医学生口腔行为在情绪症状与颞下颌关节 紊乱病间的中介作用

Mediating Effect of Oral Behaviors between Emotional Symptoms and Temporomandibular Joint Disorders in Medical Students

摘要: 目的：本研究旨在调查医学生中焦虑、抑郁、口腔行为及颞下颌关节紊乱病(TMD)的检出率及各变量间的相关性，并进一步探讨口腔行为在医学生焦虑、抑郁与TMD间统计学上的中介效应。方法：选择在2024年5月至2025年10月招募的326名国际医学生和347名国内医学生。每位参与者均根据颞下颌关节紊乱病诊断标准(DC/TMD)完成问卷调查和临床检查，并填写了广泛性焦虑障碍量表-7项(GAD-7)、患者健康问卷抑郁量表-9项(PHQ-9)及口腔行为检查表(OBC)。采用卡方检验、逻辑回归分析和斯皮尔曼相关性分析，并运用PROCESS的模型4进行中介分析。结果：与国内医学生相比，国际医学生焦虑、抑郁、口腔行为及TMD的检出率更高。相关性分析结果显示，焦虑、抑郁和口腔行为与TMD均呈正相关关系(P ˂ 0.001)。中介效应检验发现，口腔行为在焦虑、抑郁对TMD的影响过程中发挥部分统计学上的中介效应，中介效应分别占比为36.4%、28.2%。结论：口腔行为是连接焦虑、抑郁与TMD的关键行为机制。对焦虑、抑郁症状的人群进行TMD预防时，应特别关注其口腔行为的管理。

Abstract: Objective: This study aims to investigate the prevalence of anxiety, depression, oral behaviors, and temporomandibular joint disorder (TMD) among medical students, as well as the correlations among these variables. It further explores the statistical mediating effects of oral behaviors on the relationship between anxiety, depression, and TMD in medical students. Methods: A total of 326 international medical students and 347 domestic medical students were selected for recruitment between May 2024 and October 2025. Each participant completed a questionnaire and clinical examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and filled out the Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Oral Behavior Checklist (OBC). Chi-square tests, logistic regression analysis and Spearman correlation analyses were performed, with mediation analysis conducted using PROCESS Model 4. Results: Compared with domestic medical students, international medical students exhibit higher rates of anxiety, depression, oral behavioral risks, and TMD detection. Correlation analysis revealed that anxiety, depression, and oral behaviors were all positively correlated with TMD (P < 0.001). Mediating effect testing indicated that oral behaviors partially exerted a partial statistical mediating effect in the process by which anxiety and depression influence TMD, accounting for 36.4% and 28.2% of the mediating effects, respectively. Conclusions: Oral behaviors serve as a key behavioral mechanism linking anxiety, depression, and TMD. When implementing TMD prevention measures for individuals with anxiety or depression symptoms, special attention should be paid to managing their oral behaviors.