Perceived causes of stress among Saudi dental students

The Relationship between Stress and Preclinical Dental Students' Performance: A Longitudinal Study

Background

The aim of this study was to evaluate the changing levels of stress among dental students during 8 months of a basic manual skills course in the preclinical year and to examine the association between stress and dental performance.

Methods

A longitudinal study was conducted in the 2023 academic year in a total of 58 (male = 17 and female = 41; mean age = 26.43, range 22-33) undergraduate dental students at Tel Aviv University of dentistry during their fourth year of study. Depression Anxiety Stress Scale (DASS-21) and Dental Environment Stress (DES) questionnaires were used to assess the psychological well-being and the severity of DASS symptoms experienced by the students. The students' dental performances were assessed using two manual tests on plastic teeth. The questionnaires and the manual tests were used at three periods of time, T0, T1, and T2. Wilcoxon signed-rank tests were performed to compare the DASS scores and DES stressors of dental students between T0, T1, and T2. Kendall's nonparametric correlations were calculated to investigate the relationships of DES stressors and depression, anxiety, and stress scores with manual performance.

Conclusions

The perception of high stress by dental students is due to the stressful education process of the preclinical year. There is an inverse correlation between the lower level of anxiety and the increase level of dental performance with 74% of the variance in dental performance explained by the anxiety score. Work-related stressors such as manual skills might reduce dental performance in contrast to non-work-related factors such as financial obligations, personal issues, and family factors, which might increase student dental performance.

Integrating appraisal processes in the study demands-resources framework - a diary study

BACKGROUND AND OBJECTIVES

Students face various demands that can lead to health complaints. Hindering demands appear to be especially harmful. Since the perception of demands differs between persons, their individual appraisal determines stress perception. However, individual appraisal processes are largely neglected in research. Therefore, this study builds on the study demands-resources model in examining the dynamics of students' demand-appraisal processes and their effects on well-being.

DESIGN

During ten days in a four-week period, 247 students participated in a diary study.

METHODS

We analyzed our data via multilevel path analysis.

RESULTS

Our analyses revealed that the student's appraisal of the same demands varied across days and depended on available resources, i.e., the received support quality on the respective day. Appraising demands as hindering was positively linked to the perception of stress on the same day. Daily perception of stress was positively linked to person-level strain and health complaints after four weeks.

CONCLUSIONS

The results highlight the importance of assessing the individual appraisal of demands rather than pre-categorizing demands. Furthermore, our findings identify social support as a crucial resource in reducing hindering appraisal; hence, it should be included in student-focused stress-management interventions. Limitations and further implications are also discussed.

Emotional Intelligence, Depression, Stress and Anxiety Amongst Undergraduate Dental Students During the COVID-19 Pandemic

Objectives: This study aimed to measure depression, anxiety and stress (DAS) among undergraduate dental students during the COVID-19 pandemic, identify key contributing factors of stress and explore the association of emotional intelligence to DAS. Methods: A multi-centre, cross-sectional study was conducted across four universities in Malaysia. The study administered a questionnaire consisting of the validated Depression Anxiety Stress Scale (DASS), Dental Environment Stress (DES), Emotional Intelligence Scale (EI) and 10 statements assessing COVID-19 specific potential stressor factors. Results: Participants included 791 students across four universities. Abnormal levels of DAS were identified in 60.6%, 66.8% and 42.6% of the study participants, respectively. "Pressure of performance," "Faculty administration" and "Self-efficacy belief" were the highest rated stressors. On-time graduation was the main COVID-19 specific stressor factor. EI was negatively correlated with DAS scores (p < 0.001). Conclusion: The levels of DAS during COVID-19 pandemic in this population is high. However, participants with higher EI presented with lower DAS suggesting that EI may be a form of coping resource and should be enhanced in this population.

