Depression, anxiety and stress in dental students

Awake bruxism behaviors frequency in a group of healthy young adults with different psychological scores

OBJECTIVE

To assess the frequency of awake bruxism (AB) behaviors in a group of undergraduate dentistry students and correlate it with the status of anxiety and depression.

MATERIALS AND METHODS

The frequency of five oral behaviors (i.e., relaxed jaw muscle, teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using a smartphone-based ecological momentary assessment (EMA) approach. The anxiety and depression status was investigated with the four-item patient health questionnaire for anxiety and depression (PHQ-4). ANOVA with Tukey post-hoc test was used to assess the difference in frequency of AB behaviors among the four PHQ-4 groups.

RESULTS

Among the four groups, there was a statistically significant difference in the frequency of relaxed jaw muscle, teeth contact, mandible bracing, and teeth clenching, but not for teeth grinding.

CONCLUSION

Based on this cross-sectional study's findings, psyche seems to have a determinant impact on AB behaviors, which is significantly higher in individuals with anxiety and depression traits.

Depressive symptoms and their correlates among predoctoral dental students in the United States

OBJECTIVE

To investigate the prevalence of self-reported depressive symptoms among predoctoral dental students in the United States and examine potential correlates.

METHODS

A survey was emailed to all 66 dental schools in the United States, inviting them to distribute it to their predoctoral students. Depressive symptoms were assessed using the Patient Health Questionnaire-9. Data collection occurred from February to April 2020. Multivariable ordinal logistic regression was used to assess associations between demographic variables and depressive symptom severity category, adjusting for potential confounding.

RESULTS

Of an estimated 25,000 predoctoral dental students at the 66 schools, 631 students from 21 schools completed the survey. A total of 24.1% were categorized as having minimal or no depressive symptoms, 33.6% as having mild depressive symptoms, and 42.3% as having moderate, moderately severe, or severe depressive symptoms. Gender (p = 0.015) and race/ethnicity (p = 0.002) were significant predictors of severity, adjusting for other variables. Students identifying as female had higher odds of self-reporting greater depressive severity symptoms compared with students identifying as male. Students identifying as African American/Black (non-Hispanic) and Asian/Pacific Islander had higher odds of self-reporting greater depressive severity symptoms compared with students identifying as White.

CONCLUSION

There is evidence of a high prevalence of depressive symptoms among predoctoral dental students in the United States. Demographic variables may be risk indicators within this population. Approaches to reduce depressive symptoms among US predoctoral dental students are needed.

Psychophysiological wellbeing in a class of dental students attending dental school: anxiety, burnout, post work executive performance and a 24 hours physiological investigation during a working day

Aim

To the best of our knowledge, dental school students have never been evaluated for stress, anxiety, burnout, physiological indexes during a 24-h working day, and executive function performance post-work and post-work after returning from vacation; therefore, this research has been conducted.

Methods

Data were acquired at the Dental School of the University of Padua on 16 students in their 4th year, far from the exam session. While performing clinical activity on the dental chair and during a working day, electrodermal activity (EDA), heart rate variability (HRV), and heart rate (HR) were recorded. Participants' stress was measured with the Perceived Stress Scale (PSS-10 scale) and anxiety with the General Anxiety Disorder Questionnaire (GAD-7) and State-Trait Anxiety Inventory (STAI-Y-2), while burnout with the Maslach Burnout Inventory (MBI-HSS). Executive functions were evaluated using the Tower of London test (TOL-R).

Results

Three students (2F/1M) had a GAD-7 score ≥ 10. Five students (4F/1M) showed trait anxiety. Moderate levels of perceived stress were reported in 85% of participants. MBI-HSS showed that 7 participants scored high on emotional exhaustion and 7 on depersonalization. TOL-R performance (M = 15.85, SD = 4.01) was below the normative value p < 0.00001. A second test, after the holidays, showed normal values. EDA was higher during children's treatment (p < 0.05), ANOVA showed high HR during working time (p < 0.001), and HRV was higher in males (p < 0.001).

Conclusion

Based on the sample size evaluated, it is reported that being a dental student has a moderate impact on stress, anxiety, and burnout while a strong impact on executive functions buffered by rest.

The Use of Coffee Aroma for Stress Reduction in Postgraduate Dental Students

OBJECTIVES

This study aimed to investigate the potential reduction of academic stress related to a graded oral presentation in postgraduate dental students using coffee aromatherapy.

METHODS

Healthy postgraduate dental students in a seminar class were divided into coffee (n = 32) and control (n = 26) groups. There were 3 modes of aroma distribution: personal distribution with a coffee pad attached to a lanyard, a lanyard plus a personal fan for ventilation of the aroma, and the typical method of the diffuser to spread the aroma in the ambient air. Stress markers comprised levels of salivary alpha-amylase (sAA), cortisol (sCort), and chromogranin A (sCgA). Pulse rates were also measured.

RESULTS

Levels of sAA increased 176.62% ± 30.26% between pre- and postpresentation in the control group. Inhaling coffee aroma during the presentation period significantly ameliorated sAA increase at 81.02% ± 14.90% (P = .015). sCort levels tended to decrease in the coffee group, but not significantly. Surprisingly, sCgA levels increased more in the coffee group. Also, pulse rates decreased in the coffee group (-2.07 ± 2.81 bpm) and increased in the control group (6.90 ± 3.22 bpm; P = .035). Subgroup analysis did not reveal differences in salivary markers amongst the 3 aroma distribution modes.

CONCLUSIONS

Coffee aroma could have an anxiolytic effect on postgraduate dental students, as evidenced by changes in sAA levels and pulse rates. Personal aroma distribution was also a useful and effective mode of aromatherapy.

Well-being of undergraduate dental students: Questionnaire design, findings and future directions

INTRODUCTION

The recent pandemic has highlighted the importance of addressing well-being in the overall health of students. There is a need for support systems within dental schools to help students demonstrate resilience, adapt to learning environments and thrive in their professional careers.

OBJECTIVES

The main aim of the study was to evaluate Bachelor of Dental Surgery (BDS) students' understanding and experience of well-being. The objectives were to create a suitable survey to assess students' well-being, investigate the factors affecting dental students' well-being and develop a student well-being action plan based on the analysis of the survey.

