Psychological stress in undergraduate dental students: baseline results from seven European dental schools

OBJECTIVES: To determine the degree of psychological distress, the experience of emotional exhaustion, and the extent of stress associated with course work in dental students and to compare these measurements among seven European dental schools. DESIGN: Multi-centred survey. SETTING: Dental Schools at Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool and Manchester. PARTICIPANTS: 333 undergraduate first-year dental students. MEASURES: General Health Questionnaire (GHQ12), Maslach Burnout Inventory (MBI), Dental Environment Stress Questionnaire (DES), demographic variables. PROCEDURE: Questionnaire administered to all students attending first year course. Completed questionnaires sent to central office for processing. RESULTS: Seventy-nine percent of the sampled students responded. Over a third of the students (36%) reported significant psychological distress (morbidity) at the recommended cut-off point (>3 on GHQ). These scores were similar to those reported for medical undergraduates. Twenty-two percent recorded comparatively high scores on emotional exhaustion. A wide variation in these 2 measurements was found across schools (p's<0.001). Stress levels indicated by the DES were less variable (p>0.5). Some evidence showed that contact with patients and the level of support afforded by living at home may be protective. CONCLUSION: Higher than expected levels of emotional exhaustion were found in a large sample of first-year undergraduate dental students in Europe.     

Burnout,depression and suicidal ideation in dental students

Objectives: To investigate the prevalence, gender influence, and relationships between burnout, depression and suicidal ideation within the last year among second, fourth and fifth-year dental students. Study Design: A cross-sectional study was carried out in 212 dental students enrolled in the second, fourth and fifth years at the School of Dentistry of Seville using the Maslach Burnout Inventory-Student Survey and the MBI-Human Services Survey, the “Patient Health Questionnaire-2”, and the “Questions about Suicidal Ideation and Attempted Suicide”. Results: The response rate among dental students was 80%. Burnout prevalence in dental students was higher in second and fourth years than in fifth year (p= 0.059 and p= 0.003, respectively). Depression prevalence in the fourth year approached significance (p= 0.051). Prevalence of suicidal ideation within the past year was higher, yet not reaching significance, in fourth year. No gender-related differences were found. A significant association was observed between burnout and depression, and between depression and suicidal ideation (p< 0.001), but no association was found between burnout and suicidal ideation. Conclusions: This study has brought our attention to the high prevalence of burnout and depression, and reported for the first time the prevalence of suicidal ideation among dental students in preclinical and clinical years. Key words:Burnout, depression, suicidal ideation, dental students.     

Stress, burnout and health in the clinical period of dental education

The study examined the extent of stress, burnout and health problems experienced by fourth and fifth year dental students from the three universities of Dresden, Freiburg and Bern. The objectives of the study were to: (i) identify frequent sources of stress and to report the prevalence rates of burnout and health problems in dental students, (ii) determine the rate of students suffering from severe burnout symptoms and (iii) identify stress factors related to the burnout symptoms of emotional exhaustion and depersonalization. A total of 161 dental students from Dresden, Freiburg and Bern participated in the study. They completed the Psychosocial Stress Inventory, the Maslach Burnout Inventory and the Health Survey Questionnaire. Frequent sources of stress were limitation of leisure time, examination anxiety and the transition stress that was related to the adaptation to the demands of the clinical phase of dental education. Few differences existed between the students of the fourth and the fifth study year. Study-related stress was lowest in Bern and considerably higher in Dresden. Differences of mean levels of burnout symptoms were found only for the burnout dimension of emotional exhaustion. Students from Dresden and Freiburg were more emotionally exhausted than students from Bern, students from Dresden also reported more health problems than students from Bern or Freiburg. Ten per cent of the dental students suffered from severe emotional exhaustion, 17% complained about a severe lack of accomplishment and 28% reported severe depersonalization symptoms. Forty-four per cent of the variance of emotional exhaustion was explained by study-related factors such as lack of leisure time, examination anxiety and transition stress. The only predictor of depersonalization was a lack of social integration, accounting for 3% of the variance. A lack of social integration may be an indicator of low social competence which may cause difficulties in dealing with patients adequately and therefore result in depersonalization. The results indicate a need to identify the group of students who may have insufficient social skills for dealing adequately with the patients, and to train them accordingly.     

