Perceived Stress, Salivary Cortisol, and Temperament Traits among Students of Dental Medicine: A Prospective and Interventional Study

Academic stress affects students' psychological and physiological well-being. Dental undergraduate programs are known for their demanding curriculum, leading to significant stress symptoms. The objective was to determine if salivary cortisol levels were higher in students exposed to academic stress, assess the relationship between stress severity/temperament and cortisol values, and explore relaxation technique effects. Salivary cortisol was measured at two time points for all participants: Before exams and during a relaxation period after summer break. A third measurement was conducted for students with high pre-test cortisol levels who received instructions on progressive muscle relaxation (PMR) before subsequent exams. Additionally, participants completed two questionnaires: Perceived Stress Scale (PSS) and Fisher's Temperament Questionnaire. The group analysis based on the PSS indicated that 39 participants reported high stress. Women demonstrated significantly higher stress than men (p = 0.042054). A significant difference in stress levels was observed between director and builder temperament types (p = 0.029276). Cortisol levels showed a significant decrease from the first measurement to the second measurement, and the third measurement after implementing PMR. The grade in the "Dermatovenereology" course correlated with stress level according to the PSS (k = 0.578467). Pre-test cortisol levels correlated with the frequency of using PMR guidelines during winter test periods (k = 0.416138). Stress negatively affects the immune system and poses health risks. Implementing stress reduction techniques in dental/medical education could benefit students and the healthcare system.

Major Stress Sources Amongst Dental Students at Damascus University, Syria

INTRODUCTION

Stress amongst dental students is frequently reported. Various environmental, socioeconomic, and cultural factors affect students' perceived stress levels. The aim of this study was to investigate stress levels and sources amongst undergraduate dental students at Damascus University, Syria.

METHODS

A cross-sectional design was used. A questionnaire was undertaken in 2019 at the Faculty of Dentistry at Damascus University. Students participated voluntarily in the survey. The sample comprised students at the preclinical and clinical stage. A modified 29-item version of the validated Dental Environmental Stress (DES) questionnaire with a 5-point scale (1 = not stressful to 5 = extremely stressful) was used as the measurement tool. Ethical approval was granted by Damascus University.

RESULTS

In all, 365 students participated in the study, with a response rate of 96% (365/379). Cronbach's alpha was 0.83, indicating good reliability of the measurement tool. The overall mean score of the perceived stress was 2.64 (95% confidence interval [CI], 2.5-2.7). The mean scores for clinical factors, academic work, educational environment, personal factors, and living accommodation were 3.22 (95% CI, 3.1-3.3), 3.17 (95% CI, 3.1-3.2), 2.99 (95% CI, 2.9-3.0), 2.15 (95% CI, 2.1-2.2), 2.15 (95% CI, 2.0-2.2), respectively. The specific stressors with the highest mean scores were lack of dental equipment and difficulty in finding requested clinical cases; the respective means were 4.1 (95% CI, 4.0-4.2) and 3.9 (95% CI, 3.8-4.0).

CONCLUSIONS

The findings revealed moderate stress levels amongst students. The major stress factors pertained to stressors from the clinical, academic, and educational environment domains. Certain clinical and environmental stressors, such as difficulty in finding clinical cases and lack of dental equipment, were more powerful than the strongest academic stressors, such as examinations and grades and amount of assigned work.

The Dental Educational Environment of Online and Blended Learning during COVID-19, and the Impact on the Future of Dental Education

Blending face-to-face and online learning should create a focused environment that supports deep and meaningful teaching and learning that engages learners in a more active and collaborative educational experience. The present study aimed to evaluate students' online and blended learning educational environment self-perception at the Faculty of Dentistry, Kuwait University, during the COVID-19 pandemic.

METHODS

Undergraduate dental students who participated in blended learning with online lectures were invited to participate. The sample was a non-probability convenient sample, which included all clinical dental students invited to participate, who were enrolled in the fifth, sixth, and seventh (clinical year) years. All 69 students in these three clinical years were invited to participate. Electronic consent to participate and a self-administered questionnaire of two parts were completed. Part one of the questionnaire utilized the five subscales of the Dundee Ready Educational Environment Measure (DREEM) questionnaire; part two was developed in addition to evaluate the online teaching and learning subscales.

RESULTS

Descriptive statistics and analyses of variance were performed; Pearson correlations were made between the additional supplemental online teaching subscale and the original DREEM subscales. The mean students' perception of the teacher was high, followed by the academic self-perception and then the learning perception. Students' social self-perceptions had the lowest reported scores. Students' perceptions varied by year of education in all subscales except for the online domain. In comparing all domains (DREEM and the online component), graduating students (final year) had a more favorable perception than other students.

CONCLUSIONS

Within the limitations of the present study, online and blended learning were positively perceived, excluding the social self-perception and the perception that the online teaching time was not well used.

The relationship of dental students’ characteristics to social support, psychosocial factors, lifestyle, and quality of life

Objective

To examine the relationships between sociodemographic characteristics, student academic information, social support, sense of coherence, anxiety, lifestyle, and quality of life among dental students.

Methods:

A cross-sectional study among 233 dental students in Brazil. We captured data on sociodemographic and socioeconomic characteristics, social support through Social Support Appraisal, psychosocial factors (sense of coherence and anxiety based on SOC-13 and Depression, Anxiety and Stress Scale-21 – anxiety subscale, respectively), lifestyle as per individual Lifestyle Profile and quality of life based on VERAS-Q. Data was analysed through Structural Equation Modelling.

Results:

Greater social support, higher sense of coherence, lower anxiety, better lifestyle directly predicted better quality of life. Male gender, city of origin did not differ from the city of the campus, higher social support and greater sense of coherence were indirectly linked with better quality of life via better lifestyle. Lower academic semester and higher social support indirectly predicted better quality of life via lower anxiety.

