Associations Between Temporomandibular Disorder‐Related Symptoms, Psychological Distress, and Sleep Quality Among Hospital Healthcare Staff
Abstract
ABSTRACT Objectives To examine associations between temporomandibular disorder (TMD)‐related symptoms, psychological distress, and sleep quality among hospital healthcare staff, and to explore whether cumulative psychological–sleep burden was associated with pain‐related TMD in a graded pattern. Materials and Methods This cross‐sectional study included 193 healthcare employees from a tertiary public hospital in Beijing, China. TMD‐related symptoms were assessed using self‐reported symptom items from the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Symptom Questionnaire for symptom screening rather than definitive clinical diagnosis. Psychological distress was measured using the Depression Anxiety Stress Scales–21 (DASS‐21), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). An exploratory psychological–sleep composite burden index was constructed by summing standardized depression, anxiety, stress, and global PSQI scores. Multivariable logistic regression models evaluated associations between the composite index and pain‐related TMD, adjusting for age group, sex, and occupational role. Quartile‐based trend and sensitivity analyses were performed. Results Pain‐related TMD was reported by 67 participants (34.7%). Each 1‐SD increase in the composite index showed a positive but borderline association with pain‐related TMD (adjusted OR = 1.36, 95% CI: 1.00–1.86, p = 0.052). In quartile‐based analysis, each higher burden quartile was associated with increased odds of pain‐related TMD (adjusted OR = 1.37, 95% CI: 1.03–1.81, p = 0.030). After excluding headache‐only cases, the quartile‐based association remained significant (adjusted OR = 1.37, 95% CI: 1.02–1.85, p = 0.037). Symptom‐specific analyses showed heterogeneous patterns. Conclusions Higher cumulative psychological–sleep burden was associated with greater odds of pain‐related TMD among hospital healthcare staff, particularly in quartile‐based analyses. These findings support a cautious biopsychosocial interpretation and suggest that psychological distress and sleep quality may be relevant considerations in occupational oral health assessment.