Changes in mental health during the COVID-19 crisis in Romania: A repeated cross-section study based on the measurement of subjective perceptions and experiences

The coronavirus 2019 (COVID-19) pandemic has caused dramatic changes in the daily lives of Romanians, affecting their mental health. The COVID-19 pandemic has evolved at three significant peaks, which sequentially occurred on: April 29, 2020; September 18, 2020; and the third wave registered the highest severity on November 27, 2020. Little is known about the mental health changes during this phase of this pandemic. This study evaluated mental health levels in Romania at the end of the first wave of the pandemic and amidst the third and most severe wave. We administered a two-phase internet-based survey among 543 and 583 participants, respectively, recruited through snowball sampling at a 6-month interval. The IPAT Anxiety Scale measured anxiety, the Beck's Depression Inventory measured depression, and the Dissociative Experiences Scale measured dissociation. We observed no statistically significant differences in the number of participants with clinically relevant scores at either time point. In the first survey, 23.8%, 19.2%, and 32.6% reported being clinically anxious, clinically depressed, and showed clinical dissociation, respectively. Binary logistic regressions indicated that age, education level, and previous traumatic events were significantly associated with clinical levels of anxiety and depression. Moreover, multiple linear regression analysis reported a collective significant effect of gender, age, psychological impact, traumatic events, and dissociation on predicting high levels of anxiety and depression. Romanian adults' mental health status was affected during the COVID-19 pandemic, and it did not change 6 months after the first lockdown.

An examination of the internal consistency and structure of the Statistical Anxiety Rating Scale (STARS)

The purpose of the current study was to examine the internal consistency and structure of the English version of the Statistical Anxiety Rating Scale (STARS). Participants were 202 (79% females) psychology undergraduates was recruited from James Cook University's Singapore (71%) and Australia (29%) campuses. Acceptable internal consistency reliabilities, ranging from .81 to .94, were found in this sample. Approximate fit indices suggest that a correlated six first-order factor model best describes the data in contrast to theoretical considerations suggesting that a six factor model with two correlated superordinate factors (i.e., statistics anxiety and attitudes toward statistics) best describes the data. Researchers are recommended to use part one of the STARS to assess statistics anxiety and part two to assess attitudes toward statistics.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study

CONTEXT AND OBJECTIVES:

Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care.

DESIGN AND SETTING:

Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil.

METHODS:

Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used.

RESULTS:

40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%).

CONCLUSION:

Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

A novel visual facial anxiety scale for assessing preoperative anxiety

Background

There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety.

Methods

The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0–10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale.

Results

The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing ‘no’ anxiety, 250 (94.3%) participants chose the face A10 as representing ‘highest’ anxiety and 147 (55.5%) participants chose the face A8 as representing ‘moderate-high’ anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3). Similarly, the correlation of the faces A7 and A6 was significantly correlated with moderate anxiety (r = 0.87), but A7 remained because of its higher frequency (35.9% vs 22.6%). Using frequency and Spearman correlations, the final order of the faces assigned to the categories none, mild, mild-moderate, moderate, moderate-high and highest anxiety levels was A0, A1, A5, A7, A8 and A10, respectively (Fig 4).

Conclusion

The proposed VFAS was a valid tool for assessing the severity of acute [state] anxiety, and could be easy to administer in routine clinical practice.

Preliminary Study of Self-Reported Experience of Physical Aggression and Bullying of Boys Who Stutter: Relation to Increased Anxiety

This study examined the relationship of self-reported anxiety and vulnerability to bullying for 18 children who stuttered and 18 children who did not stutter. More children who stuttered were at significantly higher risk of experiencing bullying behavior (61%) than children who did not stutter (22%); 39% of children who stuttered scored at least one standard deviation above the mean on the Revised Children's Manifest Anxiety Scale, suggestive of higher anxiety. In contrast, only 6% of children who did not stutter scored at least one standard deviation above the mean. The correlation was .82 for children who stuttered between greater vulnerability to bullying and self-reported anxiety. A bidirectional relationship is hypothesized between high anxiety and bullying of children who stutter.

