Integration of mental health screening in the management of patients with temporomandibular disorders


      Mental health disorders such as depression or anxiety, or both, are more common in patients with temporomandibular disorders (TMD) (16%-40%) than in the general population (16%), and failure to recognise them may be detrimental to the management of TMD. Paper-based screening tools previously reported in this group require assessment by clinicians and subsequent collation of data. We describe our experience of a new system − IMPARTS (Integrating mental and physical: research training and services), which uses validated tools to identify and to monitor the progress of patients who may benefit from psychological intervention. At outpatient clinics, patients used an electronic tablet to complete the General Anxiety Disorder Questionnaire (GAD-7), the Patient Health Questionnaire (PHQ-9), the Inclusion of Oral Health Impact Profile (OHIP-14), and the Brief Pain Inventory (BPI). Data were linked directly to their electronic record to allow the results, with suggestions for treatment, to be reviewed immediately during the consultation. A total of 162 patients were included. Screening showed that referral was required in 28 (17%) with a probable major depressive disorder and 32 (20%) with a general anxiety disorder. Two (1%), who were identified as being at high risk of suicide or self-harm, were referred for immediate psychological assessment. Use of the system can aid the holistic treatment of patients with TMD through appropriate referral. Early identification of mental health problems and concurrent management are most beneficial in those who have had symptoms of TMD for up to two years, and are therefore essential.


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        • Rugh J.D.
        • Solberg W.K.
        Psychological implications in temporomandibular pain and dysfunction.
        Oral Sci Rev. 1976; 7: 3-30
        • Kindler S.
        • Samietz S.
        • Houshmand M.
        • et al.
        Depressive and anxiety symptoms as risk factors for temporomandibular joint pain: a prospective cohort study in the general population.
        J Pain. 2012; 13: 1188-1197
      1. American Pain Society: press release January 16, 2013. Study assesses mood disorders with TMJ pain. Available from URL: (last accessed 3 March 2017).

        • Sipilä K.
        • Veijola J.
        • Jokelainen J.
        • et al.
        Association between symptoms of temporomandibular disorders and depression: an epidemiological study of the Northern Finland 1966 birth cohort.
        Cranio. 2001; 19: 183-187
        • Yap A.U.
        • Dworkin S.F.
        • Chua E.K.
        • et al.
        Prevalence of temporomandibular disorder subtypes, psychologic distress, and psychosocial dysfunction in Asian patients.
        J Orofac Pain. 2003; 17: 21-28
        • Ismail F.
        • Eisenburger M.
        • Lange K.
        • et al.
        Identification of psychological comorbidity in TMD-patients.
        Cranio. 2016; 34: 182-187
      2. McManus S. Meltzer H. Brugha T. Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for health and social care, 2017 (Available from URL: (last accessed 3 March 2017))
        • Katon W.
        • Russo J.
        • Lin E.H.
        • et al.
        Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial.
        Arch Gen Psychiatry. 2012; 69: 506-514
        • Cepoiu M.
        • McCusker J.
        • Cole M.G.
        • et al.
        Recognition of depression by non-psychiatric physicians—a systematic literature review and meta-analysis.
        J Gen Intern Med. 2008; 23: 25-36
        • National Institute for Health and Care Excellence
        Depression in adults with a chronic health problem: recognition and management (CG91).
        National Institute for Health and Care Excellence, London2009 (Available from URL: (last accessed 3 March 2017))
      3. Integrating mental & physical healthcare: research, training & services (IMPARTS). King’s College London. Available from URL: (last accessed 3 March 2017).

        • Rayner L.
        • Matcham F.
        • Hutton J.
        • et al.
        Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder.
        Gen Hosp Psychiatry. 2014; 36: 318-324
        • Schiffman E.
        • Ohrbach R.
        • Truelove E.
        • et al.
        Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group.
        J Oral Facial Pain Headache. 2014; 28: 6-27
      4. Adult improving access to psychological therapies programme. NHS England. Available from URL: (last accessed 3 March 2017).

        • Löwe B.
        • Spitzer R.L.
        • Gräfe K.
        • et al.
        Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians' diagnoses.
        J Affect Disord. 2004; 78: 131-140
        • Bakker I.M.
        • Terluin B.
        • van Marwijk H.W.
        • et al.
        Test-retest reliability of the PRIME-MD: limitations in diagnosing mental disorders in primary care.
        Eur J Public Health. 2009; 19: 303-307
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • et al.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Slade G.D.
        • Spencer A.J.
        Development and evaluation of the Oral Health Impact Profile.
        Community Dent Health. 1994; 11: 3-11
        • Slade G.D.
        Derivation and validation of a short-form oral health impact profile.
        Community Dent Oral Epidemiol. 1997; 25: 284-290
        • Moufti M.A.
        • Wassell R.W.
        • Meechan J.G.
        • et al.
        The Oral Health Impact Profile: ranking of items for temporomandibular disorders.
        Eur J Oral Sci. 2011; 119: 169-174
        • Miettinen O.
        • Lahti S.
        • Sipilä K.
        • et al.
        Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life.
        Acta Odontol Scand. 2012; 70: 331-336
        • Yule P.L.
        • Durham J.
        • Playford H.
        • et al.
        OHIP-TMDs: a patient-reported outcome measure for temporomandibular disorders.
        Community Dent Oral Epidemiol. 2015; 43: 461-470
        • Gonzalez Y.M.
        • Schiffman E.
        • Gordon S.M.
        • et al.
        Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity.
        J Am Dent Assoc. 2011; 142: 1183-1191