Stress and Health-Promoting Attributes in Australian, New Zealand, and Chilean Dental Students

The prevalence of depression, anxiety, and sleep disorder among dental students: A systematic review and meta-analysis

BACKGROUND

Despite the increasing concern, the literature lacks a comprehensive synthesis of the prevalence of depression, anxiety, and sleep disturbances among dental students.

METHODS

We conducted a systematic review following Cochrane Manual for Systematic Reviews of Interventions and PRISMA guidelines. Our search, spanning databases like Medline, Web of Science, and Scopus, covered data until June 5, 2023. A random effect model was utilized for the meta-analysis.

RESULTS

From 508 initially identified articles, 45 studies met eligibility criteria. The pooled prevalence of depression, anxiety, and sleep disorders among dental students was estimated as follows: depression [38%, 95% confidence interval (CI): 32%-44%; I2  = 98%], anxiety [48%, 95% CI: 41%-55%; I2  = 97.7%], and sleep disorders [31%, 95% CI: 24%-38%; I2  = 85.7%]. Subgroup analyses based on geographical regions and assessment scales revealed significant between-subgroup differences. Meta-regression identified associations between the prevalence of depression and the year of publication and between the prevalence of anxiety and total sample size, participant age, and year of publication. Publication bias assessments demonstrated a lack of significant bias, strengthening the validity of the findings.

CONCLUSIONS

The prevalence of depression, anxiety, and sleep disturbances in dental students is significant. This study highlighted the need for targeted interventions and support systems within dental education to alleviate the mental health challenges students face, ultimately ensuring their well-being and competence as future healthcare providers. Further research should explore the effectiveness of interventions in this population.

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.

Impact of COVID-19 on college students at one of the most diverse campuses in the USA: a factor analysis of survey data

OBJECTIVE

This survey study is designed to understand the impact of the COVID-19 pandemic on stress among specific subpopulations of college students.

DESIGN, SETTINGS AND PARTICIPANTS

An online questionnaire was sent to the students from University of Nevada, Las Vegas, between October 2020 and December to assess the psychological impact of COVID-19. A total of 2091 respondents signed the consent form online and their responses were collected.

MAIN OUTCOME MEASURES

Measures of psychological stress, as prescribed by the Perceived Stress Scale (PSS-10). An explanatory factor analysis was carried out on the PSS-10 results. We subsequently analysed each factor using stepwise linear regression that focused on various sociodemographic groups.

RESULTS

A two-factor model was obtained using the explanatory factor analysis. After comparing with the past studies that investigated the factor structure of the PSS-10 scale, we identified these two factors as 'anxiety' and 'irritability'. The subsequent stepwise linear regression analysis suggested that gender and age (p<0.01) are significantly associated with both factors. However, the ethnicities of students are not significantly associated with both factors.

CONCLUSIONS

To our knowledge, this is the first study that assessed the perceived stress of university students in the USA during the COVID-19 pandemic. Through exploratory factor analysis, we showed that the PSS-10 scale could be summarised as a two-factor structure. A stepwise regression approach was used, and we found both of the factors are significantly associated with the gender of the participants. However, we found no significant association between both factors and ethnicity. Our findings will help identify students with a higher risk for stress and mental health issues in pandemics and future crises.

Prevalence of stress and coping disorders among dental students: An original research

Introduction:

The students pursuing professional studies such as medicine and dentistry have to endure a lot of stress. Hence, we evaluated the prevalence of stress and coping disorders among dental students.

Methods:

We conducted a questionnaire-based online survey study among 100 dental students of 1–4 years. The survey was based on the “modified General Health Questionnaire (GHQ-12; Goldberg and Williams, 1988).” The scores were analyzed for the statistical connotation, keeping P < 0.05 as significant.

Results:

We observed that over half of the dental pupils felt stressed. The dental students resorted to “Destructive coping mechanisms.” Less than 15% of students sought medical and psychiatric counseling. The mean GHQ was 12 ± 1.7.

Conclusions:

Psychological strength is a prerequisite for good health and better performance in the studies as well as for the practice. There is an urgent need to focus on the mental health of the students specifically in the medical and dental fields.

The effect of resilience on the relationship between perceived stress and change in alcohol consumption during the COVID-19 pandemic in Queensland, Australia

The COVID-19 pandemic has led to increased levels of stress and alcohol consumption. This study examined the effect of resilience on the relationship between stress and changes in alcohol consumption in the context of the COVID-19 pandemic in early 2020. A cross-sectional survey of 502 adults in Queensland, Australia (mean age = 45.68 (16.61)), found 23.9% of individuals had increased their alcohol consumption since the start of the pandemic. Regression modelling demonstrated a significant association between perceived stress and change in alcohol consumption. The study also revealed resilience was a moderating factor, where high levels of resilience buffered against increases in alcohol consumption associated with stress during the COVID-19 pandemic.

