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Association of oral health behaviors and status with depression: Results from the Korean National Health and Nutrition Examination Survey, 2010
Abstract
To examine the association of depression with oral health behaviors and oral health status in a large nationwide sample of Korean adults.
This study included 6,139 participants aged 19 years or older who participated in the fifth Korean National Health and Nutrition Examination Survey. Binary and polychotomous logistic regression analyses were used to estimate adjusted odds ratios (AORs) and 95 percent confidence intervals (CIs).
Participants with lifetime depression (self-report of past or present depression) brushed their teeth less frequently (AOR = 1.30, 95 percent CI 1.03-1.65) and were more likely not to receive treatment when experiencing dental problems (AOR = 1.43, 95 percent CI 1.23-1.66) than those without lifetime depression after adjusting for sociodemographic factors, gender, and age. After adjusting for significant oral health behaviors, current smoking status, and sociodemographic factors, participants with lifetime depression had poorer oral health status than those without this disorder: uncomfortable mastication (AOR = 1.25, 95 percent CI 1.05-1.50), toothache (AOR = 1.18, 95 percent CI 1.01-1.39), temporomandibular joint symptoms (AOR = 1.41, 95 percent CI 1.08-1.85), and maxillary periodontal bleeding (AOR = 1.29, 95 percent CI 1.03-1.61 for the right side; AOR = 1.40, 95 percent CI 1.13-1.74 for the left side).
Depression was significantly associated with oral health status, even after adjusting for the impact of oral health behaviors in Korean adults. Thus, our findings suggest the necessity of further investigation to detect underlying mechanisms in the relationship between depression and oral health that are not mediated by oral health behavior.
... 9 Psychosocial pathways are important mediators of the effects of social determinants on health outcomes. 10,28 However, depressive symptoms played a minor role in mediating the association between SES and oral health behaviors. A possible explanation of the relationship between depression and oral health behaviors is the lack of interest of depressed individuals in most normal activities, such as personal self-care. ...
... 29 Because depression and oral diseases are common in the general population, the relationship between oral health and mental health must be elucidated to improve the public health management of these factors. 28,30 In particular, it is important to know the degree to which depressive symptoms affect oral health behaviors in order to manage the oral health of patients with depressive symptoms. 28,30 The direct path from SES to dental care indicates that a higher SES is associated with more visits to the dentist. ...
... 28,30 In particular, it is important to know the degree to which depressive symptoms affect oral health behaviors in order to manage the oral health of patients with depressive symptoms. 28,30 The direct path from SES to dental care indicates that a higher SES is associated with more visits to the dentist. Possible reasons for this pattern include different financial barriers, geographic barriers, perceptions, and beliefs about oral health of groups with different SES. ...
Abstract Determinants of oral diseases include behaviors, which in turn are influenced by a series of social determinants such as psychosocial aspects and dental care services. Therefore, the aim of this study was to investigate whether depressive symptoms and use of dental care services mediate the relationship between socioeconomic status (SES) and oral health behaviors. This was a cross-sectional study that analyzed data from participants in the 2019 National Health Survey (PNS) (n = 88,531). The eligibility criteria were individuals who were 18 years and older and exclusion criterion was living in households located in special or sparsely populated census tracts. Structural equation modeling (SEM) was used to test direct and indirect pathways from a latent variable for SES to oral health through depressive symptoms (assessed through the “Patient Health Questionnaire-9”) and use of dental care services. The maximum likelihood estimator for complex samples with the robust standard error was used. The final model presented an adequate fit: RMESA of 0.008, CFI of 0.998, and SMRM of 0.005. The results showed that higher SES was directly associated with better oral health-related behaviors [standardized coefficient (SC): 0.428; p < 0.01] and indirectly through depressive symptoms [(SC): 0.002; p < 0.01] and dental care services [(SC): 0.089; p < 0.01]. The total effect of SES on oral health-related behaviors was equal to [(SC: 0.519 (p < 0.01)]. In conclusion, the findings suggest that high socioeconomic status, mediated by depressive symptoms and dental care services, has a positive effect on oral health.
... While a positive association between depression and periodontal outcomes has been claimed (Peruzzo et al., 2007;Sundararajan et al., 2015;Khambaty & Stewart, 2013;Park et al., 2014), this association remains unclear (Persson et al., 2003;Ababneh et al., 2010;Viana et al., 2013;Delgado-Angulo et al., 2015). This discrepancy of results may be explained by methodological aspects, such as use of selfreported assessment of depression and different criteria to assess periodontitis, and the lack of adjustment for mediators. ...
... The association between depressive symptoms and periodontitis observed in this study corroborates with previous findings (Genco et al., 1999;Park et al., 2014;Kambhaty & Stewart, 2013). There are two proposed pathways that can possibly explain this association. ...
... The behavioral changes would lead to increased oral biofilm burden and decreased resistance of the periodontal tissues to inflammatory breakdown. This via suggests depression as a risk factor for poor oral health, since it affects oral hygiene habits and the use of oral health services (Okoro et al., 2012;Park et al., 2014). However, our findings revealed a controlled direct effect of depressive symptoms on periodontitis, even when the value of dental flossing, a proxy used for oral hygiene behavior, was fixed in (M=0). ...
Aim
To investigate the association between depression and periodontitis among adults enrolled in the 1982 Pelotas Birth Cohort, Brazil.
Materials and methods
Major depressive episode and severity of depressive symptoms obtained in 2012 were considered the exposure of this study. In 2013, periodontitis, the outcome of interest, was clinically assessed and two different case definitions were used: the CDC/AAP and a combination of CAL and BOP simultaneously. Serum levels of C‐reactive protein and frequency of dental flossing were defined as mediators while confounders comprised a set of variables collected throughout the life‐course of the participants. The parametric g‐formula was used to test the direct, indirect and total effects of depression on periodontitis.
Results
539 participants were clinically examined. Individuals with depressive symptoms presented higher risk of periodontitis (RR 1.19). The presence of depressive symptoms was also associated with moderate/severe periodontitis (total effect RR 1.18). None of the associations was mediated by flossing or C‐reactive protein levels. Finally, neither the presence of depressive symptoms nor the presence of major depression was associated with the combination of CAL+BOP.
Conclusions
A positive association between depressive symptoms and periodontitis and moderate/severe periodontitis was found. Major depressive episode was not associated with periodontitis.
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... In the last years, most studies have drawn attention to a contribution of depression to poor oral health status [5,6,[8][9][10][22][23][24][25][26][27][28]. Conversely, there are researchers investigating a possible influence of oral health conditions on depression [11,17,29,30], suggesting a bi-directional relationship between oral health and mental disorders. ...
... Periodontal disease versus depression Five studies testing the association between periodontal disease and depression were included in this systematic review. Of these, four considered depression as exposure and periodontitis as outcome in their analyses [22][23][24]27]. These four studies had a cross-sectional design, were conducted in highincome countries (Finland, the USA, Korea), and were published between 2003 and 2015. ...
... The sample sizes ranging from 701 to 63,540 individuals. Depression was [27] assessed lifetime diagnosis of depression through self-report. Periodontal disease was assessed with clinical examination considering periodontal pocket depth ≥ 4 mm [22], clinical attachment loss ≥ 4 mm [23], periodontitis severity using the Community Periodontal Index, and horizontal bone loss > 0 mm using panoramic radiographs [24]. ...
Objectives
To systematically review the literature in order to investigate association between depression and oral diseases.
Material and methods
Electronic searches were performed in five databases. Studies testing associations between depression and oral diseases as either exposure or outcome were included. Oral disease variable included any tooth loss or edentulism, periodontal disease, and dental caries.
Results
A total of 2504 articles were identified in the electronic database search. Sixteen studies were included in this systematic review being 14 included in the meta-analyses. Eleven studies considered oral health as outcome, whereas three studies considered depression as an outcome variable. Depression was associated to dental caries, tooth loss, and edentulism. Pooled estimates showed that depression increased the odds of dental caries (OR 1.27; 95% CI 1.13–1.44), tooth loss (OR 1.31; 95% CI 1.24–1.37), and edentulism (OR 1.17; 95% CI 1.02–1.34), respectively. When the oral diseases were tested as independent variable and depression as outcome, associations with both edentulism (OR 1.28; 95% CI 1.06–1.55) and periodontal disease (HR 1.73; 95% CI 1.58–1.89) were found.
Conclusions
The results of our systematic review and meta-analyses show a positive association between depression and oral diseases, specifically dental caries, tooth loss, and edentulism, in adults and elders. More longitudinal studies are required to test causal and temporal relationship between depression and oral health status.
Clinical relevance
Mental and oral health are among the main disabilities worldwide. This article helps to understand more about the relationship between both conditions, highlighting the importance for both clinicians and policy makers of considering individual’s psychological status in management of oral health.
... Depression is a common occurrence in later life, affecting 7% of the general elderly population. 1 A decline in physical, mental, and cognitive abilities, coupled with retirement and the loss of contact with social networks, and the higher likelihood of deaths among loved ones are factors that contribute to the development of depression in older adults. [2][3][4][5][6][7] Symptoms such as persistent sadness, anxiety, feelings of hopelessness, fatigue, low energy, suicidal thoughts, insomnia, and aches and pains may all be indicators of depression in later age. 8 Evidence exists in the literature for the significant prevalence of depression among older population living in assisted living facilities (ALs). ...
