Abstract
Objectives
Psychosocial assessment needs to be integrated into the diagnosis of chronic pain conditions; however, it is not clear how this assessment should be performed with minimal patient and health care provider burden. The aim of this study was to assess the diagnostic accuracy of a single-item questionnaire to detect psychosocial distress in temporomandibular disorder (TMD) patients.
Methods
Presence of psychosocial distress was measured in 126 TMD patients using Research Diagnostic Criteria for TMD Axis II measures (depression, somatization, dysfunctional chronic pain). A newly developed single-item questionnaire served as a test to detect psychosocial distress. The association between the presence of distress and test results was analyzed using generalized linear models (GLM). Diagnostic accuracy of the one-item test was assessed.
Results
The GLM revealed a statistically significant association between the presence of psychosocial distress and a positive test result (p < 0.001). Psychosocially distressed patients were 70 % more likely to indicate psychosocial distress in the single-item questionnaire than patients without distress. However, diagnostic test accuracy of the single-item questionnaire was low (sensitivity 73.0 %, specificity 55.7 %). The resulting positive likelihood ratio (1.65) indicated that the single-item test is an inadequate measure for detecting psychosocial distress.
Conclusions
The single-item questionnaire was not sufficiently accurate for detecting TMD patients’ psychosocial distress and may therefore not be useful as an assessment tool for the various dimensions of psychosocial distress in TMD patients.
Clinical relevance
Health care providers should not trust in TMD patients’ responses to a single question regarding psychosocial distress. Nevertheless, this questionnaire may constitute a first step into a more profound patient–provider communication on psychological issues relevant to TMD.
Similar content being viewed by others
References
Westman A, Linton SJ, Ohrvik J, Wahlen P, Leppert J (2008) Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain? A validation of the Orebro Musculoskeletal Pain Screening Questionnaire. Eur J Pain 12:641–649
Reissmann DR, John MT, Wassell RW, Hinz A (2008) Psychosocial profiles of diagnostic subgroups of temporomandibular disorder patients. Eur J Oral Sci 116:237–244
Tversky J, Reade PC, Gerschman JA, Holwill BJ, Wright J (1991) Role of depressive illness in the outcome of treatment of temporomandibular joint pain-dysfunction syndrome. Oral Surg Oral Med Oral Pathol 71:696–699
McCreary CP, Clark GT, Oakley ME, Flack V (1992) Predicting response to treatment for temporomandibular disorders. J Craniomandib Disord 6:161–169
Yap AU, Chua EK, Tan KB, Chan YH (2004) Relationships between depression/somatization and self-reports of pain and disability. J Orofac Pain 18:220–225
Yap AU, Chua EK, Dworkin SF, Tan HH, Tan KB (2002) Multiple pains and psychosocial functioning/psychologic distress in TMD patients. Int J Prosthodont 15:461–466
Scherer M, Himmel W, Stanske B et al (2007) Psychological distress in primary care patients with heart failure: a longitudinal study. Br J Gen Pract 57:801–807
Demertzis KH, Craske MG (2006) Anxiety in primary care. Curr Psychiatry Rep 8:291–297
Fink P, Sorensen L, Engberg M, Holm M, Munk-Jorgensen P (1999) Somatization in primary care. Prevalence, health care utilization, and general practitioner recognition. Psychosomatics 40:330–338
Nordstrom A, Bodlund O (2008) Every third patient in primary care suffers from depression, anxiety or alcohol problems. Nord J Psychiatry 62:250–255
Fink P, Jensen J, Borgquist L et al (1995) Psychiatric morbidity in primary public health care: a Nordic multicentre investigation. Part I: method and prevalence of psychiatric morbidity. Acta Psychiatr Scand 92:409–418
Becker SM (2004) Detection of somatization and depression in primary care in Saudi Arabia. Soc Psychiatry Psychiatr Epidemiol 39:962–966
Eisenberg L (1992) Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. N Engl J Med 326:1080–1084
Higgins ES (1994) A review of unrecognized mental illness in primary care. Prevalence, natural history, and efforts to change the course. Arch Fam Med 3:908–917
Derogatis LR, Lipman RS, Covi L (1973) SCL-90: an outpatient psychiatric rating scale—preliminary report. Psychopharmacol Bull 9:13–28
Beck AT, Steer RA (1987) Beck depression inventory—manual. The Psychological Association, San Antonio
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613
Von Korff M, Ormel J, Keefe FJ, Dworkin SF (1992) Grading the severity of chronic pain. Pain 50:133–149
Linton SJ, Hallden K (1998) Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. Clin J Pain 14:209–215
Hill JC, Dunn KM, Lewis M et al (2008) A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum 59:632–641
Main CJ, Wood PL, Hollis S, Spanswick CC, Waddell G (1992) The Distress and Risk Assessment Method. A simple patient classification to identify distress and evaluate the risk of poor outcome. Spine (Phila Pa 1976) 17:42–52
