Depression and somatization in patients with temporomandibular disorders

Abstract

Istraživanja upozoravaju na povisenu somatizaciju, stres, anksioznost i depresiju u pacijenata s temporomandibularnim poremecajima (TMP-om) te je pokazana cvrsta povezanost između anksioznosti, opcih somatskih tegoba i bolova vezanih uz TMP. Svrha istraživanja bila je odrediti razlike u rezultatima depresije i somatizacije u pacijenata razlicitih dijagnostickih skupina osi I DKI/TMP i istražiti ulogu psiholoskih cimbenika (depresije i somatizacije) u TMP-u. Izabrana su 154 pacijenta ( 7 muskaraca i 117 žena ; srednja dob 9.0 p ; 14.5 godina) iz DKI/TMP kategorije s klinicki ustanovljenim TMP-om. Pacijenti su na temelju razlicitih dijagnostickih skupina pomocu DKI/TMP osi I klasificirani u 7 skupina. Razlike prosjecnih SCL-90 rezultata depresije i somatizacije između dijagnostickih skupina uspoređene su jednosmjernom analizom varijance i Scheffeovim post hoc testovima na razini znacajnosti od 0, 05. Ucestalost razlicitih dijagnostickih skupina bila je sljedeca: skupina 1 (misicni poremecaj, MP) - 5, 7% ; skupina 2 (pomak diska, PD) - 18, 2% ; skupina (artralgija, artritis, artroza, AAA) - 7, 8% ; skupina 4 (MP+PD) - 9, 1% ; skupina 5 (MP+AAA) - 1 , 0% ; skupina 6 (PD+AAA) - 9, 1% i skupina 7 (MP+PD+AAA) - 7, 1%. Vecina pacijenata imala je jednu dijagnozu (61, 7%), a ostali dvije ili vise njih ( 8, %). Oko 19, 5% klinickih pacijenata s TMP-om imalo je povisene rezultate depresije, a 27, % ih je iskusilo izražene razine nespecificnih fizickih simptoma. Samo 6 pacijenata (21, 4%) imalo je visok stupanj nefunkcioniranja s umjerenom do teskom ogranicenoscu (pacijenti s psihosocijalnom disfunkcijom). Pacijenti kod kojih su dijagnosticirani miofacijalna bol i artralgija (skupina 5 i 7) imali su znatno vise razine depresije i somatizacije u odnosu prema pacijentima kod kojih je dijagnosticiran pomak diska (skupina 2). Ti podaci pokazuju da screening i lijecenje depresije i somatizacije trebaju biti sastavni dio ispitivanja i obrade pacijenata s TMP-om. Studies have indicated that patients with TMD demonstrate increased somatization, stress, anxiety, depression.A consistent relationship has been demonstrated among anxiety, general somatic complaints, and TMD-related pain. The aims of this study were to determine the differences in depression and somatization scores in patients in different RDC/TMD axis I diagnostic groups and to investigate the role of psychological factors (depression and somatization) in TMD. One hundred fifty- four patients ( 7 male and 117 female ; mean age, 9.0 p ; 14.5 years) with RDC/ TMD-defined clinical TMD were selected. Patients were subsequently classified into 7 groups based on the presence of the various RDC/TMD axis I diagnostic groups. Differences in mean SCL-90 depression and somatization scores between the diagnostic groups were compared by one-way analysis of variance and Scheffe post hoc tests at a significance level of 0.05. The frequencies of the different diagnostic groups were as follows: group 1 (muscle disorders, MD), 5.7% ; group 2 (disc displacement, DD), 18.2% ; group (arthralgia, arthritis, arthrosis, AAA), 7.8% ; group 4 (MD+DD), 9.1% ; group 5 (MD+AAA), 1 .0% ; group 6 (DD+AAA), 9.1% ; group 7 (MD+DD+AAA), 7.1%. The majority of patients had one diagnosis (61.7%) while the remaining patients experienced two or more diagnoses ( 8. %). About 19.5% of TMD clinical patients yielded severe depression scores, and 27. % experienced severe levels of non-specific physical symptoms scores. Only 6 patients (21.4%) had high disability with moderate and severe limitations (psychosocially dysfunctional patients). Patients diagnosed with myofascial pain and arthralgia (group 5 and 7) had significantly higher levels of depression and somatization than patients diagnosed with only disc displacements (group 2). These data mandate that screening and treatment for depression and somatization should be an integral part of the evaluation and management of patients with TMD.