Depression, anxiety and stress in a cohort of Australian dentistry students

The impact of COVID-19 on the mental health of dental students at an Australian school

AIMS

The dentistry program is extremely demanding mentally and physically. Consequently, it can induce high levels of stress, anxiety and depression in students. There is some research in measuring these ramifications on dental students, but they lack the influence of the COVID-19 pandemic which has brought about many fundamental changes to the curriculum of dental students. The aim of this study was to assess dental students' mental health through the Depression, Anxiety and Stress Scale (DASS-21) during the COVID-19 pandemic in an Australian dental School.

METHODS

The Bachelor of Dental Science (Honours) students enrolled in years 2-5 were requested to complete an online questionnaire that included the DASS-21 and additional questions regarding the impact of COVID-19 on quality of life. Jamovi was utilized to conduct descriptive data analysis.

RESULTS

179 students completed the survey with 81 males (45%) and 98 females (55%). 70.4% of the participants described elevated anxiety for the health of their loved ones and themselves during the COVID-19 pandemic. The overall mean DASS-21 scores were 7.1 (5.07) in depression, 4.9 (4.00) in anxiety and 6.5 (4.32) in stress.

CONCLUSIONS

The results indicate that the COVID-19 pandemic negatively impacted the mental health of dental students. While further research is still required, it is important for universities to recognize how this pandemic affected the mental wellbeing of students so that they can implement appropriate support programs and improve dental education.

CLINICAL RELEVANCE

The COVID-19 pandemic has had a profound impact on social and mental health worldwide, and dental students are notably affected. Recognized as a psychological risk factor, COVID-19 has been linked to an increased rate of suicidal deaths. This paper underlines the importance of recognizing the full scope of the pandemic's impact on dental students, including their views and the potential effects on their physical and mental health. The study indicates a pressing need for more robust support from the organizations to improve the mental health and overall well-being of dental students.

The Association Between Mindfulness Facets and Substance Use via Emotional Psychopathology and Coping Motives in Argentinian College Students

Background: Prior studies suggest that lower levels of mindfulness contribute to the motivation of using alcohol to cope with distress. Research examining this possibility is scarce or limited to alcohol, but not marijuana, related outcomes. Objectives: We examined separate models (for alcohol and for marijuana) to determine the associations between trait mindfulness (describing, acting with awareness, non-judging, non-reactivity) and alcohol and marijuana outcomes (use indicators and negative consequences) via emotional psychopathology (i.e., a latent variable assessing symptoms of depression and anxiety) and alcohol/marijuana coping motives. Results: The final analytic sample consisted of 456 participants (Mean age = 22.96 ± 3.12 years; 66.2% women) for the alcohol model; and 232 participants (Mean age = 22.96 ± 3.01 years; 66.2% women) for the marijuana model. Two path models were conducted, such that indirect paths were examined for each trait mindfulness facet on alcohol/marijuana outcomes (e.g., describing → emotional psychopathology → alcohol coping motives → binge drinking frequency). Within the comprehensive alcohol model, describing, acting with awareness, non-judging and non-reactivity were associated with less binge drinking frequency and lower number of alcohol-related negative consequences via lower severity of emotional psychopathology symptoms and lower endorsement of drinking to cope motives. For the marijuana model, describing, acting with awareness, and non-judging of inner experience were associated with less marijuana quantity (grams) consumed and lower number of marijuana-related negative consequences via lower severity of emotional psychopathology symptoms and lower endorsement of marijuana coping motives. Conclusions: Prevention and intervention programs of alcohol and marijuana in Argentina may benefit from improving mindfulness skills and targeting emotional psychopathology and motives to use drugs, to prevent or reduce negative drug-related consequences.

Assessing Factors That Influence Pharmacy Student Burnout and Identifying Recommendations to Support Student Well-Being

OBJECTIVE

Literature indicates concerning rates of burnout and declining well-being among students. Although well-being initiatives have increased, a gap exists in identifying factors that impact pharmacy student well-being. The purpose of this study was to explore the factors students perceive that influence their burnout and identify recommendations to improve student well-being.

METHODS

First- (PY1), second- (PY2), and third-year (PY3) pharmacy students enrolled in the didactic curriculum were invited to participate in this exploratory study. Focus groups were organized by program year to explore the experiences that may be unique to each group. A semistructured interview format was used to discuss factors contributing to student burnout and fulfillment, as well as solicit recommendations for strategies to improve student well-being. Inductive coding was used to identify themes.

RESULTS

Twelve students participated in 6 sessions: 1 PY1 interview (n = 1 student), 1 PY2 focus group (n = 2 students) and 1 PY2 interview (n = 1 student), and 3 PY3 focus groups (n = 2-3 students/focus group). Common factors identified as contributing toward burnout included having too little time, overwhelming academic workload, competitive culture, and noncoursework commitments. Factors contributing to student fulfillment included life outside of pharmacy school, well-being resources, and activities aligned with future goals. Participants recommended several strategies to improve student well-being, including curricular changes (eg, course schedule layout, pass/fail grading), culture strategies, and well-being resources.

CONCLUSION

The findings underscore the impact of workload and competitive culture on student burnout. This study fills a literature gap regarding the factors influencing student burnout and informs strategies for fostering student well-being in pharmacy education.

Dental and endodontic-related stress amongst undergraduate students before and during the COVID-19 pandemic: A mixed-methods study

AIM

To determine and explain the principal sources of stress among preclinical and clinical dental undergraduate students with a particular focus on the stressors linked to endodontics.

METHODOLOGY

A mixed-methods study, with an explanatory sequential design, was employed. Volunteer students of second, third and fourth years were asked to complete both the Dental Environment Stress (DES) questionnaire and a bespoke questionnaire for endodontic-related stress assessment, which had 21 questions in common with the DES. The results were analysed by Kruskal-Wallis and Marginal Homogeneity tests. In the second part of the study, a qualitative phase was conducted through focus group interviews of students from each academic year included in the study. Interviews were analysed by inductive content analysis.

