Dental Students in Germany throughout the COVID-19 Pandemic: A Psychological Assessment and Cross-Sectional Survey

Mohamed Mekhemar, Sameh Attia, Christof Dörfer, Jonas Conrad, Mohamed Mekhemar, Sameh Attia, Christof Dörfer, Jonas Conrad

Abstract

Multiple investigations have reported high psychological distress among students since the coronavirus (COVID-19) outbreak started. This survey examined the associations between psychological features, and several demographic and social factors among dental students in German universities. Dental students registered in German universities nationwide were asked to join this survey via a self-directed online questionnaire, from July 2020 to January 2021. This study assembled data on demographic statistics, the depression anxiety stress scales (DASS-21), and the impact of events scale-revised (IES-R) instrument. The relationships between demographic-related variables and mental consequences of depression, anxiety, stress, intrusion, avoidance, and hyperarousal were inspected. Two hundred and eleven students contributed to the questionnaire and conveyed overall normal or mild outcomes of depression, anxiety, stress, intrusion, avoidance, and hyperarousal. In addition, female gender, cardiovascular diseases, smoking habits, and seeing the COVID-19 outbreak as a financial risk were stated as significant related factors (p < 0.05), with increased IES-R and DASS-21 scores. These results highlight the features that should be considered to better protect dental students' mental health in German universities during the crisis.

Keywords: COVID-19; DASS-21; IES-R; anxiety; dental students; depression; mental health; psychological impact; stress.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Wang C., Pan R., Wan X., Tan Y., Xu L., Ho C.S., Ho R.C. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health. 2020;17:1729. doi: 10.3390/ijerph17051729.
    1. Ali S., Maguire S., Marks E., Doyle M., Sheehy C. Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: An observational cohort multicentre study. BMJ Open. 2020;10:e042930. doi: 10.1136/bmjopen-2020-042930.
    1. Mehta S., Machado F., Kwizera A., Papazian L., Moss M., Azoulay É., Herridge M. COVID-19: A heavy toll on health-care workers. Lancet Respir. Med. 2021;9:226–228. doi: 10.1016/S2213-2600(21)00068-0.
    1. Hakami Z., Khanagar S.B., Vishwanathaiah S., Hakami A., Bokhari A.M., Jabali A.H., Alasmari D., Aldrees A.M. Psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on dental students: A nationwide study. J. Dent. Educ. 2020;85:494–503. doi: 10.1002/jdd.12470.
    1. Uhlen M.M., Ansteinsson V.E., Stangvaltaite-Mouhat L., Korzeniewska L., Skudutyte-Rysstad R., Shabestari M., Mdala I., Hovden E.A.S. Psychological impact of the COVID-19 pandemic on dental health personnel in Norway. BMC Health Serv. Res. 2021;21:420. doi: 10.1186/s12913-021-06443-y.
    1. Mekhemar M., Attia S., Dörfer C., Conrad J. The Psychological Impact of the COVID-19 Pandemic on Dentists in Germany. J. Clin. Med. 2021;10:1008. doi: 10.3390/jcm10051008.
    1. Proffitt E. What will be the new normal for the dental industry? Br. Dent. J. 2020;228:678–680. doi: 10.1038/s41415-020-1583-x.
    1. Coulthard P., Thomson P., Dave M., Coulthard F.P., Seoudi N., Hill M. The COVID-19 pandemic and dentistry: The clinical, legal and economic consequences—Part 1: Clinical. Br. Dent. J. 2020;229:743–747. doi: 10.1038/s41415-020-2404-y.
    1. Yildirim T.T., Atas O. The evaluation of psychological state of dental students during the COVID-19 pandemic. Braz. Oral Res. 2021;35:e069. doi: 10.1590/1807-3107bor-2021.vol35.0069.
    1. Santos-Hövener C., Busch M.A., Koschollek C., Schlaud M., Hoebel J., Hoffmann R., Wilking H., Haller S., Allenj J., Wernitz J., et al. Seroepidemiological study on the spread of SARS-CoV-2 in populations in especially affected areas in Germany—Study protocol of the CORONA-MONITORING lokal study. J. Health Monit. 2020:1–15. doi: 10.25646/7053.
