|Year : 2021 | Volume
| Issue : 6 | Page : 623-630
Perceived stress and subjective well-being of COVID-19 confinement in Latin American pediatric dentists and dental students: A cross sectional study
Ortega-López Miriam Fernanda1, Armas-Vega Ana2, Parise-Vasco Juan Marcos3, Agudelo-Suárez Andrés4, Arroyo-Bonilla David5, Viteri-García Andrés6
1 Posgrado de Odontopediatría Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
2 Facultad de Odontología, Universidad Central del Ecuador, Quito, Ecuador
3 Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
4 Facultad de Odontología, Universidad de Antioquia, Medellin, Colombia
5 Universidad Federal do Rio Grande do Sul, Porto Alegre, Brazil
6 Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador; Dirección Nacional de Normatizacion, Ministerio de Salud Pública, Quito, Ecuador
|Date of Submission||17-Jun-2021|
|Date of Decision||19-Jul-2021|
|Date of Acceptance||14-Oct-2021|
|Date of Web Publication||30-Nov-2021|
Dr. Ortega-López Miriam Fernanda
Rumipamba and Bourgeois, Quito.
Source of Support: None, Conflict of Interest: None
Aim: The COVID-19 pandemic, the first registered in the last 100 years, triggered fear and uncertainty, with manifestations related to stress, anxiety, and depression, mainly in health professionals. The study aimed to evaluate the psychological impact of the community quarantine, implemented due to the COVID-19 pandemic, in pediatric dentists and pediatric dentistry graduate students in Latin America. Materials and Methods: Convenience sample made up of 139 pediatric dentists and postgraduate pediatric dentistry students from different Latin American countries, who were asked to fill out a questionnaire, submitted electronically, with prior authorization of participation through an informed consent. The anonymity of the participants was protected using identification codes, and only their email address was requested for subsequent follow-up. Results: The multivariate model shows an association between the value of the PSS-14 v25 questionnaire and the different study variables; thus, the variables—quality of sleep (P ≤ 0.001), number of biosafety measures (P≤0.02), age (P = 0.04), and perception of their state of health (P = 0.03)—were statistically significant in the perceived stress and subjective well-being, caused by COVID-19 lockdown. In the same way, in the most representative demographic variables related to the affective and social support perceived by the participant, it was observed that, with increasing age, there is a decrease in perceived affective support and, consequently, in participants with mandatory quarantine and time restriction; there is a perception of not having emotional support. Conclusion: The disease caused by COVID-19 has modified the habits and quality of life of all professionals in the health field. The psychological impact that the community quarantine implemented due to the COVID-19 pandemic has produced is evident, as older and female individuals more frequently present signs of stress and anxiety, manifested by fear and uncertainty.
Keywords: COVID-19, Psychological Stress, Social Isolation, Stress
|How to cite this article:|
Fernanda OLM, Ana AV, Juan Marcos PV, Andrés AS, David AB, Andrés VG. Perceived stress and subjective well-being of COVID-19 confinement in Latin American pediatric dentists and dental students: A cross sectional study. J Int Oral Health 2021;13:623-30
|How to cite this URL:|
Fernanda OLM, Ana AV, Juan Marcos PV, Andrés AS, David AB, Andrés VG. Perceived stress and subjective well-being of COVID-19 confinement in Latin American pediatric dentists and dental students: A cross sectional study. J Int Oral Health [serial online] 2021 [cited 2022 Jan 26];13:623-30. Available from: https://www.jioh.org/text.asp?2021/13/6/623/331605
| Introduction|| |
The COVID-19 disease is a viral disease caused by the beta-coronavirus SARS-CoV-2,, which was reported for the first time in the city of Wuhan, China in December 2019., Its high degree of transmissibility, behavior, distribution, death rate, and variable characteristics caused the World Health Organization (WHO) to classify it as a pandemic in March 2020. The WHO reported until April 2021, more than 133,146,550 cases globally and 2,888,530 confirmed deaths associated with the disease, with 68% of this figure concentrated in the Americas, mainly (in decreasing order) in Brazil, Argentina, Colombia, Peru, and Ecuador; where, according to the health authorities of these governments, the number of deaths is related to the volume of tests implemented by each country.