RESULTS

The DES questionnaire determined that for all years the most stressful domains were 'performance pressure', 'workload' and 'clinical training'. According to the endodontic stress questionnaire, the most stressful domains were 'self-efficacy beliefs', 'endodontic clinical training' and 'faculty and administration' in early years, while they were 'endodontic patient treatment', 'performance pressure in endodontics' and 'clinical training' in later years. Comparing questions common to both questionnaires revealed that the stress score was lower for the endodontic stress questionnaire than in the DES questionnaire for 17 questions, being significantly lower for 13 questions (p < 0.05) and significantly higher for no question. The qualitative study showed that students' dental and endodontic-related stress was linked to different domains: patient, clinical procedure, organization, staff, academic education, evaluation and COVID-19-related issues. Qualitative aspects highlighted the important role that patients and COVID-19 have played in student stress. However, they suggested a possible explanation for the lower endodontic stress observed in this dental university hospital, which was based on: the nature of the teaching in endodontics, the consensus between endodontic supervisors, the use of a logical, progressive procedure and the considerable experience that students gain over the years.

CONCLUSION

Students considered endodontics stressful; however, education can play a central role in reducing stress, particularly during the early parts of the undergraduate course.

Associations of academic environment, lifestyle, sense of coherence and social support with self-reported mental health status among dental students at a university in Brazil: a cross-sectional study

OBJECTIVES

The study evaluated the association of academic environment, lifestyle, sense of coherence (SOC) and social support with self-reported mental health status among dental students.

DESIGN

Secondary analysis of data from a cross-sectional, questionnaire-based survey conducted from August to October 2018.

SETTING

Dental school of a public-funded university in the south-eastern region of Brazil.

PARTICIPANTS

233 undergraduate dental students recruited across all years of the course.

OUTCOME MEASURES

Socioeconomic and demographic characteristics, city of origin and student's academic semester were obtained through self-completed questionnaires. Perception of the academic environment (Dundee Ready Education Environment Measure (DREEM)), individual lifestyle (Individual Lifestyle Profile Questionnaire (ILPQ)), SOC (SOC Scale (SOC-13)), social support (Medical Outcomes Study Scale (MOS)), and depression, anxiety and stress (Depression, Anxiety and Stress Scale-21 (DASS-21)) were assessed using validated instruments. The relationships between variables were investigated through multivariable negative binomial regression to obtain the rate ratios (RRs) and 95% CIs.

RESULTS

Female sex was associated with greater scores of anxiety (RR 1.74, 95% CI 1.10 to 1.97) and stress (RR 1.52, 95% CI 1.12 to 2.06). Students who perceived a better academic environment and those reporting a greater SOC had a lower probability of depression, anxiety and stress. Furthermore, a favourable lifestyle was associated with lower depression scores (RR 0.99, 95% CI 0.97 to 0.99). Social support did not remain associated with depression, anxiety and stress after adjustment.

CONCLUSIONS

The present findings suggest that self-reported mental health status is associated with students' sex, academic environment, SOC and lifestyle. Enhancing the educational environment and SOC, and promoting a healthy lifestyle may improve the psychological health of dental students.

A longitudinal study of lifestyle behaviours in emerging adulthood and risk for symptoms of depression, anxiety, and stress

BACKGROUND

Little research has examined how lifestyle behaviours cluster together to contribute to mental health outcomes. The current study aimed to identify latent classes of emerging adult lifestyle behaviours (diet, physical activity, sedentary time, smoking, alcohol, cannabis, and other drug use) at age 20 years and their associations with depression, anxiety, and stress symptoms at age 22 and 27 years.

METHODS

Participants were 616 emerging adults enrolled in the Raine Study. Lifestyle classes at baseline were identified using latent class analysis. Longitudinal associations between latent class membership and risk of depression, anxiety, and stress symptoms were examined using logistic regression models.

RESULTS

Three lifestyle classes were identified: Class 1 (healthier pattern, n = 399 [64.8 %]), Class 2 (predominantly female, high substance-use, low physical activity pattern, n = 121 [19.6 %]), and Class 3 (predominantly male, high substance-use, poor diet pattern, n = 96 [15.6 %]). Following adjustment, Class 2 were at a higher risk of depression, anxiety, and stress symptoms at age 22 years, and a higher risk of anxiety and stress symptoms at age 27 years, compared to Class 1.

LIMITATIONS

This study was limited by reliance on self-report data, lack of available indicators for parental socioeconomic status, and some measurement inconsistencies across variables. Adherence to lifestyle clusters over time was not assessed.

CONCLUSIONS

Latent classes of lifestyle behaviours were identified among emerging adults, and differences in mental health outcomes were found among the classes at two prospective time points. Future research and prevention strategies for common mental disorders should target emerging adults and focus on lifestyle patterns.

Correlation of Depression, Anxiety, and Stress with Coping Strategies Among Dentistry Students: A Cross-Sectional Study

Aim: The aim of the study is to examine the level of stress and coping strategies of dentistry students in Türkiye in terms of variables such as sleep, personality, alcohol consumption, and smoking. Methods: A questionnaire including socio-demographic questions, Depression, Anxiety, and Stress Scale, and COPE Inventory was administered to 293 students. Results: The students' Depression, Anxiety, and Stress Scale scores were 13.88±10.03, 14.60±8.98, and 19.41±9.64, respectively. Income perception and the dentistry-personality relationship were the largest stress factors. No significant difference was found between years in terms of stress level. Problem-focus and emotional-focus coping strategies were negatively correlated, while less-useful coping strategies showed positive correlation with Depression, Anxiety, and Stress Scale scores. While the students who reported their sleep duration as "adequate" showed high problem-focus and emotional-focus coping scores, they had low less-useful coping strategies and Depression, Anxiety, and Stress Scale scores. The students who deemed dentistry suitable for their personality had higher problem-focus and emotional-focus coping scores and lower low less-useful coping strategies scores. Although alcohol consumption and smoking were unrelated to stress, they showed positive correlation with low less-useful coping strategies scores. Conclusion: No difference was observed between the level and sources of Depression, Anxiety, and Stress Scale and the grade. Students utilizing effective coping strategies had lower stress than those using less-useful coping strategies. Therefore, dental education should include how to acquire and use effective coping strategies. Keywords: depression, anxiety, coping strategies, dentistry, dental education