Dental students' attitude towards propranolol non-medical use: A multi-institutional cross-sectional study in Riyadh, Saudi Arabia

INTRODUCTION

The lives of college students are full of various stressors. Students seek a number of stress-relieving modalities as self-prescribed beta-blockers to improve their academic performance. The aim of this study was to assess the extent of beta-blockers (propranolol) usage amongst Saudi dental students and their attitude towards its use to enhance academic performance.

METHODS

A cross-sectional study involving a convenient sample was conducted on a group of undergraduate dental students enrolled in Riyadh dental schools during the academic year of 2019/2020. A paper format closed-ended questionnaire was used.

RESULTS

A sample of 680 students participated in the survey (43% response rate). Approximately 12% of dental students used propranolol for non-medical reasons. The prevalence did not differ significantly with the gender or year of study. A significantly higher percentage of students from private dental schools reported using propranolol for non-medical reasons (odds ratio (OR), 3.1; 95% confidence interval (CI), 1.7-5.4; p < .001). Propranolol users were significantly more likely to connect with other students using the medication. Both students, those who used and those who did not use propranolol, similarly, highly endorsed the need for being informed about the risk of using propranolol. Compared with non-users, there was more disagreement amongst propranolol users on the necessity for placing school regulations controlling medication use.

CONCLUSION

The use of propranolol to enhance academic performance amongst dental students in Saudi Arabia should not be disregarded. The study findings emphasise the importance of regulating students' usage of beta-blockers to promote a fair academic environment.

Stress amongst dental students in the transition from preclinical training to clinical training: A qualitative study

OBJECTIVES

The present study sought to qualitatively evaluate third-year undergraduate dental students' perceptions of sources of stress during the transition from preclinical to clinical training.

METHODS

This was an observational, cross-sectional, and qualitative study with a nonprobabilistic sampling design. The sample consisted of students in the third year of the five-year undergraduate degree program in dentistry offered by the São Paulo State University (UNESP), School of Dentistry, Araraquara, São Paulo State, Brazil (n = 37). Data were collected using open-ended, semistructured, and individual interviews that were recorded on a digital voice recorder. The students were interviewed on campus at a previously scheduled time. Efforts were made to provide a secure and welcoming environment for the interview. The interview questions addressed students' adaptation to clinical training and their perceptions of stress resulting from this transition. Data analysis was based on the qualitative and quantitative Discourse of the Collective Subject (DCS) technique performed with the aid of Qualiquantisoft®.

RESULTS

Most of the students evaluated (75.7%) reported difficulty in the transition from the preclinical to the clinical phase of their program and that this difficulty increased their stress levels during this transition (81.1%). The most frequently cited reason for the increase in stress was the responsibility and demands associated with caring for real patients (54.1%). Almost half of the students (48.6%) reported feeling physical symptoms of stress such as tachycardia, dizziness, headache, and muscle tension during this period. Most of the students (81.1%) required up to one semester to feel that they had adapted to the clinic. Many students used stress reduction strategies such as simply trying to calm down, studying before their clinical work, improving organisation, and asking professors for help. Adaptation to ergonomics and biosafety in the clinic was the most frequently cited impediment (45.9%) to the adaptation process. The students' main suggestions for reducing stress in this transition phase were additional preclinical training in a clinical setting, a more gradual transition, and greater professor receptiveness.

CONCLUSION

The dental students interviewed herein perceived high levels of stress during the transition from preclinical to clinical training.