METHODS

A literature review was conducted to identify and critically assess existing measures of well-being in dental students. Four domains of well-being (emotional, physical, social, intellectual) relevant to dental students were identified. Through a comprehensive iterative process, a two-part survey was developed and tested, which measured individual experiences of well-being across the four domains and collected feedback on proposed initiatives to support student well-being. The survey was disseminated to all 452 dental students from Years 1 through 6, of which 71% (321) responded.

RESULTS

The survey revealed low levels of overall well-being among the dental student population, which worsened with increasing years of clinical study. Fear of failing exams presented the biggest challenge with regard to emotional well-being, while sleep deprivation and occupational health hazards most affected the physical well-being domain. Intellectual well-being was compromised by insufficient free time to pursue extracurricular interests and concerns about achieving the required skills. Despite a majority experiencing positive relationships with their peers and tutors, less than a fifth agreed that the Faculty of Dentistry 'supported my well-being as a dental student'.

CONCLUSION

As the first investigation of the well-being of dental students in Hong Kong, the key stressors identified were examinations, long schedules and the physical burden of dental work, which are consistent with international literature. The findings reveal students' needs and preferences for well-being initiatives which will be optimized in the implementation of student-centred curricular activities.

The prevalence of depression, anxiety, and sleep disorder among dental students: A systematic review and meta-analysis

BACKGROUND

Despite the increasing concern, the literature lacks a comprehensive synthesis of the prevalence of depression, anxiety, and sleep disturbances among dental students.

METHODS

We conducted a systematic review following Cochrane Manual for Systematic Reviews of Interventions and PRISMA guidelines. Our search, spanning databases like Medline, Web of Science, and Scopus, covered data until June 5, 2023. A random effect model was utilized for the meta-analysis.

RESULTS

From 508 initially identified articles, 45 studies met eligibility criteria. The pooled prevalence of depression, anxiety, and sleep disorders among dental students was estimated as follows: depression [38%, 95% confidence interval (CI): 32%-44%; I2  = 98%], anxiety [48%, 95% CI: 41%-55%; I2  = 97.7%], and sleep disorders [31%, 95% CI: 24%-38%; I2  = 85.7%]. Subgroup analyses based on geographical regions and assessment scales revealed significant between-subgroup differences. Meta-regression identified associations between the prevalence of depression and the year of publication and between the prevalence of anxiety and total sample size, participant age, and year of publication. Publication bias assessments demonstrated a lack of significant bias, strengthening the validity of the findings.

CONCLUSIONS

The prevalence of depression, anxiety, and sleep disturbances in dental students is significant. This study highlighted the need for targeted interventions and support systems within dental education to alleviate the mental health challenges students face, ultimately ensuring their well-being and competence as future healthcare providers. Further research should explore the effectiveness of interventions in this population.

Connecting chronic stress and anxiety: a multi-dimensional perspective

Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way.

The triangle of anxiety, perfectionism, and academic procrastination: exploring the correlates in medical and dental students

INTRODUCTION

Academic procrastination is a common phenomenon among medical science students. This issue can negatively affect the students' academic performance. The aim of this study was to investigate perfectionism and anxiety as potential predictors of academic procrastination in medical and dental students.

METHODS

This cross-sectional study was conducted among medical and dental students of a public medical sciences university in the south of Iran. Students were assessed using the procrastination assessment scale for students (PASS), Tehran multidimensional perfectionism scale (TMPS), and anxiety subscale of the general health questionnaire (GHQ). Predictors of academic procrastination were evaluated using multiple regression analysis with adjustments made for gender and academic semester.

RESULTS

A total of 176 medical and 79 dental students participated in the study. None of the perfectionism components were predictors of academic procrastination. However, anxiety was a significant predictor of academic procrastination in the total sample of students (standardized β = 0.404, p < 0.001), as well as dental (standardized β = 0.356, p < 0.001) and medical (standardized β = 0.478, p < 0.001) students. Anxiety and academic procrastination were both negatively correlated with students' grade point averages.

CONCLUSIONS

The findings of this study suggest that anxiety, as opposed to perfectionism, has a more significant influence on academic procrastination among medical and dental students. Interventions aimed at lowering anxiety may be beneficial for reducing academic procrastination, thereby enhancing the academic performance of the students.

Perceived stress among dental students and the role of parental influence in career decision-making

OBJECTIVES

The current study aimed to assess perceived stress levels among dental students at Riyadh, Saudi Arabia, and to explore the influence of parental roles in their decision to pursue dentistry as a potential source of social stress.

METHODS

This cross-sectional study employed the validated Dental Environmental Stress (DES) Scale to evaluate perceived stress, and incorporated additional questions to fulfill the research aim. We approached all undergraduate dental students at King Saud University, both male and female, across all academic years, using online channels (such as emails, WhatsApp, Twitter, etc.) and hard copy distribution. Data collected were analyzed using SPSS version 20, utilizing descriptive and correlation statistics.

RESULTS

A total of 326 students participated in the study, with an even distribution of male and female students. Female students reported higher levels of stress compared to their male counterparts across most DES domains. A notable correlation emerged between mean DES scores in certain domains and influence of parents in the decision to pursue dentistry.

CONCLUSION

Our findings indicate that female dental students experience higher stress levels than males in all examined areas, barring social stressors. Furthermore, the study underscores the significant impact of parental involvement in choosing dentistry as a career on students' stress level.

Assessing students' mental health in two American dental hygiene programs

OBJECTIVES

Dental hygiene students adapt to new environments while learning technical skills and providing clinical care during their education. Understanding how stress affects students in their professional healthcare program warrants exploration. This study assessed stress among dental hygiene students in two educational settings in the Southeastern United States.

METHODS

First and second-year dental hygiene students (N = 136) from a community college setting (n = 67) and a university setting (n = 69) were invited to complete an anonymous online survey on mental health in fall 2019. Validated surveys on depression, anxiety, social support, and burnout were included. Data analysis included chi-squared and Mantel-Haenszel statistics, depending on the scale of measurement, with the level of significance set at 0.05 for all analyses.

RESULTS

Participants included 54 dental hygiene students from a community college (Response rate = 80.6%) and 69 dental hygiene students from a university (RR = 100%). There was a statistically significant difference in the proportion of students reporting moderately severe or severe anxiety (p = 0.007), with 56% (n = 30) of the community college respondents and 36% (n = 24) of the university reporting these anxiety levels. Students attending a community college were also more likely to express feelings of worry (n = 34) compared to students in a university setting (p = 0.005). There was no statistically significant difference in depression (p = 0.07) or suicidal thoughts (p = 0.41).

