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CC BY 4.0 · Eur J Dent 2023; 17(04): 1221-1228
DOI: 10.1055/s-0042-1760299
Original Article

The Impact of the SARS-CoV-2 Pandemic on Stress and Anxiety of Dental Students

Andreas Zenthöfer
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
,
Andreas Graf
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
,
Peter Rammelsberg
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
,
Anna-Luisa Klotz
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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Abstract

Objectives To investigate the impact of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic on stress and anxiety of preclinical and clinical dental students.

Materials and Methods Dental students (participants) in their clinical course (CC; n = 64) or preclinical course (PCC; n = 53) were included in the study. The subjective perceived levels of stress and anxiety were evaluated using the Dental Environment Stress (DES) questionnaire and the Depression, Anxiety and Stress Scales (DASS) questionnaire. Cortisol levels were measured in saliva samples collected from participants. Knowledge of the pandemic was evaluated using a 100-mm visual analog scale. All data were collected twice: once during the university holidays and once during term time.

Statistical Analysis Results from DES, DASS, and salivary cortisol tests were compared between baseline and follow-up using descriptive and bivariate statistics. Multivariate linear regression models were computed with DES, DASS, and cortisol values as dependent variables to analyze possible influencing factors.

Results Participants showed medium levels of stress and anxiety at baseline and follow-up. The DASS score in the “anxiety” subdomain was significantly higher in the PCC group than in the CC group at baseline (p < 0.001) and increased during term time. DASS scores in the “stress” subdomain also increased during term time. However, both subdomain scores were lower than the cutoff value for a psychological disorder. The mean total DES scores were 615.9 ± 97.7 in the CC group and 580.40 ± 98.9 in the PCC group. These scores indicated medium stress levels and were not significantly different between the groups, nor did they change during the study period. Mean saliva cortisol levels were higher in the CC group (9.2 ± 5.2) than in the PCC group (4.9 ± 2.2) at baseline (p < 0.001) but converged by follow-up. Multivariate regression models showed that intraindividual perception of stress at baseline was consistently the most important aspect for changes in stress and anxiety levels during term time. The SARS-CoV-2 pandemic affected stress and anxiety levels in some participants, but this was not ubiquitous.

Conclusion Intraindividual differences in stress perception seem to be more relevant than course affiliation (preclinical or clinical) or the SARS-CoV-2 pandemic to stress and anxiety levels in dental students.

Keywords

stress - dentistry students - COVID-19

Authors' Contribution

A.Z. conceived the idea, performed statistical analysis and was involved in writing the manuscript. P.R. conceived the idea and reviewed the manuscript. A.G. assessed data and reviewed the manuscript. A.-L.K. conceived the idea, supervised data assessment and was involved in writing the manuscript.


Ethics and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.




