Changes in mental health during the COVID-19 crisis in Romania: A repeated cross-section study based on the measurement of subjective perceptions and experiences

The coronavirus 2019 (COVID-19) pandemic has caused dramatic changes in the daily lives of Romanians, affecting their mental health. The COVID-19 pandemic has evolved at three significant peaks, which sequentially occurred on: April 29, 2020; September 18, 2020; and the third wave registered the highest severity on November 27, 2020. Little is known about the mental health changes during this phase of this pandemic. This study evaluated mental health levels in Romania at the end of the first wave of the pandemic and amidst the third and most severe wave. We administered a two-phase internet-based survey among 543 and 583 participants, respectively, recruited through snowball sampling at a 6-month interval. The IPAT Anxiety Scale measured anxiety, the Beck's Depression Inventory measured depression, and the Dissociative Experiences Scale measured dissociation. We observed no statistically significant differences in the number of participants with clinically relevant scores at either time point. In the first survey, 23.8%, 19.2%, and 32.6% reported being clinically anxious, clinically depressed, and showed clinical dissociation, respectively. Binary logistic regressions indicated that age, education level, and previous traumatic events were significantly associated with clinical levels of anxiety and depression. Moreover, multiple linear regression analysis reported a collective significant effect of gender, age, psychological impact, traumatic events, and dissociation on predicting high levels of anxiety and depression. Romanian adults' mental health status was affected during the COVID-19 pandemic, and it did not change 6 months after the first lockdown.

An examination of the internal consistency and structure of the Statistical Anxiety Rating Scale (STARS)

The purpose of the current study was to examine the internal consistency and structure of the English version of the Statistical Anxiety Rating Scale (STARS). Participants were 202 (79% females) psychology undergraduates was recruited from James Cook University's Singapore (71%) and Australia (29%) campuses. Acceptable internal consistency reliabilities, ranging from .81 to .94, were found in this sample. Approximate fit indices suggest that a correlated six first-order factor model best describes the data in contrast to theoretical considerations suggesting that a six factor model with two correlated superordinate factors (i.e., statistics anxiety and attitudes toward statistics) best describes the data. Researchers are recommended to use part one of the STARS to assess statistics anxiety and part two to assess attitudes toward statistics.

Influence of maternal anxiety on child anxiety during dental care: cross-sectional study

CONTEXT AND OBJECTIVES:

Anxiety is usually classified as a disorder of neurotic nature and is often related to contexts of stress, which may include worries, motor tension and autonomic hyperactivity. The aim of this study was to assess the influence of mothers' anxiety on their children's anxiety during dental care.

DESIGN AND SETTING:

Analytical cross-sectional study conducted at in a private dentistry school in the south of Brazil.

METHODS:

Convenience sampling was used. All mothers of children undergoing treatment were invited to participate in this study. Data to investigate anxiety related to dental treatment among the children were collected through applying the Venham Picture Test (VPT) scale. For the mothers, the Corah scale was applied. A self-administered sociodemographic questionnaire with questions about demographic, behavioral, oral health and dental service variables was also used.

RESULTS:

40 mother-child pairs were included in the study. The results showed that 40% of the children were anxious and 60% of the mothers were slightly anxious. Local anesthesia was the procedure that caused most anxiety among the mothers, making them somewhat uncomfortable and anxious (60%). Family income higher than R$ 1,577.00 had an influence on maternal anxiety (75.6%). Maternal anxiety had an influence on child anxiety (81.3%).

CONCLUSION:

Most of the children showed the presence of anxiety, which ranged from fear of dental care to panic, inferring that maternal anxiety has an influence on children's anxiety. Dental procedures did not interfere with the mothers' anxiety, but caused positive feelings, whereas they affected the children more.

A novel visual facial anxiety scale for assessing preoperative anxiety

Background

There is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety.

Methods

The initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0–10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale.

Results

The highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing ‘no’ anxiety, 250 (94.3%) participants chose the face A10 as representing ‘highest’ anxiety and 147 (55.5%) participants chose the face A8 as representing ‘moderate-high’ anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3). Similarly, the correlation of the faces A7 and A6 was significantly correlated with moderate anxiety (r = 0.87), but A7 remained because of its higher frequency (35.9% vs 22.6%). Using frequency and Spearman correlations, the final order of the faces assigned to the categories none, mild, mild-moderate, moderate, moderate-high and highest anxiety levels was A0, A1, A5, A7, A8 and A10, respectively (Fig 4).

Conclusion

The proposed VFAS was a valid tool for assessing the severity of acute [state] anxiety, and could be easy to administer in routine clinical practice.

Preliminary Study of Self-Reported Experience of Physical Aggression and Bullying of Boys Who Stutter: Relation to Increased Anxiety

This study examined the relationship of self-reported anxiety and vulnerability to bullying for 18 children who stuttered and 18 children who did not stutter. More children who stuttered were at significantly higher risk of experiencing bullying behavior (61%) than children who did not stutter (22%); 39% of children who stuttered scored at least one standard deviation above the mean on the Revised Children's Manifest Anxiety Scale, suggestive of higher anxiety. In contrast, only 6% of children who did not stutter scored at least one standard deviation above the mean. The correlation was .82 for children who stuttered between greater vulnerability to bullying and self-reported anxiety. A bidirectional relationship is hypothesized between high anxiety and bullying of children who stutter.

Prevalence and service implications of health anxiety in genitourinary medicine clinics

A comparison of the prevalence of health anxiety in genitourinary medicine (GUM) clinics in two UK centres was carried out using a new rating scale, the Health Anxiety Inventory (HAI). The relationship of health anxiety to demographic and clinical variables, and its impact on service contacts, was also examined in one of these centres. 694 patients were assessed and significant health anxiety was identified in 8–11%. HAI scores were stable over time and high levels persisted in the absence of treatment. Attenders with sexually transmitted infections had significantly lower levels of health anxiety than those with other conditions. Contacts with clinic doctors and health advisors in the nine months before and after assessment were significantly greater in those with high health anxiety, with doctor appointments 37% higher in the high HAI group ( P = 0.005). Health anxiety is a source of considerable morbidity in GUM clinics deserving further study.

[Characteristics of behavioral response of elderly women with high level of personal anxiety]

The results of studies of the behavioral response in 69 elderly women with normal and high levels of anxiety are presented in the article. Personal anxiety level was determined by «Integrative anxiety test». The indicators of strategies alteration for decision-making were assessed through a computer complex KPFK-99 «PSIHOMAT», which includes a test computer system «Binatest». It is found that more complex and structured programs of behavior are characteristic for women with normal levels of anxiety. The restriction tendency of adaptation opportunities of an organism, decrease in resistance to influence negative the stress - factors, and also tendency to doubts in correctness of a choice against any situation.