Magnitude and correlates of alcohol use disorder in south Gondar zone, northwest Ethiopia: A community based cross-sectional study

BACKGROUND

Alcohol use disorder is the major public health problem in low- and middle-income countries that account for up to 70% of alcohol related premature mortality in the region. Therefore, the aim of this study was to assess the magnitude of alcohol use disorder and its associated factors among adult residents in south Gondar zone, Northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 848 adult residents of the south Gondar zone from January 13 to February 13, 2020. A multistage sampling technique was used to recruit study participants. We assessed alcohol use disorder (AUD) using the alcohol use disorder identification test (AUDIT). A binary logistic regression model was employed to identify factors associated with AUD.

RESULTS

The prevalence of alcohol use disorder over the last 12-months was found to be 23.7% (95% CI: 20.9, 26.7). Being male (AOR = 4.34, 95 CI; 2.800, 6.743), poor social support (AOR = 1.95, 95 CI: 1.098, 3.495), social phobia (AOR = 1.69, 95 CI; 1.117, 2.582), perceived high level of stress (AOR = 2.85, 95 CI; 1.829, 34.469), current cigarette smoking (AOR = 3.06, 95 CI; 1.764, 5.307) and comorbid depression (AOR = 1.81, 95 CI; 1.184, 2.778) were significantly associated with alcohol use disorder.

CONCLUSION

The prevalence of alcohol use disorder is high among adult residents of the south Gondar zone and associated with many factors. So, it needs public health attention to decrease the magnitude of alcohol use disorder in Ethiopia.

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel

OBJECTIVE

Our objective was to quantify the associations between sleep duration and perceived and chronic stress with ideal cardiovascular health (CVH) among emergency medical services (EMS) personnel from county-based EMS agencies.

METHODS

We conducted a cross-sectional survey of cardiovascular disease (CVD)-free EMS personnel from 4 US EMS agencies. The questionnaire consisted of the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Chronic Burden Scale, and the CVH components (smoking, body mass index, physical activity, diet, blood glucose, blood pressure, cholesterol, each scored 0-2 points). The components were summed and ideal CVH considered 11-14 points. Mixed effects logistic regression models with a random intercept for agency were used to estimate the odds of ideal CVH for good sleep quality (PSQI < 5 points), recommended sleep duration (7 to < 9h), low perceived stress (PSS < 26 points), and low chronic stress (0 recent stressful events).

RESULTS

We received 379 responses (response rate = 32%). There was low prevalence of good sleep quality (23%) and recommended sleep duration (25%), but 95% reported low perceived stress, and 33% had low chronic stress. Ideal CVH was reported by 30%. No significant associations between ideal CVH and sleep quality, perceived stress, or chronic stress were found. There was a nearly 2-fold increase in the odds of ideal CVH with recommended sleep duration (odds ratio: 1.83, 95% confidence interval: 1.08-3.10).

CONCLUSION

In this sample of EMS personnel, only recommended sleep duration was associated with ideal CVH. Future longitudinal studies are needed to understand the relationship between sleep, stress, and CVD in this understudied occupational group.

Stress and anxiety among physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region: An online survey

Background

During infectious disease outbreaks, healthcare workers are at high risk of infection, infecting others, and psychological distress. This study aimed to determine the prevalence of stress and anxiety in physicians during the COVID-19 outbreak in the Iraqi Kurdistan Region and assess their associated factors.

Methods

This cross-sectional study was carried out in Erbil, Iraqi Kurdistan Region, from March 28 to April 15, 2020. An online self-administered survey questionnaire was used to collect data from physicians working in specialized COVID-19 centers and other healthcare facilities. The level of stress was measured based on the 10-items Perceived Stress Scale. The level of anxiety was measured based on the 7-item Generalized Anxiety Disorder scale.

Results

A total of 370 participants responded to the perceived stress component of the survey, of whom 57 (15.4%) had low perceived stress, 249 (67.3%) had moderate stress, and 64 (17.3%) had high stress. Being female was significantly associated with having moderate/high stress (adjusted odds ratio (AOR) = 2.40 (95% CI 1.31–4.39)). A total of 201 participants responded to the generalized anxiety disorder component of the survey, of whom 19 (9.5%) had no anxiety, 57 (28.4%) had mild anxiety, 79 (39.3%) had moderate anxiety, and 46 (22.9%) had severe anxiety. Working in COVID-19 centers (AOR = 2.23 (95% CI 1.02–4.86)) and being general practitioners (AOR = 4.16 (95% CI 1.14–15.14)) were significantly associated with having moderate/severe anxiety.