Prevalence and service implications of health anxiety in genitourinary medicine clinics

A comparison of the prevalence of health anxiety in genitourinary medicine (GUM) clinics in two UK centres was carried out using a new rating scale, the Health Anxiety Inventory (HAI). The relationship of health anxiety to demographic and clinical variables, and its impact on service contacts, was also examined in one of these centres. 694 patients were assessed and significant health anxiety was identified in 8–11%. HAI scores were stable over time and high levels persisted in the absence of treatment. Attenders with sexually transmitted infections had significantly lower levels of health anxiety than those with other conditions. Contacts with clinic doctors and health advisors in the nine months before and after assessment were significantly greater in those with high health anxiety, with doctor appointments 37% higher in the high HAI group ( P = 0.005). Health anxiety is a source of considerable morbidity in GUM clinics deserving further study.

[Characteristics of behavioral response of elderly women with high level of personal anxiety]

The results of studies of the behavioral response in 69 elderly women with normal and high levels of anxiety are presented in the article. Personal anxiety level was determined by «Integrative anxiety test». The indicators of strategies alteration for decision-making were assessed through a computer complex KPFK-99 «PSIHOMAT», which includes a test computer system «Binatest». It is found that more complex and structured programs of behavior are characteristic for women with normal levels of anxiety. The restriction tendency of adaptation opportunities of an organism, decrease in resistance to influence negative the stress - factors, and also tendency to doubts in correctness of a choice against any situation.

Anxiety is associated with higher levels of global DNA methylation and altered expression of epigenetic and interleukin-6 genes

OBJECTIVES

Anxiety is associated with elevated levels of the inflammatory cytokine interleukin-6 (IL-6) and an increased risk for diseases with an inflammatory aetiology. In cancer, higher levels of IL-6 have been associated with increased expression of the epigenetic enzymes DNMT1 and Enhancer of Zeste Homolog 2 (EZH2). However, the relationship between IL-6 and DNA methyltransferases (DNMTs) and EZH2 expression has not previously been examined in anxious individuals.

METHODS

Global DNA methylation levels were measured using the Methylflash Methylated DNA Quantification Kit and gene expression levels of the DNMT and EZH2 genes in anxious (n=25) and nonanxious individuals (n=22) were compared using quantitative real-time PCR. Specifically, we investigated whether global DNA methylation or aberrant expression of these genes was correlated with IL-6 mRNA and protein serum levels in anxious individuals.

RESULTS

Anxious participants had significantly higher levels of global DNA methylation compared with controls (P=0.001). There were no differences in the mean mRNA expression levels of the DNMT1/3A/3B, EZH2 and IL-6 genes in anxious individuals compared with controls. However, the expression of DNMT1/3A, EZH2 and IL-6 genes increases with increasing Hospital Anxiety and Depression Scale-Anxiety scores in the anxious cohort only. Interestingly, IL-6 gene expression was correlated strongly with DNMT1/3A/3B and EZH2 expression, highlighting a potential relationship between IL-6 and important epigenetic regulatory enzymes.

CONCLUSION

This study provides novel insight into the relationship between anxiety, epigenetics and IL-6. Moreover, our findings support the hypothesis that changes in DNA methylation profiles may contribute to the biology of anxiety.

An evaluation of the sociodemographic determinants of dental anxiety in patients scheduled for intra-alveolar extraction

BACKGROUND

Studies on anxiety in patients having intra-alveolar extraction as well as the effect of patient's sociodemographic characteristics influencing level of associated anxiety are few in our environment. The aim of this study was to statistically analyze the sociodemographic determinants of dental anxiety in patients scheduled for intra-alveolar extraction.

METHODS

A cross-sectional study was conducted among 93 consecutive patients attending the outpatient clinic of the Department of Maxillofacial Surgery, University of Benin Teaching Hospital for intra-alveolar extraction in the months of November and December 2013. An interview-based questionnaire, Corah Dental Anxiety Scale Revised (DAS-R), was administered to evaluate levels of dental anxiety. Sociodemographic characteristics of the subjects were recorded. Descriptive statistics and regression models were done with the independent variables (sociodemographic factors) and the dependent variable being the DAS-R. A P<0.05 was considered significant.