    1. Böttcher S., Oh D.-Y., Staat D., Stern D., Albrecht S., Willrich N., Zacher B., Mielke M., Rexroth U., Hamouda O., et al. Erfassung der SARS-CoV-2-Testzahlen in Deutschland (Stand 2.12.2020) Epid Bull. 2020;49:14–20. doi: 10.25646/7705.
    1. Schäfer M., Stark B., Werner A.M., Tibubos A.N., Reichel J.L., Pfirrmann D., Edelmann D., Heller S., Mülder L.M., Rigotti T., et al. Health Information Seeking Among University Students Before and During the Corona Crisis-Findings from Germany. Front. Public Health. 2021;8:616603. doi: 10.3389/fpubh.2020.616603.
    1. Goldstein E., Lipsitch M. Temporal rise in the proportion of younger adults and older adolescents among coronavirus disease (COVID-19) cases following the introduction of physical distancing measures, Germany, March to April 2020. Euro Surveill. 2020;25 doi: 10.2807/1560-7917.ES.2020.25.17.2000596.
    1. Ziller S., Eaton K.E., Widström E. The healthcare system and the provision of oral healthcare in European Union member states. Part 1: Germany. Br. Dent. J. 2015;218:239–244. doi: 10.1038/sj.bdj.2015.95.
    1. Mekhemar M., Conrad J., Attia S., Dorfer C. Oral Health Attitudes among Preclinical and Clinical Dental Students in Germany. Int. J. Environ. Res. Public Health. 2020;17:4253. doi: 10.3390/ijerph17124253.
    1. Knipe D., Maughan C., Gilbert J., Dymock D., Moran P., Gunnell D. Mental health in medical, dentistry and veterinary students: Cross-sectional online survey. BJPsych Open. 2018;4:441–446. doi: 10.1192/bjo.2018.61.
    1. Bono R., Blanca M.J., Arnau J., Gómez-Benito J. Non-normal Distributions Commonly Used in Health, Education, and Social Sciences: A Systematic Review. Front. Psychol. 2017;8:1602. doi: 10.3389/fpsyg.2017.01602.
    1. Habeck C.G., Brickman A.M. A common statistical misunderstanding in Psychology and Neuroscience: Do we need normally distributed independent or dependent variables for linear regression to work? bioRxiv. 2018:305946. doi: 10.1101/305946.
    1. Böhmer M.M., Buchholz U., Corman V.M., Hoch M., Katz K., Marosevic D.V., Böhm S., Woudenberg T., Ackermann N., Konrad R., et al. Investigation of a COVID-19 outbreak in Germany resulting from a single travel-associated primary case: A case series. Lancet Infect. Dis. 2020;20:920–928. doi: 10.1016/S1473-3099(20)30314-5.
    1. Loda T., Löffler T., Erschens R., Zipfel S., Herrmann-Werner A. Medical education in times of COVID-19: German students’ expectations—A cross-sectional study. PLoS ONE. 2020;15:e0241660. doi: 10.1371/journal.pone.0241660.
    1. Röhle A., Horneff H., Willemer M.C. Practical teaching in undergraduate human and dental medical training during the COVID-19 crisis. Report on the COVID-19-related transformation of peer-based teaching in the Skills Lab using an Inverted Classroom Model. GMS J. Med. Educ. 2021;38 doi: 10.3205/zma001398.
    1. Chenot J.-F. Undergraduate medical education in Germany. Ger. Med. Sci. 2009;7 doi: 10.3205/000061.
    1. Plass D., Vos T., Hornberg C., Scheidt-Nave C., Zeeb H., Krämer A. Trends in disease burden in Germany: Results, implications and limitations of the Global Burden of Disease study. Dtsch. Arztebl. Int. 2014;111:629–638. doi: 10.3238/arztebl.2014.0629.
    1. Bizri M, Kassir G, Tamim H, Kobeissy F, Hayek SE. Psychological distress experienced by physicians and nurses at a tertiary care center in Lebanon during the COVID-19 outbreak. J. Health Psychol. 2021:1359105321991630. doi: 10.1177/1359105321991630.
    1. Iosif L., Ţâncu A.M.C., Didilescu A.C., Imre M., Gălbinașu B.M., Ilinca R. Self-Perceived Impact of COVID-19 Pandemic by Dental Students in Bucharest. Int. J. Environ. Res. Public Health. 2021;18:5249. doi: 10.3390/ijerph18105249.
