Psychological burden as the primary determinant of suicidal ideation in patients with temporomandibular disorders

Assessing suicidal ideation (SI) in patients with primary temporomandibular disorders (TMD) is crucial for its early identification and intervention. This study aimed to investigate the biopsychosocial factors associated with SI in the overall TMD sample and across subgroups of painful TMD patients.

A total of 441 TMD patients were enrolled. TMD was diagnosed using the diagnostic criteria for TMD, and SI was assessed via item 9 of the Patient Health Questionnaire-9. SI prevalence was compared across painful TMD subgroups, stratified by pain duration, and classified according to the International Association for the Study of Pain (IASP) diagnostic criteria. Sociodemographic, Axis I and II, and pain characteristics were compared between the SI and non-SI groups using the Chi-square and Mann-Whitney tests. Binary logistic regression, incorporating pain persistence and depression, was performed to identify the key factors independently associated with SI.

In the overall TMD sample, encompassing both painful and non-painful patients, 8.2% reported SI. Among the painful TMD subgroups, SI prevalence was 5.7% in acute cases and 12.0% in chronic cases by pain duration, rising to 20.9% when chronic pain was defined by IASP criteria (p < 0.001). Patients with SI were more frequently divorced, had higher rates of TMD-attributed headache and myofascial pain with referral, and reported greater perceived pain intensity. They also exhibited markedly elevated depression, anxiety, non-specific physical symptoms, pain catastrophizing, and overall distress (p < 0.001), as well as greater disability (p = 0.004). Pain duration was not independently associated with SI, whereas depression emerged as a significant independent predictor (p < 0.001).

These findings highlight the substantial psychological burden in TMD patients, particularly those with chronic pain, and underscore the critical role of depression in SI. Incorporating routine biopsychosocial assessment and SI screening into TMD clinical practice is, therefore, highly recommended.