... Further, decline in the health of AL residents affects their relationships and interactions in daily life, and is a cause of isolation, separation from others, loneliness, and more severe manifestations of depression. 5,37 While in normal aging, the accumulation of chronic diseases and increased risk of functional decline and loss of independence are expected, research in the related literature has highlighted the importance of lifestyle factors in slowing the decline of physical and cognitive functions. Such studies have suggested that appropriate physical activity in the form of rehabilitative therapies and scheduled exercise may delay functional and cognitive impairment in AL residents. ...
... 47 This study found that the oral health status of our residents did not significantly correlate with depression, a result dissimilar to the findings of previous studies. [3][4][5]17 Elsewhere, depression and other chronic mental illnesses correlate with poor oral health status. For example, a recent research by Watanabe et al on a group of 4,720 frail elderly (.65 years) found that on the GDS, oral health and functioning were significantly associated with frailty. ...
Aim
This study aims to recognize and estimate the prevalence of depression and its risk factors among residents of assisted living facilities (ALs) in Jordan.
Background
Depression is commonly experienced by residents of ALs. The condition is, however, often misunderstood as a part of normal aging and may be overlooked by health care professionals. Little is known about the extent of depression and its risk factors among AL residents in Jordan.
Subjects and methods
A national representative sample of 221 residents selected from all AL units across Jordan was recruited to the study. Data on expected risk factors for depression were collected, including sociodemographics; smoking status; number of roommates; number of family members; assessments for cognitive functioning, for lower limb functioning, for hand, shoulder, and arm impairments; and oral health status. Levels of depression among the sample respondents were also assessed.
Results
The study found that around 60% of the participants reported depressive manifestations, with 48.0% of AL residents exhibiting impaired cognitive functions, one-third (33.2%) having >50% upper limb disability, two-thirds (63.2%) being at moderate risk of falls, and 69.7% having fair to poor oral health status. Being female, and having a higher level of education, disability of the upper limbs, and impairment of cognitive functions were found to be independent risk factors for depression in participants.
Conclusion
Depression is relatively common among residents of AL units in Jordan. Health care professionals, nurses, physiotherapists, and dentists working in these facilities need to work cooperatively to identify the manifestations of depression in residents and collaboratively implement the best practice in the treatment of depression and circumvent its long-term impacts on the health of residents.
... This highlights the complex interrelationship between oral behaviors and the psychological state of the patient. The majority of the previous studies on oral behaviors focused primarily on its association with depression [4,[59][60][61] rather than somatic symptom burden. For instance, S. J. Park et al. showed that oral health behaviors and depression are associated to some extent in women mainly [60]. ...
... The majority of the previous studies on oral behaviors focused primarily on its association with depression [4,[59][60][61] rather than somatic symptom burden. For instance, S. J. Park et al. showed that oral health behaviors and depression are associated to some extent in women mainly [60]. Similarly, a birth cohort in Northern Finland indicated that less favorable oral health behaviors were more present in participants with a higher number of depression symptoms [4]. ...
Background
Alexithymia is a condition in which cognitive processing of emotions is impaired. Associations between alexithymia and temporomandibular disorders (TMD) have been described in multiple studies, yet the coexistence or influence of oral behaviors has never been addressed. This study aimed to clarify the relationship between alexithymia, oral behaviors, and temporomandibular pain disorders.
Results
A total of 264 participants were included in this study. The mean age was 25.70 ± 5.99 years, with a range from 18 to 65 years. Eighty-two (31.1%) were possibly alexithymic, and 93 (35.2%) were alexithymic. A total of 12.5% of the participants were at high risk for TMD. With respect to oral behavior risk, 62.5% were at low risk, and 35.2% were at high risk. Alexithymia appeared to be a positive predictor of TMD risk ( p < 0.001). Participants with high-risk oral behaviors were found to have an increased likelihood of TMD risk ( p < 0.001). Moreover, both high-risk oral behavior and alexithymia correlated with increased somatic symptom burden levels ( p < 0.001). Pain disorders exert significant distress on individuals and lead to poorer quality of life.
Conclusion
Understanding the association of alexithymia, somatic symptom burden, and coping strategies with oral behaviors and temporomandibular pain disorders can help improve the management of this condition. By tailoring the chosen therapy to the dominant co-existing psychosocial comorbidities in TMD patients, the risk of treatment failure or relapse may be diminished.
... Associations between depression and oral health might be explained by behavioral patterns. For example, patients suffering from depression present different dietary habits (Molendijk et al., 2018) and tend to show insufficient oral health behavior (Park et al., 2014). In recent publications, however, an opposite direction of action has been discussed. ...
... Vice versa, depression might also increase the risk for periodontitis. For example, depression has been associated with unhealthy dietary habits (Molendijk et al., 2018;Ljungberg et al., 2020;Lang et al., 2015;Paans et al., 2018;Kris-Etherton et al., 2021;Liu et al., 2007) as well as a lack of sufficient oral health behavior (Park et al., 2014;Kisely et al., 2016;Tiwari et al., 2021), which leads to an increased risk of periodontal disease. ...
The aim of the current study is to investigate the association between periodontitis (exposure variable) and depression severity (outcome variable) in an older German population. We evaluated data from 6,209 participants (median age 62 years) of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Depression severity were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Multiple linear regression models were adjusted for age, sex, diabetes, education, smoking, and antidepressant medication. Linear regression analyses revealed a significant association between log-transformed depression severity and periodontitis when including the interaction term for periodontitis * age, even after adjusting for age, sex, diabetes, education, smoking and antidepressant medication. We identified a significant association between severe periodontitis and elevated depression severity, which interacts with age. Additionally, we performed a linear regression model for biomarker analyses, which revealed significant associations between depression severity and severe periodontitis with log-transformed inflammatory biomarkers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). In order to identify new therapeutic strategies for patients with depression and periodontal disease, future prospective studies are needed to assess the physiological and psychosocial mechanisms behind this relationship and the causal directionality.
... Of the parent respondents, 54.5% and 55% felt the stress due to postponement of their children' s school and online learning and the stress of receiving Emer- gency Alert Messages about COVID-19, respectively (Table 1). In 108 school-age children, 19.5% experienced emotional changes, while 48.1% responded that they felt anxiety ( Table 1). The stress felt by the children due to receiving Emergency Alert Messages was lower than that of the parents ( Table 2, p = 0.000), and there was no significant difference between children and adults in GAD-7 score (Table 2). ...
... Under the epidemic of new infectious diseases, we should understand the anxiety of children and guardians who report to the hospital and consider it in the dental care and counseling process.Several studies have shown that psychological condition impacted on oral health. According to a study, people with depression brushed their teeth less frequently and more likely not to receive dental treatment even if they had dental problems[19]. A survey of adolescents showed both males and females who reported symptoms of depression had an increased poor hand and oral hygiene including brushing their teeth less than daily[20]. ...
The purpose of this study is to evaluate the effect of the spread of a new type of coronavirus infection (COVID-19) on the mental state in school-age children and parents focusing on the aspects of sleep disorders and depression. A questionnaire survey was conducted for 123 parents and 108 school-age children who visited Department of Pediatric Dentistry, Kyung Hee University Dental Hospital at Gangdong from April 2, 2020 through April 25, 2020, via the direct writing method. Participants were assessed with Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder (GAD)-7, Center for Epidemiology Scale for Depression. Logistic regressions were used with a level of significance of 5%.The prevalence of GAD, depression, and poor sleep in parents were 34.1%, 17.1% and 44.7%, respectively. The prevalence of GAD in children was 20.4%.Logistic regression showed that stress from Emergency Alert Messages about COVID-19 was associated with GAD and depression in parents. In children, the degree of emotional change after COVID-19 was associated with GAD.This study confirmed that there was a change in the psychological status of children and guardians due to the epidemic of coronavirus disease-2019, and it would be necessary to consider their psychological status during dental treatment.
... Although not assessed in this study, lower tooth brushing frequency and higher cariogenic nutrition, which are certified a risk factor dental caries, have been reported among depressed individuals. [25,26,27,28,29,30] Park et al.reported more frequent incidents of toothache among patients with depression. [26] Conclusion Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. ...
... [25,26,27,28,29,30] Park et al.reported more frequent incidents of toothache among patients with depression. [26] Conclusion Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. Reluctance of the dental patients to reveal information resulting in low sample size was noted to be the limitation of the study. ...
Introduction
Oral health has been significantly associated with the wellness of an individual which includes physical and psychological wellbeing. In the recent past due to various reasons, depression has been noted to be evident in population. The patients visiting dental clinics are of no exclusion to have experienced depression.
Aim
to determine the prevalence of depression among dental outpatients in an secondary health facility in Benin City using the Patient Health Questionnaire-9 (PHQ-9).
Materials and Methods
This cross-sectional study mixed observational and clinical study using questionnaire and clinical oral examination was conducted among patients attending the dental outpatient clinic of Stella Obasanjo Hospital between December 2018 and January 2019.
Results and Discussion
About one-quarter (28.6%) had depression of the mild severity. Depression was highest among the 31–40 years, females, those with primary education and those that earn less the 30,000 naira monthly and nonindigenous participants. Participants with mild depression presented more with acute apical periodontitis, dental caries, and periodontal disease than those without depression.
Conclusion
Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. Further studies on patients with symptomatic chronic dental condition are recommended.
... According to research conducted by Park et al, more frequent incidents of toothache were reported by patients with depression, they also frequently reported uncomfortable mastication, as well as temporomandibular joint symptoms and periodontal bleeding. [10] Chronic diseases such as dental caries are still highly prevalent in older adults, and the risk of tooth loss in old age is high. Caries and periodontal disease are progressive processes which lead to tooth loss if not treated adequately. ...
