Investigation of Depression and Clinical Factors in Adolescent Temporomandibular Disorder Patients with Aging

Investigation of Depression and Clinical Factors in Adolescent Temporomandibular Disorder Patients with Aging | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Investigation of Depression and Clinical Factors in Adolescent Temporomandibular Disorder Patients with Aging Tae-Seok Kim, Yeon-Hee Lee This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4430130/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Temporomandibular disorder (TMD) is a musculoskeletal disorder characterized by functional limitations and pain in the masticatory muscle and the temporomandibular joint. In adolescent, TMD can significantly impact mental health and lead to psychosocial disabilities. This study aims to investigate the correlation between the depression, as assessed by the Symptom-Checklist-90-Revised (SCL-90-R) and clinical factors in adolescent patients with TMD. Methods This study included a total of 185 adolescents (69 males, 116 females, mean age 15.15 ± 2.17) diagnosed with TMD between November 2020 and May 2023. Patients were categorized into three age groups: 46 young adolescents aged 10-13, 78 middle adolescents aged 14-16, and 61 older adolescents aged 17-18. Clinical data were collected from the medical records at the patients’ initial visit. Depression of patients was evaluated with SCL-90-R. Results Depression of adolescent TMD patients exhibited strong correlation with age (rho=0.193, p=0.004). In the adolescent TMD patients, depression scores were significantly associated with stressful conditions (rho=0.347, p<0.0001), sleep problems (rho=0.249, p=0.001), dysfunction index (rho=0.243, p=0.001), presence of tinnitus (rho=0.225, p=0.002), craniomandibular index (rho=0.218, p=0.003), history of trauma (rho=0.207, p=0.005), and habitual irregular diet (rho=0.189, p=0.010). In the generalized linear model, depression exhibited the most significant association with aging (B=2.651, 95% CI: 0.363-4.940), followed by clenching habits (B=1.433, 95% CI: 0.170-2.696), obsessive-compulsiveness (B=0.581, 95% CI: 0.427-0.735), and somatization (B=0.246, 95% CI: 0.047-0.445). In contrast, pain intensity, pain duration, and joint noise were not significantly related with depression in adolescent TMD patients (p>0.05). Also, osteoarthritis in panoramic image was not significantly associated with depression in adolescent TMD patients (p>0.05). Conclusion With the results of this study, clinicians would be able to evaluate the depression state of adolescent TMD patients with concise clinical information. TMD adolescents Symptom-Checklist-90-Revised psychology depression Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Temporomandibular disorder (TMD) is a general term utilized to describe musculoskeletal and neuromuscular diseases of the temporomandibular joint (TMJ), masticatory muscles, and associated structures [ 1 ]. The prevalence of TMD ranges from 5–31% depending on the studies [ 2 ]. The common clinical symptoms of TMD include pain in the TMJ and masticatory muscles, joint noise, headache, and limited mandibular movement [ 3 ]. If left untreated, TMD can result in prolonged chronic pain, leading to dysfunction of the nociceptive nervous system, and expanding the area of pain [ 4 ]. This widespread chronic pain can result in physical dysfunction, psychological distress, and social withdrawal, thereby reducing the quality of life. Hence, for early intervention in TMD, prior studies have focused on the prevention of first-onset TMD by analyzing its potential risk factors [ 5 ]. Among the identified risk factors, psychosocial factors make TMD and chronic pain even more complex and multidimensional. Patients who experience long-lasting chronic pain become psychologically intimidated, and psychological distress can directly result in somatic pain, which causes chronic pain to worsen and last longer [ 6 ]. Additionally, chronic pain and related psychological distress are factors that contribute to the incidence of TMD [ 7 ]. Prolonged chronic pain, TMD, and psychological distress correlate to create a vicious circle of amplified suffering in patients. Meanwhile, prevalence of TMD in adolescents varies widely in the studies from 7–68% [ 8 , 9 ]. In adolescent patients, the psychological effects of TMD and chronic pain are similar to those in the adult patients, which include psychological distress, somatization, or aggressive behavior [ 10 – 12 ]. However, what makes TMD in children and adolescents even more crucial is that they are in the developmental stage. TMD and chronic pain in children and adolescents can cause developmental impairment, and its consequences on psychosocial status can persist into adulthood. Aftereffects caused by the delayed treatment of TMD and chronic pain, including growth disturbance, appearance defects, movement dysfunction, social withdrawal, or even cognitive impairment, can all have psychosocial adverse effects over a long period, or perhaps for their whole life [ 13 – 15 ]. Psychosocial impairment during the developmental stages of children and adolescents is much more likely to result in psychological disorders, poor socialization, and loss of functions necessary for daily life as adults [ 10 ]. And psychological disorders, including fear, anxiety, and maladaptive strategies to cope with pain, can also result in chronic pain, leading to a vicious circle of pain catastrophizing [ 14 ]. Among the psychological disorders, depression is one of the highly incident disorders in adolescents. Depression is defined by serial experience of sad or irritable mood, worthlessness, hopelessness, and accompanied cognitive changes including difficulty in concentrating, memory alteration, and sleep disturbance [ 16 ]. Prevalence of depression in adolescents is steadily increasing: prevalence of major depressive disorder increased from about 1.3% in 2015 to 8% in 2020, and global prevalence of depressive symptoms increased from 24% in 2011 to 37% in 2020 [ 17 ]. Depression in adolescents was investigated as the leading causes of illness and disability by world health organization in 2021, which include suicide, academic difficulties, social maladaptation, and incidence of other mental disorders. [ 17 , 18 ]. Importance of early intervention to adolescent depression has been emphasized in numerous previous studies in order to prevent more severe depression in adulthood. However, interaction between TMD and psychology in adolescents has not been studied well despite to its immense influence to the developmental period of adolescents. This study aims to investigate the relationship between depression that have been surveyed utilizing the Symptom Checklist-90-Revised (SCL-90-R) and pain-related factors in adolescents with TMD. The main hypotheses were as follows: 1) given the higher prevalence of psychological disorders in older adolescents, older adolescent TMD patients will exhibit higher depression score compared to younger adolescent TMD patients; 2) depression score will be correlated with various clinical factors of TMD, including the visual analog scale (VAS) score, onset duration, diagnostic type, TMD index, and parafunctional oral habits. With this study, we will be able to confirm whether the depression of adolescent TMD patients can be predicted utilizing the pain-related factors. Methods Study population and groups This study utilized retrospectively collected data from patients aged between 10 to 18 years who visited the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital between November 2020 and May 2023 due to the TMD-related symptoms. TMD-related symptoms included uncomfortable mouth opening, joint sounds, pain in the head and neck area, limited mouth opening, and headaches. Among the patients, those who completed the psychological examination with the SCL-90-R were included in this analysis. While patients with a history of fracture injury, orofacial surgery, severe degenerative disease that could cause drastic deformity of the orofacial bony structures, severe psychological disorder that could interfere with psychological examination, and incomplete clinical or psychological data were excluded. A total 185 patients (116 female and 69 male patients, mean age 15.15 ± 2.17) were enrolled to the study after the screening procedure. The patients were then divided into three age groups: group 1, young adolescents aged 10–13 years; group 2, middle-aged adolescents aged 14–16 years; and group 3, and older adolescents aged 17–18 years. Clinical data collection Clinical data were collected from the medical records at the patients’ initial visit, where history taking and clinical examinations were conducted by skilled dentists with training in standardized examination protocols. Patient interview was conducted first, during which all patients were asked about subjective pain intensity with VAS, duration of pain, patient history, parafunctional oral habits related with TMD. Patient history and parafunctional oral habits were recorded according to the self-report of patients. Regarding the patient history, patients were asked whether they experienced certain symptoms of not. Regarding the parafunctional oral habits and attributing factors, patients were asked whether they think they have certain habitual behaviors and symptoms or not. All of the patient history, parafunctional oral habits, and attributing factors were recorded dichotomously as yes or no. After the patient interview, palpation and mouth opening examination were conducted according to the guidelines of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). TMD indices were calculated based on the results of the clinical examination, including the palpation index (PI), dysfunction index (DI), and craniomandibular index (CMI). The PI was calculated by adding the number of pain-provoked muscle palpation sites and dividing them by the total number of palpation sites. The DI was calculated by adding the number of positive events related to TMD, including TMJ pain during jaw movement, joint noise, and pain on TMJ palpation, and dividing it by the number of all events. The CMI was the average of the PI and DI [ 19 ]. In addition, panoramic image taking was performed at the first visit of patients. All of the radiographic images were taken by following the imaging criteria of the Department of Oral and Maxillofacial Radiology in Kyung Hee University Dental Hospital, with 70kVp and 12mA of exposure. Two skilled dentists (Y-HL and T-SK) diagnosed the TMJ osteoarthritis (OA) based on panoramic image. OA in panoramic radiography was diagnosed when the indistinct cortical bone outline of TMJ exists, which is described in Fig. 1 . Psychological data collection Depression status of the patients was collected and analyzed utilizing the SCL-90-R checklist. All patients answered 90 questions on the SCL-90 R at the first visit. Patients scored each question from 1 to 5, ranging from not absolutely to extremely. T-scores of the nine psychological subscales and three indices were calculated with results of the questionnaire. The final psychological data of the patients were statistically analyzed with other variables in two ways: by the T-score itself, and by the psychological groups according to the score. The psychological groups were divided into three groups: those with a score under 59 that are normal state, those with a score between 60 and 69 with a tendency for psychological distress, and patients with scores over 70 who certainly have psychological distress [ 20 ]. Statistical analysis Statistical analysis of all data was performed utilizing IBM SPSS Statistics for Windows (version 25.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were utilized to calculate percentages, means, and standard deviations (SDs). One-way analysis of variance test with post hoc analysis for continuous variables and the chi-square test for distributed variables were conducted to compare disparities in variables between age groups. Spearman’s correlation analysis was utilized to calculate the Spearman’s correlation coefficient (rho) and evaluate the monotonic relationship between variables. Linear regression analysis and a generalized linear model were utilized to investigate the correlation between psychological status and clinical factors, with each psychological state as the dependent variable and the clinical factors as independent variables. The correlation coefficient (B), standard error, p-values, and 95% confidence intervals (95% CIs) were investigated. In all statistical analyses, a p-value < 0.05 was considered statistically significant. Ethics approval and consent to participate The procedures for human subjects in this study were conducted according to the ethical standards of the Committee on Human Experimentation of our institution and the 1975 Declaration of Helsinki. This study was approved by the appropriate ethics review board of the Kyung Hee University Dental Hospital (IRB number: KH-DT23016). Results Characteristics of patients and diagnosis of TMD Demographic and clinical characteristics of the patients are presented in Tables 1 and 2, respectively. Mean age and SDs of each age groups are 12.22 ± 0.87 in group 1, 14.99 ± 0.88 in group 2, and 17.57 ± 0.50 in group 3. In all age groups, female accounted for a greater proportion: 34 (73.9%) in age group 1, 47 (60.3%) in age group 2, and 35 (57.4%) in age group 3. Patients in age group 2 and 3 were more likely to experience some clinical symptoms than patients in age group 1, including TMJ pain (83.3% and 78.7% vs. 60.9%, respectively, p=0.015) and jaw stiffness (51.3% and 54.1% vs. 30.4%, respectively, p=0.032). Additionally, frequent parafunctional oral habits and attributing factors for each age group are illustrated in Figure 2. Patients in age group 3 were more likely to have clenching habits than those in age group 1 (57.4% vs. 21.7%, p=0.001). In panoramic image, OA was observed in 48 patients (25.9%). Depression of patients and correlation with age Table 3 and 4 display the psychological states of patients as observed in SCL-90-R results. The average depression score in the SCL-90-R was 40.95 ± 8.38 among all patients. Furthermore, the average depression scores for each age group were 37.54 ± 8.38 in age group 1, 40.71 ± 7.61 in age group 2, and 43.25 ± 9.90 in age group 3 (p=0.004). Figure 3 and 4 illustrates the depression scores across continuous age and age groups. Statistical analysis revealed significant differences in mean depression scores between age group 2 and 1 (40.71 vs 37.54, p=0.004) and between age group 3 and 1 (43.25 vs 37.54, p=0.004), representing the most notable correlation with age group among all symptom scales. Additionally, totally 10 patients (5.4%) scored above 60 for depression, marking the second-highest rate in the study. The prevalence rates of depression in age group 1, 2, and 3 were 2.2%, 6.4%, and 6.6%, respectively. However, the prevalence of depression did not exhibit a significant correlation with age (p>0.05). Correlation between depression and clinical factors The results of Spearman’s correlation analysis between depression and clinical factors are exhibited in Table 5. Figure 5 illustrates the factors that had statistically significant correlation with depression. In adolescent TMD patients, sex was closely related to the depression (rho=0.173, p=0.019). Also in addition to age group, continuous age was correlated with depression (rho=0.193, p=0.008). Pain intensity and pain duration had no significant