An 8-Week Peer Health Coaching Intervention among College Students: A Pilot Randomized Study

This study explored the effects of an 8-week peer coaching program on physical activity (PA), diet, sleep, social isolation, and mental health among college students in the United States. A total of 52 college students were recruited and randomized to the coaching (n = 28) or the control group (n = 24). The coaching group met with a trained peer health coach once a week for 8 weeks focusing on self-selected wellness domains. Coaching techniques included reflective listening, motivational interviews, and goal setting. The control group received a wellness handbook. PA, self-efficacy for eating healthy foods, quality of sleep, social isolation, positive affect and well-being, anxiety, and cognitive function were measured. No interaction effects between time and group were significant for the overall intervention group (all p > 0.05), while the main effects of group difference on moderate PA and total PA were significant (p < 0.05). Goal-specific analysis showed that, compared to the control group, those who had a PA goal significantly increased vigorous PA Metabolic Equivalent of Task (METs) (p < 0.05). The vigorous METs for the PA goal group increased from 1013.33 (SD = 1055.12) to 1578.67 (SD = 1354.09); the control group decreased from 1012.94 (SD = 1322.943) to 682.11 (SD = 754.89); having a stress goal significantly predicted a higher post-coaching positive affect and well-being, controlling the pre-score and other demographic factors: B = 0.37 and p < 0.05. Peer coaching showed a promising effect on improving PA and positive affect and well-being among college students.

Faculty caring behavior and effect on dental hygiene students' worry or anxiety

PURPOSE/OBJECTIVES

Studies in health professional students have shown the students' perception of instructor caring behaviors had a positive impact on student behaviors and their anxiety. Health professional students are under high emotional and academic demands during entry-level programs which can lead to higher anxiety. The purpose of this study was to measure the relationship between worry or anxiety and dental hygiene students' perceptions of faculty caring behaviors.

METHODS

Cross-sectional survey research was conducted with a convenience sample of dental hygiene students (n = 355) in the United States using a web-based survey. The validated instruments Nursing Students' Perceptions of Instructor Caring (NSPIC) and Penn State Worry Questionnaire (PSWQ) were used for data collection. The NSPIC contains five subscales including instilling confidence through caring (CTC), supportive learning climate, appreciation of life's meanings, control versus flexibility (F), and respectful sharing (RS). Data analysis included descriptive, correlation, and multiple linear regression.

RESULTS

The completion rate was 66% (n = 235). Findings showed the NSPIC subscale, CTC had a statistically significantly higher median score than other NSPIC sub-scales (p < 0001). The NSPIC subscale RS had the second-highest median score. The results of the PSWQ showed that 48% of participants were in the chronic worrier category. Regression analysis showed CTC was a significant predictor of worry (p < 0.001) and a one-unit increase in CTC resulted in a 0.21 decrease in the PSWQ score.

CONCLUSION

Our findings suggested instilling CTC behaviors was the most significant faculty caring behavior and was associated with lower levels of student worry. The results from this study may aid in identifying and developing effective caring behaviors for faculty to support students during stressful dental and allied dental curricula.

Use of the Depression Anxiety Stress Scale-21 in young people with temporomandibular disorders: Reliability and dimensionality

OBJECTIVE

The reliability and dimensionality of the Depression Anxiety Stress Scale-21 (DASS-21) were explored in adolescents/young adults with temporomandibular disorders (TMDs).

METHODS

TMD presence was established with the Fonseca Anamnestic Index. Reliability of the DASS-21 for participants with (WT) and without (NT) TMDs was assessed by the Cronbach alpha test, while dimensionality was examined using exploratory factor analysis.

RESULTS

Data from 400 participants (mean age 18.8 ± 1.5 years; 52.2% women) comprising 47.0% with and 53.0% without TMDs were evaluated. Total-DASS and the 3 subscales showed acceptable to high internal consistencies for the WT and NT groups, with alphas of 0.78-0.94 and 0.66-0.92, respectively. Although 3 factors contributed to about half the variance for both groups, scalar and item discrepancies in the primary anxiety-stress factor existed.

CONCLUSION

The DASS-21 has good reliability but may comprise only 2 dimensions, specifically anxiety-stress and depression, instead of the 3 originally asserted.

Temporomandibular disorders and associated comorbidities among brazilian dental students during COVID-19

Aim: This study aimed to assess the prevalence of temporomandibular disorders (TMD) and psychosocial comorbidities in undergraduate dental students in a southern Brazilian university, during the COVID-19 pandemic. Also, it aimed to verify the association between psychosocial factors and TMD. Methods: Fonseca Anamnestic Index, Depression Anxiety Stress Scale (DASS-21), a socioeconomic questionnaire, and questions about academic performance and social distancing were applied. Poisson regression analysis was used to assess the association of predictive variables with TMD. Results: The prevalence of TMD was found to be 82.4%, and more than half of the students had some degree of stress, anxiety, and depression. Students who had symptoms of stress (RR 1.11; 95% CI 1.04-1.19), anxiety (RR 1.19; 95% CI 1.12-1.27) and reported academic performance worsening (RR 1.12; 95% CI 1.07-1.19) had higher TMD scores. Conclusion: The findings suggest that TMD was highly prevalent among dental students at a federal university in southern Brazil during the pandemic, being associated with high levels of stress, anxiety, poor academic performance, and greater social distancing.

Relationship between Job Burnout, Depressive Symptoms, and Career Choice Regret among Chinese Postgraduates of Stomatology

A qualified Chinese dental postgraduate requires at least eight years of training. The huge academic burden, strict clinical requirements, and high workload increases the risk of job burnout, depression symptoms, and career choice regret of dental postgraduates, which may cause one to waver in their choice of a career as a doctor. Therefore, we aimed at assessing the relationship between job burnout, depressive symptoms, and career choice regret among Chinese dental postgraduates. The Chongqing Stomatological Association conducted an online cross-sectional study among 558 dental postgraduates in China, with an average age of 22.54 ± 2.44. Demographic information, the Maslach Burnout Inventory, the 2-item Primary Care Evaluation of Mental Disorders scale, and career choice regret scale were included in the questionnaire. About 41.0% of dental postgraduates experienced job burnout, 44.1% had depressive symptoms, and 41.6% reported career choice regret. Logistic regression analysis indicated the risk factors for job burnout were time worked/studied per week, depressive symptoms, and career choice regret. Job burnout and career choice regret was significantly related to depressive symptoms (p < 0.001). Risk factors for career choice regret were gender, postgraduate entrance examination score, daily hours of sleep, job burnout, and depressive symptoms. Such results suggest that job burnout, depressive symptoms, and career choice regrets are prevalent among dental postgraduates. Accurate measures should be taken to change this situation.