RESULTS

The internal consistency of the scale used as determined by Cronbach alpha was 0.76. Mean DAS score was 8.12±2.58. Dental anxiety and age of subjects showed significant inverse relationship. Females had a higher mean DAS score (8.76) than the males (7.37) (P=0.006). Residence (urban/rural) was not statistically significant. Singles reported the highest DAS score (9.41) (P=0.006). The educational level attained was significantly related to dental anxiety (P=0.005). Those with secondary school education had the highest DAS score (9.26). Class V social status had the highest mean anxiety score (P=0.012). Stepwise linear regression showed that the best predictors for dental anxiety were sex (P=0.008) and marital status (P=0.026).

CONCLUSION

This present study demonstrates that sex and marital status are the predictive factors for dental anxiety in the overall management of patients indicated for intra-alveolar extraction.

Sense of humor and its association with psychological disturbances among dental students in India

Although the health benefits of humor and the potential advantages of having a good Sense of Humor (SoH) have been long recognized, they have not been investigated in dental students. The aim of this study was to assess the extent and demographic correlates of SoH in dental students and its association with their self-reported level of psychological disturbances. Six hundred and five students (age 20.3±1.83 years, 250 males, 355 females) from two dental schools in India anonymously completed the Multidimensional Sense of Humor Scale (MSHS) and the Depression Anxiety Stress Scales-21. Independent samples t-test and one-way ANOVA were used to analyze the intergroup differences based on gender and year of study, respectively. The association between SoH and each of the three negative affective states was evaluated with multiple linear regressions. The mean MSHS score of the sample was 59.65±11.77. Male students showed a marginally higher SoH than females (60.78 vs. 58.86, p<0.05). The level of SoH steadily improved along the course duration, with statistically significant increases in the third and fifth years of study. SoH was negatively associated with all three negative affective states and explained nearly 3 to 5 percent of their variance. These results warrant further inquiry on the correlates of SoH in dental students, the psychosocial roles of humor, and their application in improving the psychological climate in dental schools.

[Urban insecurity and fear of crime in people suffering from mental disorders: a study in 24 Mental Health Centers in Italy]

AIMS

To assess in a sample of people with mental disorders: 1) fear of crime and perceived insecurity; 2) the association between fear of crime and insecurity; 3) the incidence of crimes.

METHODS

Twenty-four Italian mental health centres have been invited to participate in the study from the network of the Early Career Psychiatrists' Committee of the Italian Psychiatric Association. In each participating centre, the first 20 patients consecutively accessing the mental health centre between February and April 2011 have been recruited. All patients have been assessed using validated assessment tools.

RESULTS

The final sample consists of 426 patients. They are mostly female (70.1%), with a mean age of 45 years (± 13.5), and with a good level of education. Fifty-two percent of patients have a diagnosis of mood disorders, and 37.8% on anxiety spectrum disorders. About half of the sample declares that the most prominent feeling toward life is uncertainty. Almost all patients report to have at least one big fear, with the most frequently report being: 1) loss or death of a loved one (41.2%); 2) financial constraint (28.4%); 3) physical or mental health problems (26.5%).

DISCUSSION AND CONCLUSIONS

Our results show the presence of a common sense of uncertainty among patients, probably as a result of the historical moment we are facing. It is reasonable that this attitude toward life can have a detrimental impact on patients' psychological and physical wellbeing, contributing to high levels of distress. Further studies are needed in order to clarify the possible relationship between fears, uncertainty and mental disorders.

[Chinese version of a face version of the modified child dental anxiety scale: transcultural adaptation and evaluation]

OBJECTIVE

To develop the Chinese version of a face version of the modified child dental anxiety scale (MCDASf) and test the reliability and validity of MCDASf.

METHODS

The English version of MCDASf was translated and back-translated, as well as crosscultural adapted by the method of psychometrics to develop the Chinese version of MCDASf. Subsequently the Chinese version schedule was randomly investigated among 245 kindergarten children and school children aged greater than 4 and less than 12 years on two separate occasions 3 weeks apart to determine the reliability. A total of 248 children attending Pediatrics Dentistry of Peking University School and Hospital of Stomatology aged greater than 4 and less than 12 years old were selected and completed the Chinese version of MCDASf and the Chinese version of modified Children's fear survey schedule-dental subscale (CFSS-DS) before treatment to determine the validity. Then we rated the children's behavior during dental treatment by Venham's clinical anxiety rating scale and cooperative behavior rating scale to evaluate the relation between self-assessed dental anxiety scores and the behavioral reaction during the dental treatment.