relationship with depression (p>0.05). In TMD index, depression had strong relationship with DI (rho=0.243, p=0.001) and CMI (rho=0.218, p=0.003). In terms of patient history, depression had statistically significant relationship with history of jaw locking (rho=0.149, p=0.043), tinnitus (rho=0.225, p=0.002), self-reported stress (rho=0.441, p<0.0001), and trauma history (rho=0.207, p=0.005). Regarding the attributing factors, sleep problems had the most significant relation with depression (rho=0.249, p=0.001). Other significantly related attributing factors were including chin buttressing (rho=0.216, p=0.003), irregular diet (rho=0.189, p=0.010), insomnia (rho=0.183, p=0.012), and much talking tendency (rho=0.181, p=0.014). Radiological interpretation of OA showed no statistically significant correlation with depression (p>0.05). Generalized linear model of depression The regression analysis was utilized, particularly with generalized linear models, to predict depression with the investigated factors. Depression was selected as an independent variable, and clinical factors were set as dependent variables. The results of generalized linear model of depression are displayed at Table 6 and Figure 6. In adolescent TMD patients, age group was the factor most closely related to depression, and age group 3 (17-18 years) was significantly related to depression (B=2.651, 95% CI: 0.363-4.940). This was the largest coefficient value in the statistically significant results. Clenching habit also had significant relationship with depression (B=1.433, 95% CI: 0.170-2.696). Other factors that had statistically significant relationship with depression were score of obsessive-compulsive (B=0.581, 95% CI: 0.427-0.735), and score of somatization (B=0.246, 95% CI: 0.047-0.445). Radiological interpretation of OA showed no statistically significant correlation with depression (B=3.170, 95% CI: -9.159-16.578) DISCUSSION In this study, we aimed to investigate the relationship between depression and age, clinical TMD symptoms, attributing factors, and parafunctional oral habits in adolescent TMD patients. Total 5.5% of adolescents exhibited abnormal depression scores in this study. In adolescent TMD patients, older adolescents and female patients were more likely to have depressive symptoms than young adolescents or males, respectively. Intensity and duration of pain had limited relationship with depression. Regarding patient history, tinnitus, self-reported stress, history of limited mouth opening, and presence trauma history had significant relationship with depression. In the attributing factors, sleep problem was the most strongly associated factor with depression, followed by irregular diet, chin buttressing, and tendency of much talking. In adolescent TMD patients, depression had significant relationship with age. This tendency for depression in adolescents to increase in proportion to age is a unique feature of psychological disorders in children and adolescents, as it has been proven that depressive disorder is age-independent when comprehensively considered across all ages [21]. In South Korea, the prevalence rate of psychological disorders was reported to often differ between middle school and high school students, which were age groups 2 and 3 in this study [22]. This might be as a result of the change in the proportions of externalizing and internalizing problem behaviors. According to Lee and Jeong, the tendency of externalizing and internalizing problem behaviors is significantly different between middle and high school students in South Korea [22]. Externalizing problem behaviors include aggressive behavior, juvenile delinquency, and violence, whereas internalizing problem behaviors include anxiety, depressive mood, and suicidal ideation. Externalizing problem behaviors exhibited a gradual increase until the third grade of middle school, followed by a gradual decrease during the high school period. In contrast, internalizing problem behaviors showed no significant difference between the middle school and high school periods. The internalization of psychological distress in high school students elucidates the correlation observed between age group 3 and depression in this study, all of which are classified as internalizing problem behaviors. However, studies about correlation between age and depression in adolescent are still lacking, and further studies would be needed to confirm this correlation globally. Regarding the clinical factors, CMI had a statistically significant correlation with depression in adolescent TMD patients. CMI was developed for standardized evaluation of TMD symptoms and its reliability has been proved for a long time [19]. CMI can effectively reflect the severity of symptoms, and thus, CMI also shows correlations with several factors related to TMD. For example, Kim et al reported that CMI had significant correlations with the psychological state observed at SCL-90-R and Minnesota Multiphasic Personality Inventory in adult TMD patients [23]. In the study of Kim et al , CMI of adult TMD patients had correlation with somatization, anxiety and phobic anxiety of SCL-90-R. And as an extension of the previous study, this study successfully proved that the association between psychological state and CMI can also be applied to adolescent TMD patients. In this study, depression in adolescent TMD patients had large number of history and oral habits of patients, including tinnitus, self-reported stress, trauma history, chin buttressing, irregular diet, sleep problems, and clenching. Among these, clenching habit were significantly associated with depression in generalized linear model. One of the possible cause of clenching habit in adolescents is neurodevelopmental disorders, which is closely related to psychological state of adolescents [24, 25]. Neurodevelopmental disorders can cause impairments in social and executive functioning, and can act as stressors for adolescents [26]. Conversely, children and adolescents who are constantly exposed to stressful environments or have mood disorders have an increased risk of neurodevelopmental disorders [27]. Regarding psychological aspects, Endo et al reported that patients with a habit of clenching had more psychological distress than those without clenching [28]. Therefore, clenching, psychological distress, and neurodevelopmental disorders are closely related, and their correlation is also applicable to adolescents with TMD. Irregular diet was closely related to depression in adolescent TMD patients in this study. Prior studies have reported that dietary habits are a behavioral risk factor for mental health disorders in adolescents [29-31]. An inappropriate diet can cause a deficiency of certain nutrients implicated in brain function, which can affect depression risk through impaired neurological pathways, pain control, or emotional regulation [32]. Among the inappropriate diet, habitual irregular diet can result in several comorbidities that are closely related to the development of psychological disorders [33-36]. Additionally, maintaining a regular diet is a type of social rhythm, which is a series of habitual daily behaviors that can modulate the biological clock [37]. Collapsed social rhythms can result in social withdrawal and depressive mood, and patients with depression often have insufficient ability to recover and perform daily functions after disrupting life events, leading to serial collapse of other daily functions [38]. And one of the results of disrupted daily functions in adolescents is sleep problems [39, 40], which were also were significantly related to depression in adolescent TMD patients in this study. In adolescents, sleep conditions are directly related to brain development, and shifts in sleep behavior can change the developmental pattern of brain matter, leading to impaired functional outcomes in several domains including learning ability, memory, social adaptation, emotional regulation, risk-taking, and motivation [41-43]. Thus, sleep and diet are sharing a similar role in depression of adolescents, acting as important factors on maintaining daily social rhythms, encouraging brain development, and regulating emotions. Although prior studies posit that the association between depression, diet, and sleep is not universal [44, 45], the influence of inappropriate diet and sleep disturbance on depression seems to exist in adolescent patients with TMD, at least in this study. Tinnitus was highly associated with depression in adolescent TMD patients. The prevalence of tinnitus in TMD patients was approximately 30%, which is approximately eight times higher than that in patients without TMD [46, 47]. Continuous tinnitus can affect quality of life and cause distress in patients, which make TMD patients vulnerable to psychological distress. Continuous somatosensory information of tinnitus in cervical and temporomandibular area is transferred to the brain through the dorsal root ganglion or trigeminal ganglion, which can have the same role as chronic pain of orofacial area and therefore directly result in psychological distress [48]. However, despite the close relationship between tinnitus and psychological disorders, tinnitus and depression in adolescent patients has not been well studied. Since tinnitus in adolescent patients with TMD was related to depression in this study, further studies are needed to investigate the detailed mechanism of the interaction between tinnitus, psychological distress, and TMD in adolescents. Trauma history had a significant relationship with depression of adolescent TMD patients. In a previous study, Lee et al reported that the trauma history of adolescent patients with TMD had a significant relationship with the psychological state of the SCL-90-R, including somatization, obsessive compulsiveness, hostility, phobic anxiety, and psychoticism, regardless of structural disorders [49]. Trauma in adolescents has long been considered crucial because of its influence on long-term quality of life. As in adults, trauma in adolescents can cause both physical and psychological damage; however, the aftereffects of damage tend to last longer in adolescents than in adults and extend to a wider range, including general health, developmental, psychological, and behavioral outcomes [50, 51]. In contrast, pain intensity and pain duration were not significantly related with depression of adolescent TMD patients in this study. Regarding to the pain and depression of adolescents, Rabbitts et al reported that emotional health of adolescent was highly associated with the total pain area rather than pain intensity [10]. Therefore, it can be inferred that pain duration might affect to depression only when the long-lasted pain caused widespread pain of adolescents. In this study, detailed pain sites of patients were not included in statistical analysis. Further studies would be needed to investigate the correlation between pain duration, total number of pain sites, and depression of adolescent TMD patients. In this study, TMJ OA in panoramic images was not significantly associated with depression of adolescent TMD patients. Generally, depression is common in patient with osteoarthritis, and patients with TMJ OA are likely to have higher levels of depression than patient with non-painful TMD [52]. The contradictory result of this study might be due to the followings; diagnostic inaccuracy and impacted of details symptoms of OA. This study utilized panoramic radiography to diagnose OA due to its convenience for clinicians, but panoramic radiography was proven to have limited diagnostic accuracy in detecting OA, and thus OA diagnosis of this study might have diagnostic error [53]. Also, correlation between OA and depression was due to the accompanying symptoms of OA including pain, functional disability and joint sound [54]. However, asymptomatic OA even with radiological evidence of joint damage is common in adolescents [55]. Since this study didn’t distinguish asymptomatic OA in analysis, its impact on OA, its impact on depression might be less than expected Further studies would be needed with improved diagnostic methods, and detailed analysis including accompanying symptoms of OA. Despite the significance of this study, several limitations should be acknowledged. Primarily, it was a retrospective study, and patient data were collected and analyzed only at specific intervals. Consequently, the study design couldn't capture real-time changes in variables or attributing factors of TMD and depression, potentially leading to fragmentation of patient status and correlations. Furthermore, the sample was derived solely from a single dental clinic, raising concerns about potential biases. Nevertheless, to our knowledge, no previous studies have comprehensively investigated the correlation between depression and clinical factors in adolescent TMD patients. Further prospective cohort studies with a more diverse sample pool and extended follow-up periods are necessary to validate our findings and delve into the detailed causal relationships. Conclusion In this study, we hypothesized that older adolescents (aged 17-18) with TMD would exhibit higher scores in depression compared to younger adolescents (aged 10-13) with TMD. We also anticipated that depression would correlate with certain clinical factors of TMD, including VAS, pain duration, TMD index, patient history, attributing factors, and parafunctional oral habits. Results indicated that score of depression was significantly higher in older adolescent TMD patients than younger adolescents. Furthermore, several clinical factors of TMD displayed significant correlations with the depression of adolescent TMD patients. These factors encompassed sex, DI, CMI, tinnitus, self-reported stress, irregular diet, trauma history, clenching habits, and sleep problems. These findings offer valuable insights for clinicians, enabling them to promptly and effectively evaluate depression in adolescents with TMD. Abbreviations Temporomandibular disorder (TMD) Temporomandibular joint (TMJ) Symptom checklist-90-revised (SCL-90-R) Visual analog scale (VAS) Diagnostic criteria for temporomandibular disorders (DC/TMD) Palpation index (PI) Dysfunction index (DI) Craniomandibular index (CMI) Osteoarthritis (OA) Standard deviations (SDs) Spearman’s correlation coefficient (rho) Correlation coefficient (B) 95% confidence intervals (95% CIs) Declarations Ethics approval and consent to participate This research was approved by the Institutional Review Board of the Kyung Hee University Dental Hospital (IRB no. KH-DT23016). Informed consent was obtained from all participants in the study. Consent for publication All authors consented to the publication of this manuscript. Availability of data and materials The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request. Competing interests: No potential conflict of interest relevant to this article was reported. Funding: None. Authors' contributions: Writing and original draft preparation, Y-HL and T-SK; conceptualization, Y-HL; methodology, Y-HL and T-SK; software, Y-HL and T-SK; validation and formal analysis, Y-HL; investigation, Y-HL and T-SK; resources, Y-HL and T-SK; data curation, Y-HL and T-SK; writing, review, and editing, Y-HL and T-SK; visualization, Y-HL and T-SK; supervision, Y-HL; project administration, Y-HL. All authors contributed to and approved the submitted manuscript. Acknowledgements: The authors extend their special thanks to Jung-Pyo Hong of the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital and Sung-Woo Lee of the Department of Oral Medicine and Oral Diagnosis at Seoul National University. Authors' information Tae-Seok Kim, Master's Student. Department of Dentistry, Graduate School, Kyung Hee University, #26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea; [email protected] Yeon-Hee Lee, DDS, PhD. Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea; [email protected] References Okeson JP. Management of Temporomandibular Disorders and Occlusion. 8 ed. Elsevier Health Sciences; 2019. Valesan LF, Da-Cas CD, Reus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(2):441–53. 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Trauma in adolescents causes long-term marked deficits in quality of life: adolescent children do not recover preinjury quality of life or function up to two years postinjury compared to national norms. J Trauma. 2007;62(3):577–83. discussion 83. Yap AU, Tan KB, Chua EK, Tan HH. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent. 2002;88(5):479–84. Im YG, Lee JS, Park JI, Lim HS, Kim BG, Kim JH. Diagnostic accuracy and reliability of panoramic temporomandibular joint (TMJ) radiography to detect bony lesions in patients with TMJ osteoarthritis. J Dent Sci. 2018;13(4):396–404. Lin EH. Depression and osteoarthritis. Am J Med. 2008;121(11 Suppl 2):S16–9. Schmidt C, Ertel T, Arbogast M, Hugle B, Kalle TV, Neff A. Collaborators. The Diagnosis and Treatment of Rheumatoid and Juvenile Idiopathic Arthritis of the Temporomandibular Joint. Dtsch Arztebl Int. 2022;119(4):47–54. Tables Table 1 Demographics and clinical characteristics of patients. Factors Age group 1: Young adolescents (n = 46) Mean ± SD or N (%) Age group 2: Middle adolescents (n = 78) Mean ± SD or N (%) Age group 3: Older adolescents (n = 61) Mean ± SD or N (%) P-value Post hoc Mean age (year) † 12.22 ± 0.87 14.99 ± 0.88 17.57 ± 0.50 0.000*** 1 < 2 < 3 Female ‡ 34 (73.9%) 47 (60.3%) 35 (57.4%) 0.182 - Clinical examination results VAS † 2.76 ± 2.15 3.19 ± 2.14 3.48 ± 2.31 0.253 - Onset (month) † 8.63 ± 13.99 13.42 ± 15.01 13.48 ± 18.51 0.212 - CMO (mm) † 33.41 ± 9.08 31.68 ± 10.79 34.55 ± 9.13 0.232 - MMO (mm) † 41.89 ± 7.54 40.63 ± 11.36 42.13 ± 8.18 0.615 - MAO (mm) † 43.73 ± 9.83 42.09 ± 13.47 45.63 ± 8.89 0.191 - Locking (CMO < 35mm) ‡ 24 (52.2%) 45 (57.7%) 31 (50.8%) 0.695 - TMD index † PI 0.21 ± 0.34 0.14 ± 0.25 0.22 ± 0.36 0.266 - DI 0.22 ± 0.39 0.29 ± 0.50 0.25 ± 0.46 0.682 - CMI 0.21 ± 0.30 0.22 ± 0.32 0.24 ± 0.32 0.903 - Patient history ‡ TMJ noise 37 (80.4%) 63 (80.8%) 46 (75.4%) 0.546 - TMJ pain 28 (60.9%) 65 (83.3%) 48 (78.7%) 0.015* 1 < 2 Stiffness 14 (30.4%) 40 (51.3%) 33 (54.1%) 0.032* 1 < 3 Locking 26 (26.5%) 49 (62.8%) 39 (63.9%) 0.708 - Tinnitus 8 (17.4%) 16 (20.5%) 13 (21.3%) 0.693 - Orthodontic experience 13 (28.3%) 12 (15.4%) 22 (36.1%) 0.053 - Uncomfortable occlusion 7 (15.2%) 22 (28.2%) 11 (18.0%) 0.194 - Stress 12 (26.1%) 22 (28.2%) 23 (37.7%) 0.444 - Family history 11 (23.9%) 11 (14.1%) 11 (18.0%) 0.403 - Trauma history 5 (10.9%) 4 (5.1%) 4 (6.5%) 0.412 - Abnormal occlusion 3 (6.5%) 7 (9.0%) 5 (8.2%) 0.662 - Radiographic features ‡ Osteoarthritis in panoramic image 17 (37.0%) 20 (25.6%) 11 (18.0%) 0.407 - † One-way analysis of variance test was used to determine significant mean differences between three age groups. ‡ chi -square test was used to determine whether there was significant difference in distribution between three age groups. P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Statistically significant results are shown in bold text. SD: standard deviation; VAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; TMD: temporomandibular disorders; PI: palpation index; DI: dysfunction index; CMI: craniomandibular index; TMJ: temporomandibular joint; 1: age group 1 (aged 10–13); 2: age group 2 (aged 14–16); 3: age group 3 (aged 17–18) Table 2 Distribution of parafunctional oral habits of patients. Factors Age group 1: Young adolescents (n = 46) N (%) Age group 2: Middle adolescents (n = 78) N (%) Age group 3: Older adolescents (n = 61) N (%) P-value Post hoc Bruxism 19 (41.3%) 22 (28.2%) 19 (31.1%) 0.311 - Clenching 10 (21.7%) 27 (34.6%) 35 (57.4%) 0.001** 1 < 3, 2 < 3 Perioral contraction 4 (8.7%) 4 (5.1%) 3 (4.9%) 0.660 - Tongue thrusting 2 (4.3%) 4 (5.1%) 0 (0.0%) 0.212 - Bite something 7 (15.2%) 16 (20.5%) 9 (14.8%) 0.613 - Chin buttressing 6 (13.0%) 20 (25.6%) 18 (29.5%) 0.124 - Unilateral chewing 14 (30.4%) 33 (42.3%) 22 (36.1%) 0.406 - Hard food 11 (23.9%) 17 (21.8%) 14 (23.0%) 0.962 - Irregular diet 5 (10.9%) 17 (21.8%) 10 (16.4%) 0.291 - Indigestion 7 (15.2%) 10 (12.8%) 16 (26.2%) 0.106 - Coffee 6 (13.0%) 17 (21.8%) 15 (24.6%) 0.321 - Sleep problems 2 (4.3%) 7 (9.0%) 8 (13.1%) 0.298 - Insomnia 0 (0.0%) 6 (7.7%) 2 (3.3%) 0.112 - Bad posture 15 (32.6%) 35 (44.9%) 29 (47.5%) 0.266 - Much talking 5 (10.9%) 13 (16.7%) 14 (23.0%) 0.258 - chi -square test was used to determine whether there was significant difference in distribution between three age groups. P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Statistically significant results are shown in bold text. 1: age group 1 (aged 10–13); 2: age group 2 (aged 14–16); 3: age group 3 (aged 17–18) Table 3 SCL-90-R scores of patients. Factors Age group 1: Young adolescents (n = 46) Mean ± SD Age group 2: Middle adolescents (n = 78) Mean ± SD Age group 3: Older adolescents (n = 61) Mean ± SD P-value Post hoc Depression 37.54 ± 8.38 40.71 ± 7.61 43.25 ± 9.90 0.004** 1 < 2, 1 < 3 Somatization 40.37 ± 5.92 42.31 ± 6.59 44.00 ± 9.09 0.043* 1 < 3 Obsessive-compulsive 39.74 ± 8.29 41.73 ± 8.62 43.07 ± 10.47 0.182 - Interpersonal sensitivity 41.07 ± 7.49 43.91 ± 8.62 44.16 ± 10.12 0.149 - Anxiety 40.57 ± 6.24 41.59 ± 6.14 42.92 ± 7.32 0.180 - Hostility 42.80 ± 6.46 43.17 ± 5.33 44.57 ± 7.36 0.287 - Phobic anxiety 43.04 ± 4.45 44.90 ± 6.42 45.10 ± 7.77 0.213 - Paranoid ideation 40.83 ± 6.31 42.68 ± 6.37 44.39 ± 10.44 0.073 - Psychoticism 40.67 ± 4.55 42.38 ± 6.64 43.87 ± 7.21 0.040* 1 < 3 GSI 38.52 ± 6.41 40.76 ± 7.05 42.61 ± 9.28 0.027* 1 < 3 PDSI 43.63 ± 6.96 46.37 ± 9.17 46.72 ± 9.02 0.142 - PST 34.72 ± 8.59 37.64 ± 8.79 39.23 ± 10.90 0.053 - One-way analysis of variance test was used to determine significant mean differences between three age groups. P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Statistically significant results are shown in bold text. SD: standard deviation; SCL-90-R: symptom checklist 90 revised; GSI: global severity index; PSDI: positive symptom distress index; PST: positive symptom total; 1: age group 1 (aged 10–13); 2: age group 2 (aged 14–16); 3: age group 3 (aged 17–18) Table 4 SCL-90-R score groups of patients. T-score Age group 1: Young adolescents (n = 46) N (%) Age group 2: Middle adolescents (n = 78) N (%) Age group 3: Older adolescents (n = 61) N (%) P-value Post hoc Depression T-score 60 to 69 1 (2.2%) 5 (6.4%) 3 (4.9%) 0.530 - T-score over 70 0 (0.0%) 0 (0.0%) 1 (1.6%) 0.530 - Somatization T-score 60 to 69 1 (2.2%) 3 (3.8%) 2 (3.3%) 0.358 - T-score over 70 0 (0.0%) 0 (0.0%) 2 (3.3%) 0.358 - Obsessive-compulsive T-score 60 to 69 1 (2.2%) 4 (5.1%) 3 (4.9%) 0.306 - T-score over 70 0 (0.0%) 0 (0.0%) 2 (3.3%) 0.306 - Interpersonal sensitivity T-score 60 to 69 1 (2.2%) 3 (3.8%) 4 (6.6%) 0.642 - T-score over 70 0 (0.0%) 2 (2.6%) 1 (1.6%) 0.642 - Anxiety T-score 60 to 69 1 (2.2%) 1 (1.3%) 3 (4.9%) 0.409 - T-score over 70 0 (0.0%) 0 (0.0%) 0 (0.0%) 0.409 - Hostility T-score 60 to 69 3 (6.5%) 1 (1.3%) 4 (6.6%) 0.221 - T-score over 70 0 (0.0%) 0 (0.0%) 0 (0.0%) 0.221 - Phobic anxiety T-score 60 to 69 0 (0.0%) 1 (1.3%) 2 (3.3%) 0.435 - T-score over 70 0 (0.0%) 1 (1.3%) 2 (3.3%) 0.435 - Paranoid ideation T-score 60 to 69 0 (0.0%) 2 (2.6%) 4 (6.6%) 0.254 - T-score over 70 1 (2.2%) 0 (0.0%) 1 (1.6%) 0.254 - Psychoticism T-score 60 to 69 1 (2.2%) 1 (1.3%) 4 (6.6%) 0.331 - T-score over 70 0 (0.0%) 1 (1.3%) 0 (0.0%) 0.331 - P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. SCL-90-R: symptom checklist 90 revised Table 5 Correlation between depression score and clinical factors Factors Correlation with depression rho P-value Demographics Female 0.173 0.019* Age 0.193 0.008** Age group 0.225 0.002** Clinical factors VAS 0.105 0.153 Onset -0.026 0.728 CMO -0.035 0.638 MMO -0.055 0.460 MAO -0.050 0.499 PI 0.132 0.072 DI 0.243 0.001** CMI 0.218 0.003** Patient history TMJ noise 0.001 0.991 TMJ pain 0.067 0.361 Stiffness 0.077 0.299 Locking 0.149 0.043* Tinnitus 0.225 0.002** Orthodontic experience -0.053 0.475 Uncomfortable occlusion -0.032 0.662 Stress 0.347 0.000*** Family history 0.020 0.788 Trauma history 0.207 0.005** Abnormal occlusion 0.035 0.633 Parafunctional oral habits and attributing factors Bruxism 0.010 0.892 Clenching 0.122 0.097 Perioral contraction 0.011 0.882 Tongue thrusting 0.002 0.975 Bite something 0.092 0.212 Chin buttressing 0.216 0.003** Unilateral chewing 0.044 0.549 Hard food 0.083 0.261 Irregular diet 0.189 0.010* Indigestion 0.139 0.059 Coffee 0.086 0.243 Sleep problems 0.249 0.001** Insomnia 0.183 0.012* Bad posture 0.089 0.231 Much talking 0.181 0.014* Radiologic features Osteoarthritis in panoramic image -0.049 0.508 P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Statistically significant results are shown in bold text VAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; PI: palpation index; DI: dysfunction index; CMI: craniomandibular index; TMJ: temporomandibular joint Table 6 Generalized linear model of depression Factors B (95% CI) P-value Gender Male 0 Female 0.783 (-2.109–3.676) 0.596 Age group Age group 1 (aged 10–13) 0 Age group 2 (aged 14–16) 1.064 (-0.218–2.347) 0.104 Age group 3 (aged 17–18) 2.651 (0.363–4.940) 0.023* VAS 0.150 (-0.238–0.539) 0.449 Onset -0.027 (-0.084–0.031) 0.367 CMO -0.016 (-0.205–0.174) 0.870 MMO 0.039 (-0.137–0.215) 0.665 MAO -0.077 (-0.215–0.061) 0.276 TMD index CMI 0 CI 0.835 (-0.337–2.007) 0.163 PI 3.287 (-0.019–6.593) 0.051 TMJ noise No 0 Yes 0.493 (-2.942–3.929) 0.778 TMJ pain No 0 Yes -0.938 (-4.099–2.223) 0.561 Stiffness No 0 Yes 0.886 (-1.545–3.317) 0.475 Locking No 0 Yes -0.447 (-3.167–2.273) 0.748 Tinnitus No 0 Yes -0.816 (-4.466–2.834) 0.661 Orthodontic experience No 0 Yes 0.158 (-2.363–2.680) 0.902 Abnormal occlusion No 0 Yes -0.072 (-3.125–2.982) 0.963 Stress No 0 Yes 0.676 (-2.066–3.417) 0.629 Family history No 0 Yes 0.142 (-2.554–2.838) 0.918 Trauma history No 0 Yes 3.833 (-1.089–8.755) 0.127 Bruxism No 0 Yes 0.278 (-2.011–2.567) 0.812 Clenching No 0 Yes 1.433 (0.170–2.696) 0.026* SCL-90-R (T-scores) Somatization 0.246 (0.047–0.445) 0.016* Obsessive-compulsive 0.581 (0.427–0.735) 0.000*** Interpersonal sensitivity -0.037 (-0.214–0.139) 0.678 Anxiety 0.059 (-0.115–0.233) 0.506 Hostility 0.149 (-0.027–0.325) 0.097 Phobic anxiety -0.085 (-0.233–0.063) 0.259 Paranoid ideation 0.060 (-0.152–0.272) 0.578 Psychoticism 0.072 (-0.112–0.257) 0.443 P-value significance was set at < 0.05. *p-value < 0.05, **p-value < 0.01, ***p-value < 0.001. Statistically significant results are shown in bold text. CI: confidence interval; VAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; TMD: temporomandibular disorders; CMI: craniomandibular index; DI: dysfunction index; PI: palpation index; TMJ: temporomandibular joint; SCL-90-R: symptom checklist 90-revised Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4430130","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":306186503,"identity":"c8912d9a-012f-422a-bae1-3eb9bb77d403","order_by":0,"name":"Tae-Seok Kim","email":"","orcid":"","institution":"Kyung Hee University","correspondingAuthor":false,"prefix":"","firstName":"Tae-Seok","middleName":"","lastName":"Kim","suffix":""},{"id":306186504,"identity":"0f6e65eb-953b-48e5-91a9-1bf7e40317b3","order_by":1,"name":"Yeon-Hee Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYJACiYQKCTl+ECuhgFgtH87YGEs2gLQYEKlFcmZbWuKGAyAmMVr4xQ4fvM3Ddjhx8/nViR8eGDDI84sdIGDD7LRkax6ew8bbbrzdLAF0mOHM2Qn4tRjczjGT5pE4LLvtxtkNIC0JBreJ0mJwmHHzjLObfxCtRXJGQpriBv7ebcTZAvKLxYcDNsYSN3i3WSQYSBD2C7908sEbif+AUdl/dvPNHxU28vzSBLQggARYpQSxysH2HSBF9SgYBaNgFIwkAABmBkY6UviVWwAAAABJRU5ErkJggg==","orcid":"","institution":"Kyung Hee University Dental Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yeon-Hee","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2024-05-16 09:48:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4430130/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4430130/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57949600,"identity":"4f5c2058-1bcb-4823-820e-b78a75acf59b","added_by":"auto","created_at":"2024-06-07 20:46:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1323220,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOsteoarthritis (OA) of temporomandibular joint (TMJ) in panoramic images.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Example for interpretation of panoramic image of patient. Patient is male, and belongs to the age group 3 (aged 17-18). Both TMJs (yellow circles) were focused to diagnose osteoarthritis of temporomandibular joint.\u003c/p\u003e\n\u003cp\u003e(B) Normal TMJ (yellow arrows). Patient is male, and belongs to the age group 3 (aged 17-18). Distinct cortical bone outline of TMJ was observed.\u003c/p\u003e\n\u003cp\u003e(C) OA of TMJ (yellow arrows). Patient is female, and belongs to the age group 2 (aged 14-16). Indistinct cortical bone outline was observed.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/936c04c52348c4442ebe8c51.png"},{"id":57949601,"identity":"cec0cfb3-57f2-4584-af0c-7c0f87e15b79","added_by":"auto","created_at":"2024-06-07 20:46:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":209641,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFrequent parafunctional oral habits and attributing factors for each age group.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Age group 1 (aged 10-13), (B) Age group 2 (aged 14-16), and (C) Age group 3 (aged 17-18).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/8be3565923589dcb61160aea.png"},{"id":57948901,"identity":"6a911aa2-6cdd-4298-b450-8790f630c3fc","added_by":"auto","created_at":"2024-06-07 20:38:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":141593,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of depression score according to age.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/427244dfe6887bce36b520ac.png"},{"id":57948906,"identity":"056bebc8-9ea1-41be-a9d1-fea334bdb91f","added_by":"auto","created_at":"2024-06-07 20:38:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":86721,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of depression score according to age groups.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP-value significance was set at \u0026lt;0.05. *p-value \u0026lt; 0.05, **p-value \u0026lt; 0.01.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/4e3e5216dccf8a093267bced.png"},{"id":57948904,"identity":"80596016-b7c0-4f54-9852-66eaefab592e","added_by":"auto","created_at":"2024-06-07 20:38:58","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":326568,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFactors that had statistically significant correlation with depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCMI: craniomandibular index; DI: dysfunction index\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/d0e5f17e46c7ba7810c0d441.png"},{"id":57949602,"identity":"fd739a22-34f6-497e-bbf7-a8ba5bbac6ed","added_by":"auto","created_at":"2024-06-07 20:46:58","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":42635,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeneralized linear model of depression.