Conclusion

A considerable proportion of physicians experience stress and anxiety during the COVID-19 outbreak in Iraqi Kurdistan region. Generalists and those in special COVID-19 units report the greatest anxiety. There a need to establish mechanisms to reduce the risks of stress and anxiety among physicians. Mental health coping interventions through counseling should be based on COVID-19 protocol guidelines. Interventions should also emphasize physicians’ ability to work safely and efficiently in providing care to the patients.

Perceived Stress and Associated Factors in Russian Medical and Dental Students: A Cross-Sectional Study in North-West Russia

The aim was to assess perceived stress (PS) and factors associated with PS in Russian medical and dental students. A total of 406 medical and 283 dental students aged 18–25 years that attended the Northern State Medical University in Arkhangelsk, North-West Russia participated in this cross-sectional study. A structured, self-administered questionnaire was used to collect information on socio-demographic and socioeconomic factors, oral health (OH) behavior, and self-reported OH. All students were clinically examined to assess dental caries, oral hygiene, and gingiva. PS was measured by the Perceived Stress Scale 10 (PSS-10). Of the students, 26.0%, 69.1%, and 4.9% reported low, moderate, and high PS, respectively. Female sex (b = 2.28, 95% confidence interval (CI): 1.38–3.18), dental faculty (b = 1.74, 95% CI: 0.94–2.54), low subjective socioeconomic status (SES) (b = 1.71, 95% CI: 0.91–2.51), and irregular dental visits (b = 1.65, 95% CI: 0.72–2.58) were associated with higher PSS-10 score. These factors were assumed to be clinical meaningful, given that minimal clinically important difference of PSS-10 fell between 2.19 and 2.66 points. The majority of the medical and dental students reported moderate PS. Based on statistical significance and clinical meaningfulness, socio-demographic factors (sex, faculty), subjective SES, and OH behavior (regularity of dental visits) were associated with PS.

Investigation of Stress Level Among Dentistry Students, General Dentists, and Pediatric Dental Specialists During Performing Pediatric Dentistry in Kerman, Iran, in 2017

Background & Aim:

Dentists are exposed to stress and tension as they have a close contact with the patients. The increase in stress may affect the dentists’ performance and can be a major threat to the physical and mental health of the patients. Pediatric dentistry requires experience, without which the amateur dentists and students feel lack of self-confidence, and consequently be unable to deal with problematic patients. There is no study investigating stress during pediatric dentistry among the dentistry students as well as general and pediatric dentists in Iran. Regarding the importance ofthis subject, we aimed to evaluate the stress level among the aforementioned three dental service providers during pediatric dentistry.

Materials & Methods:

This study was conducted on 300 dentistry students, general dentists, and pediatric dental specialists in Kerman, Iran. The data were collected using a questionnaire entailing demographic information and therapeutic practices of pediatric dentistry. After checking the participant’s comments, the data were analyzed using SPSS version 16 (IBM, Texas, USA).

Results:

According to the results, the mean age of the participants was 28±5 years. Out of the 300 participants, 113 (37.7%) and 178 (59.3%) cases were male and female, respectively, and 9 (3%) participants did not fill out this part. Furthermore, 108 (36%), 173 (57.7%), 6 (2%), and 10 (3.3%) subjects were general students, general dentists, residents, and pediatric residents, respectively. Anesthesia injection in the mandible for an anxious child and amalgam restoration in the mandible led to the highest and lowest stress levels in the participants, respectively. Furthermore, the mean stress levels were significantly different between the practices performed in the maxilla and mandible (P<0.001). In addition, the females showed a significantly higher level of stress, compared to the males (P<0.001). The specialists had significantly lower stress than the dentistry students and general dentists (P<0.001).

Conclusion:

As the findings indicated, anesthetic injection to a nervous infant was the most stressful practice in pediatric dentistry. The results also showed that the pediatric dental specialists had lower stress level, compared to the students and general dentists.

Stressors and Protective Factors among Veterinary Students in New Zealand

A study was undertaken to investigate the stressors faced by veterinary students and the protective factors against those stressors. The study was conducted as a workshop during which students collaborated with their peers through an iterative process to identify personal and external factors that contributed to or protected against stress as a veterinary student, and then to suggest strategies that would protect their mental health and well-being. Workload and assessment were the most commonly reported stressors. Students reported a variety of effective coping strategies and avoidance behaviors, although most of the suggested solutions revolved around organizational change within the university. Students also recognized that their own perspectives, traits, and behavior could enhance their student experience or increase their perceived levels of stress. While it is important that educators monitor student feedback about the program and make changes when required, students must recognize that stress is an expected component of life and develop effective coping strategies. They should develop a balanced view of the positive and negative aspects of the student experience and, ultimately, of working as a veterinary professional.