RESULTS

In reliability study, 98.0% of 250 children completed the MCDASf. In validity study, 99.2% of 248 children completed the MCDASf. Cronbach's alpha coefficient of the translated scale was 0.814 and the test-retest reliability was 0.907. Principal component analysis of the translated scale confirmed that the scale consisted of a single unidimensional construct. The Chinese version of MCDASf significantly was correlated with the Chinese version of modified CFSS-DS (r = 0.843, P < 0.01) . It was also correlated with Venham's clinic anxiety rating scale and cooperative behavior rating scale (r = 0.675, P < 0.01).

CONCLUSIONS

The Chinese version of MCDASf demonstrated good reliability and validity and can be used as a simple self-report measurement of dental anxiety in Chinese children aged 4-11 years.

Dental anxiety and temperament in 15-year olds

OBJECTIVE

The aim of the present study was to analyze the prevalence of dental anxiety and its association with temperament, sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals.

MATERIALS AND METHODS

The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of The EAS Temperament Survey for Children modified for adults, the EASI temperament survey.

RESULTS

The results showed that 6.5% of the adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple linear regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity were also significantly predictive of dental anxiety.

CONCLUSIONS

Although some of the temperament dimensions are correlated with dental anxiety, which may emphasize an important finding with regard to personality, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.

Predictive factors for child behaviour in the dental environment

AIM

This was to evaluate the potential factors that influence behaviour in the paediatric dentistry environment of children aged 48 to 68 months who have never before been to a dentist.

STUDY DESIGN

Cross sectional.

METHODS

Child behaviour was evaluated using the Frankl scale during both clinical examination procedures and prophylaxis. All mothers of the 118 children investigated underwent a test to assess their anxiety (Manifest Anxiety Scale-MAS) and responded to a questionnaire on the medical history of the child as well as socioeconomic factors. The children were given a test to assess their anxiety (Venham Picture Test-VPT).

STATISTICS

The statistical tests adopted were the Chi-squared test and both simple and multiple unconditional logistic regression.

RESULTS

Children with high anxiety, those had previously experienced toothache and those had behaved uncooperatively during prior medical experiences, had a greater probability of behaving uncooperatively during their first dental consultation.

CONCLUSIONS

Dental professionals can identify the presence of predictive factors for child behaviour prior to the first clinical examination by including relevant questions in the dental and medical history, thereby facilitating a more positive initial contact between paediatric dentists and their patients.

The development of a dental anxiety scale with a cognitive component for children and adolescents

PURPOSE

To validate a dental anxiety scale with a cognitive component for use in children and adolescents.

METHODS

A total of 439 children (≥ 6 years old) were evaluated. For each child, 2 operators each assessed using the Abeer Children Dental Anxiety Scale (ACDAS) at visit-1, and the chief investigator also assessed using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) at visit-1 and using the ACDAS 2 weeks later. A sample of 274 children was assessed for external validity.

RESULTS

A receiver operating characteristic curve showed that the cutoff 26 gave the optimal results for sensitivity (96%, 95% confidence interval [CI]=81.7~99.9) and specificity (66%, 95% CI=57.4~73.8), with an area under the curve of 0.80 (95% CI=0.73~0.87). ACDAS had substantial to almost perfect intra- and inter examiner reliability along with good concurrent validity (r=0.77) and discriminative validity (r=0.79). For convergent validity, ACDAS had a significant relationship between the Dental Anxiety (DA) scores and cognitive status P<.001. Cronbach's alpha (α) was 0.90, which indicated good internal consistency. The external validity results indicated that the scale was generalizable.

CONCLUSIONS

The Abeer Children Dental Anxiety Scale is a valid cognitive scale to measure dental anxiety, and it encompasses the required criteria to be regarded as the gold standard among dental anxiety scales.

