials: TC
authors.lastname: Chi
authors.affiliation: Director, Department of Oral and Maxillofacial Surgery, Tainan Sin Lau Hospital, Tainan Presbyterian Church in Taiwan, Tainan, Taiwan; Assistant Professor, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan; Chief Executive Officer, Yuan Yuan Dental Federation, Tainan, Taiwan. Electronic address: aunglin1979@gmail.com.
authors.forename: Jung-Wu
authors.initials: JW
authors.lastname: Yang
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005157:Facial Pain / Q000523:psychology*; D005260:Female; D006791:Hostility; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000523:psychology; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000523:psychology*