Comparing Axis II Scores According to the RDC/TMD and DC/TMD in Israeli Patients

Aims: To use the Symptom Checklist-90-Revised (SCL-90-R)–based instru-ments of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and the Primary Care Evaluation of Mental Disorders (PRIME-MD)–based instruments of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) in order to compare these Axis II scores in temporomandibular dis-order (TMD) patients. Methods: Demographic and socioeconomic data, Axis I diagnoses, and Axis II evaluations (depression, nonspecific physical symptoms, anxiety, and Graded Chronic Pain Scale [GCPS]) were compared between two groups of patients—142 TMD patients diagnosed according to the RDC/TMD (RDC group) and 157 TMD patients diagnosed according to the DC/TMD (DC group). Pearson's chi-square test, Fisher's exact test, and Mann-Whitney test were used, and P values were adjusted for multiple comparisons. Results: The prevalences of severe depression, nonspecific physical symptoms, and anxiety were significantly lower in the DC group than in the RDC group, with no differ-ences between groups for Axis I diagnoses, characteristic pain intensity (CPI), or GCPS. Conclusion: Within the limitations of this study, the present findings reveal differences in the presence of severe depression, nonspecific physical symptoms, and anxiety between the RDC and DC groups. The differences may reflect the cut-off scores of the SCL-90-R and the PRIME-MD tools.

Axis II; Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); Primary Care Evaluation of Mental Disorders

(PRIME-MD); Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD); Symptom Checklist-90-Revised (SCL-90-R)

1. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychol Bull 2007;133:581–624.

2. Dworkin SF, LeResche L. Research Diagnostic Criteria for Temporomandibular Disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6: 301–355.

3. Dworkin SF, Huggins KH, LeResche L, et al. Epidemiology of signs and symptoms in temporomandibular disorders: Clinical signs in cases and controls. J Am Dent Assoc 1990;120: 273–281.

4. List T, Dworkin SF. Comparing TMD diagnoses and clinical findings at Swedish and US TMD centers using research diagnostic criteria for temporomandibular disorders. J Orofac Pain 1996;10:240–253.

5. Manfredini D, Winocur E, Ahlberg J, Guarda-Nardini L, Lobbezoo F. Psychosocial impairment in temporomandibular disorders patients. RDC/TMD Axis II findings from a multicentre study. J Dent 2010;38:765–772.

6. Winocur E, Steinkeller-Dekel M, Reiter S, Eli I. A retrospective analysis of temporomandibular findings among Israeli-born patients based on the RDC/TMD. J Oral Rehabil 2009;36:11–17.

7. Reiter S, Eli I, Gavish A, Winocur E. Ethnic differences in temporomandibular disorders between Jewish and Arab populations in Israel according to RDC/TMD evaluation. J Orofac Pain 2006;20:36–42.

8. Holi MM, Sammallahti PR, Aalberg VA. A Finnish validation study of the SCL-90. Acta Psychiatr Scand 1998;97:42–46.

9. Gatchel RJ, Garofalo JP, Ellis E, Holt C. Major psychological disorders in acute and chronic TMD: An initial examination. J Am Dent Assoc 1996;127:1365–1374.

10. Kight M, Gatchel RJ, Wesley L. Temporomandibular disorders: Evidence for significant overlap with psychopathology. Health Psychol 1999;18:177–182.

11. Marbach JJ, Lennon MC, Dohrenwend BP. Candidate risk factors for temporomandibular pain and dysfunction syndrome: Psychosocial, health behavior, physical illness and injury. Pain 1988;34:139–151.

12. Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW Jr. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain 2011;27:268–274.

13. Carlson CR, Reid KI, Curran SL, et al. Psychological and physiological parameters of masticatory muscle pain. Pain 1998;76: 297–307.

14. Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeResche L, Truelove E. 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 2002;16:207–220.

15. Ohrbach R, Turner JA, Sherman JJ, et al. The Research Diagnostic Criteria from Temporomandibular Disorders. IV: Evaluation of the psychometric properties of the Axis II measures. J Orofac Pain 2010;24:48–62.

16. Anderson GC, Gonzalez YM, Ohrbach R, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. VI: Future directions. J Orofac Pain 2010;24:79–88.

17. 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.

18. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606–613.

19. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002;64:258–266.

20. Löwe B, Decker O, Müller S, et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008;46:266–274.

21. International Network for Orofacial Pain and Related Disorders Methodology: A Consortium Focused on Clinical Translation Research. http://www.rdc-tmdinternational.org/. Accessed 22 August 2017.