Anxiety is associated with higher levels of global DNA methylation and altered expression of epigenetic and interleukin-6 genes

OBJECTIVES

Anxiety is associated with elevated levels of the inflammatory cytokine interleukin-6 (IL-6) and an increased risk for diseases with an inflammatory aetiology. In cancer, higher levels of IL-6 have been associated with increased expression of the epigenetic enzymes DNMT1 and Enhancer of Zeste Homolog 2 (EZH2). However, the relationship between IL-6 and DNA methyltransferases (DNMTs) and EZH2 expression has not previously been examined in anxious individuals.

METHODS

Global DNA methylation levels were measured using the Methylflash Methylated DNA Quantification Kit and gene expression levels of the DNMT and EZH2 genes in anxious (n=25) and nonanxious individuals (n=22) were compared using quantitative real-time PCR. Specifically, we investigated whether global DNA methylation or aberrant expression of these genes was correlated with IL-6 mRNA and protein serum levels in anxious individuals.

RESULTS

Anxious participants had significantly higher levels of global DNA methylation compared with controls (P=0.001). There were no differences in the mean mRNA expression levels of the DNMT1/3A/3B, EZH2 and IL-6 genes in anxious individuals compared with controls. However, the expression of DNMT1/3A, EZH2 and IL-6 genes increases with increasing Hospital Anxiety and Depression Scale-Anxiety scores in the anxious cohort only. Interestingly, IL-6 gene expression was correlated strongly with DNMT1/3A/3B and EZH2 expression, highlighting a potential relationship between IL-6 and important epigenetic regulatory enzymes.

CONCLUSION

This study provides novel insight into the relationship between anxiety, epigenetics and IL-6. Moreover, our findings support the hypothesis that changes in DNA methylation profiles may contribute to the biology of anxiety.

An evaluation of the sociodemographic determinants of dental anxiety in patients scheduled for intra-alveolar extraction

BACKGROUND

Studies on anxiety in patients having intra-alveolar extraction as well as the effect of patient's sociodemographic characteristics influencing level of associated anxiety are few in our environment. The aim of this study was to statistically analyze the sociodemographic determinants of dental anxiety in patients scheduled for intra-alveolar extraction.

METHODS

A cross-sectional study was conducted among 93 consecutive patients attending the outpatient clinic of the Department of Maxillofacial Surgery, University of Benin Teaching Hospital for intra-alveolar extraction in the months of November and December 2013. An interview-based questionnaire, Corah Dental Anxiety Scale Revised (DAS-R), was administered to evaluate levels of dental anxiety. Sociodemographic characteristics of the subjects were recorded. Descriptive statistics and regression models were done with the independent variables (sociodemographic factors) and the dependent variable being the DAS-R. A P<0.05 was considered significant.

RESULTS

The internal consistency of the scale used as determined by Cronbach alpha was 0.76. Mean DAS score was 8.12±2.58. Dental anxiety and age of subjects showed significant inverse relationship. Females had a higher mean DAS score (8.76) than the males (7.37) (P=0.006). Residence (urban/rural) was not statistically significant. Singles reported the highest DAS score (9.41) (P=0.006). The educational level attained was significantly related to dental anxiety (P=0.005). Those with secondary school education had the highest DAS score (9.26). Class V social status had the highest mean anxiety score (P=0.012). Stepwise linear regression showed that the best predictors for dental anxiety were sex (P=0.008) and marital status (P=0.026).

CONCLUSION

This present study demonstrates that sex and marital status are the predictive factors for dental anxiety in the overall management of patients indicated for intra-alveolar extraction.

Sense of humor and its association with psychological disturbances among dental students in India

Although the health benefits of humor and the potential advantages of having a good Sense of Humor (SoH) have been long recognized, they have not been investigated in dental students. The aim of this study was to assess the extent and demographic correlates of SoH in dental students and its association with their self-reported level of psychological disturbances. Six hundred and five students (age 20.3±1.83 years, 250 males, 355 females) from two dental schools in India anonymously completed the Multidimensional Sense of Humor Scale (MSHS) and the Depression Anxiety Stress Scales-21. Independent samples t-test and one-way ANOVA were used to analyze the intergroup differences based on gender and year of study, respectively. The association between SoH and each of the three negative affective states was evaluated with multiple linear regressions. The mean MSHS score of the sample was 59.65±11.77. Male students showed a marginally higher SoH than females (60.78 vs. 58.86, p<0.05). The level of SoH steadily improved along the course duration, with statistically significant increases in the third and fifth years of study. SoH was negatively associated with all three negative affective states and explained nearly 3 to 5 percent of their variance. These results warrant further inquiry on the correlates of SoH in dental students, the psychosocial roles of humor, and their application in improving the psychological climate in dental schools.

[Urban insecurity and fear of crime in people suffering from mental disorders: a study in 24 Mental Health Centers in Italy]

AIMS

To assess in a sample of people with mental disorders: 1) fear of crime and perceived insecurity; 2) the association between fear of crime and insecurity; 3) the incidence of crimes.

METHODS

Twenty-four Italian mental health centres have been invited to participate in the study from the network of the Early Career Psychiatrists' Committee of the Italian Psychiatric Association. In each participating centre, the first 20 patients consecutively accessing the mental health centre between February and April 2011 have been recruited. All patients have been assessed using validated assessment tools.

RESULTS

The final sample consists of 426 patients. They are mostly female (70.1%), with a mean age of 45 years (± 13.5), and with a good level of education. Fifty-two percent of patients have a diagnosis of mood disorders, and 37.8% on anxiety spectrum disorders. About half of the sample declares that the most prominent feeling toward life is uncertainty. Almost all patients report to have at least one big fear, with the most frequently report being: 1) loss or death of a loved one (41.2%); 2) financial constraint (28.4%); 3) physical or mental health problems (26.5%).

DISCUSSION AND CONCLUSIONS

Our results show the presence of a common sense of uncertainty among patients, probably as a result of the historical moment we are facing. It is reasonable that this attitude toward life can have a detrimental impact on patients' psychological and physical wellbeing, contributing to high levels of distress. Further studies are needed in order to clarify the possible relationship between fears, uncertainty and mental disorders.

[Chinese version of a face version of the modified child dental anxiety scale: transcultural adaptation and evaluation]

OBJECTIVE

To develop the Chinese version of a face version of the modified child dental anxiety scale (MCDASf) and test the reliability and validity of MCDASf.

METHODS

The English version of MCDASf was translated and back-translated, as well as crosscultural adapted by the method of psychometrics to develop the Chinese version of MCDASf. Subsequently the Chinese version schedule was randomly investigated among 245 kindergarten children and school children aged greater than 4 and less than 12 years on two separate occasions 3 weeks apart to determine the reliability. A total of 248 children attending Pediatrics Dentistry of Peking University School and Hospital of Stomatology aged greater than 4 and less than 12 years old were selected and completed the Chinese version of MCDASf and the Chinese version of modified Children's fear survey schedule-dental subscale (CFSS-DS) before treatment to determine the validity. Then we rated the children's behavior during dental treatment by Venham's clinical anxiety rating scale and cooperative behavior rating scale to evaluate the relation between self-assessed dental anxiety scores and the behavioral reaction during the dental treatment.

