J Oral Facial Pain Headache. 2014 Fall;28(4):338-45. doi: 10.11607/ofph.1229.
To investigate in a representative sample of South Koreans (1) the prevalence of and associations between general pain, temporomandibular disorders (TMD), and suicide ideation (SI), and (2) whether the associations between general pain, TMD, and SI differ according to cancer history.
Data were from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV; N = 16,658). KNHANES IV participants provided reports regarding their cancer history, EQ-5D (a measure of health status from the EuroQoL Group), and TMD symptoms including clicking of one or both temporomandibular joints, pain, and mouth-opening limitation (MOL). Participants were assessed for any SI over the last 12 months, as a dependent variable. The independent variables were pain/discomfort (EQ-PD) reported by the subjects on the EQ-5D, severe TMD (tenderness or reduced jaw mobility once or more per week), and total TMD (occurrence of clicking, tenderness on palpation, or reduced jaw mobility [opening < 30 mm] once or more per week). Demographic information (age and gender), socioeconomic status (income, education, occupation, and marital status), behavioral factors (smoking and binge drinking), and cancer history were evaluated as covariates. The association of TMD with SI was assessed by the prevalence ratio (PR) and 95% confidence intervals.
In fully adjusted models, elevated PRs for SI were observed for each pain condition (PR = 1.26 for total TMD, PR = 1.35 for severe TMD, and PR = 1.75 for EQ-PD). In the subgroup analyses by cancer history, the PRs were higher in the cancer history (+) group; the order of magnitude was severe TMD (PR = 2.20), EQ-PD (PR = 2.16), and total TMD (PR = 2.02).
Pain conditions, including TMD pain, might aggravate SI among those with a cancer history. These findings add to a growing body of evidence indicating that TMD warrants further attention in relation to suicide.
在韩国代表性样本中（1）调查一般疼痛、颞下颌关节紊乱（TMD）和自杀意念（SI）的患病率和相关性，以及（2）一般疼痛、TMD 和 SI 之间的关联是否因癌症史而有所不同。
数据来自第四次韩国国家健康和营养检查调查（KNHANES IV；N=16658）。KNHANES IV 参与者提供了关于他们的癌症史、EQ-5D（来自 EuroQoL 小组的健康状况衡量标准）和 TMD 症状的报告，包括一个或两个颞下颌关节的咔哒声、疼痛和张口受限（MOL）。参与者被评估过去 12 个月内是否存在任何 SI，作为因变量。自变量是受访者在 EQ-5D 上报告的疼痛/不适（EQ-PD）、严重 TMD（每周一次或多次出现压痛或下颌活动度降低）和总 TMD（每周一次或多次出现咔哒声、触诊压痛或下颌活动度降低[开口<30mm]）。评估人口统计学信息（年龄和性别）、社会经济地位（收入、教育、职业和婚姻状况）、行为因素（吸烟和狂饮）和癌症史作为协变量。通过患病率比（PR）和 95%置信区间评估 TMD 与 SI 的关联。
在完全调整的模型中，每种疼痛情况的 SI 患病率比（PR）均升高（总 TMD 的 PR=1.26，严重 TMD 的 PR=1.35，EQ-PD 的 PR=1.75）。在按癌症史进行的亚组分析中，在癌症史（+）组中 PR 更高；严重 TMD（PR=2.20）、EQ-PD（PR=2.16）和总 TMD（PR=2.02）的顺序依次增加。
包括 TMD 疼痛在内的疼痛状况可能会加重有癌症史的人的 SI。这些发现增加了越来越多的证据表明，TMD 需要进一步关注与自杀有关的问题。
