Insufficient diagnostic accuracy of a single-item questionnaire to detect psychosocial distress in temporomandibular disorder patients

Objectives: Psychosocial assessment needs to be integrated into the diagnosis of chronic pain conditions; however, it is not clear how this assessment should be performed with minimal patient and health care provider burden. The aim of this study was to assess the diagnostic accuracy of a single-item questionnaire to detect psychosocial distress in temporomandibular disorder (TMD) patients. Methods: Presence of psychosocial distress was measured in 126 TMD patients using Research Diagnostic Criteria for TMD Axis II measures (depression, somatization, dysfunctional chronic pain). A newly developed single-item questionnaire served as a test to detect psychosocial distress. The association between the presence of distress and test results was analyzed using generalized linear models (GLM). Diagnostic accuracy of the one-item test was assessed. Results: The GLM revealed a statistically significant association between the presence of psychosocial distress and a positive test result (p < 0.001). Psychosocially distressed patients were 70 % more likely to indicate psychosocial distress in the single-item questionnaire than patients without distress. However, diagnostic test accuracy of the single-item questionnaire was low (sensitivity 73.0 %, specificity 55.7 %). The resulting positive likelihood ratio (1.65) indicated that the single-item test is an inadequate measure for detecting psychosocial distress. Conclusions: The single-item questionnaire was not sufficiently accurate for detecting TMD patients' psychosocial distress and may therefore not be useful as an assessment tool for the various dimensions of psychosocial distress in TMD patients. Clinical relevance: Health care providers should not trust in TMD patients' responses to a single question regarding psychosocial distress. Nevertheless, this questionnaire may constitute a first step into a more profound patient-provider communication on psychological issues relevant to TMD.