RESULTS

In reliability study, 98.0% of 250 children completed the MCDASf. In validity study, 99.2% of 248 children completed the MCDASf. Cronbach's alpha coefficient of the translated scale was 0.814 and the test-retest reliability was 0.907. Principal component analysis of the translated scale confirmed that the scale consisted of a single unidimensional construct. The Chinese version of MCDASf significantly was correlated with the Chinese version of modified CFSS-DS (r = 0.843, P < 0.01) . It was also correlated with Venham's clinic anxiety rating scale and cooperative behavior rating scale (r = 0.675, P < 0.01).

CONCLUSIONS

The Chinese version of MCDASf demonstrated good reliability and validity and can be used as a simple self-report measurement of dental anxiety in Chinese children aged 4-11 years.

Dental anxiety and temperament in 15-year olds

OBJECTIVE

The aim of the present study was to analyze the prevalence of dental anxiety and its association with temperament, sociodemographic factors and previous painful and unpleasant experiences of dental care among 15-year old individuals.

MATERIALS AND METHODS

The sample included 263 randomly selected 15-year old individuals living in the municipality of Jönköping, Sweden. The school, parental and adolescent consent was acquired. Three self-reported questionnaires were used, one included items of sociodemography, while the others dealt with dental anxiety assessed by the Dental Fear Survey (DFS) and temperament assessed by an adapted version of The EAS Temperament Survey for Children modified for adults, the EASI temperament survey.

RESULTS

The results showed that 6.5% of the adolescents were classified as dentally anxious and with girls proportionally more fearful than boys. The three temperaments activity, impulsivity and emotionality were significantly correlated with dental anxiety. A hierarchical multiple linear regression analysis showed that pain at the last dental appointment or previous pain experiences during dental care treatment were the strongest predictors regarding dental anxiety in 15-year olds. The temperament dimensions activity and impulsivity were also significantly predictive of dental anxiety.

CONCLUSIONS

Although some of the temperament dimensions are correlated with dental anxiety, which may emphasize an important finding with regard to personality, this study showed that previous pain experiences during dental care treatment is a strong predictor for high dental anxiety in 15-year olds.

Predictive factors for child behaviour in the dental environment

AIM

This was to evaluate the potential factors that influence behaviour in the paediatric dentistry environment of children aged 48 to 68 months who have never before been to a dentist.

STUDY DESIGN

Cross sectional.

METHODS

Child behaviour was evaluated using the Frankl scale during both clinical examination procedures and prophylaxis. All mothers of the 118 children investigated underwent a test to assess their anxiety (Manifest Anxiety Scale-MAS) and responded to a questionnaire on the medical history of the child as well as socioeconomic factors. The children were given a test to assess their anxiety (Venham Picture Test-VPT).

STATISTICS

The statistical tests adopted were the Chi-squared test and both simple and multiple unconditional logistic regression.

RESULTS

Children with high anxiety, those had previously experienced toothache and those had behaved uncooperatively during prior medical experiences, had a greater probability of behaving uncooperatively during their first dental consultation.

CONCLUSIONS

Dental professionals can identify the presence of predictive factors for child behaviour prior to the first clinical examination by including relevant questions in the dental and medical history, thereby facilitating a more positive initial contact between paediatric dentists and their patients.

The development of a dental anxiety scale with a cognitive component for children and adolescents

PURPOSE

To validate a dental anxiety scale with a cognitive component for use in children and adolescents.

METHODS

A total of 439 children (≥ 6 years old) were evaluated. For each child, 2 operators each assessed using the Abeer Children Dental Anxiety Scale (ACDAS) at visit-1, and the chief investigator also assessed using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS) at visit-1 and using the ACDAS 2 weeks later. A sample of 274 children was assessed for external validity.

RESULTS

A receiver operating characteristic curve showed that the cutoff 26 gave the optimal results for sensitivity (96%, 95% confidence interval [CI]=81.7~99.9) and specificity (66%, 95% CI=57.4~73.8), with an area under the curve of 0.80 (95% CI=0.73~0.87). ACDAS had substantial to almost perfect intra- and inter examiner reliability along with good concurrent validity (r=0.77) and discriminative validity (r=0.79). For convergent validity, ACDAS had a significant relationship between the Dental Anxiety (DA) scores and cognitive status P<.001. Cronbach's alpha (α) was 0.90, which indicated good internal consistency. The external validity results indicated that the scale was generalizable.

CONCLUSIONS

The Abeer Children Dental Anxiety Scale is a valid cognitive scale to measure dental anxiety, and it encompasses the required criteria to be regarded as the gold standard among dental anxiety scales.

Thinking about eating food activates visual cortex with reduced bilateral cerebellar activation in females with anorexia nervosa: an fMRI study

Background

Women with anorexia nervosa (AN) have aberrant cognitions about food and altered activity in prefrontal cortical and somatosensory regions to food images. However, differential effects on the brain when thinking about eating food between healthy women and those with AN is unknown.

Methods

Functional magnetic resonance imaging (fMRI) examined neural activation when 42 women thought about eating the food shown in images: 18 with AN (11 RAN, 7 BPAN) and 24 age-matched controls (HC).

Results

Group contrasts between HC and AN revealed reduced activation in AN in the bilateral cerebellar vermis, and increased activation in the right visual cortex. Preliminary comparisons between AN subtypes and healthy controls suggest differences in cortical and limbic regions.

Conclusions

These preliminary data suggest that thinking about eating food shown in images increases visual and prefrontal cortical neural responses in females with AN, which may underlie cognitive biases towards food stimuli and ruminations about controlling food intake. Future studies are needed to explicitly test how thinking about eating activates restraint cognitions, specifically in those with restricting vs. binge-purging AN subtypes.

Cardiac vagal control as a prospective predictor of anxiety in women diagnosed with breast cancer

Low cardiac vagal control (CVC) has been associated with state and trait anxiety and anxiety spectrum disorders. Studies indicate that diagnosis and treatments for breast cancer may be associated with anxiety. The current study examined whether CVC prospectively predicted a trajectory of change in anxiety following breast cancer diagnosis. Forty-three women diagnosed with non-metastatic breast cancer completed the Taylor Manifest Anxiety Scale and the Perceived Stress Scale, and a 5-min resting electrocardiographic (ECG) segment was recorded. Self-report measures were completed approximately every 3 months for a year. Respiratory sinus arrhythmia (RSA) significantly predicted the trajectory of change in anxiety over the follow-up period: participants with higher baseline RSA evidenced decreasing anxiety, whereas those with lower baseline RSA had increasing anxiety. These results are consistent with the hypothesis that CVC facilitates the modulation of anxiety in women coping with significant stressors of breast cancer diagnosis and treatment.

Association of dental anxiety to personality traits in a general population sample of Finnish University students

OBJECTIVE

To estimate the association between personality and dental anxiety among Finnish University students.