Publication History

Article published online:
05 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Kay EJ, Lowe JC. A survey of stress levels, self-perceived health and health-related behaviours of UK dental practitioners in 2005. Br Dent J 2008; 204 (11) E19 , discussion 622–623
    CrossrefPubMedGoogle Scholar
  • 2 Atkinson JM, Millar K, Kay EJ, Blinkhorn AS. Stress in dental practice. Dent Update 1991; 18 (02) 60-64
    PubMedGoogle Scholar
  • 3 Langade D, Modi PD, Sidhwa YF. et al. Burnout syndrome among medical practitioners across India: a questionnaire-based survey. Cureus 2016; 8 (09) e771
    PubMedGoogle Scholar
  • 4 Wexler M. Mental health and dental education. J Dent Educ 1978; 42 (02) 74-77
    CrossrefPubMedGoogle Scholar
  • 5 Grandy TG, Westerman GH, Lupo JV, Combs CG. Stress symptoms among third-year dental students. J Dent Educ 1988; 52 (05) 245-249
    CrossrefPubMedGoogle Scholar
  • 6 Newbury-Birch D, Lowry RJ, Kamali F. The changing patterns of drinking, illicit drug use, stress, anxiety and depression in dental students in a UK dental school: a longitudinal study. Br Dent J 2002; 192 (11) 646-649
    CrossrefPubMedGoogle Scholar
  • 7 Polychronopoulou A, Divaris K. A longitudinal study of Greek dental students' perceived sources of stress. J Dent Educ 2010; 74 (05) 524-530
    CrossrefPubMedGoogle Scholar
  • 8 Kumar S, Dagli RJ, Mathur A, Jain M, Prabu D, Kulkarni S. Perceived sources of stress amongst Indian dental students. Eur J Dent Educ 2009; 13 (01) 39-45
    CrossrefPubMedGoogle Scholar
  • 9 Humphris G, Blinkhorn A, Freeman R. et al. Psychological stress in undergraduate dental students: baseline results from seven European dental schools. Eur J Dent Educ 2002; 6 (01) 22-29
    CrossrefPubMedGoogle Scholar
  • 10 Elani HW, Allison PJ, Kumar RA, Mancini L, Lambrou A, Bedos C. A systematic review of stress in dental students. J Dent Educ 2014; 78 (02) 226-242
    CrossrefPubMedGoogle Scholar
  • 11 Hoad-Reddick G, Macfarlane TV, Gibson VM. Relating personality to interview results and performance in the first year of the dental course. Br Dent J 1999; 186 (07) 348-352
    CrossrefPubMedGoogle Scholar
  • 12 Alzahem AM, Van der Molen HT, Alaujan AH, De Boer BJ. Stress management in dental students: a systematic review. Adv Med Educ Pract 2014; 5: 167-176
    CrossrefPubMedGoogle Scholar
  • 13 Alzahem AM, van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH. Stress amongst dental students: a systematic review. Eur J Dent Educ 2011; 15 (01) 8-18
    CrossrefPubMedGoogle Scholar
  • 14 Freeman RE. Dental students as operators: emotional reactions. Med Educ 1985; 19 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 15 Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK. Stress management for dental students performing their first pediatric restorative procedure. J Dent Educ 2003; 67 (05) 542-548
    CrossrefPubMedGoogle Scholar
  • 16 Pöhlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ 2005; 9 (02) 78-84
    CrossrefPubMedGoogle Scholar
  • 17 Al-Omari WM. Perceived sources of stress within a dental educational environment. J Contemp Dent Pract 2005; 6 (04) 64-74
    CrossrefPubMedGoogle Scholar
  • 18 Heymann DL, Shindo N. WHO Scientific and Technical Advisory Group for Infectious Hazards. COVID-19: what is next for public health?. Lancet 2020; 395: 542-545
    CrossrefPubMedGoogle Scholar
  • 19 Gómez-Ochoa SA, Franco OH, Rojas LZ. et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol 2021; 190 (01) 161-175
    CrossrefPubMedGoogle Scholar
  • 20 Modi PD, Nair G, Uppe A. et al. COVID-19 awareness among healthcare students and professionals in Mumbai Metropolitan Region: a questionnaire-based survey. Cureus 2020; 12 (04) e7514
    PubMedGoogle Scholar
  • 21 Garbee Jr WH, Zucker SB, Selby GR. Perceived sources of stress among dental students. J Am Dent Assoc 1980; 100 (06) 853-857
    CrossrefPubMedGoogle Scholar
  • 22 Zenthöfer A, Graf A, Büsch C, Rammelsberg P, Klotz AL. Adapting the German version of the dental environment stress questionnaire. Eur J Dent Educ 2023; 27 (03) 497-504 DOI: 10.1111/eje.12833.
    CrossrefPubMedGoogle Scholar
  • 23 Nilges P, Essau C. Depression, anxiety and stress scales: DASS—a screening procedure not only for pain patients [in German]. Schmerz 2015; 29 (06) 649-657
    CrossrefPubMedGoogle Scholar
  • 24 Saraswathi I, Saikarthik J, Senthil Kumar K, Madhan Srinivasan K, Ardhanaari M, Gunapriya R. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study. PeerJ 2020; 8: e10164
    CrossrefPubMedGoogle Scholar
  • 25 Hakami Z, Khanagar SB, Vishwanathaiah S. et al. Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: a nationwide study. J Dent Educ 2021; 85 (04) 494-503
    CrossrefPubMedGoogle Scholar
  • 26 Pani SC, Al Askar AM, Al Mohrij SI, Al Ohali TA. Evaluation of stress in final-year Saudi dental students using salivary cortisol as a biomarker. J Dent Educ 2011; 75 (03) 377-384
    CrossrefPubMedGoogle Scholar
  • 27 Rodríguez-Hidalgo AJ, Pantaleón Y, Dios I, Falla D. Fear of COVID-19, stress, and anxiety in university undergraduate students: a predictive model for depression. Front Psychol 2020; 11: 591797
    CrossrefPubMedGoogle Scholar
  • 28 Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology 1994; 19 (04) 313-333
    CrossrefPubMedGoogle Scholar
  • 29 Navazesh M, Kumar SK. University of Southern California School of Dentistry. Measuring salivary flow: challenges and opportunities. J Am Dent Assoc 2008; 139 (Suppl): 35S-40S
    CrossrefPubMedGoogle Scholar
  • 30 Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology 2009; 34 (02) 163-171
    CrossrefPubMedGoogle Scholar
  • 31 Laudat MH, Cerdas S, Fournier C, Guiban D, Guilhaume B, Luton JP. Salivary cortisol measurement: a practical approach to assess pituitary-adrenal function. J Clin Endocrinol Metab 1988; 66 (02) 343-348
    CrossrefPubMedGoogle Scholar
  • 32 Lovibond SH, Lovibond PF. Manual for the Depression Anxiety & Stress Scales. 2nd ed.. Sydney: Psychology Foundation; 1995
    Google Scholar