... Tooth loss will presumably cause functional impairment, for example, with regard to chewing and esthetics, depending on the location of tooth loss, which might ultimately affect health-related quality of life (HRQoL). [10] A reciprocal relationship between poor oral condition and mental health was noted; however, in most cases, mental condition was assessed with the use of comprehensive psychometric tools utilized to determine HRQoL which also consists of mental health. This research revealed that tooth loss and dental pain impaired HRQoL. ...
Depression is a common disorder among the elderly; however, it is not a standard element of the ageing process. Depression can affect oral health as a result of neglecting oral hygiene procedures, cariogenic nutrition, avoidance of necessary dental care which leads to an increased risk of dental caries and periodontal disease.
Assessment of the relationship of oral health parameters with depression.
500 subjects aged ≥65 (mean 74.4 ± 7.4) were involved in the study. Dental condition (decay-missing-filled index [DMFT], number of missing teeth [MT], removable denture wearing, teeth mobility), periodontal condition (bleeding on probing [BoP], pocket depth [PD], loss of attachment), oral dryness (the Challacombe Scale) and depression according to the Patient Health Questionnaire-9 (PHQ-9) scale were assessed.
Depression on a minimal level was detected in 60.2% of the subjects, mild—in 22.2%, moderate—in 6.0% and moderately—in 2.6%. The mean of the PHQ-9 scale was 3.56 ± 4.07. Regression analysis showed a positive relationship of the PHQ-9 value with DMFT, the number of MT, oral dryness and with age. No correlation was observed between other examined oral health indicators, such as periodontal condition (BoP, PD, clinical attachment level), periodontitis, removable denture wearing a PHQ-9.
The results of our study have shown that among people aged 65 and over, the severity of depression increases with a higher number of MT, the number of decayed teeth, as well as prevalence of oral dryness.
... Previous studies have reported that PIU is associated with mental health problems such as increased stress, depression, anxiety, and lack of sleep [7,10,30]. Excessive Internet use may lead to mental health problems such as stress and depression, which may ultimately lead to poor oral hygiene by reducing oral health behaviors [3,[39][40][41]. Recently, Park et al. [7] reported that subjects with depressive symptoms had a 1.3 times lower daily tooth brushing frequency, 1.4 times more periodontal bleeding, and experienced more toothache and temporomandibular disorder pain. ...
... Excessive Internet use may lead to mental health problems such as stress and depression, which may ultimately lead to poor oral hygiene by reducing oral health behaviors [3,[39][40][41]. Recently, Park et al. [7] reported that subjects with depressive symptoms had a 1.3 times lower daily tooth brushing frequency, 1.4 times more periodontal bleeding, and experienced more toothache and temporomandibular disorder pain. However, the relationship between mental health and oral health remains unclear and controversial. ...
We examined the relationship between Problematic Internet Use (PIU), sleep (sleep satisfaction, sleep duration), and experience of oral disease symptoms in Korean adolescents by gender. This cross-sectional study utilized the 6th (2010) Korean Youth Risk Behavior Web-based Survey. Participants comprised 74,980 students from 400 middle schools and 400 high schools nationwide. Among these, 73,238 students from 799 schools (38,391 boys, 34,847 girls, aged 13–18 years) were included in the analysis (inclusion rate = 97.7%). Multiple logistic regression and analysis of moment structures (AMOS) analyses were performed to identify meaningful relationships between the three factors. The “high risk group” of problematic internet usage had increased experience of oral disease symptoms (boys: adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI) = 1.63–2.28, girls: AOR = 1.98, 95% CI = 1.50–2.63) compared to the general group. Boys who used the Internet for “5–6 h” had a higher risk of oral disease symptoms compared to those who used it for “less than 1 h” (OR = 1.24, 95% CI = 1.01–1.53); however, this difference was not significant in Models II and III. For girls, the risk of 5–6 h of use (Model I: OR = 1.69, 95% CI = 1.40–2.04) was higher than that of the boys. In addition, the difference was significant in Models II and III for girl students who used the Internet for 5–6 h. In subgroup analysis, the high-risk group had a higher odds ratio for mild symptoms of bad breath to severe symptoms such as sore and bleeding gums. In addition, in the path analysis, PIU affected sleep and indirectly affected oral health. Direct and indirect causal relationships between the three factors were confirmed. Therefore, it is important to recognize that PIU can have a detrimental effect on mental, physical, and oral health.
... These include research on the association between oral health and mental health. Several studies have investigated this association using large data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) [5,[14][15][16]. A study has reported on the effects of oral health behavior and status on the quality of life in the Korean elderly [5], and only a few reports have indicated that oral pain or oral health status is correlated with depression in Korean adults or the elderly [14][15][16]. ...
... Several studies have investigated this association using large data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) [5,[14][15][16]. A study has reported on the effects of oral health behavior and status on the quality of life in the Korean elderly [5], and only a few reports have indicated that oral pain or oral health status is correlated with depression in Korean adults or the elderly [14][15][16]. However, there is a lack of research on the influence of oral health status on stress, depression, and suicidal ideation-the primary markers of mental healthamong Korean adults. ...
Background
Oral health greatly affects well-being throughout the different stages of life from childhood to late adulthood. Loss of teeth due to poor oral health hinders mastication, leading to poor nutrition absorption, and affects pronunciation and aesthetics, leading to interpersonal difficulties. As social activities become limited, a sense of isolation and loneliness, stress, and depression grows while happiness decreases. This study aimed to examine the association of stress, depression, and suicidal ideation with oral health status and oral functions in a large nationwide sample of Korean adults aged 35 years or more.
Methods
The sample comprised 15,716 adults, selected using a rolling survey sampling method and data were extracted from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES) (2010–2012). Participants were interviewed about their self-evaluation of health including oral health status and mental health, such as stress, depression, and suicidal ideation. Data from 11,347 adults were finally selected after excluding participants with missing answers. The dependent variables were stress, depression, and suicidal ideation. The independent variables were gender, age, household income, education, smoking, drinking, oral health perception, chewing, and speaking. Complex samples logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results
Participants met the criteria for stress (25.4%), depression (13.0%), and suicidal ideation (13.9%). Subjective oral health status was not significantly associated with stress, depression, and suicidal ideation. However, the presence of very uncomfortable chewing problems was significantly associated with stress (OR = 2.294, 95% CI = 1.41, 3.72), depression (OR = 3.232, 95% CI = 1.97, 5.31), and suicidal ideation (OR = 2.727, 95% CI = 1.58, 4.72). The presence of very uncomfortable speaking problems was significantly associated with stress (OR = 1.592, 95% CI = 1.13, 2.24) but not significantly associated with depression and suicidal ideation.
Conclusions
Oral functional problems including chewing and speaking difficulties can be associated with mental health. It is necessary to develop oral health promotion programs for adults and help them maintain a good quality of life and mental health.
... Jin Park ir kt. palygino depresija sergančius žmones su kontroline grupe ir pateikė duomenis, kad depresija sergančių pacientų burnos sveikata buvo prastesnė, jie valėsi dantis rečiau, susidūrę su dantų problemomis buvo labiau linkę nesilankyti pas gydytoją odontologą [7]. Naujesni tyrimai patvirtino gautus rezultatus, jog sergantieji depresija dažniau susidūrė su odontologinių paslaugų prieinamumo problemomis ir rečiau lankėsi pas gydytoją odontologą nei asmenys, nepatiriantys depresijos simptomų [8]. ...
Straipsnyje apžvelgiamas vienų iš labiausiai pasaulyje paplitusių ligų, dantų ėduonies ir depresijos, tarpusavio ryšys. Remiantis išnagrinėta literatūra galima teigti, kad depresijos simptomai turi poveikį ėduonies atsiradimui, todėl tiek gydytojai odontologai, tiek gydytojai psichiatrai turėtų žinoti apie galimą riziką. Žmogaus psichologinės sveikatos ir depresijos simptomų pastebėjimas gali padėti sudaryti individualią profilaktikos program kiekvienam pacientui ir taip sumažinti ėduonies išsivystymo tikimybę.
... Second, the oral health control of patients with depression is inadequate [34]; As the symptoms of depression worsen, people with depression need to invest more energy and economy in the treatment and care of depression, the importance of oral health gradually decreases, and the investment in oral care will also decrease. This could also explain why adults with mild depression do not have a significantly increased risk of root caries, but adults with moderate to severe depression do [35,36]. The third possible cause is dry mouth. ...
Purpose
This study aimed to investigate the link between depression and untreated dental caries among adults in the United States.
Methods
Data were collected from the National Health and Nutrition Survey (2015–2018); respondents aged 20 years or older who completed a patient health questionnaire and underwent a comprehensive oral examination were included. Participants were categorized into three groups according to depressive symptoms as follows: those with no, mild, or moderate to severe depression. Data were weighted, and multiple potential covariates were included in the analysis to provide national estimates and account for the complex sample design. A multivariable weighted logistic regression model was performed to test the hypothesis that varying degrees of depression in American adults are associated with untreated dental caries. Subgroup analyses were performed based on age and gender after adjusting for potential covariates. A P value of <.05 was considered significant.
Results
Among 8740 participants, the prevalence of untreated coronal and root caries was 20.50% and 12.92%, respectively. Moderate to severe depression was a significant risk factor (odds ratio, 1.25; 95% confidence interval, 1.09–1.66) for untreated root caries. The risk of untreated root caries increased by 87% in young adults (aged 20–44 years) and by 46% in women with moderate to severe depression. The suest analysis revealed that the impact of moderate to severe depressive disorder on untreated root caries was non-significantly different between the age subgroup (p=0.09) and sex subgroup (p=0.51). However, depression was non-significantly associated with untreated coronal caries (mild depression: OR, 1.07; 95% CI, 0.85–1.34; moderate to severe depression 1.06; 95% CI, 0.83–1.36; respectively).