"This program should come with a warning sign!": Mental wellness in occupational therapy and physical therapy students

Objectives: To measure and compare distress in entry-level masters occupational therapy (OT) and physical therapy (PT) students; to evaluate distress levels relative to existing data; and to explore factors that cause stress, effects of stress, and coping strategies. Participants: Ninety-eight OT and PT students (75 females, 23 males) from two cohorts at a Canadian university. Methods: Sequential mixed-methods including questionnaires and inductive analysis of focus group discussions. Results: OT and PT students from one cohort reported higher levels of stress, anxiety and/or depression compared to the following academic year and compared to undergraduate and general population samples. The overall theme was the unrelenting tug of war between school and other aspects of students' lives. Factors related to academic workload negatively affected mental health. Coping strategies included physical activity, strategic selection of peers, and modifying expectations. Conclusions: Wellness in OT and PT students is an important concern that deserves attention.

Evaluation of mindfulness practice in mitigating impostor feelings in dental students

OBJECTIVES

This study examined (i) the prevalence of impostor feelings in first-year dental students, (ii) student perceptions of a mindfulness practice as a tool to cope with impostor feelings, and (iii) students' ability to identify their level of impostor feelings.

METHODS

Two hundred three D1 students at a single institution participated in a mandatory Mind-Body Wellness Course that included the presentation "Understanding Imposter Phenomenon" (lecture #1) and a second presentation "Impostor Phenomenon and Mindfulness: Tools for Success" (lecture #2) 6 months later. Before lecture #2, all students predicted the level to which they suffer from imposter feelings and then took the Clance Impostor Phenomenon Scale (CIPS) to determine the actual level. After lecture #2, 155 of the students completed a survey on whether the mindfulness practices in the lecture impact their perceptions on coping with impostor feelings.

RESULTS

Fifty-two percent of students were classified as frequent or intense impostors by the CIPS. Fifty-one percent predicted their CIPS classification correctly; 43% underestimated their impostor classification. After lecture #2, 86% reported feeling confident they could recognize their impostor feelings, and 93% reported feeling more aware of how impostor feelings influence their thoughts, behaviors, and actions. Eighty-six percent reported feeling the mindfulness exercise was a helpful tool to build habits to cope with impostor feelings; 83% reported feeling confident they could utilize mindfulness practices to mitigate these feelings when they arise.

CONCLUSIONS

Frequent or intense impostor feelings may be common in first-year dental students. Mindfulness practice has potential to mitigate such impostor feelings.

Effect of group psychoeducation on depression, anxiety, stress and coping with stress of nursing students: A randomized controlled study

PURPOSE

This study was performed with the aim of determining the effect of group psychoeducation in Turkish nursing students.

DESIGN AND METHODS

This study was planned with experimental design (randomized, controlled, and pretest-posttest control group observational study).

FINDINGS

There were significant differences identified for points in the experimental group before and after psychoeducation and 1 month later and between the posttest and 1-month observation measures (p < 0.05). While there was a significant difference (p < 0.05) in the styles of coping with stress and stress, there was no significant difference (p > 0.05) in anxiety and depression, though anxiety and depression scores decreased.

PRACTICE IMPLICATIONS

The use of group psychoeducation in which stress coping styles are taught is recommended to reduce symptoms of stress and manage the symptoms of anxiety, and depression levels.

Dental Students’ Experiences during the COVID-19 Pandemic—A Cross-Sectional Study from Norway

The purpose of this cross-sectional study was to map dental students’ experience of the study situation throughout the pandemic. All clinical dental students (year 3 to 5) at the Faculty of Medicine, Department of Clinical Dentistry (IKO), University of Bergen (UiB), Norway, were invited. Participation was anonymous and voluntary, and the response rate was 63%. Questions regarding stress-related factors were divided into three categories. In the category «Stressors/learning», a statistically significant difference was observed between both the genders (p = 0.001) and years of study (p = 0.028). Statistically significant differences between the genders were also observed in the category «Stressors/infection» (p = 0.008). Women were significantly more stressed due to lack of clinical skills (p = 0.048), not receiving as good theoretical teaching as before the pandemic (p = 0.016), and uncertain issues around the exams (p = 0.000). Fourth year students were significantly more stressed due to lack of clinical skills (p = 0.012), for not passing the clinic/skills courses due to lack of study progression (p = 0.005), and worries about not being a good enough dentist after graduation (p = 0.002). In conclusion, the pandemic had a major impact on dental students. The most prominent stressors in relation to the study situation were experienced by students from the fourth year and female students. Clinical and theoretical learning outcomes among students were regarded as worse than before the pandemic. The students preferred in presence lectures, but experienced digital asynchronous video lectures as a good alternative. The pandemic negatively affected the students’ social life. Dental schools should be aware that students have been exposed to increased distress and burden through the pandemic and should provide support for those in need.

Understanding the well-being of dentistry students

INTRODUCTION

The transactional model of stress is a framework describing the process for coping with stressful events as a relationship between the individual person and environment. This study aimed to investigate the associations between personality, learning environment and experiences of mental health for a cohort of Australian dentistry students.

MATERIALS AND METHODS

Students were invited in 2017 to complete an online questionnaire including the Depression, Anxiety and Stress Scale (DASS-21), The Dundee Ready Education Environment Measure (DREEM) and Cloninger's Temperament and Character Inventory (TCIR-140). Students were followed-up one year later, and generalised estimating equations were used.