Psychological well-being and perceptions of stress amongst Japanese dental students

The purpose of this study was to investigate the relationship between Psychological General Well Being (PGWB) and perceived sources of stress amongst dental students in Japan. Second to sixth year dental students of Tokyo Medical and Dental University were invited to participate in the questionnaire survey. The questionnaire collected information on demographic and social background, lifestyle behaviours, the PGWB index and the Dental Environment Stress (DES) questionnaire. A total of 320 students (56% male) participated, with a response rate of 91%. Male students had significantly higher PGWB scores and lower DES scores than female students (P < 0.05). There were no significant differences in the year of study for DES mean score and PGWB total score. Students whose first choice of admission was dentistry experienced less stress than those whose first choice was another discipline (P < 0.05). Students who regularly exercised showed significantly lower stress levels and higher well-being status than those students who did not exercise (P < 0.01). Correlational analysis showed an inverse relationship between PGWB and DES scores (r = -0.544, P < 0.001). Multiple regression analysis revealed that DES mean score was significantly related to gender, first choice of admission and PGWB total score. It is suggested that perception of stress amongst Japanese dental students is influenced by gender, dentistry as first choice for admission and students' general well-being.     

The evaluation of perceived sources of stress and stress levels among Turkish dental students

Objective : The purpose of this study was to identify sources of stress and to evaluate stress levels among Turkish dental students and also to investigate the role of year of study and gender on perceived stressors. Methods : This study included 308 dental students. Dental Environment Stress (DES) questionnaire, Beck Depression Inventory (BDI) and Spielberger State Trait Anxiety Inventory (STAI) were used to collect data. Also, some factors considered to be effective on stress levels of dental students were questioned. Data were statistically analysed with Kruskal Wallis and Mann Whitney U tests. Results : The most stress provoking factors were fear of failing the year, completion of clinical requirements and amount of assigned work. Statistically significant differences were found between years of study and gender for many stressors. There was statistically significant difference between years of study and gender for mean DES scores but no statistically significant differences were found between years of study for mean BDI, STAI scores. There was statistically significant difference between genders for STAI‐1. Choice rank of dental school has affected stress levels of dental students. Conclusion : This study showed that perceived sources of stress of clinical students were very similar and stress levels of these students were lower than preclinical students, also gender was effective on stressors and stress levels.     

Perceived sources of stress in Nigerian dental students

The objective of this study was to identify sources of stress among dental students at the University of Lagos, Lagos, Nigeria. A modified Dental Environment Stress (DES) questionnaire was used to study the 137 students in years 3-6, of which 105 (76.6%) responded. Results show that the year 5 students indicated the highest level of stress overall on items relating to pre-clinical training with 21 (70%) recording aggregate DES score over the cut-off point for high stress. For clinical items, nearly all the students - 27(90%) of year 5 and 24 (100%) of year 6 recorded aggregates over the cut-off point. The most important stressors were those related to the lack of provision of a well-supported system of dental education in Nigeria in terms of availability of materials for clinical training and study materials. There were no significant differences in stress perception between genders. However, students who chose Medicine as their first choice for admission with Dentistry as an alternative experienced significantly higher overall mean and higher mean scores for most items. In conclusion, it appears there is a need to improve support for dental education in Nigeria.     

Work stress and burnout among dental hygienists

Objectives: The aim of this study was to describe the factors associated with work stress and burnout among dental hygienists. Furthermore, how to deal with work stressors in order to prevent burnout in the dental hygienist work environment will be discussed. Methods: From a small literature search, only a few empirical studies could be traced that describe work stress or burnout among dental hygienists. Results: Burnout incidence among dental hygienists appears to be relatively favourable, when compared with other professions, according to a 20‐year‐old study. On the contrary, in a recent study, it was described that one out of eight dental hygienists felt emotionally exhausted from work. Dental hygienists, when compared with other professionals, are relatively negative about the variety of tasks they find in their work. Factors associated with experienced work stress are, according to another study, musculoskeletal pain, combining work and private life, highly efficient organization of work, long working hours, working without assistant, difficult or demanding patients, lack of leisure time, lack of support by practice management and doubts about one's own capabilities. Some factors that may prevent burnout are: recognition of one's own work pressure, learning to unwind, time management and organization of work, realistic career expectancies, social skills, healthy life‐style, peer‐group contacts and pre‐graduate reflection. Conclusions: There appears to be a lack of recent data on burnout among dental hygienists. Although some knowledge exists on work stressors, a thorough investigation on burnout incidence, risk factors, as well as job resources is needed.     