Conclusion:

Social support, sense of coherence, anxiety, and lifestyle were relevant factors directly associated with dental student’s quality of life. Indirect pathways were observed between gender, moved home to attend dental course, academic semester, social support, sense of coherence, and quality of life.

Adapting the German version of the dental environment stress questionnaire

AIMS

To develop a German version of the Dental Environment Stress (DES) questionnaire, and to evaluate its reliability and validity.

METHODS

The original English DES questionnaire was translated into German using a forward-backward translation process. To evaluate construct stability, a subgroup of dental students (n = 43) completed the DES twice (interval: 1 week). To evaluate how the DES responds to anticipated changes in stress, all dental students' (n = 64) DES scores and saliva cortisol levels administered from a clinical study were compared between holiday and term time. Furthermore, the Depression, Anxiety and Stress Scale (DASS) and a stress self-assessment were used to determine the validity of the DES. Reliability analyses were calculated using Kendall's tau correlations. To estimate reliability strength, correlation coefficients and intraclass correlations (ICCs) were used.

RESULTS

Regarding construct stability, 24 of 25 DES items had at least moderate correlations, and most items showed strong correlations. Correlations for the seven subdomains were good (range: 0.778-1.000). The same was true for the total DES score (ICC: 0.944). Correlations for response to term-time stress were weaker and more varied. Validity analyses revealed fair correlations between the DES and students' self-assessment (Pearson's r = .592) and DASS score (Pearson's r = .392), suggesting satisfactory validity. Stress levels were quite similar between baseline and follow-up.

CONCLUSION

The German DES is a reliable tool for evaluating stress in dental students. Because it can be used to identify individual stressors in various categories, it might enable the detection of specific stress situations in educational situations and facilitate solutions (adjustment of curricula, tailored consulting services).

Stress, Sleep Quality, and Academic Performance among Dental Students in Shiraz, Iran

Background

Quality of sleep and stress level can affect the health, capacity of learning, and academic performance of the students. This study aimed to investigate the association between stress and sleep quality with academic performance among undergraduate clinical dental students in Shiraz, Iran.

Methods

This cross-sectional study was conducted during the second semester of the academic year 2020–2021 among clinical dental students at Shiraz Dental School, Iran. A total of 138 students completed Pittsburgh Sleep Quality Index (PSQI) and dental environment stress (DES) questionnaire. The grade point averages (GPAs) of the previous terms of the participants were also collected. Data analysis was performed using Kolmogorov–Smirnov test, the one-way ANOVA, post hoc Duncan's test, nonparametric Kruskal–Wallis H test, Wilcoxon–Mann–Whitney test, and the chi-squared test. The p values of less than 0.05 were considered statistically significant.

Results

Clinical dental students participated in this study experienced moderate levels of stress and poor sleep quality. Mean total DES and PSGI scores did not differ by sex, year of study, marital status, and place of residence (p values >0.05). Most of the students (52.9%) had moderate GPAs. A significant relationship was observed between sex and GPA as well as between place of residence and GPA (p values <0.05). No significant differences were found between DES total score or PSQI score and GPA categories (p values >0.05). A significant direct relationship between DES total score and PSQI score was observed (p < 0.05).

Conclusion

Dental undergraduates in Shiraz, Iran, experienced moderate levels of stress and poor sleep quality. The results showed no significant difference between sleep quality or DES and academic achievement. However, a significant direct correlation was observed between sleep quality and dental environment stress.

Psychological Distress among Undergraduate Dental Students in Saudi Arabia and Its Coping Strategies-A Systematic Review

The objective of this paper was to evaluate the studies that have reported on psychological issues among dental students in Saudi Arabia and to develop coping strategies to overcome these mental health-related issues. The present systematic review is in accordance with the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for the articles was carried out in the electronic databases by four independent researchers. The data search was performed in the electronic search engines like PubMed, Google Scholar, Web of Science, Scopus, Medline, Embase, Cochrane and Saudi Digital Library for scientific research articles published from January 2000 until December 2020. STROBE guidelines were adopted for qualitative analysis of six articles which met the eligibility criteria. The analysis of the literature revealed that most of the studies included were conducted in the past 8 years in different regions of Saudi Arabia. Findings of this systematic review clearly state that dental students in Saudi Arabia experience higher levels of depression, stress and anxiety and stress during their education period, with a higher stress for female students compared to male students. There is an urgent need to introduce interventional programs and preventive strategies to overcome the long-term effects.

Reliability and Validity of the Turkish Adaptation of Dental Environmental Stress Scale: A Methodological Study

Aim:

This paper aims to develop the Turkish version of the dental environmental stress (DES) scale that can evaluate perceived DES in Turkish dental students.

Materials and Methods:

A methodological study was conducted to adapt the DES scale to Turkish language in Gaziantep University, Faculty of Dentistry. The study group consisted of 392 students in the academic year 2018/19. The students were surveyed using the DES scale, translated into Turkish language. The demographic characteristics were analyzed by using descriptive statistical analyses. Kaiser-Meyer-Olkin and Bartlett’s Test of Sphericity were employed to evaluate the suitability of the dataset. Exploratory factor analysis was performed to assess construct validity. Depression Anxiety Stress Scale-21 was used to predict the power of the scale. In reliability analysis, the instrument’s internal consistency and corrected item-total correlation, Cronbach’s α reliability were studied.

Results:

Content Validity Index of the scale items was found to have a high validity range of 0.97. Two items with an estimate value less than 0.4 were excluded and 30 items yielded five factor. Five factors having eigenvalues greater than 1.0 explained 52.299% of the total variance. Each factor showed adequate internal consistency. Factor loadings ranged from 0.46 to 0.77. In the concurrent validity, significant positive relationship was found between DASS-21 and Turkish DES.