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.

Food and mental health: relationship between food and perceived stress and depressive symptoms among university students in the United Kingdom

AIMS

The current study assessed, by university and sex, the association between nutritional behaviour (twelve independent variables), and stress and depressive symptoms (dependent variables) in a sample from three UK countries.

METHODS

A cross-sectional survey was undertaken among undergraduates enrolled across seven universities in England, Wales and Northern Ireland (N = 3,706). Self-administered questionnaires included a 12-item food frequency questionnaire, Cohen's Perceived Stress Scale and modified Beck Depression Inventory. Sex and university comparisons were undertaken. Univariable and multivariable regression analyses were computed for each of the two outcomes--perceived stress and depressive symptoms.

RESULTS

The frequencies of consuming of the various food groups differed by university and sex, as did depressive symptoms and perceived stress. Multivariable regression analyses indicated that consuming 'unhealthy' foods (e.g. sweets, cookies, snacks, fast food) was significantly positively associated with perceived stress (females only) and depressive symptoms (both males and females). Conversely, consuming 'healthy' foods (e.g. fresh fruits, salads, cooked vegetables) was significantly negatively associated with perceived stress and depressive symptoms scores for both sexes. There was significant negative association between consuming fish/sea food and depressive symptoms among males only. For males and for females, consuming lemonade/soft drinks, meat/sausage products, dairy/dairy products, and cereal/cereal products were not associated with either perceived stress or depressive symptoms.

CONCLUSIONS

The associations between consuming 'unhealthy' foods and higher depressive symptoms and perceived stress among male and female students as well as the associations between consuming 'healthy' foods and lower depressive symptoms and perceived stress among male and female students in three UK countries suggest that interventions to reduce depressive symptoms and stress among students could also result in the consumption of healthier foods and/or vice versa.

Are students' symptoms and health complaints associated with perceived stress at university? Perspectives from the United Kingdom and Egypt

This cross-sectional survey assessed and compared by country, the levels and correlates of 21 self-reported symptoms/health complaints. We examined the associations between self-reported symptoms and perceived stress. Data was collected from universities in the United Kingdom and Egypt (N = 3706 and 3271 undergraduates, respectively). A self-administered questionnaire assessed a range of self-reported symptoms, perceived stress, sociodemographic (gender, age, marital status, year of study, living arrangements during semester, income sufficiency), lifestyle (tobacco smoking, illicit drug/s use, alcohol consumption frequency), and health variables (subjective health status, health awareness, BMI), along with religiosity, and quality of life. Factor analysis categorized the 21 self-reported symptoms into four components. Correlation analysis and linear regression tested the associations between the self-reported symptoms and stress. Factor analysis of the health symptoms generated four symptom groups for each of the UK and Egypt (psychological; circulatory/breathing; gastrointestinal; and, pains/aches), and factor loadings were quite similar for both countries. Whilst the two samples showed similarities as to the kind of symptoms most frequently reported by students, the Egyptian sample had significantly higher frequency than the UK for every symptom. Frequent complaints (both countries) included difficulties to concentrate, fatigue, headaches, nervousness/anxiety, and back pain (UK) and mood swings (Egypt). Significantly more Egyptian students reported ≥4 symptoms over the past year than the UK. For each of the UK and Egypt, across each of the four symptom groups, there was a stepladder appearance whereby the frequency of symptoms increased with increasing quartiles of perceived stress. Not controlling for other variables, for both countries, there were significant positive correlations between each of the four symptom groups and stress; the highest correlation was for psychological symptoms. After controlling for sex, age country, and other symptom groups, stress was highly and significantly associated with psychological symptoms and also with pain & aches symptoms in both countries. UK students were generally less stressed than their counterparts in Egypt. Age and female gender were also associated with stress; the younger the student was the more likely to suffer from stress. Interactions were not significant. Across both countries, the levels of stress among students and the associations between perceived stress and health complaints suggest the need for a multiple approaches in order to understand the sources of stress; how college students experience stress; and, the coping mechanisms that different students employ to mitigate stress. Interventions aimed at both preventing, treating and caring for students’ distress, and also preventive strategies to help minimize the impact of stressful situations are required. Strategies that address both physical and psychological complaints may be beneficial for this population.