RESULTS

A total of 219 (response 73.5%) students participated in the study. Two personality profiles of dentistry students were identified. Group 1 were significantly higher in the traits persistence, self-directedness, cooperativeness and reward dependence, whereas Group 2 were significantly higher in harm avoidance. Students with Group 2 personality had a 3.12 (CI:1.72-5.65) increased odds of depression compared to Group 1 students. Compared to students with positive perceptions of the learning environment, students with negative perceptions had increased odds of stress (3.48, CI: 1.85-6.53), depression (2.71, CI: 1.57- 4.65) and anxiety (2.59, CI: 1.56-4.28).

CONCLUSION

Students with personalities high in levels of self-directedness, cooperativeness and persistence and low in harm avoidance, as found in Group 1, demonstrate high levels of general well-being. Positive perceptions of the dentistry learning environment were found to be an important influence on students stress. This study highlighted a number of factors important to student well-being and provides direction for further investigation of interventions aimed at enhancing student well-being.

Understanding Mental Burden and Factors Associated With Study Worries Among Undergraduate Medical Students During the COVID-19 Pandemic

The Coronavirus disease 2019 (COVID-19) pandemic is affecting many areas of life and has led to major changes in undergraduate medical education. Even before the COVID-19 pandemic, high mental burden of medical students has frequently been reported in the literature. Additional pandemic-specific stressors could exacerbate this situation. This study aimed to assess mental health outcomes among medical students during the first semester after the COVID-19 outbreak and perception of the students on how the learning environment has changed. In May 2020, we conducted a cross-sectional survey among undergraduate medical students at a large medical school in Germany. The survey included validated mental health instruments (Distress Thermometer, Patient Health Questionnaire 4) and self-developed items to examine the perception of the study situation during the COVID-19 pandemic. Open-ended questions were analyzed by conventional content analyses. The response rate was 59.2% (914/1,545). Overall, 61.9% of the students reported distress levels above the cutoff. Year 1 students reported significantly higher levels of distress, anxiety and depression than students during their second to fourth year of studies. 48.3% of the students indicated a decrease in their study motivation since the beginning of the COVID-19 pandemic with significant differences between study years. The binary logistic regression model showed that male gender, being in study year 2, higher distress scores and higher symptoms of depression were significantly associated with a higher likelihood for experiencing serious worries. In the open-ended questions on current concerns related to the impact of the COVID-19 pandemic on their studies, students most frequently reported concerns about missing relevant practical learning experience, difficulties with self-regulated learning and self motivation as well as study-related worries. Year 4 students reported significantly more worries about the lack of practical training than students from study years 1 to 3. Analysis of gender differences showed that female students reported more frequently diverse worries. In contrast, female students shared more frequently helpful strategies in all the categories compared to male students. Our findings suggest that medical students experience significant levels of distress and mental burden during the COVID-19 pandemic and highlight the need for ongoing psychological and educational support for medical students during the COVID-19 pandemic and after.

[Engagement of students enrolled in fifth year of pharmacy studies in their academic or salaried pharmaceutical activities during the first period of lockout due to the COVID-19 pandemic (16th March-11th May 2020)]

OBJECTIVES

To characterize the engagement of students enrolled in the fifth year of pharmaceutical studies in the management of the health crisis due to the COVID-19 pandemic, and to identify some determinants of this engagement during this period.

METHODS

With the health crisis, new missions have been entrusted during hospital internships, whereas certain internship sites were removed in hospitals and as part of the health service organization. In addition, some students who were no longer in internship returned to the hospital setting for helping in critical activities. Student engagement was studied with a questionnaire and focus groups including six or seven students in each group.

RESULTS

Forty-three students participated to the study. The answers to the questionnaire highlighted that they were engaged, that they usually did not wait for compensation, and that most of them were satisfied by their activity during the crisis. The thematic analysis demonstrated that despite a feeling of frustration, which was often associated with the interruption of rewarded activities, and despite a stress due to the particular context, student engagement was supported by a better consideration of the pharmacist's role as a professional in public health and by a better acknowledgement of this role by other health professionals.

CONCLUSION

This level of engagement is particularly encouraging because it is the witness of the ability of pharmacists to mobilize for general interest, even in adverse context.

Mental burden and perception of the study situation among undergraduate students during the COVID-19 pandemic: a cross-sectional study and comparison of dental and medical students

OBJECTIVES

To investigate levels of distress, depression, anxiety, stress and perception of their current study situation during the COVID-19 pandemic among undergraduate dental and medical students.

DESIGN

Observational, cross-sectional study including two consecutive surveys (May and July 2020).

SETTING

A large medical school in Germany.

PARTICIPANTS

All first year dental and medical students were invited. 132 participating first year students (44 dental, 88 medical) from the first survey and 150 students (50 dental, 100 medical) from the second were included in our analyses.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental burden (distress thermometer, Patient Health Questionnaire-4, Perceived Stress Scale-4) and self-reported changes in mental health and perception of study situation during the COVID-19 pandemic (self-developed items) were compared. Open-ended questions were analysed by conventional content analyses.

RESULTS

A considerable proportion of students (t1: May 2020: 84.1%; t2: July 2020: 77.3%) reported distress levels above cut-off. In July 2020, dental students reported significantly higher distress scores than medical students (dental: M=7.0, SD=2.3; medical: M=5.7; SD=2.1; p<0.001). More dental than medical students reported mild, moderate and severe levels of anxiety and depression symptoms. The majority stated that their mental health and study motivation had not changed during the pandemic. Logistic regression showed that being a dental student was significantly associated with a higher likelihood for serious worries regarding the study situation during COVID-19 at t1 (OR 4.0; 95% CI 1.1 to 14.2). At t2 higher distress was significantly associated with a higher likelihood for experiencing serious worries (OR 1.8; 95% CI 1.3 to 2.5). Regarding current concerns related to the pandemic, students most frequently reported difficulties with self-regulated learning (15.2%), study-related worries and uncertainty (14.4%), missing feedback of students and lecturers (11.4%) and lack of practical training (9.8%).

CONCLUSION

The results suggest that high mental burden and the lack of practical training among medical and dental students is an increasing problem, with a possibly even higher urgency in dental students. Tailored psychological and educational support offers during and after the COVID-19 pandemic might help them as they progress through (medical and) dental school.