Conclusion
The results of this study suggested a significant association between moderate and severe depression and untreated root caries; however, the association with untreated coronal caries was non-significant. In the United States, moderate and severe depression in adults is associated with root caries.
... Over the years, various studies have found a substantial link between depression and oral health status (40,41) and use of dental services (42). According to our results, women with depression had a higher percentage of filled or capped teeth and covers (crowns), bridges or other types of prostheses or dentures than depressed men. ...
Background
The need to study the link between gender, depression, and oral health is becoming increasingly evident. This study therefore aimed to determine the prevalence and evolution over time of depression among women and men with oral health problems and to evaluate the association between depression status, lifestyle-related variables health-related variables and use of dental health services in those people.
Methods
We performed a nationwide cross-sectional study on 25,631 adults with oral health problems residing in Spain from the Spanish National Health Survey 2017 and the European Health Survey of Spain 2020, including as the main variable self-reported diagnosis of depression. We analysed independent variables such as lifestyle-related variables, health-related variables, and variables related to dental health services. Sociodemographic characteristics were considered as control variables.
Results
The prevalence of depression among adults with oral health problems in Spain was 7.81% (10.14% for women, 5.39% for men), with a notable decrease from 2017 to 2020 in women. Depressed women had a slightly higher percentage of filled or capped teeth, and had more covers (crowns), bridges or other types of prostheses or dentures, while men had more caries. Women also made more frequent, regular dental visits for check-ups and mouth cleaning, whereas men often needed extractions. Unfavourable associated factors in both genders were: perceiving their health as good, average, poor, or very poor, and having 1–2 and ≥ 3 comorbidities. Conversely, not being a current smoker was related to less likelihood of depression. In women only, not engaging in leisure-time physical activity produced more unfavourable associated factors.
Conclusion
The prevalence of depression among adults with oral health problems in Spain from 2017 to 2020 was 7.81%, but this figure has been steadily decreasing over time. In addition, the favourable and unfavourable associated factors could help us inform health professionals and authorities in order to prevent depression and enhance the care of this population according to gender.
... Reduced energy and motivation associated with depression can affect oral health by neglecting oral hygiene procedures, which leads to increased risk of dental caries and periodontal disease, cariogenic nutrition, avoidance of necessary dental care, and antidepressant-induced xerostomia. [4] No such earlier study has been carried out in our region. So, the aim of this study was to determine relationship S624 Journal of Pharmacy and Bioallied Sciences ¦ Volume 16 ¦ Supplement 1 ¦ February 2024 Kaur, et al.: Depression and its association with oral health in elderly people living in old age homes of Mathura A specially prepared close-ended structured questionnaire was given to study participants to know demographic, personal information and coexisting medical conditions. ...
A BSTRACT
Introduction
Depression can affect oral health as a result of neglecting oral hygiene procedures which leads to an increased risk of dental caries and periodontal disease.
Aim
To determine relationship between oral health and depression among elder people residing in old age homes of Mathura city.
Materials and Methods
The study was conducted among 500 subjects aged ≥60 years where dental condition, number of missing teeth, removable denture wearing, teeth mobility, periodontal condition, pocket depth, loss of attachment, and depression according to the Patient Health Questionnaire-9 scale were assessed.
Results
Regression analysis showed a positive relationship of the PHQ-9 value with DMFT and MT.
Conclusion
Among people aged 60 years and over, severity of depression increased with higher number of MT and DT.
... It is important to mention that the presence of oral prosthetics has been related with chewing problems [16] and speaking difficulties and quality of life related with oral health [17]. Park et al. [18] evaluated data from the Korean National Health and Nutrition Examination Survey and found that participants experiencing greater discomfort while eating exhibited a higher risk of depressive symptoms (OR: 1.25; 95% CI: 1.05-1.50) compared to those did not experience such discomfort. ...
Objective: To evaluate the relationship between oral health status, self-perception of oral health, and depression.
Methods: This cross-sectional study included 2953 individuals that were ≥ 18 years of age and participated in the Chilean National Health Survey (NHS), 2016–2017. Information on oral, dental, and mental health, and the presence or absence of depressive symptoms was collected. Secondary data analysis was carried out using STATA and included logistic regression models adjusted for sex, age, and educational level. The analyses factored in the expansion weights to estimate representative prevalences of the entire population.
Results: Participants experiencing frequent dental or prosthesis-related discomfort while speaking (OR: 1.57; 95% CI: 1.01–2.43) were related with exhibiting suspected depression. Removable upper denture users were at a higher risk of exhibiting suspected (OR: 2.04; 95% CI: 1.11–3.74) than those not using them. Participants diagnosed with depression in the past 12 months had a similar number of teeth (median = 24) compared to those without depression (median = 25) (OR: 0.99; 95% CI: 0.96–1.02).
Conclusion: Experiencing dental or prosthesis-related difficulties in speaking is related to suspected depression or a diagnosis of depression. These findings highlight the importance of developing comprehensive healthcare approaches that consider mental health in the context of oral health.
... Depression and self-rated health status also appear to have a significant correlation with oral health, supporting previous studies that oral health is inversely related to depression [74][75][76]. The significant correlation between masticatory ability and self-rated health status is selfexplanatory in that masticatory movement is important for eating enjoyment without limiting the variety of food and nutrition supply [77]. ...
Background
Although the importance of oral and systemic healthcare for elderly people is increasing owing to the rapid ageing of the population in South Korea, studies on the relationship between oral health, systemic health, and cognitive function, as well as on the prediction of cognitive function by oral and systemic health depending upon age groups are lacking.
Methods
We included 5,975 out of 6,488 participants from the 8th wave of the Korean Longitudinal Study of Aging (KLoSA) panel data, divided the participants into three age groups, and performed a hierarchical multiple linear regression analysis to explain cognitive function with four types of predictors: oral health status, sociodemographic factors, objective health status, and subjective health status.
Results
Oral health status was positively correlated with systemic health status and cognitive function. Of all ages over 54, cognitive function was significantly predicted by oral health variables, such as the number of functional teeth, masticatory ability, and Geriatric Oral Health Assessment Index (GOHAI); sociodemographic variables, such as age, sex, education level, and residence; and systemic health variables, such as diagnosis of diabetes mellitus, cancer or malignant tumours, cerebrovascular disease and rheumatoid arthritis, depressive symptom, and self-rated health status. Oral health variables explained cognitive function differently by age group; GOHAI appeared important predictor in the group aged < 75 years, whereas the number of functional teeth did in the group aged ≥ 75 years. Educational level, masticatory ability, depressive symptoms, and self-rated health status were pivotal factors age-independently.
Conclusions
The general and age-group-specific association between oral health, systemic health, and cognitive function were confirmed, suggesting that age-group-specific oral healthcare should be emphasized for the effective management of systemic and cognitive health in the elderly group.
... 41 In another study conducted by Park et al about depression and its association with oral health behavior, it was also revealed that patients with depression reported more frequent occurrences of dental pain. 42 Another finding of the current study is the negative association between age and all psychological variables. This result is in line with a meta-analysis on 192 epidemiological studies conducted by Solmi et al, that revealed the peak age of any mental disorders is 14.5 years of age. ...
Objectives This study aimed to determine the prevalence and distribution of dental pain and its association with psychological symptoms: stress and depression.
Materials and Methods The 2014 Indonesia Family Life Survey data were used for the abovementioned purposes. Records of self-reported dental pain and stress as well as the occurrence of depression based on the 10-item Center for Epidemiologic Studies-Depression scale were analyzed. Multivariable ordinal regression models were fitted to test the hypothesized associations between dental pain and each of the psychological symptoms, controlling for age, sex, education, wealth, and religiosity.
Results Dental pain prevalence among Indonesian population was approximately 15%. The adjusted odds ratios (ORs) from the ordinal regression models indicated that dental pain was related to the increase of the stress and depression level (OR: 1.31, 95% confidence interval [CI]: 1.14–1.49 and OR: 1.59, 95% CI: 1.41–1.79, respectively). Higher education, higher wealth, and being male are risk factors for stress. However, higher wealth and being male are protective factors for depression. Furthermore, higher religious level was a protective factor for both stress and depression.
Conclusion Dental pain was associated with a higher level of stress and a higher score of depression, even after being adjusted with age, sex, education, wealth, and religiosity.
... According to Park SJ et al, 13 people with symptoms of depression had a higher mean CPI score of 3 or more than those with a lower CPI score. According to Saletu A et al, 14 patients with chronic periodontitis had a higher mean depression score than those with gingivitis. ...
: Chronic periodontitis is a condition that causes inflammation in the tissues that support teeth, gradual attachment loss, and bone loss. Stress is the body's feedback towards detrimental forces, diseases, and additional atypical circumstances that are determined to distress its routine physiological equilibrium. On the other hand, the most prevalent psychological problems connected to periodontitis are anxiety and sadness.
: This study intends to assess the relationship between stress, depression, and anxiety with indices of periodontal health.
: A total of 171 patients were assessed & divided into 2 groups. Gingival index, modified sulcus bleeding index, community periodontal index for treatment needs, probing pocket depth, and clinical attachment level were evaluated. The Depression Anxiety Stress Scale–21 questionnaire used as the basis for the psychometric evaluation.
: The statistical analysis made use of the student 't' test and Pearson's correlation coefficient. When compared between the two groups, Group A had significantly higher values for each metric. The psychometric parameters and the periodontal parameters had a weakly positive connection (p<0.0001).
