Simple psychiatric screening for burning mouth syndrome and persistent globus pharyngeus using the hospital anxiety and depression scale: a case-control study

OBJECTIVE: To evaluate a simple psychiatric screening approach for functional otorhinolaryngologic disorders ‒ conditions that show no abnormalities on standard work-up and respond poorly to medication ‒ we analyzed Hospital Anxiety and Depression Scale (HADS) results in patients with Burning Mouth Syndrome (BMS) and persistent Globus Pharyngeus (GP) commonly seen in otorhinolaryngologic clinic, where psychiatric assessment is unfamiliar to most otorhinolaryngologists. METHODS: We conducted a single-center, retrospective case-control study including 185 subjects with BMS (n = 54), persistent GP (n = 69) (persisting ≥3-month despite anti-reflux medication), and controls (n = 62). Psychiatric screening used the HADS with a prespecified cut-off of ≥8 to define abnormal scores (0-7 normal, 8-10 mild, 11-14 moderate, 15-21 severe). Primary outcomes were abnormal anxiety and depression on HADS. We used logistic regression adjusted for age, sex, and prespecified predictors to estimate adjusted Odds Ratios (aOR) with 95% Confidence Intervals (95% CIs). RESULTS: Patients with moderate-to-severe HADS scores in anxiety or depression (47/185, 25.4%) all accepted psychiatric consultation (47/47, 100%). Abnormal anxiety occurred in 37.0% of BMS (20/54), 46.4% of GP (32/69), and 11.3% of controls (7/62); abnormal depression in 51.9% of BMS (28/54), 55.1% of GP (38/69), and 17.7% of controls (11/62), respectively. Compared with controls, odds of anxiety and depression were higher in both patient groups: [BMS ‒ anxiety (aOR = 4.254; 95% CI 1.606-11.269), depression (aOR = 4.512; 95% CI 1.902-10.701)] and [GP ‒ anxiety (aOR = 6.827; 95% CI 2.710-17.197), depression (aOR = 5.743; 95% CI 2.545-12.961)]. CONCLUSION: Patients with BMS or persistent GP had higher levels of anxiety and depression than controls. A brief HADS-based screening proved clinically feasible in an otorhinolaryngology setting by identifying patients with substantial psychiatric burden and facilitating acceptance of psychiatric referral among moderate-to-severe cases. These findings may support the integration of HADS-guided psychiatric screening and referral into routine otorhinolaryngologic care. LEVEL OF EVIDENCE: Level 4.