Conclusion:

According to psychometric properties, the Turkish version of the DES presented good results, thus it could be a valid instrument to assess the perceived stress in Turkish dental students.

Students' Perceptions of Educational Climate in a Spanish School of Dentistry Using the Dundee Ready Education Environment Measure: A Longitudinal Study

Background: Educational Climate (EC) may determine teacher and student behaviour. Our aim was to evaluate EC longitudinally in a period of ‘curricular transition’ from traditional (teacher-centred learning) to Bologna curricula (interactive student-centred learning). Methods: The ‘Dundee Ready Education Environment Measure’ (DREEM) questionnaire was completed by 397 students from a Spanish School of Dentistry. Students’ perception was assessed in different courses and academic years. Results: The overall EC scale average was 115.70 ± 20.20 (57.85%) and all domain values showed a percentage > 52%, which were interpreted as ‘positive and acceptable’. The EC mean was: 118.02 ± 17.37 (59.01%) for 2010–2011; 116.46 ± 19.79 (58.23%) for 2013–2014; 115.60 ± 21.93 (57.80%) for 2014–2015; 112.02 ± 22.28 (56.01%) for 2015–2016, interpreted as ‘more positive than negative EC’. The worst Learning domain scores corresponded to later academic years and may reflect the Bologna curriculum’s more intensive clinical training involving greater responsibility and self-learning. Conclusions: EC and its domains were perceived more positively than negatively. The Social domain was the most positively evaluated, while the Learning domain was the worst.

Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: A nationwide study

OBJECTIVES

Public mental health concerns have been raised during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to assess the psychological impact of the pandemic on dental students in Saudi Arabia.

METHODS

A cross-sectional analytical study was conducted among dental students from different universities in Saudi Arabia selected using 2-stage cluster sampling. The psychological impact was assessed using the validated Arabic version of the Depression, Anxiety and Stress Scale-21 Item questionnaire. The data were analyzed using SPSS software. The Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. A chi-squared test was used to compare the proportions between the sociodemographic data and logistic regression analysis to identify variables associated with the student's responses.

RESULTS

The internal consistency of the scale was excellent (0.954). A total of 697 dental students participated voluntarily in the study; their mean age was 21.76 ± 1.859 years, and 54.7% were female. The majority (96.1%) were single, and 69.4% lived in a household of > 5 persons. Significant differences in mental health outcomes were evident for gender, university, and survey time. Elevated levels of depression, anxiety, and stress were recorded among 60.64%, 37.02%, and 34.92%, respectively, of the students. Females, students who lived alone, and junior students were more likely to experience psychological problems during the COVID-19 pandemic.

CONCLUSIONS

The presence of elevated levels of depression, anxiety and stress among dental students highlights the need for psychological empowerment strategies involving institutional counseling services.

Self-reported psychological problems amongst undergraduate dental students: A pilot study in seven European countries

AIM

To map psychological problems amongst undergraduate dental students with a focus on different time points in clinical work in seven Eastern European and Scandinavian countries.

MATERIALS AND METHODS

A total of 1063 3rd- and 5th-year dental students (response rate 70%) participated in this pilot study and completed a pre-tested, structured questionnaire, which collected information on sociodemographic characteristics and self-reported psychological problems. Data were analysed by bivariate and multivariate methods.

RESULTS

The majority of participants were female and were younger than male participants. Most participants, though more females than males, agreed that the clinical work of dentistry was psychologically difficult. Almost half of participants felt nervous before working with patients (N = 506, 48%) and experienced a lot of stress whilst working with patients (N = 488, 46%); almost one-third (N = 287, 27%) felt anxious/worried after working with patients. Being a 3rd- and 4th-year student (vs 5th-year) reduced the odds for anxiety after working with patients; being a 3rd-year student (vs 5th-year) increased the odds for stress whilst working with patients. Studying in countries other than Norway reduced the odds for stress whilst working with patients. Less than good self-perceived health, presence of psychological health complaints before starting dental education, female gender and lack of physical activity increased the odds for psychological problems.

CONCLUSION

A high number of undergraduate dental students reported psychological problems in connection with clinical work. It is unlikely that "one size fits all"; therefore, further qualitative investigations on stressors in clinical learning environments should be done in order to design tailor-made supportive strategies.

An Intervention Study: Does a Cognitive Reappraisal Technique Reduce the Perceived Stress in Fourth-Year Dental Students in New Zealand?

Background

The fourth-year of the Bachelor of Dental Surgery (BDS) degree is considered the most stressful in the curriculum. Cognitive reappraisal is a self-applied method of stress management where an individual recognises his/her physiological responses to stress as a positive phenomenon helping him/her rise to the challenge, rather than a negative one in response to a threat situation.

Aim

To investigate whether teaching fourth-year dental students to apply cognitive reappraisal reduces their perceived levels of stress.

Methods

A survey was emailed to all fourth-year dental students, inviting them to respond to a 20-item questionnaire adapted from the Dental Environmental Stress (DES) Survey. Respondents were randomly assigned to reappraisal intervention/experimental (EXP) and control intervention (CON) groups, and each group was asked to watch an educational video. The EXP group video educated respondents on how to apply cognitive reappraisal in stressful situations, and the CON group video described generic methods of stress management. A follow-up survey was conducted after 3 weeks.

Results

The respondent rate was 47.6%. Change scores were calculated by subtracting the follow-up DES scores from baseline DES scores. The average change score for the experimental group was +3.1, indicating a decrease in average perceived stress levels. Conversely, the average change score for the CON group was −1.06, indicating an increase in average perceived stress levels. However, this difference did not reach a statistical significance.

