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

Psychosocial impacts, perceived stress, and learning effects during the transition from preclinical to clinical dental education: Validation and translation of a questionnaire

Background

During the first experiences of clinical treatment, dental students face various challenges. The purpose of the study is to standardize the questionnaire as a suitable tool for quantitative and qualitative evaluation of psychosocial impact, stress levels, and learning effect of dental students during the transition from preclinical to clinical education in Persian.

Materials and Methods

In this cross-sectional study a questionnaire including three areas of psychosocial impact, perceived stress, and learning effect was systematically translated. In the group of experts, face validity was examined. Then, the content validity ratio (CVR) and the content validity index (CVI) were determined. The reliability of the questionnaire was determined by the test-retest method and the Cohen's Kappa coefficient. In a cross-sectional study, the psychosocial impact, stress levels, and learning effect of all students newly admitted to the endodontic, prosthetics, periodontics, and restorative dentistry departments of Shahid Beheshti Dental School (128 people) were measured. Mann-Whitney and Spearman-Rho were used for statistical analysis (P = 0.05).

Results

During the CVR and CVI evaluation, 12 statements were removed from the questionnaire, and one statement was changed. All valid statements of the questionnaire were considered reliable. The initial questionnaire was finally developed in the form of 27 items. Interest in clinical treatment and collaboration between students and faculty had the greatest psychosocial effects. The highest level of stress among students was seen in the endodontic ward (mean = 3.8). The greatest effect of learning was seen in different sections in infection control (mean >4).

Conclusion

This study provided a standardized tool in Persian to evaluate the psychosocial impacts, perceived stress, and learning effect of dental students during the transition to clinical education and focused on the first clinical treatment experiences. One important psychosocial factor was collegiality between teachers and students. The ability to communicate well with the patient is thought to reduce stress.

Investigating the Relationship between Personality Traits and Distress Tolerance with Mental Health and Academic Performance of Dental Students of Kashan University of Medical Sciences

Background:Mental health and academic performance of students in the quality of dental education is very important to the learners in this field. Study aim:This study was designed to investigate the relationship between personality traits and distress tolerance with mental health and academic performance of dental students attending Kashan University of Medical Sciences, Iran. Methods:Seventy three dental students from Kashan University of Medical Sciences, Iran, participated in the present study. The sampling method was the census method. In this descriptive cross-sectional study, the Mental Health Questionnaire (GHQ), Distress Tolerance Questionnaire (DTS) and Five-Factor Personality Questionnaire (NEO) were used to assess the desired indicators and the total grade point average of students as a measure of their academic performance. Data was analyzed using Poisson regression estimators and descriptive statistics. Results:Study participants had a mean age of 22.42 years and 84.9% of them were single. In this study, the mean score was 23.84 (±11.90) for GHQ and 45.01 (±8.93) for DTS. There was no significant relationship between different variables and their dimensions and students' academic performance. Conclusion:Improving the mental health of dental students is very important and should be on the agenda of educational policy makers.

Extreme Situation Experienced by Dental Students of the Medical University of Silesia Due to the SARS-CoV-2 Epidemic during the First Lockdown

The pandemic declared in many countries in 2020 due to COVID-19 led to the freezing of economies and the introduction of distance learning in both schools and universities. This unusual situation has affected the mental state of citizens, which has the potential to lead to the development of post-traumatic stress and depression. This study aimed to assess the level of stress in dental students in the context of the outbreak of the SARS-CoV-2 virus pandemic. A survey on the PSS-10 scale was prepared to measure the level of perceived stress. The study included 164 dental students at the Faculty of Medical Sciences of the Medical University of Silesia in Katowice, Poland. The results showed the impact of COVID-19 on the stress of students, with 67.7% reporting high levels of stress. The study also revealed that stress was higher among older female students. This paper recommends that the university provide more intensive psychological care as psychological first aid strategies in epidemics or natural disasters and to consider telemedicine in order to deliver services due to the limitations of the pandemic.

