Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults

Figures & data

Table 1. Weighted prevalence (%) of clinical temporomandibular pain (TMD pain) in the Health 2000 survey among men and women by cynical hostility distrust and somatization level categories.

	Clinical^a TMD pain
	Men			Women
	N	%	p^b	N	%	p^b
All	2,860	8.9		3,449	21.2
Cynical distrust hostility score			<.001			<.001
1^st quintile (lowest)	391	5.9		760	17.3
2^nd quintile	405	6.9		532	17.0
3^rd quintile	483	7.3		549	18.7
4^th quintile	646	7.2		619	18.8
5^th quintile (highest)	747	12.1		670	28.1
Somatization level (SCL-90-SOM)			<.001			<.001
Low (≤50^th percentile)	1,568	4.8		1,523	10.4
Moderate (>50^th — ≤70^th percentiles)	588	11.0		786	17.7
High (>70^th percentile)	535	18.7		942	39.4

^aHaving pain on palpation in either masticatory muscles (temporalis or masseter) or temporomandibular joints.

^bChi-Square value.

Table 2. Weighted prevalence (%) of clinical and reported temporomandibular pain (TMD pain) in the Health 2011 survey among men and women by cynical hostility distrust categories.

	Clinical^a TMD pain						Reported^b TMD pain
	Men			Women			Men			Women
	N	%	p^c	N	%	p^c	N	%	p^c	N	%	p^c
All	681	4.3		843	10.6		681	8.2		843	12.7
Cynical distrust hostility level			.362			.210			.478			<.001
1^st quintile (lowest)	93	2.4		138	8.0		93	4.8		138	7.1
2^nd quintile	127	2.6		211	6.9		127	11.2		211	7.5
3^rd quintile	107	7.0		156	13.8		107	8.0		156	6.9
4^th quintile	156	2.2		144	8.4		156	7.2		144	18.3
5^th quintile (highest)	147	3.5		135	12.7		147	6.3		135	22.0

^aHaving pain on palpation in either masticatory muscles (temporalis or masseter) or temporomandibular joints.

^bPositive answer to either of the TMD pain symptoms questions.

^cChi-Square value.

Table 3. Multinomial logistic regression association of cynical hostility score at baseline with temporomandibular pain outcome, compared to no pain in either year, represented in odds ratio (OR) and 95% confidence intervals (95% CI).

Cynical hostility score (continuous)	TMD pain at baseline only	TMD pain in the follow-up only	TMD pain at baseline and in the follow-up
	OR (95%CI)
Unadjusted	1.0 (1.0–1.1)	1.0 (1.0–1.1)	1.1 (1.0–1.2)
Adjusted for age	1.0 (1.0–1.1)	1.0 (1.0–1.1)	1.1 (1.0–1.2)
Adjusted for gender and age	1.1 (1.0–1.1)	1.0 (1.0–1.1)	1.1 (1.0–1.2)
Adjusted for educational level at baseline (age and gender controlled)	1.0 (1. 0–1.1)	1.0 (1.0–1.1)	1.1 (1.0–1. 1)
Adjusted for depressive symptoms* (age and gender controlled)	1.0 (1.0–1.1)	1.0 (0.9–1.0)	1.1 (1.0–1.1)
Adjusted for somatization** (age and gender controlled)	1.0 (1.0–1. 1)	1.0 (0.9–1.0)	1.0 (1.0–1.1)

*Based on Beck’s Depression Inventory 21 score at baseline.

**Based on Symptom Checklist 90 somatization subscale at baseline.

Significant associations in bold.

Table 4. Multinomial logistic regression association of somatization score at baseline with temporomandibular pain outcome, compared to no pain in either year, represented in odds ratio (OR) and 95% confidence intervals (95% CI).

Somatization level (SCL-90-SOM) (continuous)	TMD pain at baseline only	TMD pain in the follow-up only	TMD pain at baseline and in the follow-up
	OR (95%CI)
Unadjusted	3.8 (2.5–5.7)	2.8 (2.0–4.0)	7.1 (4.5–11.2)
Adjusted for age	3.7 (2.4–5.7)	3.0 (2.1–4.4)	7.6 (4.7–12.4)
Adjusted for gender and age controlled	3.4 (2.2–5.2)	2.9 (2.0–4.2)	7.3 (4.4–11.9)
Adjusted for educational level at baseline (age and gender controlled)	3.2 (2.0–5.1)	3.0 (2.0–4.4)	6.0 (3. 6–10.0)
Adjusted for depressive symptoms* (age, gender, and education controlled)	2.7 (1.6–4.5)	2.5 (1.6–3.9)	5.2 (2.9–9.5)
Adjusted for health status (age, gender, and education controlled)	2.4 (1.4–4.1)	2.9 (1.9–4.7)	4.3 (2.3–7.9)

*Based on Beck’s Depression Inventory 21 score at baseline.

Significant associations in bold.

Table 5. Serial mediation model depicting the direct effect of cynical hostility (HOS) at baseline on temporomandibular pain outcome (TMD pain) in 95% confidence intervals (CI), and the indirect effect through the score of Beck’s Depression Inventory 21 (BDI-21) at baseline, the indirect effect through the level of somatization (SOM) at baseline, and the serial indirect effect through BDI-21 then through SOM in bootstrap confidence intervals (CI), all while controlling for gender, age, and educational level.

	Direct HOS—>TMD pain		Indirect HOS—>BDI-21—>TMD pain	Indirect HOS—>SOM—>TMD pain	Indirect HOS—>BDI-21—> SOM—>TMD pain
	Effect (95% CI)	p-value	Effect (Bootstrap CI)	Effect (Bootstrap CI)	Effect (Bootstrap CI)
TMD pain at baseline only	−0.0099 (−0.0810, 0.0613)	.7862	0.0159 (−0.0008, 0.0346)	0.0078 (0.0008, 0.0175)	0.0153 (0.0071, 0.0252)
TMD pain in the follow-up only	−0.0198 (−0.0752, 0.0356)	.4839	0.0090 (−0.0068, 0.0242)	0.0046 (−0.0024, 0.0126)	0.0121 (0.0060, 0.0197)
TMD pain in both baseline and the follow-up	−0.0289 (−0.1149, 0.0571)	.5102	0.0134 (−0.0119, 0.0393)	0.0155 (0.0034, 0.0305)	0.0250 (0.0148, 0.0392)

Significant effects denoted in bold.