Understanding dental students' knowledge and perceptions of older people: toward a new model of geriatric dental education

Increasing numbers of older people and the decreasing rates of edentulism highlight the importance of dental education that focuses on oral health and aging. This evaluation study assessed dental students' knowledge and beliefs about older people as well as their awareness of the biopsychosocial concerns that are potential barriers to oral health care. Dental students' (N=202) knowledge and perceptions of older people were evaluated before and after the first year of a new educational program. Students completed the Palmore Facts on Aging Quiz II (FAQ II) and answered questions about health problems and social concerns that may influence patient care. The intervention was twofold: 1) the CARES (Counseling, Advocacy, Referral, Education, and Service) Program, a clinical collaboration between the schools of Dental Medicine and Social Work, was initiated; and 2) all students were exposed to geriatric educational interventions. FAQ II scores did not significantly change, but dental students' awareness of mental health, independence, and social concerns increased between Times 1 and 2. The results of the study suggest that positive interactions with older adults by health care providers may depend more on positive perceptions toward older people than increased knowledge about aging. Future research will focus on positive experiences with older adults and attitudes of dental students toward the elderly.     

Effect of perceived stress on student performance in dental school

A commonly held view is that chronic stress has an adverse affect on academic performance. Because dental students typically report high levels of stress, they may be at particular risk. This research examined the relationship between perceived stress and academic performance in 202 dental students enrolled in an Australian dental school. In this study, four key stress factors labelled "self-efficacy beliefs," "faculty and administration," "workload," and "performance pressure" previously identified by our group from principal components analysis of the Dental Environment Stress (DES) questionnaire, together with gender, ethnicity, and stage of course, were entered as independent variables into multiple regression analyses. Three measures of academic performance (basic and applied science knowledge, clinical competency, and contextual understanding) were entered as dependent variables. Regression analysis revealed little support for the assumption that chronic stress predicted academic performance. The only finding of note was that students reporting higher levels of stress on the DES factor "faculty and administration" tended to show lower grades for clinical competency and contextual understanding. In summary, although the DES factor solution used in the present study remains to be validated, we found little support for an association between increased DES factor stress scores and reduced academic performance in dental students.     

Perceived sources of stress within a dental educational environment

The aim of this study was to identify the perceived sources of stress among dental students, dental hygiene students, and dental technology students enrolled at Jordan University of Science and Technology (JUST). The modified dental environment stress questionnaire was administered to 183 students. The perceived stressors varied between major and year. Dental students gave high scores for examinations, reduced holidays, inadequate time for relaxation, fear of failure, completing clinical requirements, and differences in opinion between staff. Dental hygiene students gave the highest scores for uncertainty about the field of study as future career, examinations, inadequate clinical training and supervision, inadequate relaxation, and discrimination between students. Dental technology students also gave high scores for uncertainty about future career, examinations, approachability of the staff, inadequate relaxation, and completing requirements. Females are more stressed than males with regard to personal factors. Dental technology and/or dental hygiene students have significantly higher scores than dental students in 12 items. Students who reported their first choice of study was not their current field of study showed more stress concerning their future careers. The high scores reported for some stressors among students emphasize the need to address student's concerns.     

