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Go Back       Himalayan Journal of Dental Science and Research | Volume:1 Issue:2 | July 30, 2022
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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



*Corresponding Author

Dr. Monika Parmar


Article History

Received: 10.07.2022

Accepted: 20.07.2022

Published: 30.07.2022


Abstract: Objectives: Dental students in their clinical training, face a higher risk of contracting the disease as well as experiencing adverse psychological outcomes. The present study was done with the objective to assess the effect of the coronavirus pandemic on the mental health of Dental Students of Himachal Pradesh Government Dental College Shimla. Methods: This cross sectional survey was conducted from January to February 2021 using Google forms among dental students of HPGDC Shimla. The questionnaire was circulated among the dental students for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 146 responses were collected. Information regarding their socio-demographic characteristics and GAD-7 scale and PHQ-9 scale for anxiety and depression were obtained. Data was analyzed using Epi info v7 software using appropriate statistical tests. Results: A total of 146 dental students participated in this survey. Among the total 34 (23.3%) were male while 112 (76.7%) were female, 131 (89.7%) were undergraduates while 15 (10.3%) were postgraduate residents. Mean age of the study participants were 21.82±1.804 years. 85 (58.2%) participants had minimal Anxiety, 49 (33.6%) had mild anxiety, 11 (7.5%) had moderate anxiety and 1 (0.7%) had severe anxiety. So, overall, 12 (8.2%) Participants met the diagnostic criteria for generalized anxiety disorder as per GAD-7 scores. 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, overall, 15 (10.3%) Participants met diagnostic criteria for major depressive disorder as per PHQ Scores. 101 (69.0%) reported that their overall mental health was impacted by the COVID-19 pandemic. There was no statistically significant difference in generalized anxiety disorders (GADs) according to Age groups, gender and study year grades. Similarly, 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 who were ≥ 20 years old. Conclusion: In conclusion, we found that poor mental health was common among surveyed dental trainees, which may have been exacerbated by fallout from the COVID-19 pandemic.


Keywords: COVID-19 lockdown, Mental Health, Depression, Anxiety, Dental Students, Himachal Pradesh.


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

GAD Score

Anxiety Grade

Frequency

Percent

Score 0-4

Minimal Anxiety

85

58.2

Score 5-9

Mild Anxiety

49

33.6

Score 10-14

Moderate Anxiety

11

7.5

Score greater than 15

Severe Anxiety

1

0.7

Total

146

100


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

PHQ Score

Depression Severity

Frequency

Percent

Score 0-4

None

88

60.3

Score 5-9

Mild Depression

43

29.5

Score 10-14

Moderate Depression

9

6.2

Score 15-19

Moderately Severe Depression

4

2.7

Score 20-27

Severe Depression

2

1.4

Total

146

100

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


GAD-7 Score

p Value

PHQ-9 Score

Total

P Value

<10

10

<10

10

Age Group

<20 years

n

35

6

0.097

33

8

41

0.032

%

85.4%

14.6%

80.5%

19.5%

100.0%

20 years

n

99

6

98

7

105

%

94.3%

5.7%

93.3%

6.7%

100.0%

Gender

Male

n

33

1

0.296

31

3

34

1.000

%

97.1%

2.9%

91.2%

8.8%

100.0%

Female

n

101

11

100

12

112

%

90.2%

9.8%

89.3%

10.7%

100.0%

Study Year Grade

Under graduates

n

119

12

0.613

117

14

131

1.000

%

90.8%

9.2%

89.3%

10.7%

100.0%

Post graduates

n

15

0

14

1

15

%

100.0%

0.0%

93.3%

6.7%

100.0%

Total

n

134

12


131

15

146


%

91.8%

8.2%

89.7%

10.3%

100.0%


DISCUSSION:

Dental schools are reported to be highly demanding and stressful learning environments. Living through a pandemic is an additional stress. Many surveys around the globe revealed psychological problems experienced by dental students during the COVID‐19 lockdown.12


In this study, we administered a survey to dental trainees at HPGDC Shimla to assess mental health during the COVID-19 pandemic. In the survey we found that poor self-reported mental health was prevalent among a few respondents and the COVID-19 pandemic is a likely contributor.


In the current survey we found that, overall, 12 (8.2%) Participants met the diagnostic criteria for generalized anxiety disorder as per GAD-7 scores and 15 (10.3%) Participants met diagnostic criteria for major depressive disorder as per PHQ Scores. There was no statistically significant difference in generalized anxiety disorders (GADs) according to Age groups, gender and study year grades. Similarly, 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 who were ≥20 years old.


It is important to note that individuals can experience distress and interference resulting from anxiety or depressive symptoms even if symptoms are not severe enough to meet diagnostic criteria for a psychiatric disorder. 101 (69.0%) reported that their overall mental health was impacted by the COVID-19 pandemic. Over 50% of participants had never used resources like counseling services or psychological care.


Our results complement previous cohort and repeated cross‐sectional studies of dental students of different countries during the COVID‐19 pandemic restrictions. Furthermore, they are in line with studies about quarantined general population in the current and previous pandemics, which showed psychological outcomes and long‐term consequences.12


Accessing resources can be a challenge for dental students with inflexible schedules, which reinforce the need to make such resources available outside of training hours and close in physical proximity to the College. Another approach to addressing unmet mental healthcare needs among dental trainees is to provide comprehensive wellness programming to all trainees. Such a process should include screening and referrals for clinical depression and anxietyand ensuring that students are engaged with school.


LIMITATIONS:

The sample size and duration of the study are restricted to 146 respondents and 2 months in time; thus, the scope and extent of the conducted research might be minimized. It’s a convenience sample through social media, which has its own limitations. Social media statistics are dynamic and can change according to its popularity and due to specific group of users being educated and having access to that information. Our sample may be biased toward healthier medical students, based on lower rates of anxiety and depression in our sample. This survey was conducted only in one dental college of India, and hence, these findings cannot be generalized all over India. Future work should focus on a larger, national representative sample population.


CONCLUSION:

In conclusion, we found that poor mental health was common among surveyed dental trainees, which may have been exacerbated by fallout from the COVID-19 pandemic. These findings support concerted efforts to promote wellness among dental trainees as a way to address unmet mental healthcare needs and prevent adverse outcomes associated with poor mental health. This survey highlights the need of providing support programs and implementing preventive measures to help dental students, particularly those who are most susceptible to higher levels of these psychological conditions.


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  3. Cawcutt KA, Starlin R, Rupp ME. Fighting fear in healthcare workers during the COVID-19 pandemic. Infection Control & Hospital Epidemiology. 2020 Oct;41(10):1192-3.

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  6. Consolo U, Bellini P, Bencivenni D, Iani C, Checchi V. Epidemiological aspects and psychological reactions to COVID-19 of dental practitioners in the Northern Italy Districts of Modena and Reggio Emilia. International journal of environmental research and public health. 2020 May;17(10):34-59.

  7. Alzahem AM, Van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH. Stress amongst dental students: a systematic review. European Journal of Dental Education. 2011 Feb;15(1):8-18.

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  9. Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic—United States, June 24–30, 2020. Morbidity and Mortality Weekly Report. 2020 Aug 8;69(32):1049-1057.

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