MATERIALS AND METHODS

A total of 880 university students in Finland returned the questionnaires addressing dental anxiety by using the Modified Dental Anxiety Scale (MDAS) questionnaire. In addition, the personality of traits (neuroticism, extraversion, agreeableness, conscientiousness and openness to experience) were noted. Personality traits of students were compared with the level (high, mild or none) of dental anxiety derived from the MDAS questionnaire. The relative odds of dental anxiety associated with the level of dental anxiety were estimated by logistic regression, Chi-Square tests and one-way analysis of variance (ANOVA).

RESULTS

Median age of the respondents was 22 years. Of the respondents, 99 (11.3%) were classified as dentally anxious patients (90, 12.2% of females; 9, 6.6% of males)). Neuroticism was the only personality trait that was significantly associated with dental fear (p < 0.001). A tendency, although not significant, was seen between high dental fear and lower extraversion and agreeableness.

CONCLUSIONS

Of the five different personality traits, neuroticism was a significant risk factor for developing dental anxiety, and this should be recognized in clinical practice.

[Dental fear and anxiety scores of a Hungarian population living in the Hungarian-Slovakian border region. A pilot study]

The aim of the authors was to investigate whether living as a minority has an influence on the dental fear and anxiety values. In this study 201 volunteers (n = 201, inside border Hungarians 144, outside border Hungarians 57, male 90, female 111; age 8 to 83 years, mean 44 +/- 16 yrs.) were investigated. Our methods included collection of demographic data (gender, age, marital status, profession), and administration of the Hungarian versions of dental fear and anxiety related scales namely: DAS, DAQ, DASQ, DFS, DBS, STAI-S, STAI-T and Expectation Scale. Mean values of the scales were: DAS: 10,34 +/- 3,54; DAQ: 2,3 +/- 1,15; DASQ: 12,58 +/- 4,55; DFS: 40,37 +/- 15,67; DBS: 32,89 +/- 12,94; Expectation Scale: 2,87 +/- 3,56, STAI-S: 39,51 +/- 10,68; STAI-T 41,65 +/- 9,08. The mean scores of all the scales were higher in the case of Hungarians living inside the borders of Hungary. The differences were significant in the case of DAS, DAQ, DASQ and DFS scales (p < 0,05). Data of our study indicate that living as a minority not necessarily leads to the increase of dental fear and anxiety.

Mental health of postgraduate orthodontic students in India: a multi-institution survey

The aim of this study was to evaluate the mental health of postgraduate orthodontic students in India by assessing the extent of three common negative affective states: depression, anxiety, and stress. Three hundred and thirty postgraduate students from thirty-two dental colleges across India anonymously completed the short version of the Depression Anxiety Stress Scale (DASS21). The statistical analysis included summary statistics, nonparametric tests for intergroup comparisons, and logistic regressions to evaluate the influence of age, gender, year of study, and marital status on these mental states. In comparison to the general population, the students experienced mildly elevated levels of depression and anxiety (11±5.1 and 8.2±4.1, respectively) and a moderately elevated level of psychological stress (22±5.2). A moderate or higher level of coexisting symptoms of all three affective states was seen in 15.8 percent of the students. Female students reported a higher level of depression than males and were two and half times more likely to experience depression to a moderate or higher level. First-year students exhibited lower levels in all three states than those in the second and third years and had lower odds than third-year students of developing a moderate or higher level of any of the three affective states. Marriage had a significant buffering potential against all these states. The results clearly indicate a suboptimal level of mental health in these postgraduate students of the specialty and the need to improve their mental resilience and the academic climate.

Objective and subjective measures for assessing anxiety in paediatric dental patients

AIM

Anxiety has been defined as a nonspecific feeling of apprehension towards a concrete situation that does not necessarily involve a previous experience. Dental anxiety can prevent patients from cooperating fully during dental treatment. Given that there is a connection between dental anxiety and uncooperative behaviour, it is important for dentists to be able to assess anxiety in their patients. There are many methods for such assessment, and in children they depend on age and intellectual development. These measures can be objective or subjective, depending on the method used to quantify the degree of anxiety. The aim of this literature review was to analyse the objective and subjective scales that are used most commonly to assess the degree of anxiety of children in a dental setting.

CONCLUSION

Knowing the degree of anxiety of dental children is important in order to guide them through their dental experience. Their level of cooperation will also improve and anxiety will be reduced as well.

Elevated social anxiety among early maturing girls

Adolescence is a key period in terms of the development of anxiety psychopathology. An emerging literature suggests that early pubertal maturation is associated with enhanced vulnerability for anxiety symptomatology, although few studies have examined this association with regard to social anxiety. Accordingly, the current study was designed to further elucidate the relation between pubertal timing and social anxiety, with a focus on clarifying the role of gender. Participants were 138 adolescents (ages 12-17 years) recruited from the general community. Level of social anxiety was examined as a function of gender and within-sample pubertal timing. As expected, early maturing girls evidenced significantly higher social anxiety, compared with on-time girls and early maturing boys, and no other differences were found as a function of gender or developmental timing. Findings and future directions are discussed in terms of forwarding developmentally sensitive models of social anxiety etiology and prevention.

[Development of Chinese version of children's fear survey schedule-dental subscale]

OBJECTIVE

To establish the Chinese version of the modified children's fear survey schedule-dental subscale (CFSS-DS).

METHODS

The original English version of CFSS-DS with facial image scale (FIS) was translated into Chinese, pre-tested and cross-culturally adapted. Subsequently the Chinese version schedule was randomly investigated among 367 children aged 5 - 12 years and their parents. Reliability and validity of the translated scale was evaluated later.

RESULTS

Totally 367 children were investigated and 311 valid questionnaire was received. Cronbach's alpha of the translated scale was 0.85 and test-rest reliability was 0.73. The 15 items were divided into four domains. There was a certain logical relationship between the items among the same domains. There was highly significant association between the self-report of the Modified CFSS-DS and Frankl Behavioral Scale (r(s) = -0.403, P < 0.01).

CONCLUSIONS

The Chinese version of modified CFSS-DS has been established successfully with good psychometric properties which provide the theoretical evidence for further application in Chinese population.

Anxiety and fear of dental treatment among users of public health services

PURPOSE

The aim of the present investigation was to determine the degree of anxiety and fear in patients treated at the dental school clinics of the Universidade Federal de Pernambuco (Brazil) regarding the different types of treatment offered.

MATERIALS AND METHODS

The sample was made up of 400 patients from both genders over 18 years of age treated between July and October 2007. Data collection was carried out through the administration of validated questionnaires by a calibrated researcher. The Modified Dental Anxiety Scale (MDAS) and Gatchel's Scale were used to evaluate the degree of anxiety and fear among the patients.