Academic distress,perceived stress and coping strategies among dental students in Saudi Arabia

ObjectivesTo evaluate the sources of stress among students in the dental school environment, their perceived levels of stress and effective coping strategies.MethodsThis study was conducted during the first semester of the academic year, 2009–10, at the College of Dentistry, King Saud University, Saudi Arabia. The eligible study group consisted of 556 undergraduate dental students from all five class years; they were surveyed with a detailed assessment tool. The validated and translated questionnaire comprised the modified version of the dental environmental stress (DES) survey, the perceived stress scale (PSS) and the brief coping scale (BCS).ResultsThe overall findings substantiated with multiple regression indicate that, out of 20 factors of both DES and BC instruments, six factors were significantly and independently related to perceived stress scores (F = 34.638; p < 0.0001). Especially, the factors self-efficacy and workload of DES and the factors behavioral disengagement, denial, positive reframing and venting of BC were positively and independently related to perceived stress scores.ConclusionsDental students displayed relatively high perceived stress scores. Female, advanced and married, compared with male, junior and single students reported more stress. Changes in certain environmental factors and coping strategies independently affected the perceived stress score. Strategies for stress management must be incorporated into dental education to ensure the output of effective dentists.     

Perceived sources of stress amongst Indian dental students

Introduction:  Dental students have to face the additional stress of their studies in addition to the stresses related to dentistry as a profession. Furthermore, increasing stress may result in declining student performance. The aim of the present study was to assess perceived sources of stress amongst dental undergraduate students at a private dental institution in India.
Materials and methods:  A modified dental environment stress (DES) questionnaire which consisted of 38 questions was used to assess the levels of stress.
Results:  The first major stressor for all the students was examination and grades with a mean score of 2.86 (SD 1.06) followed by full working day, receiving criticism from supervisors about academic or clinical work, amount of cheating in dental faculty, rules and regulations of the faculty and fear of unemployment after graduation. Amongst the six highest stressors in each year, at least three were dental faculty related. There was a significant difference in stress perception between genders with a predilection for males. Twelve of the 38 questionnaire items had significant differences across the year groups including clinical DES items.
Conclusion:  The primary sources of stress as perceived by nearly 275 students at one private dental school in India were examinations and grades followed by full working day and receiving criticism from supervisors about academic or clinical work. It appears there is a need for the establishment of student advisors and counsellors combined with a faculty advising system in addition to student-oriented programmes.     

Burnout,depression and suicidal ideation in dental and dental hygiene students

Introduction

The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study.

Subjects and methods

Third‐ and fourth‐year dental (DS) and first‐ and second‐year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ‐9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi‐square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted.

Results

A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut‐off for moderate depressive symptoms, but there were no statistical differences between the third‐ and fourth‐year dental and the first‐ and second‐year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut‐off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout.

Discussion

These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.     

Oral self-care behavior among dental school students in Greece

The purpose of this study was to determine the oral health attitudes/behavior of Greek dental students. The subjects (n = 539) were officially registered students at the University of Athens Dental School. Their oral health behavior was assessed with the use of a 12-graded-item questionnaire. A significant increase per year of study was observed in the number of students reporting careful brushing of the teeth [OR: 1.1 (1.0-1.3)] and being able to clean their teeth well without the use of toothpaste [OR: 2.5 (2.0-3.1)]. Each year of education significantly increased the probability of disagreement with statements such as: "I think my teeth are getting worse despite my daily brushing" [OR: 1.5 (1.2-1.9)], "It is impossible to prevent gum disease with tooth-brushing alone" [OR: 1.3 (1.1-1.5)], and "I put off going to the dentist until I have a toothache" [OR: 1.3 (1.2-1.6)]. Examination of the summary questionnaire score revealed that females presented significantly higher total scores. All scores increased significantly in the fourth and fifth years of dental studies. During the years of university study, the score variation and favorable attitudes/ behavior toward oral health appear to reflect the variation in the students' educational training experience.     