Conclusion

EXP group has shown to have positive effects on stress management, and its effects on BDS students demonstrate promise.

Mental Well-being of the First and Final-Year Medical and Dental Students of Kermanshah University of Medical Sciences

Background and Aim:

Medical and dental students are predisposed to developing psychiatric disorders owing to heavy physical, intellectual, and emotional activities. This study was conducted to evaluate the mental health status of medical and dental students.

Materials and Methods:

This cross-sectional study was conducted on the first- and final-year medical and dental students at Kermanshah University of Medical Sciences in 2016. The mental health status was measured by the General Health Questionnaire-28 (GHQ-28) involving somatic, social, anxiety, and depression domains. Scores > 6 (out of 28) and > 2 (out of 7) were considered to show psychiatric disorder for each domain, respectively. Data were analyzed by SPSS-18 using Kruskal-Wallis and Chi-square tests (P< 0.05).

Results:

The participants consisted of 246 students (39.4% first- and 37.8% last-year medical students; 8.1% first- and 14.6% last-year dental students) aged 18-37 years (22.6 ± 3.3). Psychiatric disorder, somatic symptoms, social dysfunction, anxiety, and depression were experienced by 44.7, 42.7, 46.3, 49.6, and 28.5% of the students, respectively. The prevalence of psychiatric disorder was comparable between the first- and final-year medical students (40.2% and 48.4%, respectively;P= 0.258). The final-year dental students significantly underwent more psychiatric disorder than the first-year dental students (61.1% and 20%, respectively;P= 0.003). There were no significant differences between the medical and dental students in the first (P= 0.089) and final (P= 0.196) years. There was also no significant association between the occurrence of psychiatric disorder and gender and age group (P> 0.05).

Conclusion:

Psychiatric disorder was common among dental and medical students. Hence, preventive and control measures are suggested to improve their mental health.

DREEM-ing of dentistry: Students' perception of the academic learning environment in Australia

INTRODUCTION

Continuous evaluation and improvement of the learning environment are required to respond to the changing nature of dental practice and dental education. This study aimed to describe a cohort of undergraduate dentistry students' perceptions of their learning environment.

METHODS

Students enrolled in years 1-4 of the Bachelor of Dental Science (Honours) programme at The University of Queensland were invited to complete an online survey which included demographics and the Dundee Ready Education Environment Measure (DREEM). This scale measures students' perception of the educational environment overall, and for five domains: Learning, Teaching, Academic self-perception, Atmosphere and Social self-perception. Data analysis was mostly descriptive, t tests and univariate statistics compared groups.

RESULTS

Participants (N = 192; females = 57%) were generally positive about their learning environment, with a total DREEM score of 127 of 200. Overall, Academic and Social self-perception domain scores were ranked lower than others. Students in preclinical years of study and/or had dentistry as a first career preference were more positive across all domains, except Social self-perception.

CONCLUSIONS

Differences between the preclinical and clinical phases of the curriculum point to the structure of teaching and learning in health professional degrees. Further research should investigate how each environmental domain more specifically correlates with other aspects of the curriculum and student progression, including well-being. This could include logistical factors such as timetabling and its effect on physical well-being, to less tangible factors that may impact on mental well-being.

Exploring personality in Australian dentistry students: Implications for coping with a challenging degree

INTRODUCTION

Dentistry is known to be a challenging degree and students are often under considerable academic pressure which may lead to stress and difficulties in coping. Personality influences coping ability, yet very little is known about the personality traits of dentistry students. This study aimed to describe the personality profiles of students enrolled in an Australian undergraduate dental degree.

METHODS

Students enrolled in year one and two of the undergraduate dental programme at The University of Queensland were invited to complete an online survey which included the Temperament and Character Inventory (TCI). Personality was measured by four dimensions of temperament: Novelty Seeking, Harm Avoidance, Reward Dependence and Persistence; and three-character traits: Self-Directedness, Cooperativeness and Self-Transcendence. Data analysis was mostly descriptive, and t tests and univariate statistics compared groups.

RESULTS

Participants (n = 134; 97% response rate; females = 51%) were generally single, spoke another language at home and lived in shared accommodation. The majority (55%) were 20-29 years old, and 40% were international students. The sample had average levels of all TCI traits, except for Cooperativeness which was high.

CONCLUSIONS

This sample of dentistry students portrayed a profile of temperament and character similar to profiles of other health profession students with the intellectual ability and drives to undertake a competitive and challenging degree. Longitudinal studies are needed to track changes in personality throughout the degree. This would provide insight into how and when to best support students.

Perceived sources of stress amongst dental students: A multicountry study

AIMS

The aim of this study was to explore the perceived sources of stress reported by dental students from fourteen different countries.

METHODS

A total of 3568 dental students were recruited from 14 different dental schools. The dental environmental stress (DES) questionnaire was used including 7 domains. Responses to the DES were scored in 4-point Likert scale. Comparison between students was performed according to the study variables. The top 5 stress-provoking questions were identified amongst dental schools. Data were analysed using SPSS software program. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Logistic regression analysis was also conducted to determine the effect of the studied variables on the stress domains. The level of statistical significance was set at <.05.

RESULTS

Internal consistency of the scale was excellent (0.927). Female students formed the majority of the total student population. The percentage of married students was 4.8%. Numbers of students in pre-clinical and clinical stages were close together. The most stress-provoking domain was "workload" with a score of 2.05 ± 0.56. Female students scored higher stress than male students did in most of the domains. Significant differences were found between participating countries in all stress-provoking domains. Dental students from Egypt scored the highest level of stress whilst dental students from Jordan scored the lowest level of stress.