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.

[Stress and depression in the social and academic setting of dentistry students in 2020]

Aim

The new modality of virtual classes undertaken by dental students can have negative effects on psychological health and / or academic performance. The objective of this study was to determine the relationship between stress and depression in the social academic environment in dentistry students at the Científica del Sur University in 2020.

Materials and Methods

The study was descriptive, observational, cross-sectional, and prospective. 108 students from 6th to 10th cycle of Dentistry at the Universidad Científica del Sur participated and were evaluated by means of a questionnaire with the SISCO Inventory to measure academic stress. The BECK scale (BID II) was also used for the evaluation of depression.

Results

Students in the 6th term presented a greater probability of stress and depression. The age group most affected was students between 19 and 22 years of age. The p value for the relationship between academic stress and depression was p <0.001.

Conclusion

There are statistically significant differences between academic stress and depression in students from the 6th to the 10th term of the Stomatology career at the Universidad Científica del Sur.

The Relationship between Stress Levels Measured by a Questionnaire and the Data Obtained by Smart Glasses and Finger Pulse Oximeters among Polish Dental Students

Stress is a physical, mental, or emotional response to a change and is a significant problem in modern society. In addition to questionnaires, levels of stress may be assessed by monitoring physiological signals, such as via photoplethysmogram (PPG), electroencephalogram (EEG), electrocardiogram (ECG), electrodermal activity (EDA), facial expressions, and head and body movements. In our study, we attempted to find the relationship between the perceived stress level and physiological signals, such as heart rate (HR), head movements, and electrooculographic (EOG) signals. The perceived stress level was acquired by self-assessment questionnaires in which the participants marked their stress level before, during, and after performing a task. The heart rate was acquired with a finger pulse oximeter and the head movements (linear acceleration and angular velocity) and electrooculographic signals were recorded with JINS MEME ES_R smart glasses (JINS Holdings, Inc., Tokyo, Japan). We observed significant differences between the perceived stress level, heart rate, the power of linear acceleration, angular velocity, and EOG signals before performing the task and during the task. However, except for HR, these signals were poorly correlated with the perceived stress level acquired during the task.

Students at Saarland University dental school-A survey on their background and curriculum perception

INTRODUCTION

With the aim of optimising dental education without overburdening students, new legislation restructuring the undergraduate dental curriculum in German is under way. The goal of this study was to survey the current situation of dental students at one specific university with respect to their socio-economic background, admission to dental school, curriculum perception and work-life balance.

MATERIALS AND METHODS

An online questionnaire was presented to all undergraduate students enrolled at Saarland University who had at least completed the first preclinical practical course in dentistry.

RESULTS

A response rate of 85% was reached with two-thirds of the student body being females. The profession of 40% of students' parents either was physicians or dentist. Students reported a slight reduction in time spent for leisure activities during their studies, however, with sports activities hardly being affected. With respect to a proper work-life balance, almost 50% of respondents considered their clinical workload as being too high. Students did not express a clear opinion regarding curriculum structure, whilst the content mostly satisfied their expectations (59%). The majority (71%) of students considered their preclinical training as being demanding whilst less than 3% fully agreed that preclinical training provided an optimal background for patient treatment. The learning modules in the first clinical semester were considered as being adequate by 56% of students. Examinations during courses were seen as properly reflecting the students' knowledge by 79% of students.

DISCUSSION

The status quo of German dental students is characterised by a high workload affecting the students' work-life balance and by a transition between preclinical and clinical education which only about half the student body perceives as being adequate. Patient-based examinations obviously are not considered as being problematic.

Level of anxiety in clinical settings and coping mechanisms used by dental undergraduate students to overcome it

INTRODUCTION

Dental undergraduate students encounter anxiety in their professional years of study, the impact of which is reflected on their overall performance. Various coping techniques are advocated that help individuals to deal effectively with the adverse effects of anxiety.

OBJECTIVE/AIMS

The objectives of this study were to determine the level of anxiety encountered by dental undergraduate students during clinical rotations, the clinical procedures precipitating it and the number of different coping strategies (problem solving, social seeking support, and avoidance) used by students for anxiety management.

METHODS

A descriptive, questionnaire-based, cross-sectional study was conducted on the third and fourth-year undergraduate dental students from six colleges of Islamabad and Rawalpindi. A total of 353 students were included in the study, and their participation in the study was anonymous and voluntary. The administered questionnaire consisted of three parts: Part 1: Moss and McManus Scale (MMM) for anxiety-provoking situations; part 2: Hamilton Anxiety Rating Scale (HAM-A) for the level of anxiety, and Part 3: Coping Strategy Indicator Scale (CSI scale) to determine the frequency of coping strategies used by students. The data were collected and analyzed using SPSS version 22.0.

RESULTS

A majority of participants (96.3%) felt mild to moderate levels of anxiety in the clinical settings. Students felt more anxious about getting infected by the patient (62%), extracting the wrong tooth (46.5%), and getting a wrong diagnosis (43.1%). A significant number of participants (47%) used problem-solving mechanisms to overcome their anxiety.

CONCLUSION

Mild to moderate levels of clinical anxiety prevailed in most dental undergraduate students. The top clinical situations precipitating anxiety were getting infected by patients and extracting the wrong tooth. Measures should be taken to encourage a vigorous, confidence-enhancing environment for students. This will reduce their levels of clinical anxiety along with training and foster healthy coping strategies to deal with unavoidable anxiety.