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistically significant result was set at p-value\u0026lt;0.05. From the linear logistic regression analysis, the beta coefficient is the score of depression (dependent variable) for every 1 unit change of the predictor variable (independent variable). The diamond and square shows the mean of beta coefficient. If zero (0) is included in the beta coefficient range, it is not a significant result. Thus, the diamond shows the significant result, and the square shows insignificant result. O-C: obsessive-compulsive; SOM: somatization; VAS: visual analog scale; DI: dysfunction index; PI: palpation index; TMJ: temporomandibular joint; OA: osteoarthritis; I-S: interpersonal\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/d36b40e1125cb07448062035.png"},{"id":58266594,"identity":"bcc5dd8d-5cd8-44a5-9d5b-852602999aed","added_by":"auto","created_at":"2024-06-13 07:29:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3256845,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4430130/v1/7db6b113-a1eb-43d0-a3f2-3eddd66524fd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigation of Depression and Clinical Factors in Adolescent Temporomandibular Disorder Patients with Aging","fulltext":[{"header":"Background","content":"\u003cp\u003eTemporomandibular disorder (TMD) is a general term utilized to describe musculoskeletal and neuromuscular diseases of the temporomandibular joint (TMJ), masticatory muscles, and associated structures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The prevalence of TMD ranges from 5\u0026ndash;31% depending on the studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The common clinical symptoms of TMD include pain in the TMJ and masticatory muscles, joint noise, headache, and limited mandibular movement [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. If left untreated, TMD can result in prolonged chronic pain, leading to dysfunction of the nociceptive nervous system, and expanding the area of pain [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This widespread chronic pain can result in physical dysfunction, psychological distress, and social withdrawal, thereby reducing the quality of life. Hence, for early intervention in TMD, prior studies have focused on the prevention of first-onset TMD by analyzing its potential risk factors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the identified risk factors, psychosocial factors make TMD and chronic pain even more complex and multidimensional. Patients who experience long-lasting chronic pain become psychologically intimidated, and psychological distress can directly result in somatic pain, which causes chronic pain to worsen and last longer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, chronic pain and related psychological distress are factors that contribute to the incidence of TMD [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Prolonged chronic pain, TMD, and psychological distress correlate to create a vicious circle of amplified suffering in patients.\u003c/p\u003e \u003cp\u003eMeanwhile, prevalence of TMD in adolescents varies widely in the studies from 7\u0026ndash;68% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In adolescent patients, the psychological effects of TMD and chronic pain are similar to those in the adult patients, which include psychological distress, somatization, or aggressive behavior [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, what makes TMD in children and adolescents even more crucial is that they are in the developmental stage. TMD and chronic pain in children and adolescents can cause developmental impairment, and its consequences on psychosocial status can persist into adulthood. Aftereffects caused by the delayed treatment of TMD and chronic pain, including growth disturbance, appearance defects, movement dysfunction, social withdrawal, or even cognitive impairment, can all have psychosocial adverse effects over a long period, or perhaps for their whole life [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Psychosocial impairment during the developmental stages of children and adolescents is much more likely to result in psychological disorders, poor socialization, and loss of functions necessary for daily life as adults [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. And psychological disorders, including fear, anxiety, and maladaptive strategies to cope with pain, can also result in chronic pain, leading to a vicious circle of pain catastrophizing [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the psychological disorders, depression is one of the highly incident disorders in adolescents. Depression is defined by serial experience of sad or irritable mood, worthlessness, hopelessness, and accompanied cognitive changes including difficulty in concentrating, memory alteration, and sleep disturbance [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Prevalence of depression in adolescents is steadily increasing: prevalence of major depressive disorder increased from about 1.3% in 2015 to 8% in 2020, and global prevalence of depressive symptoms increased from 24% in 2011 to 37% in 2020 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Depression in adolescents was investigated as the leading causes of illness and disability by world health organization in 2021, which include suicide, academic difficulties, social maladaptation, and incidence of other mental disorders. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Importance of early intervention to adolescent depression has been emphasized in numerous previous studies in order to prevent more severe depression in adulthood.\u003c/p\u003e \u003cp\u003eHowever, interaction between TMD and psychology in adolescents has not been studied well despite to its immense influence to the developmental period of adolescents. This study aims to investigate the relationship between depression that have been surveyed utilizing the Symptom Checklist-90-Revised (SCL-90-R) and pain-related factors in adolescents with TMD. The main hypotheses were as follows: 1) given the higher prevalence of psychological disorders in older adolescents, older adolescent TMD patients will exhibit higher depression score compared to younger adolescent TMD patients; 2) depression score will be correlated with various clinical factors of TMD, including the visual analog scale (VAS) score, onset duration, diagnostic type, TMD index, and parafunctional oral habits. With this study, we will be able to confirm whether the depression of adolescent TMD patients can be predicted utilizing the pain-related factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and groups\u003c/h2\u003e \u003cp\u003eThis study utilized retrospectively collected data from patients aged between 10 to 18 years who visited the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital between November 2020 and May 2023 due to the TMD-related symptoms. TMD-related symptoms included uncomfortable mouth opening, joint sounds, pain in the head and neck area, limited mouth opening, and headaches. Among the patients, those who completed the psychological examination with the SCL-90-R were included in this analysis. While patients with a history of fracture injury, orofacial surgery, severe degenerative disease that could cause drastic deformity of the orofacial bony structures, severe psychological disorder that could interfere with psychological examination, and incomplete clinical or psychological data were excluded.\u003c/p\u003e \u003cp\u003eA total 185 patients (116 female and 69 male patients, mean age 15.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.17) were enrolled to the study after the screening procedure. The patients were then divided into three age groups: group 1, young adolescents aged 10\u0026ndash;13 years; group 2, middle-aged adolescents aged 14\u0026ndash;16 years; and group 3, and older adolescents aged 17\u0026ndash;18 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eClinical data collection\u003c/h2\u003e \u003cp\u003eClinical data were collected from the medical records at the patients\u0026rsquo; initial visit, where history taking and clinical examinations were conducted by skilled dentists with training in standardized examination protocols. Patient interview was conducted first, during which all patients were asked about subjective pain intensity with VAS, duration of pain, patient history, parafunctional oral habits related with TMD. Patient history and parafunctional oral habits were recorded according to the self-report of patients. Regarding the patient history, patients were asked whether they experienced certain symptoms of not. Regarding the parafunctional oral habits and attributing factors, patients were asked whether they think they have certain habitual behaviors and symptoms or not. All of the patient history, parafunctional oral habits, and attributing factors were recorded dichotomously as yes or no. After the patient interview, palpation and mouth opening examination were conducted according to the guidelines of Diagnostic Criteria for Temporomandibular Disorders (DC/TMD).\u003c/p\u003e \u003cp\u003eTMD indices were calculated based on the results of the clinical examination, including the palpation index (PI), dysfunction index (DI), and craniomandibular index (CMI). The PI was calculated by adding the number of pain-provoked muscle palpation sites and dividing them by the total number of palpation sites. The DI was calculated by adding the number of positive events related to TMD, including TMJ pain during jaw movement, joint noise, and pain on TMJ palpation, and dividing it by the number of all events. The CMI was the average of the PI and DI [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn addition, panoramic image taking was performed at the first visit of patients. All of the radiographic images were taken by following the imaging criteria of the Department of Oral and Maxillofacial Radiology in Kyung Hee University Dental Hospital, with 70kVp and 12mA of exposure. Two skilled dentists (Y-HL and T-SK) diagnosed the TMJ osteoarthritis (OA) based on panoramic image. OA in panoramic radiography was diagnosed when the indistinct cortical bone outline of TMJ exists, which is described in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePsychological data collection\u003c/h2\u003e \u003cp\u003eDepression status of the patients was collected and analyzed utilizing the SCL-90-R checklist. All patients answered 90 questions on the SCL-90 R at the first visit. Patients scored each question from 1 to 5, ranging from not absolutely to extremely. T-scores of the nine psychological subscales and three indices were calculated with results of the questionnaire. The final psychological data of the patients were statistically analyzed with other variables in two ways: by the T-score itself, and by the psychological groups according to the score. The psychological groups were divided into three groups: those with a score under 59 that are normal state, those with a score between 60 and 69 with a tendency for psychological distress, and patients with scores over 70 who certainly have psychological distress [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis of all data was performed utilizing IBM SPSS Statistics for Windows (version 25.0; IBM Corp., Armonk, NY, USA). Descriptive statistics were utilized to calculate percentages, means, and standard deviations (SDs). One-way analysis of variance test with post hoc analysis for continuous variables and the chi-square test for distributed variables were conducted to compare disparities in variables between age groups. Spearman\u0026rsquo;s correlation analysis was utilized to calculate the Spearman\u0026rsquo;s correlation coefficient (rho) and evaluate the monotonic relationship between variables. Linear regression analysis and a generalized linear model were utilized to investigate the correlation between psychological status and clinical factors, with each psychological state as the dependent variable and the clinical factors as independent variables. The correlation coefficient (B), standard error, p-values, and 95% confidence intervals (95% CIs) were investigated. In all statistical analyses, a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe procedures for human subjects in this study were conducted according to the ethical standards of the Committee on Human Experimentation of our institution and the 1975 Declaration of Helsinki. This study was approved by the appropriate ethics review board of the Kyung Hee University Dental Hospital (IRB number: KH-DT23016).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of patients and diagnosis of TMD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic and clinical characteristics of the patients are presented in Tables 1 and 2, respectively. Mean age and SDs of each age groups are 12.22 \u0026plusmn; 0.87 in group 1, 14.99 \u0026plusmn; 0.88 in group 2, and 17.57 \u0026plusmn; 0.50 in group 3. In all age groups, female accounted for a greater proportion: 34 (73.9%) in age group 1, 47 (60.3%) in age group 2, and 35 (57.4%) in age group 3. Patients in age group 2 and 3 were more likely to experience some clinical symptoms than patients in age group 1, including TMJ pain (83.3% and 78.7% vs. 60.9%, respectively, p=0.015) and jaw stiffness (51.3% and 54.1% vs. 30.4%, respectively, p=0.032). Additionally, frequent parafunctional oral habits and attributing factors for each age group are illustrated in Figure 2. Patients in age group 3 were more likely to have clenching habits than those in age group 1 (57.4% vs. 21.7%, p=0.001). In panoramic image, OA was observed in 48 patients (25.9%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression of patients and correlation with age\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 and 4 display the psychological states of patients as observed in SCL-90-R results. The average depression score in the SCL-90-R was 40.95 \u0026plusmn; 8.38 among all patients. Furthermore, the average depression scores for each age group were 37.54 \u0026plusmn; 8.38 in age group 1, 40.71 \u0026plusmn; 7.61 in age group 2, and 43.25 \u0026plusmn; 9.90 in age group 3 (p=0.004). Figure 3 and 4 illustrates the depression scores across continuous age and age groups. Statistical analysis revealed significant differences in mean depression scores between age group 2 and 1 (40.71 vs 37.54, p=0.004) and between age group 3 and 1 (43.25 vs 37.54, p=0.004), representing the most notable correlation with age group among all symptom scales. Additionally, totally 10 patients (5.4%) scored above 60 for depression, marking the second-highest rate in the study. The prevalence rates of depression in age group 1, 2, and 3 were 2.2%, 6.4%, and 6.6%, respectively. However, the prevalence of depression did not exhibit a significant correlation with age (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between depression and clinical factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of Spearman\u0026rsquo;s correlation analysis between depression and clinical factors are exhibited in Table 5. Figure 5 illustrates the factors that had statistically significant correlation with depression. In adolescent TMD patients, sex was closely related to the depression (rho=0.173, p=0.019). Also in addition to age group, continuous age was correlated with depression (rho=0.193, p=0.008). Pain intensity and pain duration had no significant relationship with depression (p\u0026gt;0.05). In TMD index, depression had strong relationship with DI (rho=0.243, p=0.001) and CMI (rho=0.218, p=0.003).