CONCLUSION

The self-reported stress in the dental environment is still high and the stressors seem to be comparable amongst the participating countries. Effective management programmes are needed to minimise dental environment stress.

A longitudinal study on stress sources perceived by Chilean dental students

Introducción. La percepción de los estudiantes universitarios sobre el estrés académico es fundamental, ya que proporciona información valiosa sobre la eficiencia y aceptabilidad de los métodos educativos.Objetivo. Evaluar las diferencias en los factores de estrés percibidos por los estudiantes de primer año de odontología durante el primer y segundo semestre según género.Materiales y método. Estudio descriptivo exploratorio, longitudinal y no experimental. En mayo y octubre de 2016 se aplicó la versión en español del Dental Environment Stressors (DES), adaptado y validado para estudiantes de odontología en la Universidad San Sebastián (Concepción, Chile). La muestra consistió en 83 estudiantes de primer año. La comparación de las variables en estudio (stress y sus dimensiones) entre los dos períodos comparados, en general y considerando los géneros, se realizaron mediante la prueba t-Student, previa estimación de existencia o no de igualdad de varianzas entre los grupos mediante la prueba F de Fisher.Resultados. En la segunda medición, la dimensión “Formación clínica” en mujeres fue el único componente que mostró diferencias significativas con valores superiores de la media.Conclusión. Existe una percepción de estrés para todos los ítems del cuestionario DES; las mujeres tuvieron una mayor puntuación en la dimensión “Formación clínica”.

Stress Level of Dental and Medical Students: Comparison of Effects of a Subject-Based Curriculum versus a Case-Based Integrated Curriculum

The aim of this study was to investigate the stress level of medical and dental students at Kuwait University after a case-based integrated curriculum replaced the former subject-based curriculum. A modified version of the Dental Environment Stress questionnaire was used to measure possible stressors for both medical and dental students. The investigators administered the questionnaire for the first time in 2008, when Kuwait University medical and dental schools followed a subject-based curriculum (group A). The same questionnaire was administered for a second time in 2014, when both medical and dental schools had adopted a case-based integrated curriculum (group B). A total of 345 fifth- and sixth-year medical and dental students responded to the questionnaire (group A=187, group B=158), with an overall 83% response rate. The results showed that, for both the dental and medical students, changing to a case-based integrated curriculum raised the stress level for most of the stressors evaluated. "Inconsistency of feedback on work between different instructors," "difficulties in communicating with teaching staff," "amount of assigned class work," and "examinations and grades" were some of the statistically significant stressors for group B students. Female students reported higher levels of stress than male students in both groups. These results suggest that introducing stress management education into the case-based integrated dental and medical curricula could enhance students' psychological well-being.

Health professions' students have an alarming prevalence of depressive symptoms: exploration of the associated factors

BACKGROUND

There is a need to better understand the depression phenomenon and to clarify why some students become depressed and others don't. The purpose of this study was to compare the prevalence of depressive symptoms among health professions' (HP) students, and to explore the association between socio-demographic factors (e.g. year of study, discipline, gender) and depressive symptoms.

METHODS

In this descriptive-analytic, cross-sectional study, stratified proportionate sampling strategy was used to select the study sample during the academic year 2012-2013. The students from four health professions' schools situated within a large, public university located in Riyadh, Saudi Arabia were screened for depressive symptoms using the 21-item Beck Depression Inventory (BDI II). Chi-square test, student t-test and ANOVA were used to compare different categorical variables.

RESULTS

The overall response rate was 79.0 %, the highest among dental students 86.1 %, and lowest among nursing (49.7 %). The overall prevalence rate of depressive symptoms was 47.0 %; it was highest among dentistry students (51.6 %), followed by medicine (46.2 %), applied medical sciences (AMS) (45.7 %) and lowest among nursing students (44.2 %). A statistically significant association was found between the presence and severity of depressive symptoms on one hand and the female gender (p = 0.000) and year of study on the other hand.

CONCLUSION

This study seems to indicate an alarming rate of depressive symptoms. Female gender, dentistry, the third year for all schools and fifth year for medicine and dentistry have the highest association with depressive symptoms. Future studies may be needed to explore further the reasons and explanations for the variation in the prevalence of depressive symptoms among these groups. The factors that deserve exploration include curricular variables and personal factors such as the students' study skills.

Coping strategies and the Salutogenic Model in future oral health professionals

BACKGROUND

Attention to the role of context in shaping individuals' coping strategies is necessary. This study used the Salutogenic Model (SM) as a framework to identify the coping strategies of oral health profession students from three countries.

METHODS

Students from Australia, New Zealand and Chile were invited to participate in this cross-sectional study, and were given a questionnaire including socio-demographics, the Perceived Stress Scale, The SOC-13 and the Brief COPE. Descriptive analysis, correlation analysis and profile analysis were computed using SPSS v 20.0.

RESULTS

Eight-hundred and ninety-seven valid questionnaires were returned, achieving a 44 % response rate. The coping dimension that the participants most commonly reported using was "Active Coping" with a mean value of 5.9 ± 1.5. Chilean respondents reported higher stress levels (19.8 vs. 17.7) and a lower Sense of Coherence (55.6 vs. 58.0) compared to Australian/New Zealand participants (p < 0.001). The SOC was positively correlated with active coping (p < 0.01) and positive reframing (p < 0.01). Profile analysis showed that when the differences in responses by sex were accounted for, there was no significant effect by country on the coping strategies used (p < 0.32).

CONCLUSION

This initial investigation provides insights into the students' coping strategies and the validity of the SM. Students reporting high SOC scores where those who demonstrated the use of active coping and positive reframing as strategies to deal with stressful situations, which indicates the accuracy of the theoretical framework of the SM in health education environments. The results also suggest that a distinctive coping strategy pattern may apply to all participants, regardless of their country and sex.