CONCLUSION

Dental hygiene students enrolled in these two programs reported high levels of self-reported stress, mental and emotional concerns that may increase suicidal tendencies.

Sociodemographic determinants of depression, anxiety, and stress immediately after the COVID-19 pandemic: a cross-sectional study among university students in Saudi Arabia

Background

The public health measures taken in educational institutions during the COVID-19 pandemic had complex influences on students' mental health. This study aimed to evaluate the prevalence and sociodemographic determinants of Depression, Anxiety, and Stress immediately after the COVID-19 pandemic among students at Qassim University, Saudi Arabia.

Methods

We conducted a cross-sectional study among Qassim University students in Saudi Arabia. All students registered for the academic year 2022 were invited to participate in a survey through social media. A total of 453 participants completed an online survey that included the DASS-21 for assessing the emotional states of Depression, Anxiety, and Stress..

Results

The mean scores for Depression, Anxiety, and Stress, were 10.70, 11.18, and 10.40, respectively. At least 18% of the students reported experiencing moderate-to-severe levels of Depression, Anxiety, and Stress. The study showed that the feminine gender was associated with higher Depression, Anxiety, and Stress scores.

Conclusion

Students in the current study described experiencing higher levels of Depression, Anxiety, and Stress during the COVID-19 pandemic. The findings of the present study can help universities take targeted measures to address the impact of a pandemic like COVID-19 on students' mental health.

Stress experienced by dental students performing clinical training in different dental disciplines: a cross-sectional study

OBJECTIVES

To assess the stress level, the impact of stress factors, and discrepancies between fourth- and fifth-year undergraduate clinical students at the University of Jordan.

METHODS

A cross-sectional study was conducted in the academic year 2022/2023. The study group included fourth- and fifth-year dental students at the University of Jordan (n = 382) who were asked to voluntarily fill in an online dental environment stress (DES) questionnaire. Analysis was conducted using Mann-Whitney U test, independent t-test, χ2 test, and Spearman ρ rank correlations. Statistical significance was inferred when P < .05.

RESULTS

Fourth-year students reported higher levels of nervousness before treating patients for the first time. Fifth-year students faced more difficulty, higher stress, and/or fear regarding the amount of assigned work, provided treatment, completed requirements, failing the course, time to finish assignments, patient comprehensive care, and financial expenses of the course. Comparison between groups revealed that the fifth-year students scored higher levels of stress on the total DES score and all partial DES scores. Furthermore, the total DES questionnaire scores were significantly correlated with grade point average (GPA) among the total study sample and the prosthodontics clinical course marks among the fourth-year students' group.

CONCLUSIONS

The stress level among students in clinical courses was influenced by their academic performance, gender, year level, and the type and time needed for the provided treatment. Completing course requirements was among the most commonly faced stressors. Future research endeavors might be considered to study each clinical factor, its impact on students' stress level, and how to manage and positively improve these factors.

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.

Depression and Anxiety among Undergraduate Health Science Students: A Scoping Review of the Literature

Background: Health science students in post-secondary institutions experience high levels of depression and anxiety due to increased stress levels, workload, low socioeconomic status, and history of family mental illness, among other factors. Given the significant negative impact that depression and anxiety can have on undergraduate health science students, it is essential to understand the prevalence and correlation of these conditions in this population. In light of this, this scoping review aims to identify, document, and analyze the literature on the prevalence and determinants of anxiety and depression among undergraduate health sciences students and identify gaps in knowledge for future research. Methods: This scoping review was planned and executed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews statement. A comprehensive and systematic search was carried out for five databases, namely MEDLINE, Scopus, EMBASE, CINAHL, and PubMed. Results: From the literature identified by our search strategy, the lowest prevalence for anxiety was 5.8%, and the highest was 82.6%, with a median of 44.25%. The prevalence of depression ranged from a high of 88.8% to a low of 2.1%, with a median value of 34.8%. Our analysis revealed that correlates of anxiety and depression among health science students include sociodemographic factors such as age, sex, gender, relationships, ethnicity, and family history, personal health conditions, and academic and socioeconomic issues. Conclusions: With the high incidence of anxiety and depression among health science students, there is an increasing need to find practical remedies to support these students. It is also essential for policymakers and university authorities to implement interventions such as supportive text messages and other strategies geared toward providing support and improving the psychological well-being of health science students.

Prevalence, Symptoms, and Triggering Factors of Panic Attacks among Dental Students in Riyadh Saudi Arabia-A Cross Sectional Survey

Panic disorder by definition is an anxiety disorder of unexpected and repeated episodes of intense fear. Panic attacks are usually diagnosed by four or more of a set of symptoms that include palpitations, sweating, trembling, shortness of breath, chest pain, nausea, dizziness, and hot flushes. They usually interfere with daily life situations and also interfere with education. Hence, the aim of this study was to assess the prevalence of panic attacks, their symptoms, and triggering factors among dental students in Riyadh, Saudi Arabia. Data were collected from 394 students using a structured and validated questionnaire. The prevalence of panic attacks among dental students in Riyadh, Saudi Arabia, was 42.9%. Most of the participants who experienced higher episodes of panic attacks were females (53.4%) when compared to males (24.5%). Third year students displayed greater (58.3%) episodes of panic attacks compared to their respective counterparts. The most reported symptom of panic attacks was rapid or pounding heartbeat followed by breathlessness, chest pain, and shaking or trembling. It was also noted that most of the participants (63.31%) encountered a panic attack for the first time after joining dental school. The situations where dental students frequently experienced panic attacks were during exams, clinic procedures, giving presentations, and especially while under a lot of stress. The high occurrence of panic attacks 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. Dental students experiencing panic attacks should be provided with necessary counseling sessions or psychiatric consultation in order to overcome such scenarios. Dental schools should consider these findings when planning the dental curriculum. Hence, the role of the faculty members is essential in these situations to provide support for the affected students.

Association between history of academic failure during dental school and self-reported depression, anxiety, and stress: A retrospective cohort

OBJECTIVE

To investigate the association between history of academic failure (HAF) and self-reported depression, anxiety, and stress among undergraduate dental students.