Thinking about eating food activates visual cortex with reduced bilateral cerebellar activation in females with anorexia nervosa: an fMRI study

Background

Women with anorexia nervosa (AN) have aberrant cognitions about food and altered activity in prefrontal cortical and somatosensory regions to food images. However, differential effects on the brain when thinking about eating food between healthy women and those with AN is unknown.

Methods

Functional magnetic resonance imaging (fMRI) examined neural activation when 42 women thought about eating the food shown in images: 18 with AN (11 RAN, 7 BPAN) and 24 age-matched controls (HC).

Results

Group contrasts between HC and AN revealed reduced activation in AN in the bilateral cerebellar vermis, and increased activation in the right visual cortex. Preliminary comparisons between AN subtypes and healthy controls suggest differences in cortical and limbic regions.

Conclusions

These preliminary data suggest that thinking about eating food shown in images increases visual and prefrontal cortical neural responses in females with AN, which may underlie cognitive biases towards food stimuli and ruminations about controlling food intake. Future studies are needed to explicitly test how thinking about eating activates restraint cognitions, specifically in those with restricting vs. binge-purging AN subtypes.

Cardiac vagal control as a prospective predictor of anxiety in women diagnosed with breast cancer

Low cardiac vagal control (CVC) has been associated with state and trait anxiety and anxiety spectrum disorders. Studies indicate that diagnosis and treatments for breast cancer may be associated with anxiety. The current study examined whether CVC prospectively predicted a trajectory of change in anxiety following breast cancer diagnosis. Forty-three women diagnosed with non-metastatic breast cancer completed the Taylor Manifest Anxiety Scale and the Perceived Stress Scale, and a 5-min resting electrocardiographic (ECG) segment was recorded. Self-report measures were completed approximately every 3 months for a year. Respiratory sinus arrhythmia (RSA) significantly predicted the trajectory of change in anxiety over the follow-up period: participants with higher baseline RSA evidenced decreasing anxiety, whereas those with lower baseline RSA had increasing anxiety. These results are consistent with the hypothesis that CVC facilitates the modulation of anxiety in women coping with significant stressors of breast cancer diagnosis and treatment.

Association of dental anxiety to personality traits in a general population sample of Finnish University students

OBJECTIVE

To estimate the association between personality and dental anxiety among Finnish University students.

MATERIALS AND METHODS

A total of 880 university students in Finland returned the questionnaires addressing dental anxiety by using the Modified Dental Anxiety Scale (MDAS) questionnaire. In addition, the personality of traits (neuroticism, extraversion, agreeableness, conscientiousness and openness to experience) were noted. Personality traits of students were compared with the level (high, mild or none) of dental anxiety derived from the MDAS questionnaire. The relative odds of dental anxiety associated with the level of dental anxiety were estimated by logistic regression, Chi-Square tests and one-way analysis of variance (ANOVA).

RESULTS

Median age of the respondents was 22 years. Of the respondents, 99 (11.3%) were classified as dentally anxious patients (90, 12.2% of females; 9, 6.6% of males)). Neuroticism was the only personality trait that was significantly associated with dental fear (p < 0.001). A tendency, although not significant, was seen between high dental fear and lower extraversion and agreeableness.

CONCLUSIONS

Of the five different personality traits, neuroticism was a significant risk factor for developing dental anxiety, and this should be recognized in clinical practice.

[Dental fear and anxiety scores of a Hungarian population living in the Hungarian-Slovakian border region. A pilot study]

The aim of the authors was to investigate whether living as a minority has an influence on the dental fear and anxiety values. In this study 201 volunteers (n = 201, inside border Hungarians 144, outside border Hungarians 57, male 90, female 111; age 8 to 83 years, mean 44 +/- 16 yrs.) were investigated. Our methods included collection of demographic data (gender, age, marital status, profession), and administration of the Hungarian versions of dental fear and anxiety related scales namely: DAS, DAQ, DASQ, DFS, DBS, STAI-S, STAI-T and Expectation Scale. Mean values of the scales were: DAS: 10,34 +/- 3,54; DAQ: 2,3 +/- 1,15; DASQ: 12,58 +/- 4,55; DFS: 40,37 +/- 15,67; DBS: 32,89 +/- 12,94; Expectation Scale: 2,87 +/- 3,56, STAI-S: 39,51 +/- 10,68; STAI-T 41,65 +/- 9,08. The mean scores of all the scales were higher in the case of Hungarians living inside the borders of Hungary. The differences were significant in the case of DAS, DAQ, DASQ and DFS scales (p < 0,05). Data of our study indicate that living as a minority not necessarily leads to the increase of dental fear and anxiety.