Stressful Life Events of Dental Students and Salivary Immunoglobulin A

To study the perceived sources of stressful events in dental students and the relationships between their self-perceived stress levels and salivary IgA. Undergraduates as well as postgraduates at the Faculty of Dentistry, National University of Singapore were surveyed one month after the new term. A 38-item dental environmental stress (DES) questionnaire, with subscales of academic work (AW), clinical factors (CF), faculty and administration factors (FA) and personal factors (PF), was used to identify the potential stressors in the dental environment. A 4-point perceived stress scale was used to rank their self-perceived stress levels. Enzyme linked immunosorbent assay method was used to determine the salivary IgA level. One hundred and thirty students (81.3% - valid response rate) participated in the study. Overall, students ranked AW with the highest score (mean 2.76), followed by CF (2.67), FA (2.24) and PF (2.16). Among the 38 items of DES questionnaire, 1st year students perceived “fear of being unable to catch up if behind” as the most stressful event (mean 3.30). For 2nd and 3rd year students, examination and grades had the highest scores (mean 3.28, 3.19, respectively). Completing graduation requirements was the most important stressor for 4th year students (mean 3.89). Postgraduates perceived atmosphere created by clinical faculty was most stressful to them (mean 3.05). The mean total perceived stress scores were highest (22.1) in 1st year students and lowest (21.0) in postgraduates, however, no significant different among various classes. First year students had the lowest IgA secretion rates (geometric mean [GM] 46.8 μg/min), significantly lower (p<0.05) than postgraduates (GM 79.4 μg/min). An inverse correlation was noted between perceived stress scale and log IgA secretion rates (r=-0.20, p=0.002.). AW was also significantly inversely correlated with salivary IgA (r=-0.18, p=0.04). Dental students in different academic years perceived different important stressors. Salivary IgA secretion rate correlated inversely with self perceived stress.

Psychological distress and its correlates among dental students: a survey of 17 Colombian dental schools

BACKGROUND

Links between the demanding nature of studies in the health sciences, students' personality traits and psychological distress have been well-established. While considerable amount of work has been done in medicine, evidence from the dental education arena is sparse and data from Latin America are lacking. The authors conducted a large-scale investigation of psychological distress among dental students in Colombia and sought to determine its curriculum and student-level correlates.

METHODS

The Spanish version of the Derogatis' Symptoms Checklist Revised (SCL-90-R) was administered to all students officially registered and attending classes or clinics in 17 dental schools in 4 geographic districts of Colombia between January and April 2012. Additional information was collected on participants' socio-demographic information and first career choice, as well as school's characteristics such as class size. The Global Severity Index (GSI) score, a measure of overall psychological distress, served as the primary analytical endpoint. Analyses relied on multilevel mixed-effects linear and log-binomial regression, accounting for study design and sample characteristics.

RESULTS

A total of 5700 dental students completed the survey, a response rate of 67%. Pronounced gradients were noted in the association between socio-economic status and psychological distress, with students in higher strata reporting fewer problems. After adjustment for all important covariates, there was an evident pattern of increasing psychological distress corresponding to the transition from the didactic, to the preclinical and clinical phases of training, with few differences between male and female students. Independent of other factors, reliance on own funds for education and having dentistry as the first career choice were associated with lower psychological distress.

CONCLUSIONS

Levels of psychological distress correlated with students' socio-economic and study-level characteristics. Above and beyond the influence of person-level factors, variations in levels of distress paralleled specific transitional stages of the 5-year dental curriculum, providing opportunities for targeted interventions.

Academic distress, perceived stress and coping strategies among dental students in Saudi Arabia

OBJECTIVES

To evaluate the sources of stress among students in the dental school environment, their perceived levels of stress and effective coping strategies.

METHODS

This study was conducted during the first semester of the academic year, 2009-10, at the College of Dentistry, King Saud University, Saudi Arabia. The eligible study group consisted of 556 undergraduate dental students from all five class years; they were surveyed with a detailed assessment tool. The validated and translated questionnaire comprised the modified version of the dental environmental stress (DES) survey, the perceived stress scale (PSS) and the brief coping scale (BCS).

RESULTS

The overall findings substantiated with multiple regression indicate that, out of 20 factors of both DES and BC instruments, six factors were significantly and independently related to perceived stress scores (F = 34.638; p < 0.0001). Especially, the factors self-efficacy and workload of DES and the factors behavioral disengagement, denial, positive reframing and venting of BC were positively and independently related to perceived stress scores.

CONCLUSIONS

Dental students displayed relatively high perceived stress scores. Female, advanced and married, compared with male, junior and single students reported more stress. Changes in certain environmental factors and coping strategies independently affected the perceived stress score. Strategies for stress management must be incorporated into dental education to ensure the output of effective dentists.

Perceived sources of stress amongst Chilean and Argentinean dental students

INTRODUCTION

The prevalence of high levels of stress as well as its multilevel consequences is well documented amongst students in the health sciences, and particularly in dentistry. However, investigations of perceived stress amongst Spanish-speaking student groups are sparse. This study aimed to (i) describe the translation, adaptation and psychometric properties of a Spanish version of the Dental Environment Stressors questionnaire and (ii) to examine the perceived sources of stress and their associations with the students' study year and gender in two dental schools in Latin America.