METHODS

This study involved 244 dental students from one university. An online questionnaire collected information on the following variables: socioeconomic status, behavior, use of licit/illicit drugs, and the choice of dentistry as an undergraduate field of study. The 21-item Depression Anxiety Stress Scale (DASS-21) was applied. HAF in at least one subject during a participant's undergraduate tenure was defined as the main outcome. Bivariate and multivariate analyses were performed using Poisson regression with robust variance. In addition, a subgroup analysis was performed for the variable "dentistry as the first choice for undergraduate studies."

RESULTS

The prevalence of HAF was 25.00% (n = 61). Among those students, the mean number of academic failures was 5.41 ± 6.38 (range: 1-33). Higher rates of HAF were observed among older and non-white dental students. Moreover, those who self-reported at least severe depression presented a 79% higher HAF prevalence ratio (PR) (95% confidence interval [95% CI]: 1.15-2.80). Similar findings were detected among those who reported (PR: 1.79; 95% CI: 1.06-4.46) or did not report (PR: 2.21; 95% CI: 1.10-4.46) interest in dentistry as a first undergraduate option. Conversely, among women and students who did not choose dentistry as their first option, HAF was significantly lower (PR: 0.41; 95% CI: 0.21-0.80).

CONCLUSION

Higher HAF rates are observed in students who are older, non-white, and self-report at least severe depression. However, dentistry as a first option for undergraduate studies was not associated with HAF.

Clinical activities suspended: How the COVID-19 affected the self-confidence of Italian dental students

INTRODUCTION

COVID-19 emergency caused several effects on the dental educational system, especially affecting courses including practical activities. The study aims to evaluate the impact of the suspension of dental clinical activities on the Italian dental students' self-confidence. Furthermore, the other purpose of the research is to find an integrative didactics solution to improve the clinical training of dentistry during the COVID-19 pandemic.

MATERIALS AND METHODS

A questionnaire was administered to evaluate the impact of the suspension of clinical activities on dental students' self-confidence. A 67-questions survey tested the students' self-confidence in several dental disciplines (Conservative Dentistry, Endodontics, Oral Surgery and Dental Emergency). The study reached a sample of 193 dental students and the answers from 9 different Italian dental schools were analysed.

RESULTS

The degree of students' self-confidence for all the dental disciplines investigated was found statistically different between the periods before and after the interruption of clinical activities. The students proposed, as a potential solution to improve their practice during the COVID-19 pandemic, to combinate the use of a video tutorials and dental simulators.

CONCLUSION

The interruption of the training in clinical practice significantly affected the educational career and the self-confidence of students. An alternative teaching method involving the use of video tutorials as support in teaching clinical procedures deserves to be considered.

The psychological impact of the ongoing COVID-19 pandemic on health-care workers in primary health-care centers in resource-poor settings

Background

Health-care workers' psychological status is essential to Preventive control measures in a weak and unstable health system with poor infrastructural constraints. This study examines the psychological impact of the ongoing coronavirus disease 2019 (COVID-19) pandemic on the health-care providers working in primary health-care settings in Sudan.

Materials and Methods

This is a health facility-based cross-sectional study conducted in primary health-care units in White Nile State, Sudan. The psychological impact of stress and anxiety was determined using the Depression Anxiety Stress Scale 21 (DASS-21). A self-administered questionnaire measured depression, anxiety, and stress. The population of this study included health professionals working in health centers, including physicians, nurses, technicians, pharmacists, and other support staff.

Results

A total of 167 health professionals were systematically recruited. The mean anxiety score in the study population was 8.26 & 9.0 (corresponding to mild anxiety). Participants without anxiety constituted 26.35% (n = 44) of the participants. Women were significantly more likely to be affected than men (P = 0.0). Age (21-40 years), female nurses, and other health-care workers (anesthesiology, public health, health education, occupational health, psychiatry, etc.) could be strong predictors of psychological disorders (P-value of 0.0).

Conclusion

This study provided evidence for primary health care at its preparatory levels, as they are the first line of protection against the COVID-19 pandemic. Addressing the high-risk population is a high priority in the preliminary phase.

Student support services: Perceptions and recommendations for the next generation

PURPOSE

Student support services/student affairs are central to the student academic experience and success at US and Canadian dental schools. This manuscript evaluates student and administrator perceptions of support services and offers recommendations for best practices in student services in predoctoral dental education to help institutions improve the student experience.

METHODS

A survey of administrators and dental students found perceptions of student support services vary between these groups.

RESULTS

Seventeen student services administrators and 263 students started the survey, and 12 administrators and 156 students completed the full survey. Survey comments indicated access to student support services is a concern. Results of the student survey, in conjunction with current literature, were utilized to develop recommendations for dental student support services.

CONCLUSION

Recommendations for student support services in dental schools include accessibility of student services, and ensuring students have access to support in the domains of wellness, academic support, and peer support as well as implementation of humanistic practices. Wellness supports should include behavioral health services, physical health services, and access to mindfulness interventions. Academic support services should include study skills, time management training, and academic supports such as tutoring. Structured peer support programs should also be implemented. Dental schools should also be mindful of the changing support needs of incoming dental students.

Psychological Stress as a Determinant of Increased Maximum Voluntary Bite Force - A Clinical Observational Study

Background Psychological stress is a known risk factor and modulator for several oral diseases. It is among the critical etiological factors of bruxism and several other disorders. The quantum of bite force is one of the prime determinants of wear resistance and the clinical performance of restorations. Thus, the present study aims to investigate the relationship between the maximum voluntary bite force (MVBF) and the amount of perceived stress experienced by an individual.  Materials and methods Patients (n=111) fulfilling the exclusion and inclusion criteria were divided into high, medium, and low-stress groups based on their stress scores deduced from the Perceived Stress Scale questionnaire (PSS). Bite force measurement was recorded in Newtons (N) for each subject using a portable customized bite recording FlexiForce sensor (B 201). The data were analyzed using Kruskal-Wallis and independent samples t-test. Results  Among the females, the bite force in the medium and high-stress groups was greater compared to the low-stress level group. On the other hand, there was no difference in bite force between any of the stress level groups among male participants.  Conclusion The results show that higher MVBF is associated with higher perceived stress scores in adult females. Practical Implications Psychological counseling can be included in the dental treatment plan of individuals with a high-stress score to counteract their stress-related higher occlusal forces, parafunctional jaw movements, and risky oral health behaviors, thereby potentially reducing the incidence of adverse outcomes such as temporomandibular joint dysfunction and restoration failure by careful choice of restorative materials.