Dental Students' Oral Health-Related Quality of Life and Temporomandibular Dysfunction-Self-Rating versus Clinical Assessment

The aim of this study was to compare dental students' self-perception of oral health with the results of a clinical examination of the masticatory system. Seventy-four dental students (38 (51.4%) females and 36 (48.6%) males) completed the Oral Health Impact Profile questionnaire (OHIP-G-14) and underwent a clinical examination according to the Graz Dysfunction Index (GDI). Data were analyzed with descriptive and comparative statistics. Median OHIP-G-14 scores were 3 (IQR 0-6) in the total collective, 4 (1-11) in females, and 2 (0-4) in males (p = 0.072). A score of 0 was found in 29.7% of the sample. The results of the GDI were 50% "normal function", 43.2% "adaptation", 5.4% "compensation", and 1.4% "dysfunction". The comparison of OHIP-G-14 scores and DGI groups showed a significant difference (p = 0.031). Based on the questionnaire, less than one third of the sample indicated maximum oral health-related quality of life. In contrast, the GDI revealed "normal function" or "adaptation" in 93.2%. Dental students underappreciated their oral health condition. Health assessments should not be solely questionnaire-based, especially in health professionals (-to-be). To establish a valid diagnosis of the state of health, self-assessment must be complemented by an objective clinical examination, e.g., GDI.

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.

Depression among the Non-Native International Undergraduate Students Studying Dentistry in Bangladesh

BACKGROUND

Bangladesh has been attracting international students with interests in various subjects recently. Every year students from different parts of the world come to study undergraduate and postgraduate courses, mostly at private universities in Bangladesh. This study evaluates the depression status among international students who are studying dentistry in Bangladesh.

METHODS

This cross-sectional survey was conducted among International undergraduate dental students who enrolled in the Bachelor of Dental Surgery program in nine public and private dental colleges in Bangladesh. Participants were selected using a convenience sampling method. A total of 206 students completed the survey where 78.5% of them were female students and 21.5% students were male, and a CES-D 10-item Likert scale questionnaire was used for data collection. The Cronbach alpha for the 10-item CES-D scale for this population is 0.812.

RESULTS

The majority of the students (79.5%) are below 24 years of age with a mean age of 23.22 years and standard deviation of 2.3, and are students who cannot communicate well in Bengali (Bangla), about 60% of them have experienced depression. About 77.3% (p < 0.00) of the international students having financial difficulties exhibited depression. The international students who went through financial problems were two times more likely to suffer from depression (OR = 2.38; p-value < 0.01).

CONCLUSION

This study tried to highlight the struggles faced by international students in Bangladesh studying dentistry. It is evident from the findings that several factors influence students' mental well-being during demanding dental education years.

Associations between family social circumstances and psychological distress among the university students of Bangladesh: To what extent do the lifestyle factors mediate?

Background

While there is a growing body of empirical studies focusing on the social and behavioral predictors of psychological health, the mechanisms that may underlie the reported associations have not been adequately explored. This study aimed to examine the association of social and lifestyle factors with psychological distress, and the potential mediating role of the lifestyle factors in the estimated associations between social circumstances and psychological distress.

Methods

A total of 742 tertiary level students (53% females) from a range of socio-economic backgrounds and multiple educational institutions participated in this cross-sectional study. The 12-items General Health Questionnaire (GHQ-12) was utilized for measuring psychological distress. Data related to students’ socio-demographic characteristics, family social circumstances, and lifestyle factors were also collected. Modified Poisson regression analysis was used to estimate the risk ratios (RR) and their 95% confidence intervals (CI).

Results

The multivariable regression analysis suggests heightened risks of psychological distress associated with low parental Socio-Economic Position (SEP) (RR: 1.36; 95% CI: 1.07, 1.76), childhood poverty (RR: 1.31; 95% CI: 1.11, 1.55), and living away from the family (RR: 1.28; 95% CI: 1.07, 1.54). Among the lifestyle factors, past smoking, physical inactivity, inadequate fruit intake, and poor sleep quality were strongly associated with psychological distress and these associations persisted when the family social circumstances and lifestyle factors were mutually adjusted for. The lifestyle factors did not considerably mediate the estimated associations between family social circumstances and psychological distress.