Psychological Distress among Bangladeshi Dental Students during the COVID-19 Pandemic

Background: Psychological sufferings are observed among dental students during their academic years, which had been intensified during the COVID-19 pandemic. Objectives: This study assessed the levels and identified factors associated with psychological distress, fear and coping experienced by dental undergraduate students in Bangladesh. Methods: A cross sectional online survey was conducted during October-November, 2021. The Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used in order to assess psychological distress, fear and coping strategies, respectively. Results: A total of 327 students participated; the majority (72%) were 19-23 years old and females (75%). One in five participants were infected with COVID-19 and 15% reported contact with COVID-19 cases. Negative financial impact (AOR 3.72, 95% CIs 1.28-10.8), recent or past COVID-19 infection, and contact with COVID-19 cases were associated with higher levels of psychological distress; but being a third year student (0.14, 0.04-0.55) and being satisfied about current social life (0.11, 0.03-0.33) were associated with lower levels of psychological distress. Being a third year (0.17, 0.08-0.39) and a fourth year student (0.29, 0.12-0.71) were associated with lower levels of fear. Health care service use and feeling positive about life were associated with medium to high resilience coping. Conclusions: This study identified dental students in Bangladesh who were at higher risk of psychological distress, fear and coping during the ongoing pandemic. Development of a mental health support system within dental institutions should be considered in addition to the academic and clinical teaching.

Meta-Analysis of Prevalence of Depression in Dental Students during COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic has a negative impact on the mental health of the population in general, and in college students in particular. Dental students have seen their teaching altered and their clinical practice reduced. This study was aimed at conducting a systematic review and meta-analysis of studies reporting levels of depression among dental students during the COVID-19 and estimating the pooled prevalence of depression. Materials and Methods: Medline via PubMed and other databases were searched for studies on the prevalence of depression in dental undergraduates, published from 1 December 2019 to 1 September 2021. The pooled proportions of depression were calculated with random effects models. Results: We identified 13 studies from 9 countries. The pooled prevalence of depression in dental students was 37% (95% CI: 26-49%) with no variation due to gender, response rate or methodological quality. We only found a significantly higher prevalence of depression in studies from Asia compared to Europe and America. Conclusions: Our results suggest that dental students are suffering from higher levels of depression compared with the general population or other college students during the COVID-19 pandemic, with differences across regions. Measures to improve mental health and wellbeing of dental students during the pandemic are needed.

Level of anxiety and depression among undergraduate dental students of University of Hail, Saudi Arabia

BACKGROUND

Dental students have been identified as having a high level of stress.

OBJECTIVE

This study aimed to assess the prevalence of anxiety and depression among undergraduate dental students of university of Hail and to determine the association of anxiety and depression in terms of gender and respective year of study.

METHODS

This was an observational cross-sectional study. Nonprobability sampling technique was used to assess the prevalence and association of anxiety and depression among male and female dental students of preclinical and clinical years of College of Dentistry, University of Hail, Saudi Arabia. Students were contacted personally, explained the purpose of the study and asked to participate in the study. Students were asked to complete both Beck's depression inventory and Beck's anxiety inventory to assess the level of their respective status.

RESULTS

The results of the survey revealed that a greater number of females suffered from 'moderate' level of anxiety (12.3%) as compared to males (3.2%). Additionally, the percentage for females to experience 'borderline' (11.6%) and 'moderate' (9.7%) level of depression was higher than their male counterparts -'borderline' (7.7%) and 'moderate' (2.6%). The level of anxiety and depression compared with genders was found to be statistically significant. It was noted that final year students (8.4%) experienced 'moderate' level of anxiety and there was a peak rise in level of depression among 4th year (6.5%) and 6th year (5.8%) students as compared with other years.

CONCLUSION

The finding of the study emphasizes that the overall percentage of level of depression is comparatively higher than level of anxiety among dental students.

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.

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.

Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university

Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional (p = 0.054) and passive problem (p = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour (p = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders (p = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future (p = 0.023) and poor self-esteem (p = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

Oral Health Attitudes among Preclinical and Clinical Dental Students in Germany

Oral health care providers are expected to show good examples of oral health behaviours and attitudes to their community. Previous studies displayed the constructive effect of dental education on oral hygiene manners of undergraduate students. The aim of this survey was to assess and compare aspects of oral health attitudes and behaviours between preclinical and clinical dental students in German universities. The German-language version of the HU-DBI was distributed to preclinical and clinical students from different German universities. Dichotomized (agree/disagree) responses to 20 HU-DBI items were provided in this study, with a maximum possible score of 19. A quantitative estimate of oral health attitudes and behaviours was provided by the total of appropriate answers given to every statement by each group. Data were analysed statistically. The overall mean score of answers favouring good oral hygiene was marginally higher in preclinical (14.62) than clinical students (14.31) but showed no statistical significance. Similarly, the analysis of each item individually displayed no statistically significant differences between preclinical and clinical participants, except in a single item of the survey. This study showed no effective differences in oral hygiene attitudes and behaviour between preclinical and clinical students in German universities. This reveals a weak effect of dental education on improving students' oral health attitudes in Germany and might demand the introduction of more courses emphasizing the importance of correct oral health behaviour of health care providers.

Perceived stress and coping strategies among undergraduate dental students - an institutional based study

Background Coping strategies are highly mediated by the environment, in particular when the person deals with the obstacles and impediments to fulfill their goals. This study aimed to investigate the Perceived Stress and Coping Strategies among Undergraduate Dental Students of Panineeya Institute of Dental Sciences Hyderabad, India. Materials and Methods A cross-sectional study was carried out among 267 undergraduate dental students. The survey tool comprised of Perceived Stress Scale (PSS) and Brief COPE Scale along with demographic variables. Statistical analysis was done using SPSS 20.0. Results Based on gender, females had high PSS mean scores (23.8±7.3) than males and to overwhelm these stress levels most of the students followed adaptive coping strategies (40.4±7.8) with no significant difference. But, significant difference noted for maladaptive coping dimension "denial" (p=0.004). On comparison between year of study, higher perceived stress was noted among second year students (26.7± 5.8), and least among first years (21.6±7). In order to defeat the stressors most of the second year undergraduate students used adaptive coping strategies. However, highest mean adaptive coping scores were noted among first years (41.6±7.5) and least scores observed among fourth years (38.6±9.2). However, total PSS score showed significant positive correlation (p<0.001) with maladaptive coping strategies. Conclusion Females and second year students perceived more stress levels, to overtake those stressors most of them followed adaptive coping strategies. Hence, institutional authorities should take measures to decrease the stress levels and encourage the students to adopt healthy life style such as meditation and exercise to beat their stressors.

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”.

Depression, anxiety and stress in dental students

OBJECTIVES

To measure the occurrence and levels of depression, anxiety and stress in undergraduate dental students using the Depression, Anxiety and Stress Scale (DASS-21).

METHODS

This cross-sectional study was conducted in November and December of 2014. A total of 289 dental students were invited to participate, and 277 responded, resulting in a response rate of 96%. The final sample included 247 participants. Eligible participants were surveyed via a self-reported questionnaire that included the validated DASS-21 scale as the assessment tool and questions about demographic characteristics and methods for managing stress.

RESULTS

Abnormal levels of depression, anxiety and stress were identified in 55.9%, 66.8% and 54.7% of the study participants, respectively. A multiple linear regression analysis revealed multiple predictors: gender (for anxiety b=-3.589, p=.016 and stress b=-4.099, p=.008), satisfaction with faculty relationships (for depression b=-2.318, p=.007; anxiety b=-2.213, p=.004; and stress b=-2.854, p<.001), satisfaction with peer relationships (for depression b=-3.527, p<.001; anxiety b=-2.213, p=.004; and stress b=-2.854, p<.001), and dentistry as the first choice for field of study (for stress b=-2.648, p=.045). The standardized coefficients demonstrated the relationship and strength of the predictors for each subscale. To cope with stress, students engaged in various activities such as reading, watching television and seeking emotional support from others.

CONCLUSIONS

The high occurrence of depression, anxiety and stress among dental students highlights the importance of providing support programs and implementing preventive measures to help students, particularly those who are most susceptible to higher levels of these psychological conditions.