Apeldoorn AT, Bosselaar H, Ostelo RW et al (2012) Identification of patients with chronic low back pain who might benefit from additional psychological assessment. Clin J Pain 28:23–31
Löwe B, Kroenke K, Grafe K (2005) Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 58:163–171
Kriston L, Holzel L, Weiser AK, Berner MM, Harter M (2008) Meta-analysis: are 3 questions enough to detect unhealthy alcohol use? Ann Intern Med 149:879–888
Bowling A (2005) Just one question: If one question works, why ask several? J Epidemiol Community Health 59:342–345
Cunny KA, Perri M 3rd (1991) Single-item vs multiple-item measures of health-related quality of life. Psychol Rep 69:127–130
Mitchell AJ (2007) Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol 25:4670–4681
Milton K, Bull FC, Bauman A (2011) Reliability and validity testing of a single-item physical activity measure. Br J Sports Med 45:203–208
Kriston L, Gunzler C, Rohde A, Berner MM (2010) Is one question enough to detect female sexual dysfunctions? A diagnostic accuracy study in 6,194 women. J Sex Med 7:1831–1841
Cook C, Cleland J, Huijbregts P (2007) Creation and critique of studies of diagnostic accuracy: use of the STARD and QUADAS methodological quality assessment tools. J Man Manip Ther 15:93–102
John MT, Hirsch C, Reiber T, Dworkin S (2006) Translating the research diagnostic criteria for temporomandibular disorders into German: evaluation of content and process. J Orofac Pain 20:43–52
Dworkin SF, LeResche L (1992) Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 6:301–355
Kröner-Herwig B, Denecke H, Glier B et al (1996) Qualitätssicherung in der Therapie chronischen Schmerzes. Ergebnisse einer Arbeitsgruppe der Deutschen Gesellschaft zum Studium des Schmerzes (DGSS) zur psychologischen Diagnostik. IX. Multidimensionale Verfahren zur Erfassung schmerzrelevanter Aspekte und Empfehlungen zur Standarddiagnostik. Schmerz 10:47–52
Hautzinger M, Bailer M (1995) Allgemeine Depressionsskala (ADS). Beltz, Weinheim
Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Von Zerssen D (1976) Die Beschwerden-Liste. Beltz, Weinheim
Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E (2002) Reliability, validity, and clinical utility of the Research Diagnostic Criteria for Temporomandibular Disorders Axis II Scales: depression, non-specific physical symptoms, and graded chronic pain. J Orofac Pain 16:207–220
John MT, Zwijnenburg AJ (2001) Interobserver variability in assessment of signs of TMD. Int J Prosthodont 14:265–270
Schmitter M, Ohlmann B, John MT, Hirsch C, Rammelsberg P (2005) Research Diagnostic Criteria for Temporomandibular Disorders: a calibration and reliability study. Cranio 23:212–218
Deeks JJ, Altman DG (2004) Diagnostic tests 4: likelihood ratios. BMJ 329:168–169
McGee S (2002) Simlipfying likelihood ratios. J Gen Intern Med 17:647–650
Jaeschke R, Guyatt GH, Sackett DL (1994) User's guide to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? J Am Med Assoc 271:703–707
Kirmayer LJ, Robbins JM (1996) Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychol Med 26:937–951
Gatchel RJ (2004) Psychosocial factors that can influence the self-assessment of function. J Occup Rehabil 14:197–206
Hayward P, Bright JA (1997) Stigma and mental illness: a review and critique. J Ment Health 6:345–354
Barney LJ, Griffiths KM, Jorm AF, Christensen H (2006) Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry 40:51–54
Lobbezoo F, van Selms MK, John MT et al (2005) Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: translation efforts and reliability assessments in The Netherlands. J Orofac Pain 19:301–308
Wolf E, Petersson K, Petersson A, Nilner M (2001) Long-lasting orofacial pain—a study of 109 consecutive patients referred to a pain group. Swed Dent J 25:129–136
Manfredini D, Borella L, Favero L, Ferronato G, Guarda-Nardini L (2010) Chronic pain severity and depression/somatization levels in TMD patients. Int J Prosthodont 23:529–534
Yap AU, Tan KB, Chua EK, Tan HH (2002) Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent 88:479–484
Pandey M, Devi N, Thomas BC, Kumar SV, Krishnan R, Ramdas K (2007) Distress overlaps with anxiety and depression in patients with head and neck cancer. Psychooncology 16:582–586
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ (1977) Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 106:203–214
Wool CA, Barsky AJ (1994) Do women somatize more than men? Gender differences in somatization. Psychosomatics 35:445–452
John MT, Selle D (1998) Assessment of personality traits in patients with craniomandibular disorders. Dtsch Zahnarztl Z 8:547–550
Löwe B, Wahl I, Rose M et al (2010) A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord 122:86–95
Acknowledgments
We thank Linda S. Raab and Leesa Morrow for the editorial assistance and Annett Schrock for the data management.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reissmann, D.R., John, M.T., Kriston, L. et al. Insufficient diagnostic accuracy of a single-item questionnaire to detect psychosocial distress in temporomandibular disorder patients. Clin Oral Invest 17, 1937–1945 (2013). https://doi.org/10.1007/s00784-012-0892-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00784-012-0892-0