Mental Health and Physical Activity in Health-Related University Students during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic led to increased negative emotional states among students. Physical activity is known to have positive impacts on mental health and well-being. However, due to the closure of gyms and other recreational facilities as a restrictive measure, students' physical activity levels may decrease. This cross-sectional study aimed to determine the prevalence of depression, anxiety, and stress symptoms and physical activity among health-related students during the second partial COVID-19 lockdown. The study included 823 students from the Faculty of Dental Medicine and Health of the University of Osijek in Croatia. The Depression Anxiety Stress Scale-21 (DASS-21) and the Godin-Shephard Leisure Time Questionnaire for Physical Activity (GSLTPAQ) questionnaires were used to assess the prevalence of depression, anxiety, and stress symptoms as well as physical activity. Two-thirds (59.2%) of students in health-related fields were insufficiently active, while the prevalence of depression (50.8%), anxiety (50.9%), and stress (49.9%) symptoms were high. Also, female respondents had significantly higher levels of depression, anxiety, and stress than their male counterparts. Graduate students had higher levels of all three negative emotional states, but only anxiety levels were significant. This study shows that students in health-related fields had reduced physical activity and a high prevalence of negative emotional conditions (depression, anxiety, and stress) during the second partial lockdown. The resulting symptoms were mostly of mild intensity; however, we consider this a significant mental health issue during the COVID-19 pandemic. Hence, it is crucial to control and support students' mental health, especially in more affected female individuals, in order to reduce the pandemic's negative impact.

Perceived quality of life among oral health therapy and dental students: A cross-cultural comparison

OBJECTIVES

This cross-sectional study examined the perceived quality of life (QOL) of Oral Health Therapy (OHT) students and compared the domain differences between Dental students, gender, and year-of-study.

METHODS

OHT students from a local polytechnic were invited to participate (IRB no. (SHS-2019-001). Perceived QOL was assessed with the multidimensional World Health Organization QOL (WHOQOL)-BREF instrument. Demographic information and WHOQOL-BREF responses were collected electronically. Raw scores were converted to transformed scores and related to data of Dental students from other countries. Statistical analyses were performed with a T-test, one-way ANOVA/posthoc Tukey's test, and Pearson's correlation (p < 0.05).

RESULTS

Of the total cohort of 66 students, 65 consented to participation (98.5% response rate). The study sample (mean age 19.2 ± 2.9 years) comprised of 83.1% females (54/65). Mean domain scores were as follows: Physical health - 54.90 ± 9.78; psychological - 50.98 ± 17.36; social relationships - 60.69 ± 16.47; and environment - 66.80 ± 13.66. The psychological domain was rated the lowest as with most other studies on Dental students. Mean scores for the overall perception of QOL and "satisfaction with health" (SWH) were 3.46 ± 0.83 and 3.35 ± 0.89 respectively. No significant difference in the domain and overall QOL/SWH scores were observed between genders. Psychological and environmental domains scores were significantly different between the first and third-year students (p ≤ 0.02). Correlations coefficients between the QOL domains ranged from r_s  = 0.18-0.66.

CONCLUSION

Aside from the USA and Saudi Arabia, the perceived QOL of Asian OHT students was generally comparable to those of Dental students from other countries. Overall perceived QOL and satisfaction with health were moderately favourable.

Stress and work-life balance in undergraduate dental students in Birmingham, United Kingdom and Hong Kong, China

PURPOSE/OBJECTIVES

Dentistry is a challenging profession, subjecting students to various stressors which can affect well-being. This study in 2019 investigates the relationship between stress and work-life balance in dental students at University of Birmingham and The University of Hong Kong, from two different countries.

METHODS

Online anonymous questionnaires were completed by 54 students from Birmingham and 48 students from Hong Kong. Ethical approval was gained by both centres. Quantitative and qualitative data were captured with Likert scales and open questions. Using simple descriptive statistics in SPSS, Pearson chi-square tests determined statistical significance between categorical and quantitative variables (p < 0.05).

RESULTS

The majority of students from University of Birmingham (38.9%) felt "extremely stressed," whereas the majority of students from The University of Hong Kong (45.8%) only felt "slightly stressed" (p < 0.001). Exercise and emotional support appeared to be positive approaches for stress relief. Hong Kong dental students (68.8%) reported a good work-life balance compared to significantly fewer students (24.1%) in University of Birmingham (p < 0.001).

CONCLUSION

Major stressors in this study included examinations and fear of failure. Students found that hobbies and extracurricular activities contributed to a healthier lifestyle. A better work-life balance reduced reported stress levels.

Perfectionism as a mediator of psychological distress: Implications for addressing underlying vulnerabilities to the mental health of medical students

OBJECTIVE

Medical students have personalities that are often shown to be perfectionistic. Perfectionism can manifest as maladaptive and lead to psychological distress. This study examined the mediating role of perfectionism on the association between personality trait profiles and levels of psychological distress.

METHODS

First-year medical students completed a questionnaire containing measures of personality, perfectionism (Concern over Mistakes: CoM), stress, anxiety and depression. Latent profile analysis classified students based on their personality traits and identified a profile vulnerable to psychological distress. Structural equation models examined the mediation effects of perfectionism on the relationship between the vulnerable personality profile and distress.

RESULTS

The sample totalled 376 (84% response). The vulnerable personality profile was highest in Harm Avoidance, lowest in Self-Directedness, and significantly correlated with the highest Perfectionism-CoM. High Perfectionism-CoM was associated with the highest levels of stress, anxiety and depression. Perfectionism-CoM was a significant mediator for the relationship between personality and higher levels of psychological distress.

CONCLUSION

Certain personality profiles are predisposed to psychological distress such as anxiety, stress and depression. Perfectionism, as a mediator between personality and psychological distress, may be a target strategy to help increase students' self-acceptance, and self-awareness of their perfectionistic tendencies and lower their vulnerability to poor mental health.

Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study

Background

The COVID-19 pandemic is found to affect the mental health of the population. Undergraduate medical students are especially prone to mental health disorders and hence could be more vulnerable to the impact of the pandemic.

Methods

A prospective longitudinal study was conducted on 217 undergraduate medical students in a medical college at Chennai, India. Depression, anxiety, and stress levels were recorded using Depression Anxiety Stress Scale 21 Items (DASS21) before and during the COVID-19 outbreak in India in December 2019 and June 2020, respectively. In the follow-up survey, in addition to DASS21, the Pittsburgh Sleep Quality Index to assess sleep quality and a self-administered questionnaire to assess the impact of COVID-19 related stressors were used. The self-administered questionnaire assessed the status of COVID-19 testing, interactions with COVID-19 patients, self-perceived levels of concerns and worries related to academics (COVID-19-AA (academic apprehensions)) and those pertaining to the self and family/friends (COVID-19-GA (general apprehensions)). Cross-sectional and longitudinal comparison of overall scores of depression, anxiety, and stress and scores stratified by gender, year of study, place of residence and monthly family income were performed. Predictors for depression, anxiety, and stress during COVID-19 were investigated using adjusted binary logistic regression analysis and results were expressed as adjusted odds ratio with 95% confidence interval (CI). A P value < 0.05 was considered statistically significant.

