Impact of comorbid depression and anxiety on temporomandibular disorders related pain, sleep, function, behaviors, and quality of life

This study examined the prevalence of comorbid depression and anxiety in Chinese patients with temporomandibular disorders (TMDs), and their associations with pain intensity, sleep propensity, oral behaviors, jaw function, and oral health-related quality of life (OHRQoL). It also evaluated the likelihood of different TMD subtypes among individuals with no depression or anxiety (NC), depression alone (DA), anxiety alone (AA), and comorbid conditions (CC). Participants recruited from a dental hospital completed a survey comprising sociodemographics, the Diagnostic Criteria for TMDs (DC/TMD) Symptoms Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Numerical Pain Rating Scale, Epworth Sleepiness Scale, Oral Behaviors Checklist, Jaw Functional Limitation Scale-8, and the Oral Health Impact Profile for TMDs. Clinical examinations followed the DC/TMD protocol, classifying individuals into intra-articular (IT), pain-related (PT), or combined (CT) TMDs. Statistical analyses included chi-square tests, non-parametric methods, and multinomial logistic regression (α = 0.05). Among 798 participants (mean age 29.8 years [SD 10.7]; 79.6% women), 48.0%, 10.8%, 7.9%, and 33.3% had NC, DA, AA, and CC, respectively. Significant differences were observed in pain intensity (CC/AA/DA > NC), sleep propensity (CC/DA > AA/NC), jaw overuse behavior (CC > AA/NC; DA > NC), jaw functional limitation (CC > DA > NC; AA > NC), and OHRQoL (CC > AA > DA > NC). Moderate correlations were observed between jaw functional limitation and OHRQoL across groups, with additional links to pain intensity in DA and AA (r_s = 0.43-0.54). In adjusted models, DA was associated with greater odds of CT (OR 2.26; 95% CI 1.19-4.27), and CC with higher odds of PT (OR 1.72; 95% CI 1.02-2.89) and CT (OR 1.78; 95% CI 1.14-2.77). Comorbid depression and anxiety were linked to increased pain, sleep propensity, oral behaviors, jaw dysfunction, and poorer OHRQoL, reinforcing the need for integrated psychological care.