Conclusion

The social and lifestyle factors operated independently to increase students’ risk of psychological distress. Accordingly, while promoting students’ healthy lifestyles may reduce the overall burden of psychological distress, any equity initiative aiming to minimize the social inequalities in psychological health should be targeted to improving the living conditions in early life.

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.

An investigation into security, self-confidence and gender differences related to undergraduate education in Endodontics

AIM

To analyse responses from dental practitioners (DPs) on how secure they felt as a newly graduated dentist, level of confidence or self-efficacy when performing root canal treatment (RCT), and if undergraduate (UG) education in Endodontics adequately met their needs in a dental practice.

METHODOLOGY

An electronic questionnaire was sent to 459 dentists who graduated from the University of Bergen, Bergen, Norway, between 2008 and 2018. The survey consisted of questions with closed-end options and Likert scale (1-5). An open-ended free text option was always provided.

RESULTS

A total of 314 (68.4%) DPs answered the questionnaire. Of these, 87 (27.8%) were men and 224 (71.3%) were women. Three respondents did not disclose their gender. As a newly graduated dentist, 37.3% of the respondents felt secure when performing RCT, 30.7% felt indifferent, and 32.0% felt insecure. The majority (72.4%) of respondents were either confident or very confident when performing RCT, 21.3% were indifferent, and 6.3% had little or no confidence. A majority of DPs (84.4%) self-evaluated the quality of their root fillings as good or very good, and 15.2% were indifferent. Only one DP selected 'not good' and none selected 'bad'. There were significant gender differences where male DPs felt more secure than female DPs when performing RCT (P < 0.001). A significantly larger number of men were very confident compared to women (P < 0.001). A logistic regression analysis using confidence as a dependent variable to predict self-efficacy revealed that DPs who felt secure when performing RCT as a newly graduated dentist had about 8 times more self-efficacy (odds ratio = 8.49) than those who were insecure or indifferent. Respondents who rated their quality of root fillings as good or very good had forty times more self-efficacy (odds ratio = 40.06) when performing RCT. UG education in endodontics was considered inadequate by 71.3% of the respondents where a significantly larger number of DPs (70%) wanted more clinical training (P < 0.05). About half the DPs (47.7%) stated that there was a need for lifelong learning with majority preferring hands-on courses and continuing dental education organized by dental associations.

CONCLUSIONS

The results of this study suggest that there is a need to promote self-efficacy during UG education in Endodontics. Hands-on training is the preferred form of lifelong learning for DPs.

The Role of Yoga in Treating Stress-Related Symptoms in Dental Hygiene Students

Context:

Research has provided evidence for yoga's effectiveness in the prevention and treatment of pain and stress, both of which have been implicated as significant negative moderators of student performance and experience.

Aims:

This study investigated the feasibility and preliminary impact of a 10-week yoga intervention with dental hygiene students to reduce perceptions of stress and stress-related symptoms.

Settings and Design:

Students self-selected into a yoga treatment versus control condition. They completed stress and pain measures at four time points during and after the intervention or control period of 10-weeks.

Methods:

Participants were students enrolled in a dental hygiene program. All 77 participants completed a 10-week study, self-selecting into an intervention or control group. They completed three self-report questionnaires assessing pain and stress, administered at baseline, mid-point, postintervention, and two follow-ups. The 10-week yoga intervention consisted of 10 90-min yoga sessions that provided check-ins, breathing exercises, sequences of postures, relaxation exercises, and closing meditations.

Statistical Analysis Used:

Independent samples t-tests were used to compare perceived stress levels of participants in the control versus treatment groups. Paired t-test was used to assess differences in stress-related symptom levels across time.

