The University of Washington Oral Medicine Clinic Psychology Service: When and Why are Patients Referred?

Abstract

Psychosocial factors are known to be frequently associated with orofacial pain. The purpose of this retrospective case-control study was to characterize patients with orofacial pain who were referred by oral medicine specialists to an internal psychology service within the University of Washington Oral Medicine Clinical Services (OMCS) to discover demographic, clinical, and psychological variables that would explain when and why patients are referred. The group of referred patients was compared to a group of controls who had no history of an OMCS psychology referral. The primary aim was to measure levels of anxiety, depression, somatization, and somatization without pain using the Symptom Checklist (SCL-90R) instrument. The study population included 164 subjects that attended OMCS between July 2009 and December 2017 who were equally divided between the Referred case group and the Not Referred control group. Logistic regression analysis revealed that the Referred group had significantly higher levels of anxiety and depression when compared to the Not Referred group. The adjusted odds ratios (OR, 95% CI; P value) of moderate and severe anxiety and moderate and severe depression for the Referred group were 2.60 (1.08 to 6.50; P = 0.037), 5.50 (1.65 to 22.60; P = 0.009), 0.94 (0.38 to 2.30; P = 0.90), and 3.10 (1.30 to 7.80; P = 0.013), respectively. Of note, the Not Referred group also had a high percentage of subjects with moderate or severe anxiety and depression. There were no statistically significant differences in somatization or somatization without pain between the two groups. This study found that there were prevalent psychosocial comorbidities among the study population as a whole that highlight the need for routine psychological screening and appropriate treatment to address any psychosocial distress detected.