    1. Elbay R.Y., Kurtulmuş A., Arpacıoğlu S., Karadere E. Depression, anxiety, stress levels of physicians and associated factors in Covid-19 pandemics. Psychiatry Res. 2020;290:113130. doi: 10.1016/j.psychres.2020.113130.
    1. 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. doi: 10.7717/peerj.10164.
    1. Islam M.S., Sujan M.S.H., Tasnim R., Sikder M.T., Potenza M.N., Van Os J. Psychological responses during the COVID-19 outbreak among university students in Bangladesh. PLoS ONE. 2021;15:e0245083. doi: 10.1371/journal.pone.0245083.
    1. Altemus M., Sarvaiya N., Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front. Neuroendocrinol. 2014;35:320–330. doi: 10.1016/j.yfrne.2014.05.004.
    1. Bahrami F., Yousefi N. Females are more anxious than males: A metacognitive perspective. Iran. J. Psychiatry Behav. Sci. 2011;5:83–90.
    1. Hertrampf K., Flörke C., Conrad J., Passia N., Kunzendorf B., Größner-Schreiber B., Dörfer C., Kern M., Orthuber W., Wiltfang J. COVID-19 pandemic: Infection control in dental health care of infected patients—A state concept. Oral Dis. 2020 doi: 10.1111/odi.13529.
    1. Valentine S.E., Shipherd J.C. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin. Psychol. Rev. 2018;66:24–38. doi: 10.1016/j.cpr.2018.03.003.
    1. Pieh C., O Rourke T., Budimir S., Probst T. Relationship quality and mental health during COVID-19 lockdown. PLoS ONE. 2020;15:e0238906. doi: 10.1371/journal.pone.0238906.
    1. Stanley S.M., Markman H.J. Helping Couples in the Shadow of COVID-19. Fam. Process. 2020;59:937–955. doi: 10.1111/famp.12575.
    1. Widarsson M., Engström G., Rosenblad A., Kerstis B., Edlund B., Lundberg P. Parental stress in early parenthood among mothers and fathers in Sweden. Scand. J. Caring Sci. 2013;27:839–847. doi: 10.1111/j.1471-6712.2012.01088.x.
    1. Singh A.K., Misra A. Impact of COVID-19 and comorbidities on health and economics: Focus on developing countries and India. Diabetes Metab. Syndr. 2020;14:1625–1630. doi: 10.1016/j.dsx.2020.08.032.
    1. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z., Xiang J., Wang Y., Song B., Gu X., et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
    1. Bae S., Kim S.R., Kim M.-N., Shim W.J., Park S.-M. Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: A systematic review and meta-analysis. Heart. 2021;107:373. doi: 10.1136/heartjnl-2020-317901.
    1. Nishiga M., Wang D.W., Han Y., Lewis D.B., Wu J.C. COVID-19 and cardiovascular disease: From basic mechanisms to clinical perspectives. Nat. Rev. Cardiol. 2020;17:543–558. doi: 10.1038/s41569-020-0413-9.
    1. Ng W.H., Tipih T., Makoah N.A., Vermeulen J.-G., Goedhals D., Sempa J.B., Burt F.J., Taylor A., Mahalingam S. Comorbidities in SARS-CoV-2 Patients: A Systematic Review and Meta-Analysis. mBio. 2021;12:e03647-20. doi: 10.1128/mBio.03647-20.
    1. Mukhtar S. Are individuals with cardiovascular disease at risk of COVID-19-related mental health problems or individuals with cardiovascular disease at risk of cardiovascular disease-related mental health problems during COVID-19? A psychological-psychiatric perspective. Med. Hypotheses. 2020;144:109919. doi: 10.1016/j.mehy.2020.109919.
    1. Gallay L., Uzunhan Y., Borie R., Lazor R., Rigaud P., Marchand-Adam S., Hirschi S., Israel-Biet D., Valentin V., Cottin V. Risk Factors for Mortality after COVID-19 in Patients with Preexisting Interstitial Lung Disease. Am. J. Respir. Crit. Care Med. 2021;203:245–249. doi: 10.1164/rccm.202007-2638LE.