MATERIALS AND METHODS

All students officially registered in the dental schools of the University of San Sebastian (USS) in Chile and the Catholic University of Cordoba (CUC) in Argentina were invited to participate in the study. The DES30 questionnaire was adapted in Spanish using translation/back-translation, an expert bilingual committee, and consensus building. Cronbach's alpha was used to measure the instrument's internal consistency, and iterated principal factor analysis with promax rotation was employed to explore its underlying factor structure. Descriptive, bivariate and multivariate methods were used to examine the patterns of association between individual stressors, factor scores and students' characteristics.

RESULTS

Three hundred and four students comprised the study's analytical sample, with two-thirds of those being female. The DES30-Sp demonstrated good internal consistency (Cronbach's α = 0.89). A four-factor solution emerged and included 'academic workload', 'clinical training', 'time constraints' and 'self-efficacy beliefs' factors. 'Fear of failing a course or a year', 'examinations and grades' and 'lack of time for relaxation' were amongst the top individual-item stressors reported by students in both schools. Amongst this group of undergraduate dental students, those in Argentina, in higher study year, and females reported higher perceived stress.

CONCLUSIONS

Increased workload, time constraints and some aspects of clinical training were the top stressors of approximately 300 Chilean and Argentinean dental undergraduates. Some variations between schools, males and females and study years were noted. The Spanish version of the DES30 questionnaire performed well, but future studies should evaluate the instrument's properties in larger and more diverse dental student populations.

Stress and burnout in postgraduate dental education

INTRODUCTION

High levels of stress and burnout have been documented among dental students and practicing dentists, but evidence among dental residents and postgraduate students is lacking.

MATERIALS AND METHODS

Ninety-nine postgraduate students enrolled in clinical, non-clinical and PhD programmes in the Athens University School of Dentistry completed the Graduate Dental Environment Stress (GDES) questionnaire and the Maslach Burnout Inventory. Perceived stress was measured in two domains, academic (GDES-A) and clinical (GDES-C) and burnout was measured using the scales of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). Analyses relied on descriptive, univariate and multivariate methods based on ANOVA and generalised linear models.

RESULTS

Participants' mean age was 30 years; two-thirds were women and practised dentistry independently of their graduate studies. Residents in clinical programmes reported significantly higher levels of perceived stress compared to non-clinical and PhD students (P<0.05). There were no gender differences in perceived stress. Forty per cent of respondents were burnout 'cases' on the EE scale, while this proportion was 38% for reduced PA and smaller, 13% for DP. Perceived stress was positively correlated with all burnout dimensions, whereas independent dental practice and higher age had a protective effect.

CONCLUSIONS

High rates of burnout manifestations were detected among this sample of Greek postgraduate dental students. Perceived stress correlated with burnout and was more pronounced among those enrolled in clinical residency compared to non-clinical and PhD programmes.

Stress amongst dental students: a systematic review

The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer-reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.

Learning climate in dental hygiene education: a longitudinal case study of a Japanese and Canadian programme

Educational climates have been found to have important influences on learning, but little feedback has been obtained from dental hygiene students. The purpose of this study was to gain an understanding of the learning climate in Japanese and Canadian dental hygiene programmes for the purpose of making positive changes. A survey instrument with 10 dimensions relating to learning climate was adapted from business and dental models, and designated as the Dental Hygiene Student Learning Climate Survey (DHS-LCS). Higher scores indicated a more positive and supportive learning climate, and lower scores indicated an environment that is potentially less desirable. Students enrolled in a Japanese and a Canadian dental hygiene programme participated in this four-year study from 2005 to 2008. A total of 402 surveys were returned for an average response rate of 62%. The mean total DHS-LCS score of Canadian students was statistically significantly higher than that of Japanese students (P < 0.001) in all years tested, indicating that the Canadian students' perceptions of their learning environment were more favourable than those of the Japanese students. Based on the analyses of the DHS-LCS data, interventions to improve learning climates were designed and implemented. There were statistically significant improvements (P < 0.01) in DHS-LCS scores of Japanese and Canadian students over the years of the study, suggesting that student-centred interventions improved the perceived learning environment. The instrument appears to be helpful in identifying student concerns and can be used to implement interventions to help support a healthier learning climate.

Survey of perceived stress-inducing problems among dental students, Saudi Arabia

OBJECTIVE

This study was conducted to assess the problems related to stress encountered by Saudi dental students.

METHODS

One thousand and thirty questionnaires were distributed in four dental schools to all students from 2nd year level up to the internship level. The questionnaire contained 66 items organized into four categories: personal and administrative, theoretical, preclinical and clinical. The relationship between the demographic variables and students' academic performance with the investigated items was also assessed.

RESULTS

The response rate was 53%. Saudi dental students showed high levels of perceived stress. The clinical training issues imposed the highest level of stress on the students. Some significant relationships between the investigated variables and the level of the perceived stress were found.

CONCLUSIONS

Female students had higher mean overall problem scores compared to male students, and second-year students showed lower perceived problems compared to other students.

Students' perceptions regarding educational environment in an Indian dental school

BACKGROUND

As one of India's premier dental schools, the Manipal College of Dental Sciences, Manipal, has striven to be in the forefront of dental education ever since its inception in 1965. But one of our main drawbacks has been the lack of students' perceptions about the educational atmosphere in our institution.

AIM

(1) To understand the students' perceptions of the educational environment. (2) To compare the results with those of other dental/medical schools.

METHODS

Dundee Ready Education Environment Measure (DREEM) was used to gather information about the environment in our institution. The same was administered to first year and final year students (63 each).

RESULTS

The main area of convergence of both groups was that the social atmosphere was not very congenial. But the thought-provoking finding was that both groups felt that the teachers were authoritarian.

CONCLUSION

The lack of congenial atmosphere in our institution seems to be due to the attitude of the course organizers.A need for makeover in attitudes and approach on the part of the teachers to make the learning experience more pleasant for the students was made obvious by this study.