\u003c/p\u003e\n\u003cp\u003eIn terms of patient history, depression had statistically significant relationship with history of jaw locking (rho=0.149, p=0.043), tinnitus (rho=0.225, p=0.002), self-reported stress (rho=0.441, p\u0026lt;0.0001), and trauma history (rho=0.207, p=0.005). Regarding the attributing factors, sleep problems had the most significant relation with depression (rho=0.249, p=0.001). Other significantly related attributing factors were including chin buttressing (rho=0.216, p=0.003), irregular diet (rho=0.189, p=0.010), insomnia (rho=0.183, p=0.012), and much talking tendency (rho=0.181, p=0.014). Radiological interpretation of OA showed no statistically significant correlation with depression (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneralized linear model of depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe regression analysis was utilized, particularly with generalized linear models, to predict depression with the investigated factors. Depression was selected as an independent variable, and clinical factors were set as dependent variables. The results of generalized linear model of depression are displayed at Table 6 and Figure 6.\u003c/p\u003e\n\u003cp\u003eIn adolescent TMD patients, age group was\u0026nbsp;the factor most closely related to depression, and age group 3 (17-18 years) was significantly related to depression (B=2.651, 95% CI: 0.363-4.940). This was the largest coefficient value in the statistically significant results. Clenching habit also had significant relationship with depression (B=1.433, 95% CI: 0.170-2.696). Other factors that had statistically significant relationship with depression were score of obsessive-compulsive (B=0.581, 95% CI: 0.427-0.735), and score of somatization (B=0.246, 95% CI: 0.047-0.445). Radiological interpretation of OA showed no statistically significant correlation with depression (B=3.170, 95% CI: -9.159-16.578)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDISCUSSION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, we aimed to investigate the relationship between depression and age, clinical TMD symptoms, attributing factors, and parafunctional oral habits in adolescent TMD patients. Total 5.5% of adolescents exhibited abnormal depression scores in this study. In adolescent TMD patients, older adolescents and female patients were more likely to have depressive symptoms than young adolescents or males, respectively. Intensity and duration of pain had limited relationship with depression. Regarding patient history, tinnitus, self-reported stress, history of limited mouth opening, and presence trauma history had significant relationship with depression. In the attributing factors, sleep problem was the most strongly associated factor with depression, followed by irregular diet, chin buttressing, and tendency of much talking.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn adolescent TMD patients, depression had significant relationship with age. This tendency for depression in adolescents to increase in proportion to age is a unique feature of psychological disorders in children and adolescents, as it has been proven that depressive disorder is age-independent when comprehensively considered across all ages\u0026nbsp;[21]. In South Korea, the prevalence rate of psychological disorders was reported to often differ between middle school and high school students, which were age groups 2 and 3 in this study\u0026nbsp;[22]. This might be as a result of the change in the proportions of externalizing and internalizing problem behaviors. According to Lee and Jeong, the tendency of externalizing and internalizing problem behaviors is significantly different between middle and high school students in South Korea\u0026nbsp;[22]. Externalizing problem behaviors include aggressive behavior, juvenile delinquency, and violence, whereas internalizing problem behaviors include anxiety, depressive mood, and suicidal ideation. Externalizing problem behaviors exhibited a gradual increase until the third grade of middle school, followed by a gradual decrease during the high school period. In contrast, internalizing problem behaviors showed no significant difference between the middle school and high school periods. The internalization of psychological distress in high school students elucidates the correlation observed between age group 3 and depression in this study, all of which are classified as internalizing problem behaviors. However, studies about correlation between age and depression in adolescent are still lacking, and further studies would be needed to confirm this correlation globally.\u003c/p\u003e\n\u003cp\u003eRegarding the clinical factors, CMI had a statistically significant correlation with depression in adolescent TMD patients. CMI was developed for standardized evaluation of TMD symptoms and its reliability has been proved for a long time\u0026nbsp;[19]. CMI can effectively reflect the severity of symptoms, and thus, CMI also shows correlations with several factors related to TMD. For example, Kim \u003cem\u003eet al\u003c/em\u003e reported that CMI had significant correlations with the psychological state observed at SCL-90-R and Minnesota Multiphasic Personality Inventory in adult TMD patients\u0026nbsp;[23]. In the study of Kim \u003cem\u003eet al\u003c/em\u003e, CMI of adult TMD patients had correlation with somatization, anxiety and phobic anxiety of SCL-90-R. And as an extension of the previous study, this study successfully proved that the association between psychological state and CMI can also be applied to adolescent TMD patients.\u003c/p\u003e\n\u003cp\u003eIn this study, depression in adolescent TMD patients had large number of history and oral habits of patients, including tinnitus, self-reported stress, trauma history, chin buttressing, irregular diet, sleep problems, and clenching. Among these, clenching habit were significantly associated with depression in generalized linear model. One of the possible cause of clenching habit in adolescents is neurodevelopmental disorders, which is closely related to psychological state of adolescents\u0026nbsp;[24, 25]. Neurodevelopmental disorders can cause impairments in social and executive functioning, and can act as stressors for adolescents\u0026nbsp;[26]. Conversely, children and adolescents who are constantly exposed to stressful environments or have mood disorders have an increased risk of neurodevelopmental disorders\u0026nbsp;[27]. Regarding psychological aspects, Endo \u003cem\u003eet al\u003c/em\u003e reported that patients with a habit of clenching had more psychological distress than those without clenching\u0026nbsp;[28]. Therefore, clenching, psychological distress, and neurodevelopmental disorders are closely related, and their correlation is also applicable to adolescents with TMD.\u003c/p\u003e\n\u003cp\u003eIrregular diet was closely related to depression in adolescent TMD patients in this study. Prior studies have reported that dietary habits are a behavioral risk factor for mental health disorders in adolescents\u0026nbsp;[29-31]. An inappropriate diet can cause a deficiency of certain nutrients implicated in brain function, which can affect depression risk through impaired neurological pathways, pain control, or emotional regulation\u0026nbsp;[32]. Among the inappropriate diet, habitual irregular diet can result in several comorbidities that are closely related to the development of psychological disorders\u0026nbsp;[33-36]. Additionally, maintaining a regular diet is a type of social rhythm, which is a series of habitual daily behaviors that can modulate the biological clock\u0026nbsp;[37]. Collapsed social rhythms can result in social withdrawal and depressive mood, and patients with depression often have insufficient ability to recover and perform daily functions after disrupting life events, leading to serial collapse of other daily functions\u0026nbsp;[38]. And one of the results of disrupted daily functions in adolescents is sleep problems\u0026nbsp;[39, 40], which were also were significantly related to depression in adolescent TMD patients in this study. In adolescents, sleep conditions are directly related to brain development, and shifts in sleep behavior can change the developmental pattern of brain matter, leading to impaired functional outcomes in several domains including learning ability, memory, social adaptation, emotional regulation, risk-taking, and motivation\u0026nbsp;[41-43]. Thus, sleep and diet are sharing a similar role in depression of adolescents, acting as important factors on maintaining daily social rhythms, encouraging brain development, and regulating emotions. Although prior studies posit that the association between depression, diet, and sleep is not universal\u0026nbsp;[44, 45], the influence of inappropriate diet and sleep disturbance on depression seems to exist in adolescent patients with TMD, at least in this study.\u003c/p\u003e\n\u003cp\u003eTinnitus was highly associated with depression in adolescent TMD patients. The prevalence of tinnitus in TMD patients was approximately 30%, which is approximately eight times higher than that in patients without TMD\u0026nbsp;[46, 47]. Continuous tinnitus can affect quality of life and cause distress in patients, which make TMD patients vulnerable to psychological distress. Continuous somatosensory information of tinnitus in cervical and temporomandibular area is transferred to the brain through the dorsal root ganglion or trigeminal ganglion, which can have the same role as chronic pain of orofacial area and therefore directly result in psychological distress\u0026nbsp;[48]. However, despite the close relationship between tinnitus and psychological disorders, tinnitus and depression in adolescent patients has not been well studied. Since tinnitus in adolescent patients with TMD was related to depression in this study, further studies are needed to investigate the detailed mechanism of the interaction between tinnitus, psychological distress, and TMD in adolescents.\u003c/p\u003e\n\u003cp\u003eTrauma history had a significant relationship with depression of adolescent TMD patients. In a previous study, Lee \u003cem\u003eet al\u003c/em\u003e reported that the trauma history of adolescent patients with TMD had a significant relationship with the psychological state of the SCL-90-R, including somatization, obsessive compulsiveness, hostility, phobic anxiety, and psychoticism, regardless of structural disorders\u0026nbsp;[49]. Trauma in adolescents has long been considered crucial because of its influence on long-term quality of life. As in adults, trauma in adolescents can cause both physical and psychological damage; however, the aftereffects of damage tend to last longer in adolescents than in adults and extend to a wider range, including general health, developmental, psychological, and behavioral outcomes\u0026nbsp;[50, 51].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, pain intensity and pain duration were not significantly related with depression of adolescent TMD patients in this study. Regarding to the pain and depression of adolescents, Rabbitts \u003cem\u003eet al\u003c/em\u003e reported that emotional health of adolescent was highly associated with the total pain area rather than pain intensity\u0026nbsp;[10]. Therefore, it can be inferred that pain duration might affect to depression only when the long-lasted pain caused widespread pain of adolescents. In this study, detailed pain sites of patients were not included in statistical analysis. Further studies would be needed to investigate the correlation between pain duration, total number of pain sites, and depression of adolescent TMD patients.\u003c/p\u003e\n\u003cp\u003eIn this study, TMJ OA in panoramic images was not significantly associated with depression of adolescent TMD patients. Generally, depression is common in patient with osteoarthritis, and patients with TMJ OA are likely to have higher levels of depression than patient with non-painful TMD\u0026nbsp;[52]. The contradictory result of this study might be due to the followings; diagnostic inaccuracy and impacted of details symptoms of OA. This study utilized panoramic radiography to diagnose OA due to its convenience for clinicians, but panoramic radiography was proven to have limited diagnostic accuracy in detecting OA, and thus OA diagnosis of this study might have diagnostic error\u0026nbsp;[53]. Also, correlation between OA and depression was due to the accompanying symptoms of OA including pain, functional disability and joint sound\u0026nbsp;[54]. However, asymptomatic OA even with radiological evidence of joint damage is common in adolescents\u0026nbsp;[55]. Since this study didn\u0026rsquo;t distinguish asymptomatic OA in analysis, its impact on OA, its impact on depression might be less than expected Further studies would be needed with improved diagnostic methods, and detailed analysis including accompanying symptoms of OA.\u003c/p\u003e\n\u003cp\u003eDespite the significance of this study, several limitations should be acknowledged. Primarily, it was a retrospective study, and patient data were collected and analyzed only at specific intervals. Consequently, the study design couldn\u0026apos;t capture real-time changes in variables or attributing factors of TMD and depression, potentially leading to fragmentation of patient status and correlations. Furthermore, the sample was derived solely from a single dental clinic, raising concerns about potential biases.\u003c/p\u003e\n\u003cp\u003eNevertheless, to our knowledge, no previous studies have comprehensively investigated the correlation between depression and clinical factors in adolescent TMD patients. Further prospective cohort studies with a more diverse sample pool and extended follow-up periods are necessary to validate our findings and delve into the detailed causal relationships.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we hypothesized that older adolescents (aged 17-18) with TMD would exhibit higher scores in depression compared to younger adolescents (aged 10-13) with TMD. We also anticipated that depression would correlate with certain clinical factors of TMD, including VAS, pain duration, TMD index, patient history, attributing factors, and parafunctional oral habits. Results indicated that score of depression was significantly higher in older adolescent TMD patients than younger adolescents. Furthermore, several clinical factors of TMD displayed significant correlations with the depression of adolescent TMD patients. These factors encompassed sex, DI, CMI, tinnitus, self-reported stress, irregular diet, trauma history, clenching habits, and sleep problems. These findings offer valuable insights for clinicians, enabling them to promptly and effectively evaluate depression in adolescents with TMD.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTemporomandibular disorder (TMD)\u003c/p\u003e\n\u003cp\u003eTemporomandibular joint (TMJ)\u003c/p\u003e\n\u003cp\u003eSymptom checklist-90-revised (SCL-90-R)\u003c/p\u003e\n\u003cp\u003eVisual analog scale (VAS)\u003c/p\u003e\n\u003cp\u003eDiagnostic criteria for temporomandibular disorders (DC/TMD)\u003c/p\u003e\n\u003cp\u003ePalpation index (PI)\u003c/p\u003e\n\u003cp\u003eDysfunction index (DI)\u003c/p\u003e\n\u003cp\u003eCraniomandibular index (CMI)\u003c/p\u003e\n\u003cp\u003eOsteoarthritis (OA)\u003c/p\u003e\n\u003cp\u003eStandard deviations (SDs)\u003c/p\u003e\n\u003cp\u003eSpearman\u0026rsquo;s correlation coefficient (rho)\u003c/p\u003e\n\u003cp\u003eCorrelation coefficient (B)\u003c/p\u003e\n\u003cp\u003e95% confidence intervals (95% CIs)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was approved by the Institutional Review Board of the Kyung Hee University Dental Hospital (IRB no.