    1. Pedrozo-Pupo J.C., Campo-Arias A. Depression, perceived stress related to COVID, post-traumatic stress, and insomnia among asthma and COPD patients during the COVID-19 pandemic. Chron. Respir. Dis. 2020;17:1479973120962800. doi: 10.1177/1479973120962800.
    1. Jiang C., Chen Q., Xie M. Smoking increases the risk of infectious diseases: A narrative review. Tob. Induc. Dis. 2020;18:60. doi: 10.18332/tid/123845.
    1. West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol. Health. 2017;32:1018–1036. doi: 10.1080/08870446.2017.1325890.
    1. Tzu-Hsuan Chen D. The psychosocial impact of the COVID-19 pandemic on changes in smoking behavior: Evidence from a nationwide survey in the UK. Tob. Prev. Cessat. 2020;6:59. doi: 10.18332/tpc/126976.
    1. Stanton R., To Q.G., Khalesi S., Williams S.L., Alley S.J., Thwaite T.L., Fenning A.S., Vandelanotte C. Depression, Anxiety and Stress during COVID-19: Associations with Changes in Physical Activity, Sleep, Tobacco and Alcohol Use in Australian Adults. Int. J. Environ. Res. Public Health. 2020;17:4065. doi: 10.3390/ijerph17114065.
    1. Caponnetto P., Inguscio L., Saitta C., Maglia M., Benfatto F., Polosa R. Smoking behavior and psychological dynamics during COVID-19 social distancing and stay-at-home policies: A survey. Health Psychol. Res. 2020;8:9124. doi: 10.4081/hpr.2020.9124.
    1. Bommele J., Hopman P., Walters B.H., Geboers C., Croes E., Fong G.T., Quah A.C.K., Willemsen M. The double-edged relationship between COVID-19 stress and smoking: Implications for smoking cessation. Tob. Induc. Dis. 2020;18:63. doi: 10.18332/tid/125580.
    1. Du J., Mayer G., Hummel S., Oetjen N., Gronewold N., Zafar A., Schultz J.-H. Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study. J. Med. Internet Res. 2020;22:e24240. doi: 10.2196/24240.
    1. Jones H.E., Manze M., Ngo V., Lamberson P., Freudenberg N. The Impact of the COVID-19 Pandemic on College Students’ Health and Financial Stability in New York City: Findings from a Population-Based Sample of City University of New York (CUNY) Students. J. Urban Health. 2021;98:187–196. doi: 10.1007/s11524-020-00506-x.
    1. Yang C., Chen A., Chen Y. College students’ stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion. PLoS ONE. 2021;16:e0246676. doi: 10.1371/journal.pone.0246676.
    1. Aristovnik A., Keržič D., Ravšelj D., Tomaževič N., Umek L. Impacts of the COVID-19 Pandemic on Life of Higher Education Students: A Global Perspective. Sustainability. 2020;12:8438. doi: 10.3390/su12208438.
    1. Redler P., Wuppermann A., Winter J., Schwandt H., Currie J. Geographic Inequality in Income and Mortality in Germany. Fisc. Stud. 2021;42:147–170. doi: 10.1111/1475-5890.12259.
    1. Hauschildt K., Vögtle E.M., Gwosc C. Social and Economic Conditions of Student Life in Europe; Synopsis of Indicators—Eurostudent VI 2016–2018. W. Bertelsmann Verlag; Bielefeld, Germany: 2018.
    1. Guse J., Heinen I., Kurre J., Mohr S., Bergelt C. Perception of the study situation and mental burden during the COVID-19 pandemic among undergraduate medical students with and without mentoring. GMS J. Med. Educ. 2020:37. doi: 10.3205/zma001365.
    1. O’Byrne L., Gavin B., McNicholas F. Medical students and COVID-19: The need for pandemic preparedness. J. Med. Ethics. 2020;46:623–626. doi: 10.1136/medethics-2020-106353.
    1. Gonzalez T., de la Rubia M.A., Hincz K.P., Comas-Lopez M., Subirats L., Fort S., Sacha G.M. Influence of COVID-19 confinement on students’ performance in higher education. PLoS ONE. 2020;15:e0239490. doi: 10.1371/journal.pone.0239490.

Source: PubMed

3
Abonnere