Effects of COVID-19 Lockdown on the Mental Health of Dental Students at Himachal Pradesh Government Dental College Shimla

Dr. Monika Parmar¹, Dr. Amit Sachdeva², Dr. Ashu Gupta³, Dr. Anupriya Sharma⁴ and Dr. Manish Sahore⁵

¹Dr. Monika Parmar, Professor, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India

²Dr. Amit Sachdeva, Assistant Professor, Department of Community Medicine, IGMC, Shimla, Himachal Pradesh, India

³Dr. Ashu Gupta, Principal, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India

⁴Dr. Anupriya Sharma, Assistant Professor, Tanda Medical College, Himachal Pradesh, India

⁵Dr. Manish Sahore, Assistant Professor, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India

INTRODUCTION

Since the beginning of January 2020, COVID-19, a new contagious disease, has been threatening the health and welfare of humans globally. The viral pandemic was first defined in the Chinese city of Wuhan and was able to spread internationally in a few months. This rapid disease transmission with growing numbers of infected cases and associated critical health conditions or fatalities led to noticeable public anxiety and panic.Early studies examining immediate psychological impacts during the COVID-19 wave of infection described moderate or severe psychological effects of the outbreak on the general population¹.

In addition to the psychological effects of the pandemic on the general population, healthcare workers are exposed to additional psychological difficulties due to their direct treatment of infected patients and the accompanying, increased risk of infection. These include the fear of transmitting the disease to their families or loved ones, feeling discriminated against or rejected by society as potential carriers of the virus, as well as heavy workloads and time pressure, despite depleted personnel protection equipment.^2-5

Among all healthcare workers, the COVID-19 outbreak also negatively obstructed the activities of the dental profession. The dental student training experience increases one’s risk for poor mental health, as exemplified by the high levels of stress, anxiety, and depression reported by dental students. Sources of stress include exams, grades, workload, competition, poor mental health can lead to adverse outcomes during dental school. The COVID-19 pandemic has exacerbated mental health problems among young adults and especially for 18- to 24-year-olds, the age group to which most dental trainees belong. A large body of literature examining stress in undergraduate dental students has revealed a significant increase in stress that intensifies with students’ year of study.^6-9

The World Health Organization defines depression as "a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite and feelings of tiredness and poor concentration. It can be long-lasting or recurrent, substantially impairing a person’s ability to function at work, school or cope with daily life. Despite their interrelationship, anxiety and depression in dental students have not been explored as frequently as stress.¹⁰

A study of mental health of dental trainees may be particularly worthwhile for determining the impact of the COVID-19 pandemic on trainee mental health and other related outcomes especially in the context of growing concerns about dental student wellness. In this study, estimate the prevalence of mental health problems and the extent to which poor mental health and the COVID-19 pandemic are related. Ultimately, this knowledge can be used to inform the development of relevant dental trainee wellness interventions – perhaps on a national scale – aimed at addressing unmet mental health needs, mitigating the psychological effects of the COVID-19 pandemic.¹¹

OBJECTIVES OF THE STUDY:

To assess the effect of the coronavirus pandemic on the mental health of Dental Students of Himachal Pradesh Government Dental College Shimla

RESEARCH METHODOLOGY:

• Research Approach: Analytic.

• Research Design: Cross-sectional survey design.

• Study Area: Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India.

• Study Duration: Between January to February 2021.

• Study Population:

All Undergraduate and Post Graduate Dental students of Himachal Pradesh Government Dental College, Shimla

• Sample Size:

146 Dental students assuming 20% had some form of mental health problems, 5% absolute error, 95% confidence level, and 5% non-response rate.

• Sampling Technique: Convenience sampling technique.

• Study Tool:

A Google form questionnaire consisting of questions regarding socio-demography, GAD-7 scale and PHQ-9 scale for anxiety and depression was created. The questionnaire was initially pre-tested on a small number of people to identify any difficulty in understanding by the respondents.

• Description of Tool:

• Demographic Data Survey Instrument:

The demographic form elicited information on participants’ background: age, gender, education and many more.