Results:

Results suggested that a yoga intervention is feasible for this group and that active yoga practice can lower perceived stress across multiple domains and across time.

Conclusions:

A specially adapted and designed 10-week yoga protocol appears to be an accessible option for dental hygiene programs that seek to support their students in improving overall wellbeing.

The Influence of Gender and Year of Study on Stress Levels and Coping Strategies among Polish Dental

Background and objectives: Stress is a common term used to describe various adverse psychological conditions. Students in the dentistry field face many negative psychological outcomes. The core factors for stress among dental students are related to their training course and social contacts with peers. This research aimed to assess the stress of dental students depending on their gender and study year. Materials and methods: We used the Perceived Stress Scale (PSS-10) and Mini-COPE questionnaire. The surveys were conducted among 446 dental students (320 women and 126 men) at the Faculty of Medical Sciences of the Medical University of Silesia in Katowice. Results: For the second-year and fifth-year students, the differences in scores were statistically significant, while in both cases, men had significantly lower values on the analysed scale. The results of the Kruskal-Wallis test indicated significantly lower values on the PSS-10 scale for the third-year and fourth-year students than in first-year students. The performed statistical analysis of the data obtained from the Mini-COPE questionnaire showed significant differences between men and women in individual years of study. In the first year, women chose more often the strategies related to turning to religion (p = 0.007), seeking emotional support (p = 0.046), seeking instrumental support (p = 0.045) and dealing with something else (p = 0.029) in coping with stress than men. Conclusions: The highest level of stress was found among first-year dental students. Moreover, women were characterised with higher stress levels than men. Men more often use psychoactive substances and resort to a sense of humour to cope with stress. On the other hand, women turn to religion, seek instrumental and emotional support.

Evaluation of knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic

BACKGROUND

The novel coronavirus disease (COVID-19) is a new viral respiratory illness, first identified in Wuhan province, China. Dental professionals and dental students are at an increased risk for these viruses from dental patients, as dental practice involves face-to-face communication with the patients and frequent exposure to saliva, blood, and other body fluids. Dental education can play an important role in the training of dental students, adequate knowledge and adopting attitudes regarding infection control measures. The aim of this study was to evaluate knowledge, attitudes, and clinical education of dental students about COVID-19 pandemic.

METHODS

A total of 355 pre-clinical and clinical dental students (242 and 113, respectively, comprising 190 females and 165 males) at Fırat University Dentistry Faculty, in Elazığ, Turkey answered an online questionnaire about the biosafety procedures for and their attitudes to and knowledge of COVID-19. The study was conducted in March 2020, Turkey. The data gained were analyzed using descriptive statistical methods and chi-square test.

RESULTS

Both the clinical and preclinical students were found to be afraid of infecting themselves and their environment with COVID-19, and the difference between them was statistically significant. Three quarters (74.9%) of the participants responded yes to the question of whether they thought that experiences related to COVID-19 affected them psychologically, with the differences between gender and clinical status were statistically significant. Responses to the question of which clinical rotation worried them more were 29.9% endodontics, 25.1% oral and maxillofacial surgery, 16.3% prosthesis, 15.2% periodontology, 6.8% restorative dentistry, 3.9% oral diagnosis and radiology, 1.7% pedodontics, and 1.1% orthodontics, with a significant difference between the preclinical and clinical students. Regarding the measures applied by the clinical students in their clinical rotation, the responses were 100% gloves and 100% mask (with 11.5% FFP3/N95 mask), 73.6% face protective shield and 37.1% safety glasses, and 49% bonnet and 16.8% disposable box, with 90.2% frequent hand washing, and 86.7% frequent hand antiseptic usage.

CONCLUSIONS

While students gave good responses regarding the standard measures they take to protect against transmission of COVID-19, their knowledge and attitudes about the extra measures they can take should be improved. For students to be least affected by fears associated with the disease, dental faculties should be ready to provide psychological services to those in need.