: According to the current study, people who are stressed, depressed, or anxious are more likely to develop periodontal disease. Therefore, stress, depression & anxiety could be viewed as a significant periodontal disease risk factor.
... Likewise, Park SJ et al., in 2014 reported toothache to be significantly associated with depression (AOR = 1.18, 95 percent CI 1.01-1.39) 17 . Yang SE et al., in 2016 also reported dental pain to be significantly associated with depression 18 . ...
Objective: To assess depression and its associated factors among patients coming to the dental OPD of a public and a private dental college of Karachi.Methods: A cross-sectional study was carried out in public and a private dental college of Karachi from November 2018 to May 2019. The inclusion criterion of the study was being 18 years of age or above whereas those who refused to give written informed consent were excluded from the study. After checking eligibility and taking written informed consent, a total of 250 participants were included in the study using systematic random sampling. These dental outpatients were interviewed by the principal investigator with the help of a pretested structured questionnaire that contained questions about socio-demographic information, dental risk factors and questions from Patient Health Questionnaire-9. Data were analyzed on the statistical package for social sciences version 21. Inferential analysis was performed using chi-square test whereas the significance level was set at 0.05.Results: The study results revealed that 70 (28.0%) participants had minimal depression, 99 (39.6%) had mild depression, 45 (18.0%) had moderate depression, 28 (11.2%) had moderately severe depression whereas 8 (3.2%) had severe depression. Moreover, among demographic characteristics, only monthly income (p=0.037) and family history of depression (p<0.001) were found to be significantly associated with severity of depression whereas, regarding dental risk factors only frequent dental pain (p=0.014), increased sensitivity (p=0.001) and presence of any systemic morbidity (p=0.001) were found to be significantly associated with severity of depression.Conclusion: The study results revealed that almost a third of the dental outpatients had moderate, moderately severe or severe depression. Moreover, low monthly income, positively family history of depression, frequent dental pain, increased sensitivity and presence of any systemic morbidity were identified as factors associated with depression among the study participants
... back pain, can lead to depression (McWilliams et al., 2004). Additionally, depression is associated with risk factors for poor physical health, including cigarette use (Weinberger et al., 2017), poor dental care (Park et al., 2014), and obesity (Luppino et al., 2010). Lastly, depression and chronic medical conditions share common pathways. ...
Background:
Medical comorbidity and healthcare utilization in patients with treatment resistant depression (TRD) is usually reported in convenience samples, making estimates unreliable. There is only limited large-scale clinical research on comorbidities and healthcare utilization in TRD patients.
Methods:
Electronic Health Record data from over 3.3 million patients from the INSIGHT Clinical Research Network in New York City was used to define TRD as initiation of a third antidepressant regimen in a 12-month period among patients diagnosed with major depressive disorder (MDD). Age and sex matched TRD and non-TRD MDD patients were compared for anxiety disorder, 27 comorbid medical conditions, and healthcare utilization.
Results:
Out of 30,218 individuals diagnosed with MDD, 15.2 % of patients met the criteria for TRD (n = 4605). Compared to MDD patients without TRD, the TRD patients had higher rates of anxiety disorder and physical comorbidities. They also had higher odds of ischemic heart disease (OR = 1.38), stroke/transient ischemic attack (OR = 1.57), chronic kidney diseases (OR = 1.53), arthritis (OR = 1.52), hip/pelvic fractures (OR = 2.14), and cancers (OR = 1.41). As compared to non-TRD MDD, TRD patients had higher rates of emergency room visits, and inpatient stays. In relation to patients without MDD, both TRD and non-TRD MDD patients had significantly higher levels of anxiety disorder and physical comorbidities.
Limitations:
The INSIGHT-CRN data lack information on depression severity and medication adherence.
Conclusions:
TRD patients compared to non-TRD MDD patients have a substantially higher prevalence of various psychiatric and medical comorbidities and higher health care utilization. These findings highlight the challenges of developing interventions and care coordination strategies to meet the complex clinical needs of TRD patients.
... Youth in lack self-control due to psychological immaturity, are more susceptible to addiction than adults because of their brimming curiosity that lead to difficulty in recognizing the adverse effects of internet usage (Blinka et al., 2015). The excessive internet usage such as playing games, shopping, chatting and watching pornography became the causes of reduced physical activity and sleep time, which have adverse effects on physical and mental health during young age when one should be forming proper health habits (Park, 2014;Nuutinen et al., 2014;. Lam (2014) found relationship between excessive internet usage and depression, in which excessive internet usage influences sleep problems like reduced sleep time, poor sleep quality, insomnia and so on. ...
Internet usage became an integrated part of everyday life, especially among youth. It influences the life style drastically the way of communication. Internet usage reflects the amount of data an individual uses for a specified period of time. This study is conducted to explore the relationship among internet usage, sleep disorder and somatic symptoms among youth. 500 college students from different colleges in Salem city were selected through stratified random sampling and the data was collected with the help of Internet usage scale by Robinson and Mukundan, 2016; Sleep disorder symptom checklist-17 by Klingman, Jungquist and Perlis, 2017 and Somatic symptom disorder-B criteria scale by Toussaint, Lowe, Brahler and Jordan, 2017. Results revealed that the internet usage of youth had a significant positive association with Insomnia, Circadian rhythm, Narcolepsy, Obstructive sleep apnea, Restless legs syndrome and Parasomnias dimensions of sleep disorder. Cognitive, Behavioral and Affective aspects of somatic symptoms were significantly correlated with the internet usage of youth. Internet usage had a significant influence on the sleep pattern and somatic problems of individuals.
... Emerging evidence suggests a link between AD and oral health, based on self-reported oral health-related quality of life (OHRQoL), objective indicators of oral health clinical assessments (e.g., missing teeth and gingival bleeding) (Ericsson et al., 2009;Zuluaga et al., 2012), and other indicators, including oral microbiota (Sureda et al., 2020), active potent neuroinflammatory regulators (e.g., IL-1β, IL-6, and TNF-α) (El Idrissi et al., 2021), and high salivary cortisol levels (Venturelli et al., 2016). An age-related change of oral status together with a decline in cognitive may be defined as a state of oral frailty (Dibello et al., 2021), representing toothache, oral dryness, tooth loss, dental caries, periodontal disease, and a set of worse oral daily practice functions, which may result in psychological distress (Vasiliou et al., 2016;Turner et al., 2017)and behavioral disturbances (Park et al., 2014;Kubo et al., 2017;Dahl et al., 2018). These oral clinical symptoms may eventually evolve into new stressors, thereby affecting disease outcomes (Mariño et al., 2020). ...
Community individuals with Alzheimer's disease (AD) experience oral disease alongside neuropsychiatric symptoms (NPS) with disease progression. Despite growing evidence for the link between oral health and cognitive status, few studies have investigated the associations between oral health and NPS, especially based on individuals' experience of AD. The primary aim of this study was to examine (a) the difference in oral health-related stressors among individuals with AD, mild cognitive impairment (MCI), and subjective cognitive decline (SCD); and (b) the associations of these stressors with NPS under the framework of the stress process model (SPM). A cross-sectional study was conducted among individuals diagnosed with AD (n = 35), MCI (n = 36) or SCD (n = 35), matched for age, sex education, and body mass index (BMI). Multiple regression and mediation model analyses were performed to explore predictors and their relationships with NPS based on the SPM. Data collection comprised four sections: (a) individual context; (b) oral health-related stressors, including dental caries, periodontal status, oral hygiene, the geriatric oral health assessment index (GOHAI), oral salivary microbiota, pro-inflammatory cytokines, and oral health behavior; (c) subjective stressors (i.e., perceived stress [PS]); and (d) NPS. Decayed, missing, and filled teeth (DMFT), missing teeth (MT), loss of attachment (LoA), plaque index (PLI), PS, oral health behavior, GOHAI, pro-inflammatory cytokines, and salivary bacterial composition were significantly different among the three groups; these parameters were poorer in the AD group than SCD and/or MCI group. LoA, PLI, PS, and pain or discomfort in the GOHAI were directly associated with NPS. PLI, LoA, and psychosocial function in the GOHAI indirectly affected NPS, and this relationship was mediated by PS. Individuals with AD reported greater oral health-related stressors. This study identifies direct and indirect associations linking oral health-related stressors and PS with NPS in individuals with AD. Our findings suggest that targeted dental care and oral-related stressor control may be valuable for managing NPS.
... There are many international studies documenting the association between depression and oral health (Dumitrescu et al., 2009;Hugo et al., 2012;Kim et al., 2017;M and C, 2016;Quine and Morrell, 2009;Rosania et al., 2009;Silveira et al., 2016;Takiguchi et al., 2016;Yang et al., 2016). Limitations of these studies include the age inclusion criteria of the study population of 60 years and older (Hugo et al., 2012) as well as examination of only one oral health outcome such as periodontal disease (Rosania et al., 2009), dental caries (Yang et al., 2016) and dental behaviors (Park et al., 2014). There have also been mixed findings on the association between depression and oral health. ...
Objectives
Depression is highly prevalent across populations, yet studies on its contribution to oral health are lacking. Therefore, our goal is to examine the association of depression and oral health problems (preventative care, access to dental care, and oral condition in relation to quality of life) controlling for sociodemographic and chronic disease indicators (CDI).
Methods
5,992 respondents’ data 18+ years old were analyzed from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). The independent variable of interest was depression symptoms status. Oral health outcomes were the dependent variables. We used the Patient Health Questionnaire-9 (PHQ-9) for depression and the Oral Health Questionnaire (OHQ) to measure oral health outcomes. Covariates included sociodemographics (age, education, sex, race/ethnicity, and income) and CDI included current smoking, diabetes, and body mass index. All data were weighted using 2 years sample weight.