\u0026nbsp;KH-DT23016).\u0026nbsp;\u003cem\u003eInformed consent was obtained from all participants\u003c/em\u003e in\u003cem\u003e\u0026nbsp;\u003cem\u003ethe\u003c/em\u003e\u0026nbsp;\u003c/em\u003estudy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors consented to the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e No potential conflict of interest relevant to this article was reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eWriting and original draft preparation, Y-HL and T-SK; conceptualization,\u0026nbsp;Y-HL;\u0026nbsp;methodology,\u0026nbsp;Y-HL and T-SK;\u0026nbsp;software,\u0026nbsp;Y-HL and T-SK;\u0026nbsp;validation\u0026nbsp;and formal analysis, Y-HL; investigation,\u0026nbsp;Y-HL and T-SK; resources,\u0026nbsp;Y-HL and T-SK; data curation,\u0026nbsp;Y-HL and T-SK; writing, review, and editing,\u0026nbsp;Y-HL and T-SK; visualization,\u0026nbsp;Y-HL and T-SK; supervision,\u0026nbsp;Y-HL; project administration, Y-HL. All\u0026nbsp;authors contributed to and approved the submitted manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors extend their special thanks to Jung-Pyo Hong of the Department of Orofacial Pain and Oral Medicine at Kyung Hee University Dental Hospital\u0026nbsp;and Sung-Woo Lee of the Department of Oral Medicine and Oral Diagnosis at Seoul National University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTae-Seok Kim, Master\u0026apos;s Student.\u0026nbsp;\u003c/strong\u003eDepartment of Dentistry, Graduate School, Kyung Hee University, #26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea; [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYeon-Hee Lee, DDS, PhD.\u0026nbsp;\u003c/strong\u003eDepartment of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, #26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Korea; [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOkeson JP. 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Sleep and human cognitive development. Sleep Med Rev. 2021;57:101472.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarokh L, Saletin JM, Carskadon MA. Sleep in adolescence: Physiology, cognition and mental health. Neurosci Biobehav Rev. 2016;70:182\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarokh L, Van Reen E, LeBourgeois M, Seifer R, Carskadon MA. Sleep EEG provides evidence that cortical changes persist into late adolescence. Sleep. 2011;34(10):1385\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnastasiades PG, de Vivo L, Bellesi M, Jones MW. Adolescent sleep and the foundations of prefrontal cortical development and dysfunction. Prog Neurobiol. 2022;218:102338.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMolendijk M, Molero P, Ortuno Sanchez-Pedreno F, Van der Does W, Angel Martinez-Gonzalez M. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J Affect Disord. 2018;226:346\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimaldi M, Bacaro V, Natale V, Tonetti L, Crocetti E. The Longitudinal Interplay between Sleep, Anthropometric Indices, Eating Behaviors, and Nutritional Aspects: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(14):3159.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuergers R, Kleinjung T, Behr M, Vielsmeier V. Is there a link between tinnitus and temporomandibular disorders? J Prosthet Dent. 2014;111(3):222\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManfredini D, Olivo M, Ferronato G, Marchese R, Martini A, Guarda-Nardini L. Prevalence of tinnitus in patients with different temporomandibular disorders symptoms. Int Tinnitus J. 2015;19(2):47\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMichiels S, van der Wal AC, Nieste E, Van de Heyning P, Braem M, Visscher C, et al. Conservative therapy for the treatment of patients with somatic tinnitus attributed to temporomandibular dysfunction: study protocol of a randomised controlled trial. Trials. 2018;19(1):554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee YH, Lee KM, Kim T, Hong JP. Psychological Factors that Influence Decision-Making Regarding Trauma-Related Pain in Adolescents with Temporomandibular Disorder. Sci Rep. 2019;9(1):18728.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilgoff R, Singh L, Koita K, Gentile B, Marques SS. Adverse Childhood Experiences, Outcomes, and Interventions. Pediatr Clin North Am. 2020;67(2):259\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolbrook TL, Hoyt DB, Coimbra R, Potenza B, Sise MJ, Sack DI, Anderson JP. Trauma in adolescents causes long-term marked deficits in quality of life: adolescent children do not recover preinjury quality of life or function up to two years postinjury compared to national norms. J Trauma. 2007;62(3):577\u0026ndash;83. discussion 83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYap AU, Tan KB, Chua EK, Tan HH. Depression and somatization in patients with temporomandibular disorders. J Prosthet Dent. 2002;88(5):479\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIm YG, Lee JS, Park JI, Lim HS, Kim BG, Kim JH. Diagnostic accuracy and reliability of panoramic temporomandibular joint (TMJ) radiography to detect bony lesions in patients with TMJ osteoarthritis. J Dent Sci. 2018;13(4):396\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin EH. Depression and osteoarthritis. Am J Med. 2008;121(11 Suppl 2):S16\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt C, Ertel T, Arbogast M, Hugle B, Kalle TV, Neff A. Collaborators. The Diagnosis and Treatment of Rheumatoid and Juvenile Idiopathic Arthritis of the Temporomandibular Joint. Dtsch Arztebl Int. 2022;119(4):47\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDemographics and clinical characteristics of patients.\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFactors\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 1: Young adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 2:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMiddle adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;78)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 3:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eOlder adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePost hoc\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean age (year) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.000***\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;2\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFemale\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e34 (73.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e47 (60.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35 (57.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.182\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eClinical examination results\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eVAS\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.253\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOnset (month) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e8.63\u0026thinsp;\u0026plusmn;\u0026thinsp;13.99\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13.42\u0026thinsp;\u0026plusmn;\u0026thinsp;15.01\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13.48\u0026thinsp;\u0026plusmn;\u0026thinsp;18.51\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.212\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCMO (mm) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e33.41\u0026thinsp;\u0026plusmn;\u0026thinsp;9.08\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e31.68\u0026thinsp;\u0026plusmn;\u0026thinsp;10.79\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e34.55\u0026thinsp;\u0026plusmn;\u0026thinsp;9.13\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.232\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMMO (mm) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e41.89\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.63\u0026thinsp;\u0026plusmn;\u0026thinsp;11.36\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.18\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.615\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMAO (mm) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.73\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.09\u0026thinsp;\u0026plusmn;\u0026thinsp;13.47\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e45.63\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.191\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLocking\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(CMO\u0026thinsp;\u0026lt;\u0026thinsp;35mm) \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e24 (52.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e45 (57.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e31 (50.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.695\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTMD index\u003c/span\u003e\u003csup\u003e\u003cspan class=\"Bold\"\u003e\u0026dagger;\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.266\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.682\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCMI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.903\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePatient history\u003c/span\u003e\u003csup\u003e\u003cspan class=\"Bold\"\u003e\u0026Dagger;\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTMJ noise\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e37 (80.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e63 (80.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e46 (75.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.546\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTMJ pain\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e28 (60.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e65 (83.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e48 (78.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.015*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;2\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eStiffness\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14 (30.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40 (51.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e33 (54.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.032*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLocking\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e26 (26.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e49 (62.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e39 (63.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.708\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTinnitus\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e8 (17.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e16 (20.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13 (21.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.693\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOrthodontic experience\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13 (28.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12 (15.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 (36.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.053\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUncomfortable occlusion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7 (15.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 (28.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (18.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.194\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eStress\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12 (26.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 (28.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e23 (37.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.444\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFamily history\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (23.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (14.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (18.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.403\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTrauma history\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 (10.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (5.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (6.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.412\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAbnormal occlusion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (6.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7 (9.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 (8.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.662\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eRadiographic features\u003c/span\u003e\u003csup\u003e\u003cspan class=\"Bold\"\u003e\u0026Dagger;\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOsteoarthritis in panoramic image\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17 (37.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e20 (25.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (18.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.407\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003eOne-way analysis of variance test was used to determine significant mean differences between three age groups.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003cspan class=\"Italic\"\u003echi\u003c/span\u003e-square test was used to determine whether there was significant difference in distribution between three age groups.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eStatistically significant results are shown in bold text.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eSD: standard deviation; VAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; TMD: temporomandibular disorders; PI: palpation index; DI: dysfunction index; CMI: craniomandibular index; TMJ: temporomandibular joint; 1: age group 1 (aged 10\u0026ndash;13); 2: age group 2 (aged 14\u0026ndash;16); 3: age group 3 (aged 17\u0026ndash;18)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDistribution of parafunctional oral habits of patients.\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFactors\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 1: Young adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 2:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMiddle adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;78)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 3:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eOlder adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePost hoc\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBruxism\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e19 (41.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 (28.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e19 (31.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.311\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eClenching\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10 (21.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e27 (34.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35 (57.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.001**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;3, 2\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePerioral contraction\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (8.