# Chain mediation of anxiety and suicidal ideation: a 2021–2025 cross-sectional analysis in Chinese temporomandibular disorders patients

## TL;DR

This study explores how anxiety and quality of life factors influence suicidal thoughts in patients with temporomandibular disorders in China.

## Contribution

The study identifies anxiety and TMD-related quality of life as key mediators of suicidal ideation in TMD patients.

## Key findings

- Anxiety is strongly associated with suicidal ideation in TMD patients.
- Pain and TMD-related quality of life mediate the relationship between anxiety and suicidal ideation.
- Psychological and social aspects of TMD-QoL are significantly linked to suicidal ideation.

## Abstract

Chronic musculoskeletal disorders are risk factors for suicidal ideation (SI). As a musculoskeletal condition, temporomandibular disorders (TMDs) are frequently associated with pain, psychological distress, and reduced quality of life, all of which may contribute to SI. However, the study of SI in TMDs is relatively scarce, and its influencing factors and pathways of impact have not been fully explored. This study aimed to investigate the factors affecting SI and the pathways of its influence.

This cross-sectional study included 934 TMDs patients and collected demographic information, anxiety levels, pain severity, and TMD-related quality of life (TMD-QoL) using questionnaires. Correlation and mediation analyses were conducted to explore their relationships.

Anxiety was associated with SI (OR = 6.74, 95% CI [3.46–13.13], p < 0.001), even after adjustment (OR = 6.70, 95%CI [3.42–13.09], p < 0.001). And multiple domains of the TMD-QoL, such as psychological discomfort (OR = 3.61, 95%CI [2.19–5.96], p < 0.001), social disability (OR = 4.66, 95%CI [2.67–8.13], p < 0.001), were linked to SI. The association between anxiety on SI was mediated by pain (0.11, 95%CI [0.07–0.15], p < 0.001) and impact on TMD-QoL (0.25, 95%CI [0.18–0.32], p < 0.001).

This study underscores the need to incorporate psychological screening into the clinical management of TMDs to identify risk factors for SI. However, this study is limited by its cross-sectional design, which precludes the exploration of causal relationships. Future longitudinal studies are necessary to further validate these pathways.