Results

The average scores of depression, anxiety, and stress during the baseline survey were 7.55 ± 7.86, 4.6 ± 6.19 and 7.31 ± 7.34 with the prevalence (95% Cl) of 33.2% [27-39.9%], 21.2% [16-27.2%] and 20.7% [15.5-26.7%]; in follow-up survey, the mean scores were 8.16 ± 8.9, 6.11 ± 7.13 and 9.31 ± 8.18 with the prevalence being 35.5% [29.1-42.2%], 33.2% [27-39.9%] and 24.9% [19.3-31.2%] for depression, anxiety, and stress respectively. There was a significant increase in both the prevalence and levels of anxiety and stress (P < 0.001), with depression remaining unchanged during COVID-19, irrespective of gender, year of study, place of residence and family's monthly income. Poor sleep quality, higher levels of baseline depression, anxiety, and stress, higher COVID-19-GA, COVID-19 patients in family/friends and direct interactions with COVID-19 patients were found to be significant predictors of negative mental health in undergraduate medical students. COVID-19-AA was not significantly associated with depression, anxiety, and stress.

Conclusion

The COVID-19 pandemic appears to negatively affect the mental health of the undergraduate medical students with the prevalence and levels of anxiety and stress being increased, and depression symptoms remaining unaltered. Addressing and mitigating the negative effect of COVID-19 on the mental health of this population is crucial.

Paediatric dentists' stress during dental care for children under sedation: a cross-sectional study

PURPOSE

The knowledge of the stress related to the practice of paediatric dentistry is scarce. The aim of this study was to verify the stress perceived by paediatric dentists related to young children's dental treatment under sedation and their association with child's behaviour and other independent variables.

METHODS

A cross-sectional repeated measures study was performed with four paediatric dentists who treated 81 sedated preschoolers. Paediatric dentists reported their stress at the end of the session using the visual analog scale (VAS 0-100 mm). Samples of saliva were collected to measure the dentists' salivary cortisol level throughout the dental session. The sessions of dental treatment were video recorded for evaluation of the child's behaviour. Children's behaviour was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The association between the VAS scores and the other variables was verified using bivariate tests and generalised estimating equation (alpha 0.05).

RESULTS

Paediatric dentists felt slightly stressed in most of the sessions (VAS median 7 points; minimum 0, maximum 97 points). VAS associated with the struggling behaviour of the child (B 0.53; 95%CI 0.32-0.74; p ≤ 0.001) and the time since dentist's graduation (B - 1.41, 95% CI - 1.87 to - 0.94; p ≤ 0.001) but not with dentist's salivary cortisol (rho - 0.053, p = 0.639).

CONCLUSION

The more frequent the child's struggling behaviour during dental treatment and the shorter the time elapsed since the professional's graduation, the higher the level of objectively and subjectively measured stress of the paediatric dentist during the dental procedure.

Self-reported depressive symptoms in dental students: Systematic review with meta-analysis

OBJECTIVE

This study aimed to systematically review the literature about the prevalence of self-reported depressive symptoms in dental students.

METHODS

PUBMED, SCOPUS, and EMBASE databases were search up to January 2020 with the following focused questions: "What is the prevalence of self-reported depression symptom in dental students?" and "Are sex and years of educational training associated with self-reported depressive symptom in dental students?". Observational studies that applied a questionnaire assessing depression were eligible. Standard mean differences (SMD) and pooled odds ratios (OR) were calculated for the questionnaires' scores and self-reported depressive symptom, respectively.

RESULTS

Fifty-eight studies were included, and 15 different questionnaires were used. The prevalence of self-reported depressive symptoms/at least mild depression ranged from 2.75% to 89.84%, and the pooled overall prevalence was 29% (95% confidence interval [CI]: 26-34). Meta-analysis showed significantly lower scores in the questionnaires for self-reported depressive symptoms of male students (SMD: -0.22; 95% CI: -0.42 - -0.03). Conversely, no significant difference was detected for the OR of self-reported depressive symptom in the comparison between sex (OR: 1.11 - 95% CI: 0.77-1.62). Similarly, no significant difference was observed for the different school years regardless of the analytical strategy used.

CONCLUSION

It was concluded that female dental students presented more self-reported depressive symptoms, but no difference is demonstrated during the years of dental education.

Student Pharmacist Perspectives on Factors That Influence Wellbeing During Pharmacy School

Objective. To explore first-year student pharmacist perspectives on the influence of individual, educational system, and health care system factors on their wellbeing during pharmacy school. Methods. As part of a required course, first-year student pharmacists were required to submit reflective essays detailing the factors that most significantly contributed to their wellbeing since starting pharmacy school. Reflections from students who consented to participate during the study period from February 2019 to July 2019 were included for analysis. Qualitative thematic analysis was performed using open and axial coding, hierarchical categorization, and representative theme determination through a process of iterative review and deliberation. Coders developed a codebook with operational definitions for each emergent code. Coders met biweekly with lead researchers to ensure consistency and reliability of data analysis and to address minor discrepancies in coding. All team members discussed and revised themes until consensus regarding final representative themes was achieved. Results. Forty-nine students (36.8% of the first-year class) submitted reflective essays for analysis. Five themes emerged for the factors most influential on student pharmacist wellbeing: workload; learning environment culture and values; meaningful pharmacy school experiences; relationships; and personal factors. Student pharmacists did not consistently identify health care system factors as influencing their wellbeing. Conclusion. Student pharmacists identified both education system and individual factors as influencing their wellbeing. Education systems should prioritize implementation of systematic strategies that address curricular and learning climate factors, maximize student engagement in meaningful experiences, optimize social connectedness, and provide individual student support.