Patient-specific virtual simulation in the clinical training for prosthetic dentistry

INTRODUCTION

Dental education always involves live patient treatment, and clinical training for each patient is different for students. Using an intraoral scanner and Simodont Dental Trainer, we can provide students with an opportunity to train on actual patient cases in a virtual environment before real preparation. This study aimed to develop, implement and test patient-specific virtual simulation training in prosthetic dentistry curriculum.

MATERIALS AND METHODS

Before the actual preparation, the students' patients were scanned using 3Shape intraoral scanner. Thereafter, the .stl file was uploaded to Simodont Dental Trainer (Nissin dental products) where all the scanned teeth were prepared virtually. The 'prepared' .stl file was downloaded and submitted to the teacher. Instruction manuals for virtual simulation patient-specific tasks were provided. The students were asked to voluntarily complete the survey, at the end of the course.

RESULTS

Forty-two 4th year students from the Faculty of Dentistry performed a patient-specific virtual simulation training task and completed a survey. The created training materials served as guidelines for students to perform all the steps on their own without teacher assistance, except in the final step, where the teacher evaluated the digital preparation. Students appreciated the amount of information provided regarding the technologies used and patient-specific tasks. Students admitted that the patient-specific task was more interesting than standard tasks. However, they were not satisfied with the technical performance of Simodont Dental Trainer or the reflection of reality.

CONCLUSION

Patient-specific virtual simulation can be accepted by students for training before actual teeth preparation in the clinic. However, technical improvements are required in this regard.

A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic

INTRODUCTION

The ongoing SARS-CoV-2 pandemic is a global health crisis which poses many psychological research challenges. The objective of this study was to evaluate the responsiveness and validity of depression, anxiety and stress in a representative cohort of Hellenic military personnel using the short version of the Greek military version of the Depression-Anxiety-Stress Scales-21 (DASS-21) questionnaire.

METHODS

A total of 158 participants were voluntarily surveyed using an electronically developed structured questionnaire. The anonymous e-questionnaire included a social demographic section and the DASS-21 scale section. It was distributed in September 2020 to the military personnel of the Hellenic Tactical Air Force Units using an intranet network during government restrictive measures due to the COVID-19 crisis.

RESULTS

Our DASS-21 survey indicated a positive outcome at the psychometric level of our military sample population. Age, sex and systemic medications were statistically correlated with anxiety. Inter-correlations between the DASS-21 statements showed that individuals with low-level depression also experienced some degree of stress. Factor analysis indicated the reliability and validity of the questionnaire.

CONCLUSIONS

The low levels of depression and stress among our military sample population demonstrate the importance of periodic monitoring of the psychometric items of the DASS-21 subscales to design and implement psychological prevention strategies, especially during the ongoing and future healthcare crises.

A Study on the Assessment of Anxiety and Its Effects on Students Taking the National Eligibility cum Entrance Test for Undergraduates (NEET-UG) 2020

Background Test anxiety is a major, often overlooked, mental health concern among students. We live in a society that decides a person's future by their performance in an examination. In our country, issues about test anxiety, academic-related depression, and stress are less discussed. Most of the institutions don't guide students with stress management. The present study was conducted to measure the anxiety levels and their effect on the mental health of students taking the National Eligibility cum Entrance Test for Undergraduates (NEET-UG) 2020. Methods A cross-sectional study was done among 200 students of a private junior college taking the NEET-UG 2020 exam using the Westside Test Anxiety Scale questionnaire. The results obtained were analyzed by appropriate statistical tests using SPSS Statistics version 25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.). Results Out of 200 students, the results showed that, overall, 151 (75.5%) were stressed out before the exam, and 49 (24.5%) were not stressed out. This study revealed that the majority of the students didn't receive any professional help to combat their mental health problems or any professional counseling to improve their morale. Conclusion It is evident from the results of the study that the majority of the students faced difficulties in their academic performance due to test anxiety, and the effects were prominent irrespective of the age and gender of the students. Professional psychological counselors, guidance, and the availability of healthcare professionals in institutions to address the mental health needs of students will yield better outcomes.

Educating dental students to provide compassionate age friendly care for older adults

As the world population ages, the need for age friendly care increases. In dentistry, age friendly care requires an appropriate comprehension of multiple factors that can be categorized in socio-economic circumstances, systemic health problems, and oral health conditions. In addition to the understanding of these factors and its relationships among each other, the future dental workforce should also be aware of unconscious and pervasive societal stereotypical perception of older persons, aging, and being old, which results in ageism and ageist attitudes. Dental schools can play an important role on raising ageism awareness and combating ageism in healthcare, thus preparing the future of the dental workforce to provide compassionate age friendly care. This paper will discuss ageism in dental schools and learning strategies used to combat it and increase compassionate care delivery for older adults.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

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

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

Self-doubt masked in success: Identifying the prevalence of impostor phenomenon among undergraduate dental students at Qassim University

Objective

To investigate the prevalence of impostor phenomenon (IP) among undergraduate dental students and explore its relationship with gender and academic year.

Methods

This study involved observational cross-sectional research involving undergraduate dental students (first to fifth year) at Qassim University Dental School, between February and April 2021. An electronically administered, 20-item pre-validated Clance Impostor Phenomenon Scale (CIPS) was used for data collection. Data analysis was performed using SPSS version 23. Mean IP scores of both genders were compared using t-tests, one-way ANOVA and Post-Hoc tests to establish the relationship between year-wise IP scores.

Results

The response rate was 80.59% (162 respondents). The results indicated that 8.8% of the participants had mild IP experiences, 84.1% had moderate to severe IP experiences, and 7.05% exhibited intense IP experiences. The mean IP score was highest and lowest in the third and fourth-year dental students, respectively. A statistically significant relationship was identified between year wise IP scores, while no significant difference was observed based on gender.

Conclusions

Impostor phenomenon is prevalent in substantial frequencies amongst dental students. This may have damaging physical and mental effects with negative consequences and could subsequently affect their intellectual and professional developments. The implementation of a modified curriculum and self-development plans are some of the recommended solutions.

Predictors of perceived stress and quality of life amongst dental master and doctoral students

OBJECTIVES

This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students.