Health-related impediments to learning among dental and oral surgery students

Dental education is a challenging experience that places significant demands on students' intellectual, financial, and psychosocial well-being. Dental students who simultaneously experience physical illness, emotional upset, or interpersonal difficulty may be at greater risk of experiencing negative academic consequences. It is well documented that stress affects student learning, however, the impact of other health concerns on academic success is less understood. The purpose of this manuscript is to document the prevalence and perceived academic impact of 24 health concerns on the academic performance of a sample of 130 undergraduate dental students as measured by the National College Health Assessment (NCHA). Health concerns that were most prevalent among dental students were generally also perceived to be most detrimental to their learning. These included upper respiratory infections (cold, flu, sore throat), interpersonal concerns (concerns about a troubled friend or family member, and relationship difficulty), and mental health issues (depression/anxiety/seasonal affective disorder, and stress).

Prevalence and correlates of common mental disorders among dental students in Brazil

This study aimed to estimate prevalence of common mental disorders (CMD) and associated factors among dental students. In this cross-sectional study, 230 students answered a questionnaire and instruments to assess CMD (Self Reporting Questionnaire-20), hazardous alcohol consumption (Alcohol Use Disorder Identification Test), social support (Social Support Scale), perceptions of academic life (Dundee Ready Education Environment Measure), coping (Ways of Coping Inventory) and resilience (Resilience Scale). Bivariate analysis was conducted using the Chi-Square and Mann-Whitney tests. Logistic regression included all explanatory variableswith p<0.20 in the bivariate analysis, besides sex and academic year. The explanatory variables were analyzed in five successive blocks (backward-stepwise), until all variables presented statistical significance in the final model (p<0.05). The prevalence of CMD was 45.2% (95%CI: 38.7–51.6), with no significant differences between sexes. Students with no extracurricular activities, who had negatively self- assessed their health status and their academic performance, were about four times more likely to present CMD, followed by receiving psychological or psychiatric treatment during university (AOR: 2.65; 95%CI: 1.1–6.1) and those with high scores for confrontive coping (AOR: 1.20; 95%CI: 1.0–1.4). Resilience was a protective factor for CMD among dental students (AOR: 0.93; 95%CI: 0.9–1.0). Aspects related to academic performance, health status and confrontive coping strategies were risk factors to students’ mental health. Individuals with high levels of resilience showed lower prevalence of CMD. Further prospective studies could contribute to understanding the role of resilience among this population.

Stressors and coping strategies among physiotherapy students: Towards an integrated support structure

Background

Stress is a major problem among university and, specifically, health care students, as it may influence academic performance and psychological well-being negatively.

Aims

To develop and implement a student support system based on the perceived stress, stressors and coping strategies of physiotherapy students.

Methods

A cross-sectional, descriptive study was undertaken, using a literature-based, self-compiled questionnaire and the 28-item General Health Questionnaire (GHQ-28). Over a period of three years, 207 third- and fourth-year physiotherapy students at a South African university were included.

Results

Psychological distress was experienced by 61.8%-71.2% of participants. During the 3 months prior to the study, 6% of participants received psychological or psychiatric help and 9% of participants used some form of psychiatric medication. The main stressors identified during clinical training were the suffering and death of patients, academic pressure and tension during interaction with personnel. Participants indicated that they mainly coped with these stressors by talking to someone such as a family member or a friend.

Conclusions

Based on the findings of this study, a framework to identify and support students in pre-clinical and clinical training years was developed and implemented over five years. This proposed framework might positively contribute to the psychological well-being of health care students.

Psychosocial impact, perceived stress and learning effect in undergraduate dental students during transition from pre-clinical to clinical education

INTRODUCTION

This study aimed to develop a suitable instrument for a comprehensive quantitative and qualitative assessment of perceived psychosocial impact, levels of stress and learning effect in undergraduate dental students during the transition from pre-clinical to clinical education. These findings might improve curricular structures and didactic organisation during this period.