RESULTS

There was a 23.0% prevalence of dental anxiety; 9.5% were very anxious, 13.5% were anxious and 77.0% were not anxious. Women were more anxious than men (20.7% and 11.3%, respectively, P = 0.995). The age group that exhibited the highest prevalence of anxiety was 30 to 39 years (29.3%). Regarding fear, 13.5% felt extreme fear; 30.5% felt moderate fear and 56% felt no fear. Schooling was the only significant socioeconomic factor for both anxiety and fear. In the association between fear and anxiety, 38.9% of the patients with extreme fear were classified as very anxious.

CONCLUSION

The majority of individuals were classified as non-anxious and without fear regarding dental procedures.

Factors of importance to maintaining regular dental care after a behavioural intervention for adults with dental fear: a qualitative study

OBJECTIVE

Dental phobia is prevalent in the general population and can be successfully treated through cognitive behavioural therapy, which results in patients being able to cope with dental treatments. The aim of this study was to increase the understanding of factors of importance for maintaining regular dental care after completion of a cognitive behavioural therapy programme.

MATERIAL AND METHODS

A qualitative study design was used. Fourteen individuals who had successfully completed the programme and had thereafter been referred to a general dental practitioner were interviewed. An interview guide with open-ended questions was used. The interviews were tape-recorded and transcribed verbatim. The texts were analysed using descriptive and qualitative content analysis (Grounded Theory).

RESULTS

The manifest analysis identified four content areas: experience of dental care, content of the behavioural therapy programme, perception of therapy and impact on quality of life. The latent analysis identified influence on quality of life, security, activity and barriers to dental care as categories. Although all informants had successfully completed the dental fear treatment programme, only a few stated that they had an uncomplicated relation to dental care afterwards. Barriers to dental care were lack of money and fear. A sense of security was conclusive to coping with dental care, and a respectful approach on the part of the dental care personnel was essential to development of this sense.

CONCLUSIONS

Confidence in one's own ability to cope with dental care and the right to guide the treatment were important. Thus the theme in the present study was self-efficacy and respectful dental care personnel.

Development of a measure of childhood information learning experiences related to dental anxiety

OBJECTIVE

The aim of this study was to develop a measure of childhood information learning experiences related to dental anxiety according to Rachmnan's theory of fear acquisition entitled "Dental Information Learning History Questionnaire (DILHQ)" and to determine its test quality with regard to factorial validity, reliability, divergent, discriminant, and predictive validity.

METHOD

Sample 1 included 228 dental patients, answering a 17-item-pool of the DILHQ, the Dental Anxiety Scale (DAS: Corah, 1969), and the Self-Consciousness Scale by Fenigstein et al. (1975). A second sample of 197 patients filled in the final 12-item test version, the DAS and the state version of the State-Trait Anxiety Inventory (Spielberger et al., 1970). Ninety-five participants constituting the third sample answered the DILHQ twice with a 14-days interval.

RESULTS

An exploratory study using the first sample resulted in two dimensions underlying the DILHQ-answers after removal of the unique loading items. The two-factorial structure was confirmed in the second sample. The factor-analytically derived Danger Information and Acceptance Information subscales showed sufficient internal consistency (Alpha = 0.87 and 0.72) and temporal stability (r(tt) = 0.77 and 0.76). Dentally fearful patients remembered being exposed to more danger information and less acceptance information about dentistry during childhood than low-fearful patients did (p < 0.001 each). Danger information and acceptance information predicted anxious response to the following dental procedure in opposite directions (r = 0.29 and r = -0.29).

CONCLUSION

The results suggest that the DILHQ fulfils criteria of good construct validity. Exposure to threatening information about dentistry during childhood may increase the risk for dental fear acquisition and for exaggerated anxious response to treatment, while acceptance information might have a protective effect.

[Efficacy of adepress (paroxetin) in generalized anxiety disorder]

The aim of the study was to evaluate efficacy of adepress (paroxetin) in different clinical variants of generalized anxiety disorder (GAD). Adepress was used as a monotherapy during 42 days. Patient's state was assessed using Hamilton anxiety scale (HAM-A) at baseline and every week thereafter. The study included 49 patients aged 36,2+/-8,2 years. Patients were stratified into two groups according to the predominance of somatic (24 cases) or cognitive (21 cases) anxiety. The efficacy of adepress was shown both in a separate GAD and in a GAD with comorbid psychopathology. The effect of the drug was seen in patients with somatic anxiety after 3-4 weeks and in patients with cognitive anxiety after 3-6 weeks.

Dental anxiety and its relationship with self-perceived health locus of control among Indian dental students

PURPOSE

The objective of the present study was to assess dental anxiety and study its relationship with the perceived Health Locus of Control (HLC) among students in an Indian dental school.

METHODS

A total of 325 students returned completed history forms that consisted of the Multidimensional Health Locus of Control (MHLC) scale and the Modified Dental Anxiety Scale (MDAS).

RESULTS

'Fear of the needle' was the greatest stimulus of dental anxiety with a mean score of 3.3, which was followed by 'tooth drilling' whose mean score was 2.7. There was also a statistically significant decrease in the mean scores for all of the MDAS items from 1st year to 4th year, except the item related to local anaesthetic injection, whose mean score remained high throughout. The mean scores of the three aspects of the MHLC scale (internal, chance and powerful others) were compared with respect to dental anxiety. The results showed that 'internal' was the most powerful of the three aspects of MHLC among all three anxiety groups. The mean 'internal' score for the low anxiety group was 4.4, which reduced to 4.1 for the high anxiety group. A statistically significant inverse correlation was also found between the 'internal' dimension of MHLC and dental anxiety.

CONCLUSION

Perceived HLC was found to play an important role in predicting the dental anxiety among dental students.

How do we measure dental fear and what are we measuring anyway?

Dental anxiety shares similar characteristics with many clinical anxiety disorders, and this is especially the case with other specific fears and phobias. These often debilitating conditions comprise several different dimensions, including cognitive, emotional, behavioural and physiological components. In addition, dental anxiety and fear are associated with a range of aversive health consequences. A number of indices have been developed to measure dental anxiety and fear, but their sheer number is indicative of a continuing problem with delineating the concept of dental fear and anxiety and how these should best be measured. This paper addresses the widespread confusion in the use of relevant terminology and aims to trace and assess the theoretical underpinnings of a selection of the most widely used self-report measures. It is concluded that the most popular measures of dental anxiety and fear lack adequate or sufficiently explained theoretical foundations. This is of concern given that these scales, by their very nature, serve to define the concept they aim to measure.

Identifying and assessing anxiety in pre-operative patients

Increasing demands for hospitals to be more efficient mean that patients attending for an operation are generally admitted on the day of surgery. As a result, healthcare professionals have little time to talk to the patient to ascertain his or her wellbeing, to check for any signs of anxiety and ask whether the patient requires further information about the forthcoming procedure. Healthcare professionals should be encouraged to use appropriate interventions to identify and assess anxious patients. There are several instruments available to measure the patient's level of pre-operative anxiety. This article reviews the Amsterdam Preoperative Anxiety and Information Scale, which is easy for patients to complete and may help to identify which individuals need extra support.