Faced with this reality on a global scale, countries adopted prevention and control strategies to minimize COVID-19 infections, such as biosecurity protocols, social distancing, isolation, and quarantine, including restricting the movement of people potentially exposed to the disease, hand hygiene, use of masks, and the suspension of activities of high concentration of people. These measures had variable characteristics and durations, with different results after their implementation in each country.,,,,,
The COVID-19 pandemic, the first registered in the last 100 years, triggered fear and uncertainty with manifestations related to stress, anxiety, and depression,,,, mainly in health professionals.,, A dentist is routinely subjected to stressful and fearful situations, closely linked to pain and discomfort from his/her patients, in such a way, he/she has become a high-risk professional,, which has led him/her to a reduction in the frequency of routine care,, limiting it to emergency care with the subsequent reduction in admissions, increased stress, consequently bringing negative repercussions on the quality of life of the oral health professional.,
Different reports show the psychological impact the control measures implemented to contain the COVID-19 pandemic have produced on dental professionals,; however, given the recent and urgent evolution of the disease caused by COVID-19, there are no specific studies carried out in pediatric dentists and pediatric dentistry students from Latin American countries; hence the objective of this study was to evaluate the psychological impact of the community quarantine implemented due to the COVID-19 pandemic in pediatric dentists and postgraduate students in pediatric dentistry in Latin America.
| Materials and Methods|| |
A descriptive and cross-sectional study was carried out; for the sample size, the probability of making a type II error (\betaβ) was calculated as follows: β = Pr (Fail to Reject a False Null Hypothesis Ho), with a power of Power = 1−β = 1−0.3453=0.6547; however, as it was a study of perceptions and subjective variables, the authors considered it convenient to use the entire sample. Thus, the sample consisted of 139 pediatric dentists and postgraduate students of pediatric dentistry from different Latin American countries who completed the questionnaire and sent it electronically together with the authorization of participation and informed consent. The anonymity of the participants was protected by means of identification codes, and their e-mail address was only requested for subsequent follow-up. The study included pediatric dentists and students of pediatric dentistry in continuous professional practice, with permanent residence in one of the participating Latin American countries until February 2020, excluding from the study retired dentists, without clinical practice, with administrative positions, with disabling diseases, impossibility of manual mobility or pre-existing locomotor mobility, and those diagnosed with COVID-19 in the period of application of the survey.
A collaborating researcher was appointed to contact each participant in each country via email or instant messaging: WhatsApp®. Participants were asked to fill out the questionnaire designed on the Google Forms platform, with identification data such as sex, age, years of professional practice, level of training, family responsibilities and functionaries under their command, place and type of residence, and type of practice of odontology activity. Additionally, the participants were classified according to the type of quarantine they carried out in their country of origin: quarantine recommended but not mandatory, quarantine by zones, mandatory quarantine, and mandatory quarantine with time restriction. The variables of stress and subjective well-being were evaluated using the Perceived Stress Scale (PSS-14) and the Subjective Well-being Scale of the WHO, with questions previously validated in Spanish and Portuguese translation.
The collected data were exported to an Excel worksheet, filtered by a single researcher, and statistically analyzed using the SPSS-14 program, version v25. The analysis included three main outcome variables: PSS questionnaire value (continuous variable), presence of psychological support (binary variable), and presence of social support (binary variable). Initially, through the Wilcoxon statistical tests, one-way analysis of variance (ANOVA), and simple linear regression models, the PSS-14 values and different variables were analyzed. For the multivariate regression analysis, a multivariate linear regression model was used to establish an association between the values of the PSS-14 questionnaire and the different variables.