MATERIALS AND METHODS

This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated.

RESULTS

The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity.

CONCLUSIONS

Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population.

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.

Students' resilience and mental health in the dental curriculum

OBJECTIVES

Dental education is perceived as a source of students' psychological and occupational stress. Resilience has been proposed as a protective factor that may support students' in managing that stress. The objectives of this study were twofold: to map the mental health and well-being content in the curriculum of the Faculty of Dentistry (FoD) at the University of British Columbia (UBC) and to investigate factors influencing resilience levels amongst dental students at UBC.

METHODS

The curricular database and website of UBC's FoD were used to gather information on mental health content. A survey with the Connor-Davidson 10-Item Resilience Scale was distributed to dental students at UBC (N = 289). Students' de-identified demographic data were also collected.

RESULTS

Two main mental health and well-being curricular components were identified: one didactic session on stress management and one interactive workshop on resilience. The response rate for the survey was 68.2%. Students who did not receive any mental health content (2020/21 year 1 students) had higher resilience scores (p = .043) when compared to students who received both components (2019/20 year 1 students and 2018/19 year 2 students). The multiple regression analysis highlighted North American/European ethnic origins as a predictor for higher resilience levels (p = .008).

CONCLUSIONS

The results of this study showed that ethnic origins and major life events, such as the pandemic, influenced resilience. Curricular activities promoting resilience seemed to not necessarily impact students' resilience. Further longitudinal studies are needed to assess the curricular and non-curricular activities influence over dental students' well-being.

A study on psychological stress assessment of higher educational institution's students based on computer data mining technology

Safety begins in the human mind, and the individual's need for psychological safety is the most fundamental need. This fundamental need takes psychological safety as the starting point for the gradual formation of a connection with the outside world. Graduates are the backbone of China's economic development, and their healthy development is of great significance to the sustainable development of China's economy and society. Excessive psychological pressure may bring pain to students in physical and psychological aspects, and even lead to suicide. If students with abnormal psychological pressure can be found in time, the school can provide help and intervention in time to relieve psychological pressure. This paper uses pressure sensor technology for data collection and data mining techniques for data analysis to assess and predict the psychological stress level of Higher Educational Institutions (HEIs) students. The results show that this method can accurately and objectively evaluate the psychological stress of the students, and the evaluation results of students' psychological stress are stable, which can provide students with psychological stress assessment services. It implies that HEI's policymakers should consider these techniques to assess the psychological stress of the students proactively.

Prevalence, characteristics and measurement of somatic symptoms related to mental health in medical students: a scoping review

INTRODUCTION

Somatic symptoms related to mental health in medical students are under-researched, with nothing on the topic being published in the United States in over three decades. This scoping review is the first of its kind to explore the prevalence, type and severity of somatic symptoms induced by stress, anxiety, depression and burnout amongst medical students, with the objective of describing the significance and breadth of this issue.

METHODS

PRISMA-ScR guidelines were used to guide this review. A comprehensive search was performed of 22 databases, followed by bibliographic and hand searching. Inclusion criteria were published, peer-reviewed articles with a sample of medical students and at least one measure of somatic symptoms related to mental health, in English or with an English-language translation. Excluded were review, companion and editorial articles. Coding was done by an experienced coder trained in systematic review techniques. Two authors reviewed each article.

RESULTS

Twenty-nine articles met inclusion criteria, representing 16 countries, 31 schools/teaching hospitals and 9,887 medical students. The prevalence of somatic symptoms ranged from 5.7 to 80.1%, and somatic symptoms were overwhelmingly found to be significantly correlated with mental ill-health. Somatic symptoms included back pain, neck pain, headaches, sleep disturbances and functional gastrointestinal disorders. Eleven different outcome measures were used, with varying degrees of validity and reliability, which were compared and assessed.

CONCLUSIONS

Somatic symptoms appear strongly correlated with mental ill-health in medical students, and are likely highly prevalent. This review highlights the need for further research on somatic symptoms of mental ill-health in medical students, particularly in the United States, and the addition of larger, multi-institutional cohorts to expand our understanding of prevalence, incidence and inciting factors of somatic symptoms. Longitudinal studies tracking somatic symptoms' effect on career trajectory and professional burnout levels are also needed. Finally, future research should explore interventions for reducing physical symptom burden in medical students.

Appraisal of empathy among dental interns and postgraduate students at King Abdulaziz University: A cross-sectional study

PURPOSE/OBJECTIVES

Empathetic communication of dentists with their patients is a primary characteristic of their health care. This study aims to evaluate dental students' empathy levels during the transitional period of internship and postgraduate studies of different specialties at one of the oldest dental schools in Saudi Arabia and explore how this empathy was affected by gender, age, and study duration.

METHODS

In this study, the self-reported empathy level among the participants was assessed using the Jefferson scale of empathy-student version (JSE-HPS). This survey includes a 20-question Likert scale formulated to measure clinical empathy in health care professionals. The JSE-HPS was distributed to all registered dental interns and postgraduate students during the academic year 2019-20 in King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia.

RESULTS

Mean total score of empathy of the participants was (101.07 ± 14.8) with a response rate of 89%. A statistically significant higher empathy score appeared among dental postgraduate students in general (p = 0.04) and specifically among the females (p = 0.04) and those with postgraduate programs for more than four years, (p = 0.02). Dental postgraduate students scored significantly higher in the parameters of standing in patients' shoes (p = 0.02).

CONCLUSION

Gender, academic level, and duration of postgraduates' studies influenced empathy more than the age of the dental graduates in KAUFD. Our recommendation is to integrate empathy into the dental curriculum emphasizing interactive communication skills and early patient contact.

Dental trainees' mental health changes, sources of stress, coping strategies, and suggestions for mental health improvement 1 year into the pandemic

OBJECTIVES

The goal of this study was to assess how the mental health of dental trainees has changed during the pandemic and to identify the most stressful aspects of trainees' programs, stress coping strategies, and suggestions for individual and institution-driven solutions to improve wellness.

METHODS

The study focused on dental trainees at the University of Washington who completed a wellness survey in fall 2020 (n = 126; response rate = 35.5%) and spring 2021 (n = 105; response rate = 29.6%). The survey included self-report measures assessing four mental health outcomes: depression, anxiety, isolation from peers, and burnout. Stressful aspects of the training program, coping strategies, and institution-driven solutions were measured with open-ended survey items. The chi-square test was used to compare mental health outcome measures between fall and spring and open-ended survey responses were inductively coded.