Self-reported driving behaviors as a function of trait anxiety

This study examined self-reported driving behaviors in 120 (Israeli) male drivers as a function of trait anxiety (TA). TA was assessed through the TA scale of the State-Trait Anxiety Inventory. For the analysis of driving behaviors, the present study used the Driver Behavior Questionnaire (DBQ) and adopted previous distinctions between four classes of behaviors within the DBQ: errors, lapses, ordinary violations and aggressive violations. Regression analyses revealed that level of TA had a significant direct positive effect on all dependent variables, suggesting riskier driving behaviors among high-anxious individuals. Significant logarithmic effects for all measures indicate that these aberrant driving behaviors increase more at increasing LTA-, than at increasing HTA-values. Consistent with the general adverse effects of anxiety on performance effectiveness, the present findings as well, are interpreted in the framework of theories which suggest that worries occupy the capacities of working memory, at the expense of the task to be performed. The positive relation between aggressive violations and TA is sought to reflect low levels of emotional adjustment among high-anxious individuals.

[The effects of visual imagery on adjustment and quality in life of hemodialysis patients]

OBJECTIVE

Relaxation and imagery techniques have been widely used among patients with chronic physical illnesses other than end stage renal failure (ESRF). Case studies and some controlled studies suggest that relaxation and imagery techniques can be successfully used with hemodialysis patients to improve their adjustment. Nonetheless, randomized controlled studies are needed to systematically examine this effect.

METHOD

The present study examined the effect of a specific visual imagery technique on adjustment and quality of life in a sample of 153 hemodialysis patients. Control procedures included an active control and a no-treatment control. The former consisted of relaxation training and general imagery techniques. Outcome variables included beliefs about hemodialysis treatment, ways of evaluating life, emotional adjustment, and quality of life. The ESRF Beliefs Questionnaire, the Life Evaluation Questionnaire for Hemodialysis Patients, the Hospital Anxiety and Depression Scale, the Ladder Scale, and 2 SF-36 summary scales were used to measure these outcome variables.

RESULTS

The findings show that the specific imagery intervention did not have an effect on emotional adjustment or quality of life, either post-treatment or at follow-up; however, the rate of patient compliance with the interventions was moderately high and patients reported that they were satisfied with the intervention procedures.

CONCLUSION

The present study is the first randomized controlled intervention study of the effects of relaxation and imagery on adjustment in hemodialysis patients. The findings are discussed in terms of their implications for future studies as well as their limitations.

[The reliability and validity of Turkish Brief Measure of Worry Severity based on Turkish university students]

OBJECTIVE

The aim of this study was to examine reliability and validity of the Turkish Brief Measure of Worry Severity (BMWS) for assessing the level of dysfunctional worry.

METHOD

The study sample consisted of two different student groups from various faculties of Hacettepe University (age range: 17-25 years). First, data were collected from the group, composed of 210 female and 170 male students to evaluate the scale's test re-test correlation, Cronbach's alpha coefficient, and criterion and convergent validity. Next, the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to the other group, composed of 805 students to assess distinctive validity of the Turkish BMWS. Students that scored over a quarter on median of BDI were regarded as having severe depression symptoms and the students that scored > 26% on BAI were regarded as having severe anxiety symptoms. In this manner anxiety (12 male, 38 female) and depression groups (4 male, 10 female) were formed.

RESULTS

Following a series of analyses, test-retest correlation (r = 0.76) and internal consistency (Cronbach's alpha 0.88) of the Turkish BMWS was determined to be statistically high. While the Turkish BMWS showed unifactorial construct, the scores of the scale differentiated between the depression group and the anxiety group (depression group: X = 8.14, SS = 4.03; anxiety group: X = 11.56, SS = 5.11). Furthermore, the Turkish BMWS's correlations with the Name Penn State Worry Questionnaire (r = 0.75) and Trait State Anxiety Inventory (State Anxiety Inventory: r= 0.42; Trait Anxiety Inventory r = 0.72) were statistically significant and supported the scale's construct validity.

CONCLUSION

The results show that the Turkish BMWS is a reliable and valid scale for use with Turkish university students.

Efficacy of wrists overnight compression (HT 7 point) on insomniacs: possible role of melatonin?

AIM

Insomnia is a major problem which decreases life quality. Many causes are involved with it and anxiety is often associated. The underlying mechanism is not completely understood, even though different factors seem to be associated. Among them melatonin and its circadian rhythm is thought to have an important role. In addition, acupressure and acupuncture are known to ameliorate insomnia and anxiety, when a specific wrist point is stimulated (HT 7 Shenmen). With these bases, the aim of the present study has been to evaluate the efficacy of an acupressure device, ''H7-insomnia control'', positioned on HT 7 points, during the night, in terms of general health and anxiety levels, together with the evaluation of sleep quality and the urinary melatonin metabolite 6-hydroxymelatonin sulphate determination, in a number of insomniacs.

METHODS

Forty patients with insomnia were divided into two groups and randomly received either the H7 or placebo treatments, in a double-blind protocol, for 20 nights. Before and after treatments every subject answered a series of questionnaires (General Health Questionnaire 28 items; State-Trait Anxiety Inventory; Pittsburgh Sleep Quality Index) and collected 24 h urines, divided into two samples of 12 h each. Urinary melatonin metabolite was then determined using a RIA method.

RESULTS

Data obtained indicate that the device H7-insomnia control is efficacious to ameliorate quality of sleep and reduce anxiety levels in insomniacs, at a higher extent than in the placebo group. In addition, the 24 hours urinary melatonin metabolite rhythm, obtained at the end of treatment, was considered as being normal in a higher percentage of H7-treated patients, with respect to the placebo group.

CONCLUSION

It is plausible to hypothesize that the wrist acupressure device might be considered a valid tool, without adverse effects since it does not contain pharmaceutical products, that is able to naturally ameliorate sleep quality in insomniacs, acting through a not jet completely clarified mechanism, that may involve melatonin.

Marital psychological and physical aggression and children's mental and physical health: direct, mediated, and moderated effects

Relations between marital aggression (psychological and physical) and children's health were examined. Children's emotional insecurity was assessed as a mediator of these relations, with distinctions made between marital aggression against mothers and fathers and ethnicity (African American or European American), socioeconomic status, and child gender examined as moderators of effects. Participants were 251 community-recruited families, with multiple reporters of each construct. Aggression against either parent yielded similar effects for children. Children's emotional insecurity mediated the relation between marital aggression and children's internalizing, externalizing, and posttraumatic stress disorder symptoms. No differences were found in these pathways for African American and European American families or as a function of socioeconomic status or child gender.