Results
The mean age of respondents was 47.22 years (45.97-48.46) and 46% were males. Participants with depression present 6.93%, and females 63.85% were higher than males 36.15%.
Participants with depression have significantly low income 43.10% than others p value <.0001. After adjusting for sociodemographics and CDI, participants who have depression were more prone to report fair/poor oral condition [aOR=1.91 (1.29-2.84)], oral pain [aOR=2.66 (1.91-3.71)], and difficulty accessing needed dental care [aOR=2.52 (1.96-3.24)] than others. Having depression was associated with poor oral health perceptions [aOR=2.10 (1.41-3.13)], and having difficulty at job/school because of their oral health [aOR=2.85 (1.90-4.26)].
Conclusion
Based on the empirical evidence provided by our study, there is an association between depression and oral health outcomes and oral health-related quality of life.
... [5] According to a study that analyzed data from the Korean National Health and Nutrition Examination Survey (KNHANES), toothache was reported more frequently by patients with depression than by those without depression, and they also frequently reported uncomfortable mastication, temporomandibular joint symptoms and periodontal bleeding. [6] Several studies have demonstrated an agreement between subjective oral health and objective evaluations. In previous studies, individuals who reported an increased number of oral health symptoms, including dry mouth, impairment, and disabilities such as tooth loss and dental problems, assessed their oral health negatively. ...
Oral health can affect or be a manifestation of general health. Although oral health assessment has been used as a proxy for general health, few studies have reported an association between oral health status and allergic diseases. This cross-sectional study aimed to investigate the relationship between subjective oral health status and asthma/allergic rhinitis in a nationwide representative sample of Korean adults.
A total of 227,977 participants from the Korean Community Health Survey 2015 were enrolled. Participants were asked about their subjective oral health status (very good, good, normal, poor, very poor), periodontal status (mobility, swelling, calculus, bleeding), teeth brushing frequency, and scaling history within the past 12 months. Histories of physician-diagnosed asthma and allergic rhinitis throughout life were surveyed. The associations between subjective oral health status and allergic diseases were analyzed using multiple logistic regression analysis. Age, sex, economic level, educational level, region of residence, smoking, alcohol, obesity, subjective general health status, stress level, physical activity, periodontal status, teeth brushing frequency, and scaling history within the past 12 months were adjusted as covariates.
A higher prevalence of asthma (3.6%) was reported in the poor oral health group than in the good (1.8%) and normal (2.1%) groups (P < .001). Poor oral health status was significantly related to asthma, with an adjusted odds ratio (aOR) of 1.19 (95% CI = 1.07–1.33, P = .002). Although the prevalence of allergic rhinitis was not higher in the poor oral health group (13.4%) than in the good (15.4%) and normal oral health groups (15.9%), the aOR for allergic rhinitis was 1.05 (95% CI = 1.00–1.11, P = .045) in the poor oral health group after adjusting for covariates.
Subjective poor oral health status was significantly associated with asthma and allergic rhinitis in Korean adults.
... Jin Park et al. compared depressed people with a control group and showed that those with a lifetime diagnoses of depression brushed their teeth once or less a day (15.8%), had bad self-perceived oral health (52.3%), had a toothache more (31.5%) and a higher rate of periodontal bleeding (in both jaws) (27). Other research concluded that depressed respondents had higher odds of gum bleeding (4.96 times) (28). ...
Introduction
The problems of oral health of people diagnosed with depression are not adequately recognized, either in developed or developing countries. Social stigma, lack of self-interest, or even inadequate approaches of dental doctors towards the unique situation of this group of people this lead to excessive oral health problems.
Methods
The bibliographic database PubMed/Medline, Google Scholar, and Whiley online library were searched using the following text and MeSH as separate key terms and in combination: depression and oral health/dental caries/periodontal disease/tooth loss/utilization of oral health services/and barriers. The content of documents was analysed using qualitative methodology.
Results
Twenty-six original studies were included in the review. Level/severity of depression, medication and medical comorbidity are the most important medical barriers influencing the oral health of people diagnosed with depression. Dental fear and anxiety are mostly combined with low oral hygiene and bad oral health. Socioeconomic status, dental insurance, bad habits and education also have important roles in the oral health status of people diagnosed with depression.
Conclusion
Including individuals with depression and oral health problems in national health programs, creating specific prevention programs, or subsidizing the cost of treatment are some of the recommendations suggested as solutions.
... In Korea, the prevalence of dementia was 9.2% and of Alzheimer disease was 5.7% in elderly patients (aged ≥ 65 years); these values were higher than those from Western and other Asian countries. [2] Several epidemiologic studies have suggested that infectious diseases, such as periodontitis, [3] and noninfectious diseases, including atherosclerosis, [4] type 2 diabetes, [5] and obesity, [6] are risk factors for the development of neurodegenerative dementia. These diseases are related to a chronic inflammatory phenotype. ...
The aim of this case-control study was to evaluate the association between chronic rhinosinusitis (CRS) and neurodegenerative dementia in a large representative Korean population. The ≥ 50-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2015. A total of 17,634 neurodegenerative dementia patients were matched in a 1:4 ratio with 70,536 control participants for age, sex, income, and region of residence. Neurodegenerative dementia was defined using the ICD-10 codes G30 and F00. CRS was identified based on the ICD-10 code J32. Among the cohort, we selected participants who were treated ≥ 2 times and those who underwent head and neck computed tomography. The odds ratio (OR) for CRS in patients with dementia was analyzed using a conditional logistic regression model. Subgroup analyses were conducted according to age and sex. There was no difference in the prevalence of CRS with/without nasal polyps between the dementia (1.1%) and control (1.2%) groups (P = .825). CRS with/without nasal polyps was not significantly associated with dementia (adjusted OR = 0.96, 95% CI = 0.82-1.13, P = .653). In the subgroup analyses according to age and sex, the adjusted ORs for CRS with/without nasal polyps were not higher in the dementia group than in the control group. Previous CRS was not associated with neurodegenerative dementia in the Korean population.
... In addition, it has been pointed out that depression and temporomandibular disorder are related. 27 A relationship between stress and attrition has also been identified in adolescents, 28 which is consistent with the results of this study. It has also been reported that salivary a-amylase in children undergoing long-term psychostimulant therapy compared to healthy children are low, although not significantly different. ...
Background/purpose
Stress in the elderly is caused by loss of physical and psychological health. Although there have been many reports on the intraoral environment affecting physical health, few reports exist on stress and the intraoral environment in the elderly. The aim of this study was to investigate the relationship between salivary α-amylase as an index of stress value and the intraoral environment.
Materials and methods
Three hundred and nineteen participants were community-dwelling independent individuals over 65 years old. The outcome variable was salivary α-amylase. After measurement, salivary α-amylase was classified into four groups (0 = 0–30, 1 = 31–45, 2 = 46–60, 3 = 61–200). The predictor variables were physical status (which includes age and male body-mass index) and subjective and objective symptoms (which include present teeth, torus palatinus, torus mandibularis, temporomandibular joint noise, bruxism, and dental attrition). These variables were compared among participants using univariate analysis and multiple logistic regression analysis.
Results
The participants included 77 men and 242 women, with a mean age of 75.8 ± 5.4 years (65–94 years). Although temporomandibular joint noise and dental attrition were significantly positively correlated with salivary α-amylase, bruxism was significantly negatively correlated with salivary α-amylase (p < 0.05). Stepwise regression analysis revealed a significant relationship between salivary α-amylase and temporomandibular joint noise, bruxism, and dental attrition.
Conclusion
High salivary α-amylase is associated with a high rate of temporomandibular joint noise and dental attrition, and a low rate of bruxism among elderly participants.
... 4,20 The limitations of this study includes small sample size, descriptive cross-sectional method, and lack of data on several factors affecting oral health such as oral health habits and knowledge. 21 This study is unable to clarify whether depression might be linked to poor oral hygiene nor it can compare the oral hygiene of depressed patients and nondepressed patients therefore future study should consider these factor for better understandings. ...
Introduction: Oral hygiene is one of the most critical factor in maintaining oral health. Depression symptoms may affect an individual’s oral health due to poor health behaviour, making depressed individuals prone to oral diseases such as caries and periodontal diseases. This study was aimed to obtain the oral hygiene status overview of depressed patients in West Java Psychiatric Hospital. Methods: This study was an observational descriptive with a cross-sectional approach to depressed patients (F.32 ICD Code). The measuring instrument used was Oral Hygiene Index-Simplified (OHI-S). Based on OHI-S, oral hygiene can be assessed into poor within 3.0 – 6.0 score point, fair within 1.3-3.0 score point, or good within 0.0 – 1.2 score point. Results: There were 30 respondents recruited using a purposive sampling method. Based on the plaque index, 1 respondent (3%) fell into good category, 23 respondents (77%) fell into the fair category, and 6 respondents (20%) fell into poor category. Based on the calculus index, 7 respondents (23%) fell into good category, 10 respondents (60%) fell into the fair category, and 5 respondents (17%) fell into poor category. Based on OHI-S, 2 respondents (7%) fell into the good category, 18 respondents (60%) fell into the fair category, and 10 respondents (33%) fell into poor category. Conclusion: Oral hygiene in-dex of depressed patients was categorised as fair.