RESULTS

The prevalence of self-reported depression and anxiety did not change between fall 2020 and spring 2021 (17.2% vs. 21.1%, p = 0.473; 22.4% vs. 23.7%, p = 0.818). Isolation from peers and burnout each significantly increased by almost 20% from fall 2020 to spring 2021 (46.8% vs. 64.3%; p = 0.009 and 26.6% vs. 43.9%; p = 0.017). Trainees identified workload as the most stressful aspect of their program and described using exercise and social support to cope with stress. Trainees suggested institution-supported increases in social events and mental health resources.

CONCLUSIONS

One year into the coronavirus disease 2019 pandemic, poor mental health outcomes were common among dental trainees because of high workload and isolation from peers. Dental schools should promote targeted programs and services aimed at improving dental trainees' well-being.

The relationship of dental students’ characteristics to social support, psychosocial factors, lifestyle, and quality of life

Objective

To examine the relationships between sociodemographic characteristics, student academic information, social support, sense of coherence, anxiety, lifestyle, and quality of life among dental students.

Methods:

A cross-sectional study among 233 dental students in Brazil. We captured data on sociodemographic and socioeconomic characteristics, social support through Social Support Appraisal, psychosocial factors (sense of coherence and anxiety based on SOC-13 and Depression, Anxiety and Stress Scale-21 – anxiety subscale, respectively), lifestyle as per individual Lifestyle Profile and quality of life based on VERAS-Q. Data was analysed through Structural Equation Modelling.

Results:

Greater social support, higher sense of coherence, lower anxiety, better lifestyle directly predicted better quality of life. Male gender, city of origin did not differ from the city of the campus, higher social support and greater sense of coherence were indirectly linked with better quality of life via better lifestyle. Lower academic semester and higher social support indirectly predicted better quality of life via lower anxiety.

Conclusion:

Social support, sense of coherence, anxiety, and lifestyle were relevant factors directly associated with dental student’s quality of life. Indirect pathways were observed between gender, moved home to attend dental course, academic semester, social support, sense of coherence, and quality of life.

A cross-sectional study investigating mental health and resilience among pre-doctoral students at a US dental school

PURPOSE/OBJECTIVES

This study explored key mental health measures as self-reported by pre-doctoral dental students enrolled in all four years of dental school and their relationships with a year in school and resilience.

METHODS

This study utilized archival data from the National Collegiate Health Assessment (NCHA) survey administered in Fall 2020. This instrument is a compilation of validated measures assessing a broad spectrum of health-related behaviors, including nutrition, substance use, social relationships, and mental health. The mental health measures explored in this study included validated scales assessing mental distress, suicide behavior risk, psychological well-being, and resilience.

RESULTS

Students in all 4 years of dental school completed the survey (62% response rate). Most students reported high resilience, positive psychological well-being, and moderate mental distress, with mental health challenges spiking in the D2 and D3 years. Resilience emerged as a protective factor for student mental health. Years in school did not retain a significant impact on mental health when controlling for resilience.

CONCLUSIONS

Resilience is important in bolstering dental students' mental health. Dental students' mental health challenges increased during the D2 and D3 years. Dental educators may positively influence student well-being by taking measures that foster resilience at the beginning of and midway through dental school.

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.

Factors associated with poor academic performance among undergraduate dental students: A cross‐sectional study

OBJECTIVE

To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil.

METHODS

A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05).

RESULTS

In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance.

CONCLUSION

A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Prevalence of depressive symptoms among dental students is influenced by sex, academic performance, smoking exposure, and sexual orientation

Aim: To estimate the prevalence and associated factors of self-reported depressive symptoms in undergraduate and graduate dental students. Methods: The Depression, Anxiety and Stress Scale (DASS-21) was applied, and only the depression domain was verified. A structured questionnaire was used to collect sociodemographic, behavioral, and COVID-19 pandemic-related fear variables. Academic performance was assessed based on academic records, ranging from 0 (worst possible grade) to 10 (best possible grade). Respondents included 408 regularly enrolled dental students. Bi- and multivariate analyses were performed using Poisson regression with robust variance to verify the association between at least moderate depressive symptoms and independent variables. Results: The prevalence of at least moderate depression was 40.5% among undergraduate students and 26% among graduate students. The prevalence of fear and anxiety due to the COVID-19 pandemic was 96.1% among undergraduate students and 93.5% among graduate students. In the final multivariate analysis, being female (prevalence ratio [PR]:2.01; 95% confidence interval [95%CI]:1.36–2.96) was associated with a higher PR for depression. Conversely, no exposure to smoking (PR:0.54; 95%CI:0.36–0.82) and a final academic performance average ≥7.0 (PR:0.56; 95%CI:0.41–0.76) was associated with a lower PR for depression. Finally, among graduate students, a non-heterosexual orientation was associated with a higher PR for depression (PR:6.70; 95%CI:2.21–20.29). Conclusion: Higher rates of depression symptoms were observed in female undergraduates, students with lower academic performance and smoking exposure, and graduate dental students with a non-heterosexual orientation.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Conceptual Framework for Implementation of Internationalization in Dental Education with Foundations in Dental Student Life

The integration of internationalization within higher education has gained attention in both international and local programs, which allows the enrichment of the institutional quality. Previous literature reveals multidimensional considerations to determine the level of internationalization, considered as pre-existing performance indicators, including: (1) 'Curriculum and academic offerings'; (2) 'Collaboration and partnership'; (3) 'Student and academic staff mobility'; (4) 'Institutional policy'; (5) 'Resources'; (6) 'Campus life'; and (7) 'Performance review and accountability'. This study aimed to investigate the impact of performance indicators of internationalization on academic performance and extracurricular activities among dental students. A validated online self-administered questionnaire was distributed to dental undergraduates. The data from 93 students (response rate: 96.86%) were analyzed using descriptive statistics and simple linear regressions. The findings demonstrated that all performance indicators appeared to have significant impact on self-perceived participations of extracurricular activities (p < 0.05), while only 'Collaboration and partnership' (p = 0.016), 'Student and academic staff mobility' (p = 0.009), 'Institutional policy' (p = 0.008), and 'Campus life' (p = 0.005) significantly affected actual participations. None of them appeared to be significant predictors for actual and self-perceived academic performance (p > 0.05). The statistical model constructed in this research can be utilized as a conceptual framework in the future establishment of internationalization among dental schools.