Career choice and attitudes towards dental education amongst dental students in Japan and Sweden

The purpose of this study was to identify and compare the perspectives of dental students towards their career choice and dental education in Japan and Sweden. One hundred and fourteen dental students from the Nippon Dental University, Japan and 43 dental students from the Karolinska Institutet, Sweden participated in this study. Information was derived from a self-answered questionnaire consisting of five items for career choice and six items for dental education. Chi-square test and Wilcoxon signed-rank test were used for comparison. Significant differences were detected for 10 questionnaire items between the two countries. Regarding motivation towards the career choice, 44% of Swedish students indicated interpersonal motives related to helping other people, whereas 32% of Japanese students indicated expectations of their family in the dental profession. As future career options, 64% of Japanese and 47% of Swedish students planned to work as general dentists. More Swedish students (37%) preferred specialisation than Japanese students (17%). Nearly three-quarters of the Swedish students were satisfied with the teaching faculty of their school, whilst only 32% of the Japanese students indicated content. The perspectives of dental students were different in Japan and Sweden. This study provides a description of the perspectives of Japanese and Swedish dental students and enables better understanding of career decision and dental curriculum issues.

Canadian dental students' perceptions of stress and social support

This study explored the relationship between dental school stress and social support reported by undergraduate students in a Canadian dental school. Students completed questionnaires comprised of Dental Environment Scale stress items, social support measures evaluating perceived contact and two proxy measures of social support (marital status and living arrangement). Sixty-two per cent of undergraduate students in all four academic years participated in the study conducted in March--April 2005. Second-year students living with parents had significantly higher adjusted total stress scores (P < 0.001), whilst fourth-year students living with roommates had significantly lower total adjusted stress scores (P = 0.008). Social support systems utilised by students included teacher, parental, student and relationship support. Students who received more support from teachers and from students inside and outside dental school had lower adjusted total stress scores. Multiple regression analysis assessing the effect of social support on total adjusted stress scores identified two significant variables after adjustment: second-year students living with parents (P < 0.001) and low teacher support (P = 0.032). This study identified social support and proxy measures as significant predictors of dental school stress in Canadian dental students. Further studies are needed to elucidate the role of social support and proxy measures as potential dental school stress alleviators.

The academic environment: the students' perspective

Dental education is regarded as a complex, demanding and often stressful pedagogical procedure. Undergraduates, while enrolled in programmes of 4-6 years duration, are required to attain a unique and diverse collection of competences. Despite the major differences in educational systems, philosophies, methods and resources available worldwide, dental students' views regarding their education appear to be relatively convergent. This paper summarizes dental students' standpoint of their studies, showcases their experiences in different educational settings and discusses the characteristics of a positive academic environment. It is a consensus opinion that the 'students' perspective' should be taken into consideration in all discussions and decisions regarding dental education. Moreover, it is suggested that the set of recommendations proposed can improve students' quality of life and well-being, enhance their total educational experience and positively influence their future careers as oral health physicians. The 'ideal' academic environment may be defined as one that best prepares students for their future professional life and contributes towards their personal development, psychosomatic and social well-being. A number of diverse factors significantly influence the way students perceive and experience their education. These range from 'class size', 'leisure time' and 'assessment procedures' to 'relations with peers and faculty', 'ethical climate' and 'extra-curricular opportunities'. Research has revealed that stress symptoms, including psychological and psychosomatic manifestations, are prevalent among dental students. Apparently some stressors are inherent in dental studies. Nevertheless, suggested strategies and preventive interventions can reduce or eliminate many sources of stress and appropriate support services should be readily available. A key point for the Working Group has been the discrimination between 'teaching' and 'learning'. It is suggested that the educational content should be made available to students through a variety of methods, because individual learning styles and preferences vary considerably. Regardless of the educational philosophy adopted, students should be placed at the centre of the process. Moreover, it is critical that they are encouraged to take responsibility for their own learning. Other improvements suggested include increased formative assessment and self-assessment opportunities, reflective portfolios, collaborative learning, familiarization with and increased implementation of information and communication technology applications, early clinical exposure, greater emphasis on qualitative criteria in clinical education, community placements, and other extracurricular experiences such as international exchanges and awareness of minority and global health issues. The establishment of a global network in dental education is firmly supported but to be effective it will need active student representation and involvement.

Stress levels of dental students at the Fiji School of Medicine

INTRODUCTION

The Fiji School of Medicine is the primary health care educational institution in Fiji and possesses the only dental school in the Pacific. The oral health programme is a multi-entry/exit programme. The aim of this study was to determine the perceived sources or stress and at risk groups within the undergraduate oral health care programmes.

METHODS

A modified version of the Dental Environment Stress questionnaire was used to assess levels of stress for 41 items.

RESULTS

A total of 115 undergraduate students participated (response rate = 84%). Of the respondents, 54% were male and 46% were female; 55% were Indo-Fijians, 18% Indigenous-Fijians, 8% Polynesians, 7% Micronesians, whilst Melanesians and others were each 6%. Moderate to severe stressful items were: full loaded day, followed by criticism from clinical supervisors in front of patients, amount of assigned work, fear of failing a course or year, examination and grades, financial resources, fear of employment after graduation and fear of facing parents after failure. Of the questionnaire items, 24% had significant differences across year groups. Overall, third years were most stressed followed by fourth years, fifth years, first years and second years. Indo-Fijians were the most stressed, followed by Indigenous-Fijians, Polynesians, others and Melanesians. Females were significantly more stressed than males for 27% of items. Private fee-paying students were more stressed than sponsored students.

CONCLUSION

Overall stress levels were slight to moderate and were higher in senior years, Indo-Fijians, females and private fee-paying students.