22. Reiter S, Emodi-Perlman A, Goldsmith C, Friedman-Rubin P, Winocur E. Comorbidity between depression and anxiety in patients with temporomandibular disorders according to the research diagnostic criteria for temporomandibular disorders. J Oral Facial Pain Headache 2015;29:135–143.

23. Hobfoll SE, Canetti D, Hall BJ, et al. Are community studies of psychological trauma’s impact accurate? A study among Jews and Palestinians. Psychol Assess 2011;23:599–605.

24. Hall BJ, Hobfoll SE, Canetti D, Johnson R, Palmieri P, Galea S. Exploring the association between posttraumatic growth and PTSD: A national study of Jews and Arabs during the 2006 Israeli-Hezbollah War. J Nerv Ment Dis 2010;198:180–186.

25. Hobfoll SE, Canetti-Nisim D, Johnson RJ. Exposure to terrorism, stress-related mental health symptoms, and defensive coping among Jews and Arabs in Israel. J Consult Clin Psychol 2006;74:207–218.

26. Hobfoll SE, Canetti-Nisim D, Johnson RJ, Palmieri PA, Varley JD, Galea S. The association of exposure, risk, and resiliency factors with PTSD among Jews and Arabs exposed to repeated acts of terrorism in Israel. J Trauma Stress 2008;21:9–21.

27. Palmieri PA, Canetti-Nisim D, Galea S, Johnson RJ, Hobfoll SE. The psychological impact of the Israel-Hezbollah War on Jews and Arabs in Israel: The impact of risk and resilience factors. Soc Sci Med 2008;67:1208–1216.

28. Palmieri PA, Chipman KJ, Canetti D, Johnson RJ, Hobfoll SE. Prevalence and correlates of sleep problems in adult Israeli Jews exposed to actual or threatened terrorist or rocket attacks. J Clin Sleep Med 2010;6:557–564.

29. Levy I, Goldstein A, Fischel T, Maor Y, Litachevsky V, Rahav G. Neurocognitive disturbances and psychiatric disorders among patients living with HIV-1 positive in Israel [in Hebrew]. Harefuah 2013;152:196–199, 248–249.

30. Von Korff M. Assessment of chronic pain in epidemiological and health services research: Empirical bases and new directions. In: Turk DC, Melzack R (eds). Handbook of Pain Assessment, ed 3. New York: Guilford, 2011:455–473.

31. Benjamini Y, Hochberg Y. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J Roy Statist Soc Ser B 1995;57:289–300.

32. Michelotti A, Alstergren P, Goulet JP, et al. Next steps in development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): Recommendations from the International RDC/TMD Consortium Network workshop. J Oral Rehabil 2016;43: 453–467.

33. Lobbezoo F, van Selms MK, John MT, et al. Use of the Research Diagnostic Criteria for Temporomandibular Disorders for multinational research: Translation efforts and reliability assessments in the Netherlands. J Orofac Pain 2005;19:301–308.

34. Cameron IM, Crawford JR, Lawton K, Reid IC. Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. Br J Gen Pract 2008:58;32–36.

35. Wahl I, Löwe B, Bjorner JB, et al. Standardization of depression measurement: A common metric was developed for 11 self-report depression measures. J Clin Epidemiol 2014;67:73–78.

36. Cameron IM, Crawford JR, Lawton K, Reid IC. Differential item functioning of the HADS and PHQ-9: An investigation of age, gender and educational background in a clinical UK primary care sample. J Affect Disord 2013;147:262–268.

37. Huang FY, Chung H, Kroenke K, Dellucchi KL, Spitzer RL. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med 2006;21:547–552.

38. Pedersen G, Karterud S. Is SCL-90R helpful for the clinician in assessing DSM-IV symptom disorders? Acta Psychiatr Scand 2004;110:215–224.

39. Kim MJ, Lim MJ, Park WK, Kho HS. Comparison between the SCL-90-R and MMPI in TMD patients with psychological problems. Oral Dis 2012;18:140–146.

40. Veijola J, Jokelainen J, Läksy K, et al. The Hopkins Symptom Checklist-25 in screening DSM-III-R Axis-I disorders. Nord J Psychiatry 2003;57:119–123.

41. Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: Relationship to somatic and psychosocial variables. Psychosom Med 2004;66:837–844.

42. Marks DM, Han C, Krulewicz S, et al. History of depressive and anxiety disorders and paroxetine response in patients with irritable bowel syndrome: Post hoc analysis from a placebo-controlled study. Prim Care Companion J Clin Psychiatry 2008;10:368–375.

43. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 2008;70:890–897.

44. Löwe B, Spitzer RL, 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.