... The patient suffering from periodontitis tend to neglect the oral hygiene which in turn leads to increased biofilm load, inflammation, attachment loss and development of periodontitis. 11,12 Other mechanism is related to psychonueroimmunologic changes. Psychological stressors activate the peripheral and central system that maintain homeaostasis. ...
... Likewise, Park SJ et al., in 2014 reported toothache to be significantly associated with depression (AOR = 1.18, 95 percent CI 1.01-1.39) 17 . Yang SE et al., in 2016 also reported dental pain to be significantly associated with depression 18 . ...
Objective: To assess depression and its associated factors among patients coming to the dental OPD of a public and a private dental college of Karachi. Methods: A cross-sectional study was carried out in a public and a private dental college of Karachi from November 2018 to May 2019. The inclusion criterion of the study was being 18 years of age or above whereas those who refused to give written informed consent were excluded from the study. After checking eligibility and taking written informed consent, a total of 250 participants were included in the study using systematic random sampling. These dental outpatients were interviewed by the principal investigator with the help of pretested structured questionnaire that contained questions about socio demographic information, dental risk factors and questions from Patient Health Questionnaire-9. Data were analyzed on statistical package for social sciences version 21. Inferential analysis was performed using chi-square test whereas the significance level was set at 0.05. Results: The study results revealed that 70 (28.0%) participants had minimal depression, 99 (39.6%) had mild depression, 45 (18.0%) had moderate depression, 28 (11.2%) had moderately severe depression whereas 8 (3.2%) had severe depression. Moreover, among demographic characteristics, only monthly income (p=0.037) and family history of depression (p<0.001) were found to be significantly associated with severity of depression whereas regarding dental risk factors only frequent dental pain (p=0.014), increased sensitivity (p=0.001) and presence of any systemic morbidity (p=0.001) were found to be significantly associated with severity of depression. Conclusion: The study results revealed that almost a third of the dental outpatientshad moderate, moderately severe or severe depression. Moreover, low monthly income, positively family history of depression, frequent dental pain, increased sensitivity and presence of any systemic morbidity were identified as factors associated with depression among the study participants.
... 33 Depression has also been correlated with modified behaviors related to maintaining proper oral hygiene. 34 In our study, the intensity of depression showed a significant positive correlation with OHIP total scores and the OHIP subscales of physical pain and physical disability. The higher the severity of depression, the lower the quality of life in terms of oral health, as well as physical pain and physical disability. ...
Objective
We aimed to investigate the influence of depression and self-esteem on oral health-related quality of life (OHRQoL) in students.
Methods
Among the 67 included participants, we measured self-esteem using the Rosenberg Self-Esteem Scale, severity of depression using the Patient Health Questionnaire-9 (PHQ-9), personality dimensions with the Neuroticism–Extraversion–Openness Five-Factor Inventory, and OHRQoL using the Oral Health Impact Profile 49 (OHIP-49).
Results
Among all participants, 7.5% (n = 5) had the dominant personality trait openness to experience, 11.9% (n = 8) presented a neurotic personality type, and 64.% (n = 11) had an extraverted personality type. The most frequent was conscientious personality type, accounting for 64.2% (n = 43) of participants. Our results showed a significant correlation between increased PHQ-9 scores and OHIP scores (Spearman’s r = 0.280); thus, participants with poorer oral health tended to have more severe depression. An increase in depression severity was significantly and positively correlated with increased scores across the other two OHIP subcategories, physical pain (Spearman’s r = 0.314) and physical disability (Spearman’s r = 0.290).
Conclusion
The presence and severity of depression influences OHRQoL. An important factor in the presence of depression and level of self-esteem is the personality type, especially the neuroticism dimension.
... This result suggests that periodontitis is an independent risk factor for subsequent MD regardless of sex, age, and the comorbidities except for diabetes, alcohol abuse, and cancer. On the other hand, in a meta-analysis on four cross-sectional studies [64][65][66][67] that were assessed as moderate-high quality of the evidence and considered periodontitis as the outcome and MD as the exposure, the pooled estimate does not show association between periodontitis and MD (OR 0.96, 95% CI 0.84-1.10) [68]. ...
Increasing evidence implies a possible causal link between periodontitis and neuropsychiatric disorders, such as Alzheimer’s disease (AD) and major depression (MD). A possible mechanism underlying such a link can be explained by neuroinflammation induced by chronic systemic inflammation. This review article focuses on an overview of the biological and epidemiological evidence for a feasible causal link of periodontitis to neuropsychiatric disorders, including AD, MD, Parkinson’s disease, and schizophrenia, as well as the neurological event, ischemic stroke. If there is such a link, a broad spectrum of neuropsychiatric disorders associated with neuroinflammation could be preventable and modifiable by simple daily dealings for oral hygiene. However, the notion that periodontitis is a risk factor for neuropsychiatric disorders remains to be effectively substantiated.
... The flap reconstruction and radiotherapy treated oral cancers patients witness severe dysphagia, depression, speech impairment and salivary dysfunctions (Airoldi et al. 2011). The painful and chronic ailments of oral cavity cause psychological disorders including anxiety and depression (Jin et al. 2014;Aditya and Lele 2015;Patil and Savalagi 2015;Gonçalves et al. 2017). ...
Smoking is a pernicious practice prevalent worldwide. It involves breathing of burnt-tobacco fumes/smoke which comprises of numerous chemical entities posing deleterious aftermaths in the oral cavity. Tobacco fumes carry carcinogens namely damaging chemicals like nitrosamines, polycyclic aromatic hydrocarbons, aldehydes, nicotine, phenols, carbon monoxides, radioactive elements, heavy metals ions. Oral cavity (mouth or buccal cavity), forming initial contacts with tobacco smokables, plays an essential role in the digestive system, facial determinations and speech. Smoking is a significant risk factor for oral cavity cancers. Nearly 50% of deaths from oral cavity cancer (oral cancer) attribute to smoking. This review intends to focus on the smoking mediated molecular modulations that are associated with the genesis of oral cancers.
... 14 Park SJ et al. showed the negative relation between depression and oral health status. 15 The study showed that participants with lifetime depression brushed their teeth less frequently and were found that while experiencing dental problems did not receive any treatment. ...
Various health determinants are interrelated throughout life and understanding this relationship provides insight into the connection between genetic factor, biological systems, neurobiology, human behaviour, individual characteristics and influences from social and psychological factors. This narrative literature review helps to enumerate the various psychological factors that determine oral health. This creates a better understanding of the oral diseases from a relatively less explored aspect and for the better management of oral diseases. Thus, the multidimensional model of causative factors of oral diseases is considered which includes the psychological factors, rather than the conventional biomedical model
... 7 Some studies have suggested an association between psychiatric problems and those related to the stomatognathic system. [8][9][10][11][12][13][14] Depression is considered a disease of modern times with high prevalence worldwide and increasing incidence over time. Therefore, knowledge about its symptomatology, medication therapy used, and its mechanism of action, in addition to adverse reactions resulting from some medications, will enable dentists to understand the presence of possibly related oral comorbidities, and thus diagnose and treat them correctly. ...
Aims:
To investigate the symptoms of depression and oral health status in Brazilian public healthcare system users.
Materials and methods:
Analysis of a cross-sectional study conducted with a sample of 776 individuals aged 15 years or older, in the urban areas of Recife (Brazil), obtained by multistage sampling. Committee on Ethics in Research with Human Beings (CAAE) 0538.0.172.172-11. Depression symptoms were verified by means of Axis II of the Research Diagnostic Criteria in Temporomandibular Disorder. For the socioeconomic level, the economic classification criteria of the Brazilian Association of Research Companies and clinical exam record charts were used to establish variables related to oral health conditions.
Results:
The variables discomfort on occlusion (OR = 1.882 CI = 1.384-2.560), gingival bleeding (OR = 1.384 CI = 1.002-1.912), and self-perception of oral health (OR = 1.549 CI = 1.054-2.277), remained in the regression model.
Conclusion:
Discomfort on occlusion, self-perception of oral health, gingival bleeding, sex, and skin color were shown to be associated with the presence of depressive symptoms.
... The Institutional Review Board of the KCDC approved survey protocol. Additional details about the study design and methods are provided in previous reports [15,16]. ...
Cancer survivors remain at life-long risk of developing oral complications. This study investigated the oral health status and behavior among cancer survivors in comparison to subjects without a history of cancer using a nationwide survey. Cancer survivors and control subjects were selected from the sixth Korean National Health and Nutrition Examination Survey (2013-2015). Survivors reported chewing (34.8%) and speaking difficulties (15.3%) resulting from oral health problems. More than 36% of survivors had periodontal disease and 15.9% needed dentures. In multiple logistic regression analysis, age, household income, education level, smoking status, cancer site, and current cancer status were associated with oral health status. Approximately 43.3% of cancer survivors brushed their teeth more than three times a day. In addition, 44.9% of survivors used secondary oral products, and 30.8% had been screened for oral health problems over the past year. Age, household income and education level were associated with oral health behavior. The oral health status and behavior excepting periodontal disease and the use of secondary oral products were not significantly different between cancer survivors and controls. Although oral health status of cancer survivors was not worse than that of controls, more than half of the survivors maintained unhealthy oral practices.