Anxiety levels in adolescents who stutter

High levels of anxiety can negatively affect the lives of children and adolescents. Thirty-six adolescents who stutter and 36 adolescents who do not stutter were administered standardized scales for anxiety and self-esteem. Significant differences were found for the total T-scores for Revised Children's Manifest Anxiety Scale for the two groups, although both groups mean T-scores were within normal range. Eighty-three percent of adolescents who stutter and 95% of adolescents who do not stutter earned scores in the normal range. No significant differences were found on the self-esteem scale, with 86% of adolescents who stutter and 97% of adolescents who do not stutter earning scores in the normal/positive range. Adolescents who stutter with co-occurring disorders displayed significantly higher levels of anxiety than adolescents who stutter with no co-occurring disorders. No significant differences were found between groups on ethnicity, socioeconomic class, gender and anxiety levels. A positive, significant correlation between anxiety scores and self-esteem scores was found for both groups.

LEARNING OUTCOMES

Readers will learn about and understand (a) the role of anxiety and self-esteem in stuttering; (b) the methods used to evaluate anxiety and self-esteem in adolescents; and (c) the similarities between adolescents who stutter and adolescents who do not stutter on anxiety and self-esteem scales.

Clinical outcome of a short-term psychotherapeutic intervention for the treatment of dental phobia

OBJECTIVE

Anxiety before receiving dental treatment is widespread. The aim of this investigation was to evaluate the effect of a brief psychologic treatment on adherence to the dental treatment regimen in patients with dental phobia.

METHOD AND MATERIALS

Dental phobic patients (n = 160) received 3 sessions of cognitive behavioral therapy that consisted of stress management training and exposure to phobic stimuli. The outcome was determined in terms of 3 subsequent dental visits.

RESULTS

Participating patients had not visited a dental clinician for an average of 6 years. Comparison of patients who completed the psychologic treatment with those who dropped out showed that 68% of the former but also 52% of the latter adhered to the subsequent dental treatment regimen. The number of psychologic treatment sessions correlated significantly and positively with anxiety level before treatment.

CONCLUSION

Short-term psychologic therapy of 3 sessions results in a success rate of 70% to adherence to dental treatment among dental phobic patients. Duration of avoidance of anxiety before treatment was not related to success in completing the trial. Nevertheless, the more intense the patient's phobia, the more psychotherapeutic sessions were necessary.

Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa

OBJECTIVES

This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios.

METHODS

The test group of dental operators (n = 9) was trained in ART The control group (n = 11) was not, and did not apply ART The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t-test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios.

RESULTS

The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups.

CONCLUSION

The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios.

Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial

BACKGROUND

Oral and Maxillofacial operations can be extremely frightening treatment situations. General data on this phenomenon should be acquired through a multi-centre trial.

METHOD

A 10-page questionnaire was developed which was answered by 600 oral and maxillofacial patients before individual treatment. Control groups consisted of 800 surgical, dental and general practitioners/internal medicine patients. Twenty six medical practices and hospital departments in 11 German cities were involved in the trial.

RESULTS

Both subjective anxiety assessment by patients and objective testing (State Trait Anxiety Inventory; STAI) indicated a high level of treatment anxiety for oral and maxillofacial treatment situations. Oral and Maxillofacial Surgery (OMFS) patients' scores were significantly higher than those of control groups. Especially younger and female patients, patients treated under local anaesthesia and out-patients showed intensive anxiety. Previous treatment experience in OMFS did not modify test results.

CONCLUSION

Managing perioperative anxiety is still a major challenge in OMFS. Irrespective of technical, pharmacological and surgical advances, developing and establishing stress-reducing and anxiolytic perioperative techniques is of considerable importance for both patients and surgeons.

Hypnotizability, Absorption and Negative Cognitions as Predictors of Dental Anxiety

BACKGROUND

The authors conducted two pilot studies that investigated the roles of hypnotizability, absorption (defined as the ability to maintain focused attention on a task or stimulus) and state versus trait anxiety as predictors of dental anxiety. One of the studies also examined the effectiveness of hypnosis in managing dental anxiety.

METHODS

Participants in study 1 completed measures of hypnotizability and anxiety, viewed a video of a dental procedure either under hypnosis or not, and completed dental anxiety questionnaires. Participants in study 2 were told either that the video showed major dental work or a routine polishing. All subjects watched the video and then completed measures assessing their perceptions of the video and their anxiety.

RESULTS

The authors found a positive relationship between hypnotizability and scores on the Dental Anxiety Scale (DAS) (F(1,290) = 3.45, P = .06), as well as an interaction between hypnotizability and hypnosis (F(1,290) = 6.55, P = .01). An analysis of covariance found a relationship between trait and dental anxiety (F(1,290) = 11.50; P = .001). A two-way analysis of variance found a main effect for hypnosis (F(1,290) = 3.20, P = .07). The authors found an effect for group on the DAS (F(1,228) = 3.67, P = .057), such that subjects in the negative-cognition group scored higher on the DAS. The authors found an interaction between absorption and cognition in perceptions of pain experienced by the patient in the video (F(1,228) = 3.70, P = .05) and in ratings of one's own pain level if in the same situation (F(1,228) = 4.38, P < .05).

CONCLUSIONS

Hypnotizability or absorption, pre-existing anxiety and cognitions about dental procedures predict dental anxiety, and hypnosis may be helpful for some, but not all, patients.

CLINICAL IMPLICATIONS

Characteristics such as hypnotizability, trait anxiety and negative cognitions predict which people develop dental anxiety and who will be more responsive to hypnosis. The authors provide suggestions for dentists treating anxious patients.

Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale

BACKGROUND

A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form.

AIMS

To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)), and to provide normative data for dental anxiety for children using the MCDAS(f).

DESIGN

To determine the test-retest reliability, 287 schoolchildren aged 8-10 years completed the MCDAS(f) on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10-12 years completed the MCDAS(f) and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents.

RESULTS

The MCDAS(f) showed good test-retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDAS(f) significantly correlated with the CFSS-DS (r = 0.80, P < 0.001). Dental anxiety assessed using the MCDAS(f) was related to the dmft (t = -2.17, P = 0.03), DMFT (t = -4.19, P < 0.001), and dental general anaesthetic experience (t = -4.46, P < 0.01). The mean MCDAS(f) score for the normative sample (n = 475) was 19.81 (95% CI: 19.20, 20.43).

CONCLUSIONS

The MCDAS(f) is a reliable and valid measure of dental anxiety in children aged 8-12 years.

Rapid relaxation--practical management of preoperative anxiety

Rapid relaxation (RR) is a brief set of suggestions, given while applying topical anesthetic, to reduce anxiety during local anesthesia and subsequent dental treatment. RR is recommended for managing mild dental anxiety, which is almost universal. RR combines elements of hypnosis, meditation and good basic chairside manner. It is noninvasive, takes little additional time, and empowers patients by providing them with an attractive, immediate alternative to catastrophization. We have found that RR markedly improves the quality of the dental experience.