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (5.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (4.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.660\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTongue thrusting\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (4.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (5.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.212\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBite something\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7 (15.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e16 (20.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e9 (14.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.613\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChin buttressing\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6 (13.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e20 (25.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e18 (29.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.124\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUnilateral chewing\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14 (30.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e33 (42.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e22 (36.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.406\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHard food\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11 (23.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17 (21.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14 (23.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.962\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIrregular diet\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 (10.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17 (21.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10 (16.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.291\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndigestion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7 (15.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10 (12.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e16 (26.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.106\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCoffee\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6 (13.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e17 (21.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15 (24.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.321\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSleep problems\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (4.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e7 (9.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e8 (13.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.298\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInsomnia\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6 (7.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.112\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBad posture\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15 (32.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35 (44.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e29 (47.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.266\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMuch talking\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 (10.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e13 (16.7%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e14 (23.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.258\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e\u003cspan class=\"Italic\"\u003echi\u003c/span\u003e-square test was used to determine whether there was significant difference in distribution between three age groups.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eStatistically significant results are shown in bold text.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003e1: age group 1 (aged 10\u0026ndash;13); 2: age group 2 (aged 14\u0026ndash;16); 3: age group 3 (aged 17\u0026ndash;18)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSCL-90-R scores of patients.\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFactors\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 1: Young adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 2:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMiddle adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;78)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 3:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eOlder adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePost hoc\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDepression\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e37.54\u0026thinsp;\u0026plusmn;\u0026thinsp;8.38\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.61\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.90\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.004**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;2, 1\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSomatization\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.92\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.09\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.043*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eObsessive-compulsive\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e39.74\u0026thinsp;\u0026plusmn;\u0026thinsp;8.29\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e41.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.07\u0026thinsp;\u0026plusmn;\u0026thinsp;10.47\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.182\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInterpersonal sensitivity\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e41.07\u0026thinsp;\u0026plusmn;\u0026thinsp;7.49\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.91\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.12\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.149\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAnxiety\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e41.59\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.32\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.180\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHostility\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.80\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.17\u0026thinsp;\u0026plusmn;\u0026thinsp;5.33\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.36\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.287\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePhobic anxiety\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.04\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44.90\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e45.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.213\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eParanoid ideation\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.37\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e44.39\u0026thinsp;\u0026plusmn;\u0026thinsp;10.44\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.073\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePsychoticism\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.21\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.040*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGSI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e38.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.41\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e40.76\u0026thinsp;\u0026plusmn;\u0026thinsp;7.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e42.61\u0026thinsp;\u0026plusmn;\u0026thinsp;9.28\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.027*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePDSI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e43.63\u0026thinsp;\u0026plusmn;\u0026thinsp;6.96\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e46.37\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e46.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.02\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.142\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePST\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e34.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.59\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e37.64\u0026thinsp;\u0026plusmn;\u0026thinsp;8.79\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\"\u0026plusmn;\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e39.23\u0026thinsp;\u0026plusmn;\u0026thinsp;10.90\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.053\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eOne-way analysis of variance test was used to determine significant mean differences between three age groups.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eStatistically significant results are shown in bold text.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eSD: standard deviation; SCL-90-R: symptom checklist 90 revised; GSI: global severity index; PSDI: positive symptom distress index; PST: positive symptom total; 1: age group 1 (aged 10\u0026ndash;13); 2: age group 2 (aged 14\u0026ndash;16); 3: age group 3 (aged 17\u0026ndash;18)\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSCL-90-R score groups of patients.\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 1: Young adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 2:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eMiddle adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;78)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 3:\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eOlder adolescents\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003e(n\u0026thinsp;=\u0026thinsp;61)\u003c/div\u003e\n\u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePost hoc\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eDepression\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e5 (6.4%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (4.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.530\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.530\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSomatization\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (3.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.358\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.358\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eObsessive-compulsive\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (5.1%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (4.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.306\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.306\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eInterpersonal sensitivity\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (3.8%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (6.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.642\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (2.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.642\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eAnxiety\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (4.9%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.409\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.409\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eHostility\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3 (6.5%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (6.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.221\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.221\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePhobic anxiety\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.435\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (3.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.435\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eParanoid ideation\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2 (2.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (6.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.254\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.254\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePsychoticism\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score 60 to 69\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (2.2%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4 (6.6%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.331\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eT-score over 70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1 (1.3%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.331\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\"\u003eSCL-90-R: symptom checklist 90 revised\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCorrelation between depression score and clinical factors\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFactors\u003c/div\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCorrelation with depression\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003erho\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eDemographics\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.173\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.019*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.193\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.008**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.225\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.002**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eClinical factors\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eVAS\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.105\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.153\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOnset\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.026\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.728\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCMO\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.035\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.638\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMMO\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.055\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.460\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMAO\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.050\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.499\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.132\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.072\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eDI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.243\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.001**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCMI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.218\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.003**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePatient history\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTMJ noise\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.001\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.991\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTMJ pain\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.067\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.361\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eStiffness\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.077\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.299\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLocking\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.149\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.043*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTinnitus\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.225\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.002**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOrthodontic experience\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.053\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.475\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUncomfortable occlusion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.032\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.662\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eStress\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.347\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.000***\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFamily history\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.020\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.788\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTrauma history\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.207\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.005**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAbnormal occlusion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.035\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.633\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eParafunctional oral habits and attributing factors\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBruxism\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.010\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.892\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eClenching\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.122\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.097\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePerioral contraction\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.011\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.882\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTongue thrusting\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.002\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.975\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBite something\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.092\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.212\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eChin buttressing\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.216\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.003**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eUnilateral chewing\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.044\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.549\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHard food\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.083\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.261\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIrregular diet\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.189\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.010*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eIndigestion\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.139\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.059\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCoffee\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.086\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.243\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eSleep problems\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.249\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.001**\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eInsomnia\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.183\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.012*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eBad posture\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.089\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.231\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMuch talking\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.181\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.014*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eRadiologic features\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eOsteoarthritis in panoramic image\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.049\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.508\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eStatistically significant results are shown in bold text\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eVAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; PI: palpation index; DI: dysfunction index; CMI: craniomandibular index; TMJ: temporomandibular joint\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab6\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGeneralized linear model of depression\u003c/div\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFactors\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eB (95% CI)\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eP-value\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eGender\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.783 (-2.109\u0026ndash;3.676)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.596\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eAge group\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 1 (aged 10\u0026ndash;13)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 2 (aged 14\u0026ndash;16)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1.064 (-0.218\u0026ndash;2.347)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.104\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAge group 3 (aged 17\u0026ndash;18)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2.651 (0.363\u0026ndash;4.940)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.023*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eVAS\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.150 (-0.238\u0026ndash;0.539)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.449\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eOnset\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.027 (-0.084\u0026ndash;0.031)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.367\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eCMO\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.016 (-0.205\u0026ndash;0.174)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.870\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eMMO\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.039 (-0.137\u0026ndash;0.215)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.665\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eMAO\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.077 (-0.215\u0026ndash;0.061)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.276\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTMD index\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCMI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.835 (-0.337\u0026ndash;2.007)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.163\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePI\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.287 (-0.019\u0026ndash;6.593)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.051\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTMJ noise\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.493 (-2.942\u0026ndash;3.929)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.778\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTMJ pain\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.938 (-4.099\u0026ndash;2.223)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.561\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eStiffness\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.886 (-1.545\u0026ndash;3.317)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.475\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eLocking\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.447 (-3.167\u0026ndash;2.273)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.748\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTinnitus\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.816 (-4.466\u0026ndash;2.834)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.661\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eOrthodontic experience\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.158 (-2.363\u0026ndash;2.680)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.902\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eAbnormal occlusion\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.072 (-3.125\u0026ndash;2.982)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.963\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eStress\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.676 (-2.066\u0026ndash;3.417)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.629\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eFamily history\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.142 (-2.554\u0026ndash;2.838)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.918\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eTrauma history\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.833 (-1.089\u0026ndash;8.755)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.127\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eBruxism\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.278 (-2.011\u0026ndash;2.567)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.812\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eClenching\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1.433 (0.170\u0026ndash;2.696)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.026*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSCL-90-R\u003c/span\u003e (T-scores)\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eSomatization\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.246 (0.047\u0026ndash;0.445)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.016*\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eObsessive-compulsive\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.581 (0.427\u0026ndash;0.735)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003e0.000***\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eInterpersonal sensitivity\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.037 (-0.214\u0026ndash;0.139)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.678\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eAnxiety\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.059 (-0.115\u0026ndash;0.233)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.506\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eHostility\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.149 (-0.027\u0026ndash;0.325)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.097\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePhobic anxiety\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e-0.085 (-0.233\u0026ndash;0.063)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.259\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003eParanoid ideation\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.060 (-0.152\u0026ndash;0.272)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.578\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e\u003cspan class=\"Bold\"\u003ePsychoticism\u003c/span\u003e\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.072 (-0.112\u0026ndash;0.257)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.443\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eP-value significance was set at \u0026lt;\u0026thinsp;0.05. *p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.01, ***p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eStatistically significant results are shown in bold text.\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\"\u003eCI: confidence interval; VAS: visual analog scale; CMO: comfortable mouth opening; MMO: maximum mouth opening; MAO: maximum assisted opening; TMD: temporomandibular disorders; CMI: craniomandibular index; DI: dysfunction index; PI: palpation index; TMJ: temporomandibular joint; SCL-90-R: symptom checklist 90-revised\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"TMD, adolescents, Symptom-Checklist-90-Revised, psychology, depression","lastPublishedDoi":"10.21203/rs.3.rs-4430130/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4430130/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTemporomandibular disorder (TMD) is a musculoskeletal disorder characterized by functional limitations and pain in the masticatory muscle and the temporomandibular joint. In adolescent, TMD can significantly impact mental health and lead to psychosocial disabilities. This study aims to investigate the correlation between the depression, as assessed by the Symptom-Checklist-90-Revised (SCL-90-R) and clinical factors in adolescent patients with TMD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included a total of 185 adolescents (69 males, 116 females, mean age 15.15 ± 2.17) diagnosed with TMD between November 2020 and May 2023. Patients were categorized into three age groups: 46 young adolescents aged 10-13, 78 middle adolescents aged 14-16, and 61 older adolescents aged 17-18. Clinical data were collected from the medical records at the patients’ initial visit. Depression of patients was evaluated with SCL-90-R.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepression of adolescent TMD patients exhibited strong correlation with age (rho=0.193, p=0.004). In the adolescent TMD patients, depression scores were significantly associated with stressful conditions (rho=0.347, p\u0026lt;0.0001), sleep problems (rho=0.249, p=0.001), dysfunction index (rho=0.243, p=0.001), presence of tinnitus (rho=0.225, p=0.002), craniomandibular index (rho=0.218, p=0.003), history of trauma (rho=0.207, p=0.005), and habitual irregular diet (rho=0.189, p=0.010). In the generalized linear model, depression exhibited the most significant association with aging (B=2.651, 95% CI: 0.363-4.940), followed by clenching habits (B=1.433, 95% CI: 0.170-2.696), obsessive-compulsiveness (B=0.581, 95% CI: 0.427-0.735), and somatization (B=0.246, 95% CI: 0.047-0.445). In contrast, pain intensity, pain duration, and joint noise were not significantly related with depression in adolescent TMD patients (p\u0026gt;0.05). Also, osteoarthritis in panoramic image was not significantly associated with depression in adolescent TMD patients (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith the results of this study, clinicians would be able to evaluate the depression state of adolescent TMD patients with concise clinical information.\u003c/p\u003e","manuscriptTitle":"Investigation of Depression and Clinical Factors in Adolescent Temporomandibular Disorder Patients with Aging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 20:38:53","doi":"10.21203/rs.3.rs-4430130/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9b59dd0-46b0-4042-a86e-696567f6a997","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-13T07:21:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-07 20:38:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4430130","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4430130","identity":"rs-4430130","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}