Stress, anxiety and depression in dental students: Impact of severe acute respiratory syndrome-coronavirus 2 pandemic

INTRODUCTION

With the emergence of COVID-19, dental medicine students were faced with a new reality, as a modification of the learning methods in Dentistry colleges happened. The aim of this study was to characterise the possible effects of Covid-19 pandemic in terms of anxiety, depression, and stress among students of dentistry.

MATHERIALS AND METHODS

This cross-sectional study was conducted between October 2020 and May 2021. A total of 1115 participants from a total of approximately 3000 students from the seven university institutions that teach the master's degree in dentistry in Portugal, agreed to participate. An online self-reported questionnaire was applied through Google Forms® platform. The questionnaire was divided in three sections: the students' sociodemographic characterisation, pedagogical aspects, and questions about anxiety, depression, and stress using the Depression, Anxiety, and Stress-21 Scale.

RESULTS

Normal levels of anxiety, depression, and stress, were found in 41%, 36.7%, and 22.7% of the participants, respectively. Being female was the most significant and strong predictor of anxiety and stress, and for depression, not feeling fulfilled in the course they were in was the most significant variable.

CONCLUSION

The participants presented high values of anxiety, depression, and stress, during the pandemic state. Gender and not feeling fulfilled in the course were important predictors.

Mobile phone addiction and depression among Chinese medical students: the mediating role of sleep quality and the moderating role of peer relationships

The literature has shown that mobile phone addiction is an important risk factor for depression. However, the internal mechanisms of mobile phone addiction leading to depression are still not clear. This study examined the mediating role of sleep quality and moderating role of peer relationships in the association between mobile phone addiction and depression. A sample of 450 Chinese medical students were recruited to complete measures of mobile phone addiction, depression, sleep quality and peer relationships. In this study, SPSS 25.0 and macro PROCESS were used to conduct statistical analysis on the collected data. The results showed that sleep quality partially mediated the association between mobile phone addiction and depression. Moreover, the effect of sleep quality on depression was moderated by peer relationships. The present study can advance our understanding of how and when mobile phone addiction leads to depression. Limitations and implications of this study are discussed.

Somatization symptoms-prevalence and risk, stress and resilience factors among medical and dental students at a mid-sized German university

Objective

Previous studies have shown that an increased prevalence of mental illness can be found among medical and dental students. Among these, somatization symptoms are severely understudied. The present study examined the prevalence of somatization symptoms in a subpopulation of medical and dental students and aimed at finding associated risk and resilience factors.

Methods

A cross-sectional survey was conducted using a self-reporting questionnaire, including the SOMS-2, the Becks-Depression-Inventory-II (BDI-II), the NEO-Five-Factor-Inventory, and a questionnaire on socio-demographics for possible risk and resilience factors. A total of 271 medical and dental students of a mid-sized German university completed the questionnaire.

Results

The Somatization index yielded a mean of 9.12 symptoms for the total sample, which is 1.2 SD higher than the reported norm. A total of 50.7% of the medical students and 63.6% of the dental students transcend a critical somatization score. Significant positive associations for eight general risk factors, four university related stress factors, and a significant negative association for seven resilience factors were found.

Conclusion

Medical and even more dental students at the studied university showed a high burden of somatoform complaints. Also, factors were found that could be of etiological relevance and others that could be used to enhance resilience. Both could present an opportunity for the prevention of somatization disorders but prospective and multicenter studies with an aged-matched comparison group are needed to obtain a more accurate overview.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Stress and anxiety in orthodontic residents during the coronavirus disease 2019 pandemic

INTRODUCTION

The coronavirus disease 2019 pandemic has had far-reaching effects on health care providers and health professional students; however, little is known about the factors related to stress and anxiety levels, specifically among orthodontic residents during this time.

METHODS

A 2-part questionnaire, which included modified stress and anxiety inventories, was disseminated electronically to U.S. orthodontic residents between June and July 2020. Descriptive and comparative statistics were used to analyze the data.

RESULTS

Overall, 261 participants responded (56% female), representing a response rate of 26.8%. Significant gender differences were found in 18 stress items, with female respondents expressing more stress than their male counterparts. Only 1 stress item (ie, fear of being unable to catch up if behind) varied as a function of the difference on the basis of respondents' stage in the program. First-year residents reported more stress in relation to this than more senior residents. Responses to all anxiety items but 1 item varied by gender, with females reporting higher scores. Residents in the middle stages of their program responded with higher anxiety scores with significant differences on 3 anxiety items.

CONCLUSIONS

Although financial responsibilities and travel plans were the most stressful and anxiety-inducing items for orthodontic residents during the early aspect of the coronavirus disease 2019 pandemic, multiple items contributed to their stress and anxiety. In addition, both gender and stage of progress in a residency program impacted the level of stress and anxiety reported by respondents.

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.

Mental Health Among Medical Students During COVID-19: A Systematic Review and Meta-Analysis

Background

The mental health of medical students is an issue worthy of attention, especially during COVID-19. Many studies have shown that depression and anxiety are the main problems faced by medical students. To assess the pooled prevalence of depression and anxiety among medical students worldwide, we conducted this meta-analysis.

Methods

According to PRISMA, we used a computerized strategy to search studies in EMBASE, PubMed, PsycArticles, Web of Science, and China Biology Medicine disc. The pooled prevalence of depression and anxiety was calculated by a random-effects model. Heterogeneity was explored by subgroup analysis. Sensitivity analysis and publication bias were also carried out in this meta-analysis.

Results

Of 1316 studies, 41 studies were selected based on 36608 medical students. The pooled depression prevalence was 37.9% (95% CI: 30.7-45.4%), and pooled anxiety prevalence was 33.7% (95% CI: 26.8-41.1%). The prevalence of depression and anxiety among medical students varied by gender, country, and continent.

Conclusion

The data reported that the prevalence of depression and anxiety among medical students during COVID-19 was relatively higher than those of the general population and the healthcare workers. The impact of COVID-19 on medical students and how to protect the mental health of medical students are needed to determine through further research.

Systematic Review Registration

[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021274015], identifier [CRD42021274015].