Effect of professional training on dental health attitudes of Israeli dental students

Few studies have been published regarding the importance of oral hygiene education for dental students and little is known about the influence of dental education in dental schools on students' attitudes to the subject. The objective of the present research was to examine the changes that occur in the attitudes of Israeli dental students toward their dental health during the course of their professional training. The research was based on a questionnaire developed at The Hiroshima University, Japan (The Hiroshima University Dental Behavioral Inventory, HU-DBI), and provides a quantitative estimate of the students' attitudes to their dental health. Similar studies have been carried out in several countries (Japan, Australia, Indonesia and Finland). This study was performed on students from the two dental schools in Israel, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University and The Faculty of Dental Medicine at Hebrew University, Jerusalem. Students from all six academic years (1st-6th) were requested to complete the questionnaire within two months, from the beginning of the academic year that started in October 1999. While no significant differences could be detected in the students' attitudes with regard to the dental school of their origin, female students (from both schools) showed a significantly better attitude than their male colleagues throughout the years. Results showed a significant improvement in the students' attitudes through the years of their professional training, especially between the 1st year and the clinical years (5th and 6th) of their studies. This can be related to the teaching curricula in the dental schools in Israel that emphasizes clinical issues in the two last years of study. When comparing the results of this study to similar ones that were conducted in other parts of the world, certain differences become apparent. In spite of the gradual improvement in the Israeli students' attitudes during the course of their studies, their initial attitudes (1st year) as well as their final attitudes (6th year), were the lowest compared to their colleagues from other countries (Japanese, Australian and Finnish students). Apparently, the improvement in the Israeli students' attitudes is not satisfying and a higher level of improvement should be expected. The attitudes of the Israeli students should be further improved by means of comprehensive programs that emphasize the importance of personal oral hygiene and dental health. Hopefully this will enable future improvement in the dental health of their patients, as well as improvement in the community dental health in Israel, in general.     

First year enrollment of Canadians in North American dental schools

Data is presented relating to the number of students admitted to the first year classes of Canadian dental schools for the period 1974 through 1988 and projections for 1989. Additional data showing the number of non-Canadians in Canadian dental schools and the number of Canadians enrolled in the first year of United States dental schools is included. The study concludes that the number of Canadians in North American dental schools has not decreased but has actually increased over the last five years. Also, since there is a significant number of Canadians studying dentistry in the United States, there will probably be increased pressure to change the policies of the National Dental Examining Board of Canada presuming that these Canadians will return home. Further data is presented which leads to the conclusion that the proportion of admitted students who graduate as dentists has remained fairly constant over the study period.     

The evolution of dental health in dental students at the University of Barcelona

The aim of this research was to study the evolution of dental health of dental students during their academic training and to assess the extent to which the knowledge acquired was reflected in their own dental care. A sample of 107 students at the schools of dentistry and medicine (the latter as a comparison group) of the University of Barcelona, Spain, underwent an oral examination and completed a questionnaire during their training in the third and fifth academic years. The oral examinations were limited to the status of teeth. Bitewing radiographs were used for both posterior sectors, and these were interpreted using the criteria proposed by Pitts (1984). The data were analyzed using the SPSS package. At the end of the study, medical students had more teeth present than dental students (29.80 vs. 28.94 [p = 0.022]) and a lower DMFT index of 4.33 vs. 5.91 (p=0.038), with an FT component of 2.44 and 5.23 (p = 0.011), respectively. All dental students underwent more treatment of all types than medical students, and dental health habits and knowledge were superior in dental students. The third year was the key year for decision making with regard to the student's dental health. We conclude that dental students are highly motivated about maintaining their dental health and their dental education experiences appear to have had a clear influence on this behavior.     

Preventive practice of Mongolian dental students

To investigate the preventive practice of Mongolian dental students, in relation to their knowledge of preventive care, self-perceived competency, oral self-care, and dental health status, a questionnaire was distributed to all (n = 79) clinical-year students of The Dental School of the Mongolian National Medical University. Dental students' reported preventive practice was explained by their knowledge of preventive care (P = 0.002) and self-perceived competency (P = 0.002), whereas their study-year, oral self-care, and dental health status, expressed as the Tissue Health Index (THI), remained statistically non-significant in the linear regression model. This explained 28% of the variation in the parameters examined. In logistic regression analysis, a student's study year (OR = 2.5), knowledge of preventive care (OR = 1.1), and THI (OR = 1.8) were related to their highest scores on preventive practice. Preventive practice among Mongolian dental students could be improved by increasing their knowledge, particularly in modern methods for caries-prevention such as fluoride, sealants, and xylitol. Preventive methods should be integrated into all topics of the dental curriculum and the learning environment should support such training for future oral health professionals.