MATERIALS AND METHODS

At the beginning of their first clinical year, undergraduate dental students were asked to complete an anonymous forty-item questionnaire. Two hundred and seventy-six undergraduate dental students were willing to participate and completed the questionnaire and participated during the years 2011-2016.

RESULTS

The response rate was between 45% and 96%. Correlational analysis (Spearman-Rho) in the field of psychosocial impact showed the dental teacher to be the most important multiplier of students' feelings. If the students feel that their teacher acts cooperatively, positive items increase and negative items decrease significantly (P < .0001). Also, students who report high levels of stress are affected significantly in their psychosocial interaction (P < .0001). Wilcoxon test yielded highest levels of stress in endodontology during the first weeks (P < .0001). During the same period, the greatest learning increment was seen for diagnostics and caries excavation.

CONCLUSION

In conclusion, teaching of undergraduate dental students during the transition period from pre-clinical to clinical education can be positively influenced by a supportive learning environment and by specific chronological modifications in the curriculum. Students should start their clinical training with diagnostics, preventive dentistry and initial periodontal treatment. Due to high levels of perceived stress, endodontology should be introduced later in the clinical curriculum.

Psychometric Properties of the Croatian Language Version of the Dental Environment Stress Questionnaire on Dental Medicine Students

OBJECTIVE

To develop the Croatian version of the 41-item Dental Environment Stress questionnaire (DES) for stress assessment of dental students in both, preclinical and clinical years of study and to test its psychometric properties in Croatian dental student population.

MATERIALS AND METHODS

The English version of the 41-Item DES questionnaire was first translated into the Croatian language. Subsequently, it was set on the google drive and filled out by a total of 202 students from the School of Dental Medicine, University of Zagreb and 30 additional students from other Faculties. Students also assessed their overall level of stress on the Likert scale (1=no stress, 5=highest level of stress). Internal consistency was tested on 202 dental students; test-retest reliability on 30 dental students who filled out the same questionnaire twice; convergent validity on 202 dental students; and divergent validity on 202 dental students and 30 students from faculties not belonging to the biomedicine group.

RESULTS

Internal consistency showed high Cronbach alpha coefficient (0.9) and test-retest reliability showed no significant difference (P>0.05) within the period of 14 days when stress level had not changed (vacation). Convergent validity was confirmed by the significant association between the DES summary scores and the self- perceived level of stress (Spearman's rho=0.881; P<0.001). Divergent validity was confirmed by significantly lower DES summary scores in students not belonging to the Biomedicine group (t=7.5, P<0.001).

CONCLUSION

Excellent psychometric properties of the Croatian version of the DES questionnaire enable its utilization for assessment of stress level in Croatian dental students.

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

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

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.

Psychological distress and type 2 diabetes mellitus: a 4-year policemen cohort study in China

OBJECTIVES

This study investigated whether psychological distress predicts the development of type 2 diabetes mellitus (T2DM) and if the association differs between populations at a high or low diabetes risk level among Chinese police officers.

DESIGN

Prospective cohort study.

SETTING

Single centre.

PARTICIPANTS

6559 participants underwent clinical measurements at the hospital in April 2007. 5811 police officers participated in the follow-up consisting of new-onset diabetes (NOD) events occurring annually between 2008 and 2011.

PRIMARY OUTCOME MEASURES

Baseline data were collected from policemen who completed the Symptom Checklist 90-Revised (SCL-90-R) questionnaire and a self-designed questionnaire. Psychological distress was measured by the SCL-90-R questionnaire. Hong Kong Chinese Diabetes Risk Score (HKCDRS) was used to evaluate the risk of T2DM, and the participants were divided into low-risk group and high-risk group based on the HKCDRS. Cox proportional hazards regression was used to calculate the HRs of the incidence of T2DM related to psychological distress and further stratified the analysis based on HKCDRS.

