The impact of psychological attachment on the relationship between periodontal health and dental fear in patients with versus without psoriasis: a questionnaire-based, cross-sectional study

Periodontal maintenance: individual patient responses and discontinuations

Aim

There is a lack of data on long-term impact of different psychological variables on periodontitis. Aim of the current study was to investigate the impact of psychological factors in patients with chronic periodontitis (CP; according to the 1999 Classification of Periodontal Diseases) to explain adherence to or discontinuation of supportive periodontal therapy (SPT) in a university setting.

Methods

A sample of n = 119 patients were examined in a questionnaire-based, cross-sectional survey. All patients had received active periodontal treatment (APT) and were reevaluated in a university setting (Kiel) before 2016 [T1: start SPT]. Patients who showed sufficient adherence to SPT of ≥ 2 years (maximum ± 6 months of deviation between SPT intervals, last visit and questionnaire at T2) were assigned to the adherence group (AG: n = 58), or, if they interrupted SPT or stopped treatment altogether, to the non-adherence group (NAG: n = 61). In addition to dental parameters, we assessed socio-demographic, treatment-related (critical attitudes/complaints), dental as well as psychological variables (especially psychological attachment, but also dental fear, patient participation style, personality functioning) and examined between-group differences as well as possible mediating factors of non-adherence to treatment continuation.

Results

For both groups we found similar average observation time (NAG/AG: 15.9(8.9)/14.9(10.6)years). There were significant differences in age, critical attitudes, dental fear, and patient participation style between the groups. With the help of exploratory sequential mediation models, we found a significant indirect pathway of the impact of attachment anxiety on discontinuation of treatment mediated through dental fear and number of critical attitudes/complaints.

Conclusion

Considering the limitations, dentists should be aware of personality-related risk-factors such as attachment anxiety as well as their interplay with levels of dental fear and critical attitudes which may influence adherence to SPT.

Trial registration: The clinical trial was retrospectively registered in the DRKS—German Clinical Trials Register (https://www.drks.de) with registration DRKS00030092 (26/08/2022).

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

Objective

Although treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.

Methods

194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.

Results

Non-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.

Conclusion

In cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

Do psychological attachment styles influence dental anxiety and dental attendance?

Objectives Attachment style has been shown to influence patient engagement in medical settings but has been little explored in dentistry. The aim of our study was to identify whether there was a link between patients with insecure attachment styles and dental attendance and anxiety.Methods A survey was circulated and completed by 317 participants on social media. Respondents completed the revised Adult Attachment Scale and questions about the timing of their last dental visit, anxiety levels and the perceived reasons for these.Results Participants classed as having a secure attachment were most likely to have attended a dental appointment in the last two years (87%) and least likely to report dental anxiety (25%). Participants in the fearful attachment group had the highest levels of dental anxiety (75%) and lowest rates of attendance (63%). Both anxious attachment traits (M2.68, 2.09, z = 4.09; p <0.001) and avoidant attachment traits (M2.81, 2.51, z = -2.94; p <0.01) were associated with reduced dental attendance in the past two years. Common themes surrounding visiting the dentist included: unpleasant emotional experiences, previous psychological trauma and inaccurate beliefs about dentistry, resulting in mistrust.Conclusion Attachment styles are related to dental anxiety and attendance. Understanding the role of attachment in service planning and education of dentists could improve the care of patients.

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.