• Questionnaire:

• Anxiety was assessed with the 7-item Generalized Anxiety Disorder scale (GAD-7), which maps to the diagnostic criteria for generalized anxiety disorder. Each item was scored from 0 (not at all) to 3 (nearly every day) and a total score was calculated by summing item scores. We used the standard threshold of a total score of 10 or greater to classify individuals as likely meeting the criteria for generalized anxiety disorder.

• Depression was assessed with the 9-item Patient Health Questionnaire (PHQ-9), which maps to the diagnostic criteria for major depressive disorder (major depression).PHQ-9 scores are calculated like GAD-7 scores. Using the standard threshold, a PHQ-9 total score of 10 or greater was classified as suggestive of major depressive disorder.

• We created a new item on social support, “Do you ever feel alone or isolated from your peers?” (no/yes), and assessed use of a professional support system by asking respondents to select from a newly-created checklist of resources which they had used while at the college (e. g., counseling and treatment services).

• Validity of Tool: By the experts in this field.

• Inclusive Criteria: Who were willing to participate in the study.

• Exclusion Criteria: Who were not willing to participate in the study.

• Data Collection:

Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin among the dental students till the 146 responses were collected. Responses were then recorded in a Google Excel spreadsheet.

• Data Analysis:

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical tests.

• Ethical Considerations: Participants confidentiality and anonymity was maintained.

RESULTS:

A total of 146 dental students of Himachal Pradesh Government Dental College Shimla participated in this survey. Among the total 34 (23.3%) were male dental students while 112 (76.7%) were female dental students. 41 (28.1) dental students were aged less than 20 years, 78 (53.4%) were aged between 21-23 years while 27 (18.5%) were aged above 23 years. Mean age of the study participants were 21.82±1.804 years. Among these, 26 (17.8 %) were of first year, 45 (30.8%) were of second year, 37 (25.3%) were of third year, 23 (15.8%) were of fourth year and 15 (10.3%) were postgraduate residents (Figure-1).

Image is available at PDF file

Figure 1: Socio-demographic Characteristics of study participants

In this survey we found that 85 (58.2%) had minimal Anxiety, 49 (33.6 %) participants had mild anxiety, 11 (7.5%) had moderate anxiety and 1 (0.7 %) had severe anxiety. So, among the total, 12 (8.2%) Participants had GAD-7 scores suggesting that they met diagnostic criteria for generalized anxiety disorder (Table-1).

Table 1: GAD Scores and grading among Study Participants

On our PHQ findings, we found that 88 (60.3 %) participants had no depression, 43 (29.5%) had mild depression, 9 (6.2%) had moderate depression, 4 (2.7%) had moderately severe depression and 2 (1.4 %) had severe depression. So, among the total, 15 (10.3%) Participants had PHQ scores suggesting that they met diagnostic criteria for major depressive disorder (Table-2).

Table 2: PHQ Scores and grading among Study Participants

Among the total 146 study participants, 101 (69.0%) reported that their overall mental health was impacted by the COVID-19 pandemic.

In the present study, generalized anxiety disorder (GAD) was found in 6 (14.6%) of dental students aged <20 years and 6 (5.7%) of dental students aged ≥20 years. GAD was found in 1 (2.9%) of male dental students and 11 (9.8%) of female dental students. GAD was found in 12 (9.2%) of Undergraduate dental students and none of the postgraduate dental students. There was no statistically significant difference in generalized anxiety disorders (GADs) according to Age groups, gender and study year grades (Table-4).

In the present stud, Major depressive disorder (MDD) was found in 8 (19.5%) of dental students aged <20 years and 7 (6.7%) of dental students aged ≥20 years. MDD was found in 3 (8.8%) of male dental students and 12 (10.7%) of female dental students. MDD was found in 14 (10.7%) of Undergraduate dental students and 1 (6.7%) of postgraduate dental students. There was no statistically significant difference in Major depressive disorder (MDD) according to gender and study year grades but it was significantly more in dental students <20 years old as compared to dental students who were ≥20 years old (Table-3).

Table 3: Uni-variate analysis of Generalized Anxiety Disorder (GAD) & Major Depressive Disorder (MDD) according to socio-demographic variables