RESULTS

Among 5811 participants, 179 subjects developed NOD during the 4-year follow-up. 54 subjects (1.63%) with a HKCDRS 0-7 vs 125 subjects (4.98%) with a HKCDRS>7 developed NOD (p<0.05). There was a significant association between psychological distress and T2DM (HR=1.46; 95% CI 1.05 to 2.02). Among the participants with a high-risk score (HKCDRS>7), 7.07% of those with psychological distress developed T2DM compared with 4.43% of participants without psychological distress (p<0.05). The corresponding adjusted HR for psychological distress was 1.61 (95% CI 1.10 to 2.37).

CONCLUSIONS

Psychological distress is an independent risk factor for T2DM in this prospective cohort study. Stratification analysis indicated that psychological distress was associated with T2DM in a high-risk level population.

Environmental and perceived stress in Australian dental undergraduates: Preliminary outcomes

Background. Dental students have reported a high prevalence of psychological stress and the causes are associated with the challenging dental environmental and demographic factors. This study aimed to conduct a preliminary investigation on dental students’ stress status, using a sample of first-to-third-year Bachelor of Dental Surgery students in an Australian university. Special interests included causes of dental environmental stress and access to help services.

Methods. A sample of 145 students was surveyed with a modified Dental Environmental Survey and Depression Anxiety Stress Scale in 2014. The participants’ demographic information was also collected.

Results. The response rate was 95.4%. Second-year (P = 0.042), third-year (P < 0.001) and employed students (P = 0.027) were more likely to report stress resulting from transition to clinical learning. Third-year students were more often stressed about communicating and approaching staff (P = 0.023) as well as different opinions between staff (P < 0.001) and reduced holidays (P < 0.001). Students that were younger than 21 years of age (P = 0.001), that were first years (P < 0.001), and that were not in a relationship (P = 0.010) more often found difficulty of course work stressful. Students who were not in a relationship more often considered learning manual dexterity a source of stress (P = 0.034). Students previously seeking professional help were more likely to be stressed (P = 0.010).

Conclusion. Causes of dental environment stress varied among years of study and demographic backgrounds. Professional support to stressed students should be enhanced. Further investigation is indicated.

Burnout prevalence and correlates amongst Colombian dental students: the STRESSCODE study

INTRODUCTION

Accumulating evidence amongst dental students indicates an alarming prevalence of stress, which can precipitate the development of burnout--a state of mental or physical exhaustion and disengagement. Understanding individual and educational correlates of burnout is necessary for its prevention. The aims of this study were to determine the prevalence of burnout amongst a large sample of Colombian dental undergraduates and investigate its psychosocial and educational correlates.

MATERIALS AND METHODS

Survey data collected from 5647 students participating in the Stress in Colombian Dental Education study were used for this analysis. Burnout was measured using the Maslach Burnout Inventory-Student Survey (MBI-SS). Covariates included participants' socio-demographic characteristics and perceived stress, as well as educational environment factors. Descriptive, bivariate and multivariate methods based on multilevel mixed-effects logistic regression modelling were used for data analysis.

RESULTS

Seven per cent of the students surveyed met the criteria for burnout. The prevalence of burnout was higher amongst upper classes, older and married students, those who reported not having passed all required courses and not having dentistry as their first career choice, as well as students in public institutions and those with large class sizes. Moreover, students' perceived stress in the domains of workload and self-efficacy was significantly and positively associated with burnout.

CONCLUSIONS

Both personal and educational environment characteristics were found to be associated with burnout. Irrespective of these factors, students' perceived stress with regard to workload and self-efficacy was a strong influence on burnout and its alleviation may be a promising avenue to prevent psychological morbidity.

Psychological Distress and its Correlates among University Students: A Cross-Sectional Study

STUDY OBJECTIVE

Mental health disorders are common among university students. In addition to the normal stressors of everyday life, students must deal with stresses related to their education. Our aim was to identify the mental health status of university students and its correlation with socio-demographic, academic performance, and menstrual features.