Mental health of postgraduate orthodontic students in India: a multi-institution survey

The aim of this study was to evaluate the mental health of postgraduate orthodontic students in India by assessing the extent of three common negative affective states: depression, anxiety, and stress. Three hundred and thirty postgraduate students from thirty-two dental colleges across India anonymously completed the short version of the Depression Anxiety Stress Scale (DASS21). The statistical analysis included summary statistics, nonparametric tests for intergroup comparisons, and logistic regressions to evaluate the influence of age, gender, year of study, and marital status on these mental states. In comparison to the general population, the students experienced mildly elevated levels of depression and anxiety (11±5.1 and 8.2±4.1, respectively) and a moderately elevated level of psychological stress (22±5.2). A moderate or higher level of coexisting symptoms of all three affective states was seen in 15.8 percent of the students. Female students reported a higher level of depression than males and were two and half times more likely to experience depression to a moderate or higher level. First-year students exhibited lower levels in all three states than those in the second and third years and had lower odds than third-year students of developing a moderate or higher level of any of the three affective states. Marriage had a significant buffering potential against all these states. The results clearly indicate a suboptimal level of mental health in these postgraduate students of the specialty and the need to improve their mental resilience and the academic climate.

Objective and subjective measures for assessing anxiety in paediatric dental patients

AIM

Anxiety has been defined as a nonspecific feeling of apprehension towards a concrete situation that does not necessarily involve a previous experience. Dental anxiety can prevent patients from cooperating fully during dental treatment. Given that there is a connection between dental anxiety and uncooperative behaviour, it is important for dentists to be able to assess anxiety in their patients. There are many methods for such assessment, and in children they depend on age and intellectual development. These measures can be objective or subjective, depending on the method used to quantify the degree of anxiety. The aim of this literature review was to analyse the objective and subjective scales that are used most commonly to assess the degree of anxiety of children in a dental setting.

CONCLUSION

Knowing the degree of anxiety of dental children is important in order to guide them through their dental experience. Their level of cooperation will also improve and anxiety will be reduced as well.

Elevated social anxiety among early maturing girls

Adolescence is a key period in terms of the development of anxiety psychopathology. An emerging literature suggests that early pubertal maturation is associated with enhanced vulnerability for anxiety symptomatology, although few studies have examined this association with regard to social anxiety. Accordingly, the current study was designed to further elucidate the relation between pubertal timing and social anxiety, with a focus on clarifying the role of gender. Participants were 138 adolescents (ages 12-17 years) recruited from the general community. Level of social anxiety was examined as a function of gender and within-sample pubertal timing. As expected, early maturing girls evidenced significantly higher social anxiety, compared with on-time girls and early maturing boys, and no other differences were found as a function of gender or developmental timing. Findings and future directions are discussed in terms of forwarding developmentally sensitive models of social anxiety etiology and prevention.

[Development of Chinese version of children's fear survey schedule-dental subscale]

OBJECTIVE

To establish the Chinese version of the modified children's fear survey schedule-dental subscale (CFSS-DS).

METHODS

The original English version of CFSS-DS with facial image scale (FIS) was translated into Chinese, pre-tested and cross-culturally adapted. Subsequently the Chinese version schedule was randomly investigated among 367 children aged 5 - 12 years and their parents. Reliability and validity of the translated scale was evaluated later.

RESULTS

Totally 367 children were investigated and 311 valid questionnaire was received. Cronbach's alpha of the translated scale was 0.85 and test-rest reliability was 0.73. The 15 items were divided into four domains. There was a certain logical relationship between the items among the same domains. There was highly significant association between the self-report of the Modified CFSS-DS and Frankl Behavioral Scale (r(s) = -0.403, P < 0.01).

CONCLUSIONS

The Chinese version of modified CFSS-DS has been established successfully with good psychometric properties which provide the theoretical evidence for further application in Chinese population.