The variables of social support and trust were of binary origin and analyzed with the χ2 test and Fisher’s exact test; subsequently, a multivariate logistic regression model was used. Intentional selection of variables in logistic revision was performed in the search to find a model of regression variables for which an intentional selection of covariates was used with a P-value <0.15, after which a simple one-way ANOVA regression model was performed with the selected variables with a P-value <0.05. In addition, to be included in the final model, effect modifications and modification of P-values among all variables were considered.
| Results|| |
A total of 139 participants were included, among others pediatric dentists and postgraduate pediatric dentistry students from 14 countries. Regarding their place of residence, most of the participants were from Peru 23.7% (n = 33), Ecuador 21.6% (n = 30), Venezuela 12.2% (n = 17), and Brazil 8.6% (n = 12); 33.9% (n = 47) of the respondents resided in other Latin American countries. According to sex, 94.2% (n = 131) of the respondents were women, and the remaining 5.8% (n = 8) were men. The average age of the individuals in the study was 41.16 years (± 10.879). Another important element subject to evaluation was the stay at home, which presented an average of 2.71 days (± 2.71); in addition, the average mandatory isolation was 71.23 days (± 28.93). The body mass index (BMI) variable presented an average of 39.76 (± 7.37); therefore, it is possible to recognize that the sample on average has levels of overweight or obesity. The information on COVID-19 that the study sample handled in the first instance was through smartphones or official information applications; thus, knowledge of COVID-19 was presented as good, obtaining a score of 7.87 points (±1.42); slightly higher was the concern about COVID-19, which obtained an average score of 8.36 points (±1.75). Therefore, sleep saturation scored slightly high with 6.81 points (±2.16); likewise, prevention was observed with a score of 6.69 points (±1.22).
The multivariate model shows an association between the value of the PSS questionnaire and the different study variables; therefore, the quality of sleep was statistically significant and obtained a value of P≤0.001, that is, by increasing each point in the quality of sleep, β 0.60 decreased on the PSS-14. The number of biosafety measures obtained a value of β 0.84 (P≤0.02), also determining its influence on the stress variable. When considering the age variable and relating it to the stress variable, a P-value of 0.04 was obtained, showing that with a year of increase in the age of the individuals, stress decreases by β 0.07 points according to the questionnaire that assesses stress against confinement. The variable of perception of the health status showed a statistical significance with stress (P = 0.03); thus people who consider their health status bad or very bad have an increase of β 2.60 points on the stress scale in relation to who they consider having an excellent or good state of health. The number of days of isolation showed statistical significance in relation to the stress variable (β 0.31 and P = 0.02) [Table 1].
|Table 1: Multivariate regression model associating PSS values and different demographic variables|
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In the demographic characteristics according to the presence of affective and social support the participants received, statistical significance was found when relating them to age, people’s knowledge about COVID-19, the implementation of biosafety measures, type of quarantine, having met a person with COVID-19 and present some symptoms of COVID-19 (P≤0.05) [Table 2].
|Table 2: Demographic characteristics of the participants according to affective and social support|
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The logistic regression model showed an association between the most representative demographic variables with the affective and social support perceived by the participant, observing that with increasing age there is a decrease in the perception of affective support, where participants being subject to the mandatory quarantine with time restriction increased their perception of not having emotional support in a more evident way than in those subjected to recommended but not mandatory quarantine; thus, age was statistically significant (P≤0.05) in both affective and social support, showing that each year the participants have 1.07 OR and 1.08 OR times of not having affective and social support, respectively.
Participants in mandatory quarantine with time restriction presented a reduced risk of not having emotional support by 69%, when compared with people who were in recommended but not mandatory quarantine; likewise, at each point that the quality of sleep increases, through information on COVID-19, people reduce the risk of not having social support by 42% and 50%. Participants in mandatory quarantine with time restriction reduce the risk of not having social support by 93%, when compared with people who were in recommended but not mandatory quarantine, highlighting the evident association between increasing age and perception of a decrease in social support and a reduction in sleep quality, showing that people who were in mandatory quarantine with time restriction have a higher perception of stress and less well-being compared with those in recommended but not mandatory quarantine [Table 3].