DESIGN

A cross sectional study was conducted among undergraduate health students using the Symptoms Checklist-90- Revised (SCL-90-R). The Global Severity Index (GSI), raw scores of SCL-90-R subscales, and correlated factors were reported and analyzed.

RESULTS

A total of 171 health students completed the survey. Psychopathological symptoms were found in 23% of the student. Depression was the most prevalent mental reported symptom (100%). There was no significant association between the symptoms and variables such as age, gender, living in university dormitories, marital status, field of study, academic performance, and the day of menstrual cycle while filling the form. GSI scores were significantly related to regular menses. The odds of being identified as a mentally unhealthy individual was 0.37 times lower for those who experienced regular menstrual cycles.

CONCLUSION

Psychological distress is prevalent among health students and tends to be reported more by female students with irregular periods and during luteal phase of menstrual cycle. Preventive and treatment programs need to be developed. It is also recommended that SCL-90-R be administered at least 7 days after the end of menstrual bleeding.

Evaluation of anxiety, depression and suicidal intent in undergraduate dental students: A cross-sectional study

BACKGROUND

There is an increasing amount of stress in undergraduate dental students leading to anxiety, depression, and suicidal attempts/suicide.

AIMS

This study aims to evaluate anxiety, depression and suicidal intent in undergraduate dental students and to find out the various areas of stress.

MATERIALS AND METHODS

A cross-sectional study was conducted using a semi-structured questionnaire (to assess academic and nonacademic areas of stress) and three scales-Hamilton scale for anxiety (HAM-A); Hamilton depression rating scale (HDRS) and Beck's Suicide Intent Scale (BSI). Descriptive statistics; Pearson's Chi-square test; Multiple ANOVA; Kruskal-Wallis test and Mann-Whitney test were used to analyze the data at the significant level of P ≤ 0.05.

RESULTS

In a total of 258 dental undergraduate students, academic areas of stress that were found to be statistically significant were long teaching hours (P = 0.002); high workload (P ≤ 0.001); frequency of tests (P ≤ 0.001) and competition/fear of failure (P = 0.009). Lack of interest in the profession was a statistically significant nonacademic area for stress (P ≤ 0.001). The students of first and final year reported higher anxiety (HAM-A 13.93 ± 6.908 and 16.44 ± 7.637 respectively) and depression (HDRS 14.29 ± 6.302 and 14.22 ± 5.422); whereas suicidal intent was reported almost the same throughout the study sample (BSI 5.65 ± 5.465).

CONCLUSION

An increasing level of anxiety, depression and suicidal intent due to various stressors in undergraduate dental students indicate a need to modify current education system and timely help to have psychological healthy dental professionals in future.

Weight status and psychological distress in a Mediterranean Spanish population: a symmetric U-shaped relationship

Psychological disorders in people with extreme weight (low weight or obesity) should be taken into consideration by health professionals in order to practice an effective treatment to these patients. This study evaluates the association between body mass index (BMI) and psychological distress in 563 inhabitants of Málaga (South of Spain). Participants were classified in four categories of BMI: Underweight (BMI <18.5 Kg/m²), Normal weight (BMI 18.5–24.99 Kg/m²), Overweight (BMI 25.0–29.99 Kg/m²) and Obesity (BMI >30 Kg/m²). Psychological distress was measured with the Spanish version of the Derogatis’ Symptoms Checklist Revised (SCL-90-R). We observed a symmetric U-shaped relationship between weight status and psychological distress in all SCL-90-R dimensions (p for quadratic trend <0.001) for both men and women. Participants with extreme weight showed the worst psychological status, and participants with normal weight exhibited the best. We found no statistically significant differences between underweight and obese participants in 9 of the 10 SCL-90-R dimensions analyzed among men, and in 8 of the 10 dimensions among women. Underweight and obese participants showed no gender differences in psychological distress levels. Psychological treatment of Mediterranean people with extreme weight, should consider underweight and obese patients at the same level of psychological distress.