Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Evid Based Dent Pract. 2023 Jun;23(2):101860. doi: 10.1016/j.jebdp.2023.101860. Epub 2023 Mar 17.
Mounting evidence indicates the associations of temporomandibular disorders (TMD) with depression and anxiety symptoms. However, the temporal and casual relationships between TMD and depression and between TMD and anxiety must be further clarified.
This study is a retrospective cohort analysis that employed data from the Taiwan National Health Insurance Database and comprised the following sub analyses: temporomandibular joint disorders (TMJD) as the cause of subsequent major depressive disorder (MDD) or anxiety disorders (AnxDs) and TMJD as the consequence of MDD or AnxDs. Patients with antecedent TMJD (N = 12,152 for the MDD study and 11,023 for the AnxD study), MDD (N = 28,743), or AnxDs (N = 21,071) and their respective control cohorts were identified between January 1, 1998 and December 31, 2011. The control cohorts (1:10) were matched by age, sex, income, residential location, and comorbidities. Individuals with subsequent new-onset TMJD, MDD, or AnxDs were identified from January 1, 1998 to December 31, 2013. The risk of the outcome disorders of the individuals with antecedent TMJD, MDD, or AnxD were estimated using Cox regression models.
Patients with TMJD had an approximately 3-fold higher risk (hazard ratio [HR]: 3.98, 95% confidence interval [CI]: 3.28-4.84) of subsequent MDD development and a 7-fold higher risk (HR: 7.26, 95% CI: 5.90-8.94) of AnxD development than those without TMJD. Antecedent MDD and AnxDs were predictive of 5.80-fold (95% CI: 4.81-6.98) and 8.29-fold (95% CI: 6.67-10.30), respectively, increases in the risk of subsequent TMJD development.
Our results demonstrate that precedent TMJD and MDD/AnxDs are associated with elevated risks of subsequent MDD/AnxDs and TMJD developments and indicate temporal associations of TMJD with MDD and AnxDs are bidirectional.
越来越多的证据表明，颞下颌关节紊乱（TMD）与抑郁和焦虑症状有关。然而，TMD 与抑郁之间以及 TMD 与焦虑之间的时间和因果关系仍需进一步阐明。
本研究采用回顾性队列分析方法，利用台湾全民健康保险数据库的数据，包括以下亚分析：以颞下颌关节紊乱（TMJD）为随后发生的重度抑郁症（MDD）或焦虑障碍（AnxDs）的病因，或以 TMJD 为 MDD 或 AnxDs 的后果。于 1998 年 1 月 1 日至 2011 年 12 月 31 日期间，确定了先前有 TMJD（MDD 研究中为 12152 例，AnxD 研究中为 11023 例）、MDD（28743 例）或 AnxDs（21071 例）的患者及其各自的对照组。对照组（1:10）按年龄、性别、收入、居住地点和合并症进行匹配。1998 年 1 月 1 日至 2013 年 12 月 31 日期间，从所有参与者中确定随后出现新诊断的 TMJD、MDD 或 AnxDs 的个体。采用 Cox 回归模型估计先前有 TMJD、MDD 或 AnxDs 的个体发生结局障碍的风险。
与无 TMJD 的患者相比，TMJD 患者发生后续 MDD 发展的风险约增加 3 倍（风险比[HR]：3.98，95%置信区间[CI]：3.28-4.84），发生 AnxD 发展的风险增加 7 倍（HR：7.26，95% CI：5.90-8.94）。先前的 MDD 和 AnxDs 分别预测随后 TMJD 发展的风险增加 5.80 倍（95% CI：4.81-6.98）和 8.29 倍（95% CI：6.67-10.30）。
我们的研究结果表明，先前的 TMJD 和 MDD/AnxDs 与随后发生的 MDD/AnxDs 和 TMJD 发展的风险增加有关，并表明 TMD 与 MDD 和 AnxDs 之间的时间关联是双向的。