Prevalence of dental anxiety among 5- to 8-year-old Taiwanese children

OBJECTIVES

Many people experience discomfort to a greater or lesser degree about the prospect of dental treatment. Dental treatment can be a terrible experience, especially for children with dental anxiety. This study estimated the prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City, Taiwan.

METHODS

The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was translated into Chinese, and a receiver operating characteristic (ROC) curve was made based on criteria determined from pretest clinical observations of a sample population to set a cutoff score. Then, the parental CFSS-DS was used as a screening tool to survey the dental anxiety levels of 5- to 8-year-old children at kindergartens and elementary schools in Kaohsiung City, Taiwan. Participants were selected by stratified random sampling. The stratification was done by geographic district, age group, and sex. A total of 3,597 valid questionnaires were collected.

RESULTS

The Chinese version of the CFSS-DS had an optimal cutoff score of 38/39 (sensitivity was 0.857, specificity was 0.882) with an area under the ROC curve of 0.912. The estimated prevalence of dental anxiety among 5- to 8-year-old children in Kaohsiung City was 20.6 percent. The dental anxiety score was found to decrease as age increased; primary school boys had significantly lower scores.

CONCLUSIONS

The prevalence of dental anxiety was found to be high for 5- to 8-year-old Taiwanese children. The study's findings point to the urgent need for preventive health education and intervention programs in Taiwan to promote children's oral health and reduce dental anxiety.

Salivary cortisol levels and dental anxiety in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The present study tested the hypotheses that children with ADHD, particularly those exhibiting severe hyperactivity and impulsivity, have a different stress reaction (measured by salivary cortisol) during a dental recall visit and are more dentally anxious than children in a control group. Eighteen children with ADHD and a control group of 71 children, all 13 yr of age, underwent a clinical dental examination and completed the Corah Dental Anxiety Scale (CDAS). Four saliva samples were gathered for analysis of cortisol: one prior to dental examination, one after, and two the following morning. The subgroup ADHD with hyperactivity/impulsivity had statistically significantly lower cortisol levels than the control group 30 min after awakening. When cortisol values were plotted on a timeline, this subgroup always had lower cortisol concentrations than children in the control group. There was a significant correlation between CDAS scores and cortisol concentrations prior to the dental examination in both the ADHD and the control group. Behavioral expressions of anxiety in children with ADHD may be different from those in other children, not only due to the characteristics of their disorder, but also because of lower stress reactivity.

Attitudes to dental hygienists: evaluation of the Dental Hygienist Beliefs Survey in a Swedish population of patients and students

The aim was to evaluate and test the psychometric properties of the Dental Hygienist Beliefs Survey (DHBS) in a Swedish sample of different patient groups and students. It was hypothesized that negative dental hygienist beliefs would discriminate between fearful and non-fearful study groups. The DHBS was distributed together with the revised Dental Beliefs Survey (DBS-R) and the Dental Anxiety Scale (DAS). The study sample included 394 subjects (130 students, 144 general dental patients, 90 periodontal patients and 30 patients on a waiting list for dental fear treatment). The results verified that the DHBS discriminates well between dentally fearful and non-fearful study groups. The DHBS had high internal consistency (Cronbach's alpha = 0.96-0.98) in all the groups. The correlation between the DHBS and the DBS-R was high (rho = 0.82, P < 0.001). Furthermore, the DHBS correlated significantly with the DAS, as well as with a low but significant correlation to age (more negative attitudes in younger age groups) and gender (more negative attitudes amongst women). Regression analysis showed that gender and the DHBS items: 23, 16 and 28, i.e. items related to feeling helpless, worries/fears not being taken seriously and fear about 'bad news' possibly preventing treatment, were the most important predictors of dental fear. The results suggest that the DHBS may be a valid and reliable scale to use in order to assess patient's specific attitudes to dental hygienists. However, the psychometric properties including test-retest analysis and the underlying factor structure of the DHBS need to be further explored.

Factors that predict treatment choice and satisfaction with the decision in men with localized prostate cancer

PURPOSE

Men diagnosed with localized prostate cancer (LPC) often have the opportunity to participate in the treatment choice. The purpose of this study was to evaluate relationships between influential factors on treatment choice and the decision-related outcomes of decisional conflict and satisfaction.

PATIENTS AND METHODS

This report presents data from 260 men diagnosed with LPC who were identified by their clinicians as having a choice of treatments. Men completed questionnaires at home within 2 weeks of the informational clinic visit with the clinician, but before treatment. The respondent sample had a mean age of 63.2 years (standard deviation, 8.1 years); the majority were married/partnered (82.7%), working (51.5%), white (93.8%), and educated at the collegiate level (83.8%). Personal factors (information, influential people, and outcomes), treatment choice, and decisional conflict and satisfaction with the decision (SWD) were queried. Relationships between all variables and the outcomes, SWD, and treatment choice were explored using exhaustive chi(2) automatic interaction detector.

RESULTS

The strongest predictor partition variable for SWD was the subscale "factors contributing to uncertainty" (adjusted P < 0.0001) followed by the Trait Anxiety score (adjusted P = 0.0388). The strongest predictive partition for the actual treatment choice was age group (adjusted P < 0.0001), followed by interacting marital status (adjusted P = 0.0003), influence of the urologist (adjusted P = 0.0008), and use of the Internet (adjusted P = 0.0479). Men with LPC were more satisfied with their treatment choice when they reported fewer uncertainty factors; these are factors mainly relevant to information needed to understand the pros and cons and to make a decision. Consistent with this finding for treatment choice is the use of the Internet, though this factor interacted with age, the influence of their surgeon, and marital status.

CONCLUSION

This study suggests that personally meaningful information communicated between patients and clinicians is paramount.

Management of the Anxious Patient: What Treatments are Available?

Fear of the dentist is a common phenomenon. There are many ways of dealing with anxious patients and this review aims to present the most common methods available to general dental practitioners.

CLINICAL RELEVANCE

An ability to deal with anxious patients successfully is undoubtedly a practice builder. Anxious patients can be stressful to manage but they often become the most vocal advocates of dentists that they trust.

Predicting anxiety during dental treatment using patients'self-reports

BACKGROUND

Self-reported dental fear measures seldom are used in clinical practice to assess patients' fears. This study examined how well dental fear measures predicted anxious behaviors displayed during dental treatment.

METHODS

One hundred eight adult patients (54 percent female) in a periodontology clinic completed several paper-and-pencil demographic, dental fear and general anxiety measures before treatment. Dental practitioners, blinded to their patients' responses, rated their patients' anxiety during treatment on a series of 100-millimeter visual analog scales.

RESULTS

Higher Dental Fear Survey scores, younger age, more invasive treatment type and previous avoidance of dental care because of a bad experience all were predictive of greater observed anxiety. Neither self-reported nor observed anxiety was affected by previous experience with a particular practitioner or treatment.

CONCLUSIONS

Dentists may assess patients' anxiety quickly and accurately with the Dental Fear Survey or a similar measure, as well as by asking patients about their current dental attendance and previous dental experiences.