|Table 3: Logistic regression model associating the presence of affective support and different demographic variables|
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The representative rate of the participants corresponds to 90.65% (126 participants).
| Discussion|| |
The variable age of the participants showed a relationship with the perception of stress, revealing a decrease in stress with increasing age, coinciding with previous studies, in which the self-perception of anxiety, sadness, loneliness, and comorbid anxiety-depressive symptoms increased as the age decreased, which could be associated with a decrease in an active social life typical of young individuals. However, it differs from another study carried out in the current era of pandemic in Europe, where anxiety and stress presented a direct relationship with age that could be associated with ignorance of the disease and the triggering implications of its presence, during the first phase of the COVID-19 outbreak.
When considering the sex of the participants, our results coincide with those reported in previous studies in which female participants showed an increase in stress and a decrease in their perception of well-being, which could be explained by the association of domestic activities combined with professional activities and family burden closely linked to female participants., An influence of emotional burden on eating habits was also found, a finding that coincided with other studies that even carried out in other contexts of less generalized confinement, triggered modification of habits, and even increase in the weight of the participants.
It is evident that when faced with a unique reality, in the current era, the generated, imposed, or voluntary changes modified the habits of all individuals, and in the professional field, dentists were affected in the dynamics of interpersonal relationships, generating inherent conflicts to the human condition with repercussions in the family environment, generating various emotions and fears, of personal nature and related to family issues, developed by considering the economic and social aspects, which would be triggering a negative effect on mental health that throughout these months, has been described, evaluated, and evidenced in our results, especially considering that the study was carried out in the first months of confinement, when the information on the virus and its repercussions was minimal, often obtained from unreliable sources.
The consequences of the implementation of confinement strategies can only be measured in the long term, which may constitute a limitation to be considered in this study, due to its application in a determined period of time and applied to health personnel with activities in the first line and consequently with a high probability of contagion. Signs of job anxiety or stress associated with fear need to be considered in future health strategies, as well as the structure and application of measures to be implemented as soon as possible by healthcare authorities, aimed at health personnel, such as dentists and pediatric dentists who face them, due to the implications of contacts, typical of their activity.
Within the dental practice, pediatric dentists have to monitor the oral health of their patients using various strategies for dental care including the use of the internet, social networks to provide online consultations, and virtual games for pediatric patients, but this type of strategy cannot be applied to all children: in children with special needs, previous face-to-face appointments are required for adaptation to the consultation but due to the COVID-19 pandemic we are limited to this activity as the activities within the consultation are emergent or urgent to avoid contagions, a series of protocols must be followed to prevent cross infections in the post-pandemic era, this situation has generated stress for the pediatric dentist professional.,
| Conclusion|| |
The disease caused by COVID-19 has completely changed the habits and quality of life of pediatric dentistry professionals; the psychological impact of the community quarantine implemented as a result of the COVID-19 pandemic is evident, with older people and women showing more frequent signs of stress and anxiety, manifested by fear and uncertainty.
We thank MSc. Susana Hidalgo, Professor at Universidad UTE, for her advice in translating this article into English.
Financial support and sponsorship
This research did not receive any specific grants from funding agencies in the public, commercial, or nonprofit sectors.
Conflicts of interest
We have no financial relationships with organizations that may have an interest in the article published in the last years and we have no other relationships or activities that may influence the publication of the article.
OLF: concepts, conceptualization, draft manuscript writing, design, methodology research, resources, data curation, visualization, supervision; AVA: concepts, conceptualization, resources, visualization, supervision; PVJM and VGA: resources, visualization, supervision; ASA: resources, visualization; ABD: resources, data curation. Finally, all authors reviewed and approved the final version of the manuscript.
Ethical policy and Institutional Review board statement
This study is approved by the Human Research Ethics Committee of the University of Antioquia Colombia No. 64-2020.
Patient declaration of consent
Data availability statement
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[Table 1], [Table 2], [Table 3]