A systematic review of literature, in order to investigate an association between Major depressive disorder (MDD) and Oral health was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on PROSPERO (registration number: CRD42023470383). The search and screening according to previously established protocol were conducted by two authors. Electronic databases such as PubMed, Scopus, and DOAJ were searched from January 2000 until October 2022 for studies reporting data on oral health status and MDD. Quality assessment of included studies was evaluated using NIH tool developed by NHLBI for retrospective and prospective studies and Cochrane risk of bias 2 (RoB 2) tool for interventional studies through its domains. The RoB summary graph and RoB summary applicability concern were plotted using RevMan software version 5.3. All the studies tried to understand the association and impact of major depressive impact on oral health and hygiene. The collective result demonstrates a mixed relationship of depression and oral health. Recognizing the oral health status of individuals with depressive symptoms can serve as valuable information for both dental and mental health professionals. This awareness enables the development of customized treatment plans to assist patients in achieving comprehensive wellness. There is an opportunity for further research of similar nature in developing countries such as India, Indonesia, and China, which have substantial population sizes.
Mood disorders collectively represent one of the most common mental illnesses. Patients with mood disorders are more likely to have various physical illnesses compared to the general population. Of these diverse physical illnesses, poor oral health conditions are common, but they are often neglected in the care of mood disorders. This review examines the currently available evidence that altogether shows that oral disease both is common in patients with mood disorders and affects the course of mood disorders. In particular, oral disease is found to be common in patients with mood disorders, and patients with mood disorders put less effort toward oral hygiene than the general population. Symptoms of mood episodes, comorbid tobacco, alcohol, and substance use, diet, and pharmacological agents for mood disorder are all factors that could worsen oral health by worsening oral hygiene care. Etiological associations have also been suggested. Severe mood disorders can worsen oral health, and poor oral health could worsen mood disorder by increasing chronic low-grade inflammation. Mental health professionals should remain aware of the importance of oral hygiene in the clinical course of mood disorders and they should advise their patients to do regular dental checkups. [ Psychiatr Ann. 2024;54(8):e226–e229.]
Background
Individuals with mental illness have poor oral health compared to those without mental health conditions. However, the literature is still lacking regarding the specifics of this relationship.
Objective
This study aims at examining the relationship between depression and oral health problems such as oral conditions, access to dental care, and oral hygiene measures.
Methods
A cross-sectional study using a secondary data analysis of 9,693 participants from the 2017 to March 2020 prepandemic National Health and Nutrition Examination Survey (NHANES). The independent variable was severity of depressive symptoms as measured by the Patient Health Questionnaire–9 (PHQ-9). Proportional odds and binary logistic regression were used to calculate crude and adjusted odds ratios (AORs) between depression and 8 oral health outcomes and oral hygiene–related behaviors.
Results
After adjusting for sociodemographics, health conditions, and behaviors, individuals with depression were significantly more likely to have dental aches in the past year (AOR = 1.70; 95% confidence interval [CI], 1.13–2.56), difficulty getting dental care when needed (AOR = 1.93; 95% CI, 1.45–2.58), and difficulty at their jobs due to a problem in their mouth (AOR = 1.63; 95% CI, 1.07–2.49) compared to individuals without depression.
Conclusion
Individuals with depressive symptoms often neglect oral hygiene and self-care practices and are less likely to seek medical care for oral health problems, making them at increased risk of poor oral health outcomes. These findings can be applied by dentists, psychologists, and therapists to increase awareness of links between depression and oral health and to encourage patients with depression to seek oral hygiene preventative care.
Knowledge Transfer Statement
Health care professionals can be on the frontline in creating awareness in the general public about the links between depression and oral health and hygiene. Applying the findings from this study can help communicate about the relationship between depression and poor oral health and relieve some burden on the American health care sector, which often struggles to provide medical care to patients with depression and oral health issues.
Objective
To evaluate the relationship between oral health status, self-perception of oral health, and depression.
Methods
This cross-sectional study included 2953 individuals that were ≥ 18 years of age and participated in the Chilean National Health Survey (NHS), 2016–2017. Information on oral, dental, and mental health, and the presence or absence of depressive symptoms was collected. Secondary data analysis was carried out using STATA and included logistic regression models adjusted for sex, age, and educational level. All expansion factors were taken into consideration.
Results
Participants experiencing frequent dental or prosthesis-related discomfort while eating (odds ratios (OR): 1.58; 95% confidence intervals (CI): 0.99–2.54) or speaking (OR: 1.57; 95% CI: 1.01–2.43) were at a higher risk of exhibiting suspected depression compared to those who did not experience these difficulties. The odds (OR: 1.18; 95% CI: 0.65–2.16) of having been diagnosed with depression in the past 12 months were also higher among participants experiencing frequent dental or prosthesis-related discomfort. Removable upper denture users were at a higher risk of exhibiting suspected (OR: 2.04; 95% CI: 1.11–3.74) compared to those that did not use them. Participants diagnosed with depression in the past 12 months had a slightly lower number of teeth (median = 24) compared to those without depression (median = 25), although this difference was not statistically significant (OR: 0.99; 95% CI: 0.96–1.02).
Conclusion
Experiencing dental or prosthesis-related difficulties in in eating, speaking, and social interactions is associated with an increased risk of suspected depression or a diagnosis of depression. These findings highlight the importance of developing comprehensive healthcare approaches that consider mental health in the context of oral health.
Introduction
Veterans suffer from lower overall well-being than non-veterans because of their unique life course. This study aims to compare the impact of depression on oral health for veteran and non-veteran populations.
Materials and Methods
Data from 11,693 adults (18+) participating in the National Health and Nutrition Examination Survey (2011-2018) were analyzed. The outcome variables were dichotomous (at/above mean) decayed, missing, and filled teeth due to caries (DMFT), as well as the components, namely, missing teeth, filled teeth (FT), and decayed teeth (DT). The primary predictor variable combined depression screening outcome and veteran status (veteran/depressed, veteran/not depressed, non-veteran/depressed, and non-veteran/not depressed). Covariates included socioeconomic factors, demographics, wellness factors, and oral health–related habits. Associations between outcome and predictor variables were assessed with a fully adjusted logistic regression analysis.
Results
Veterans, regardless of depression status, had more DMFT, FT, missing teeth, and DT compared to non-veterans. After controlling for covariates, veterans suffering from depression had higher odds of DT (1.5, 95% CI, 1.0-2.4) compared to non-veterans without depression. In general, veterans who screened negative for depression had better oral health compared to all groups, with lower odds of DT (0.7, 95% CI, 0.6-0.9) and higher odds of FT (1.4, 95% CI, 1.1-1.7) compared to non-veterans with and without depression.
Conclusions
This study found that not only veterans have higher odds of overall caries experience, but also veterans suffering from depression have higher odds of active caries compared to non-depressed veterans. Most veterans lack Veterans Health Administration dental benefits and face challenges maintaining oral health on top of medical and mental health burdens. Our results add further urgency to increasing dental care access for this vulnerable population because of the exacerbation of unmet oral health care needs attributable to the additional mental health challenges veterans face.
Background:
There is limited knowledge regarding the association between oral health and mental health in terms of depressive symptoms and particularly anxiety symptoms. Therefore, our aim was to close this gap in knowledge.
Methods:
Cross-sectional data were used from wave 5 of the pan-European Survey of Health Ageing, and Retirement in Europe (SHARE) (n = 62 358 observations). The Beck Anxiety Inventory was used to quantify anxiety symptoms and the Euro-D was used to measure depressive symptoms. Oral health was quantified based on the presence of missing natural teeth, the number of missing natural teeth and the extent of replaced teeth. It was adjusted for several covariates in regression analysis.
Results:
Multiple linear regressions revealed that the presence of missing natural teeth was associated with higher anxiety symptoms (β = 0.11, P < 0.001) and higher depressive symptoms (β = 0.22, P < 0.001) among the total sample. Among individuals with at least one missing natural tooth, the number of missing natural teeth was positively associated with higher anxiety symptoms (β = 0.02, P < 0.001) and higher depressive symptoms (β = 0.02, P < 0.001) - and fully replaced teeth (compared to not at all replaced teeth) were associated with lower anxiety symptoms (β = -0.35, P < 0.001) and lower depressive symptoms (β = -0.36, P < 0.001).
Conclusion:
Our study stresses the association between lower oral health and lower mental health among older adults in Europe. Future studies based on longitudinal data are required.
Background/aim
Limited research has been conducted regarding the association between mental illness and dental caries. We studied the impact of emotional distress on current and new dental caries among low-income African-American caregivers in Detroit, Michigan and if this association was mediated by poor oral hygiene and sugar consumption and modified by a chronic health condition.
Methods
Data came from Detroit Dental Health Project, a prospective cohort study of low-income African American caregivers and their children. We focused on baseline (n = 1,021) and 4-year follow-up participants (n = 614). Dental caries were assessed using the International Caries Detection and Assessment System. The study outcomes included two baseline caries outcomes (counts of non-cavitated lesions, baseline counts of cavitated lesions) and two outcomes of new caries over 4 years (new cavitated lesions and new non-cavitated lesions). The exposure was emotional distress. We performed multivariable quasi-Poisson regression analysis to test the association between emotional distress and caries. We tested effect modification by stratifying data by chronic health conditions and performed causal mediation analysis to test an indirect effect of oral hygiene and sugar consumption.
Results
Ninety six percent of the caregivers were female, and their average age was 28 years old. Thirteen percent reported emotional distress at baseline. After accounting for potential confounding, emotional distress was positively associated with cavitated lesions at baseline (IRR = 1.36, 95% CI = 1.08, 1.70). Among those with a chronic health condition, stronger association was observed (IRR = 1.73, 95% CI = 1.27, 2.35). After 4 years, those with emotional distress and chronic health conditions had an increased risk of developing non-cavitated carious lesions (IRR = 1.41, 95% CI = 1.06, 1.88). Poor oral hygiene explained 51% of the association between emotional distress and baseline cavitated lesions (natural indirect effect = 1.16, 95% CI = 1.02, 1.33), but there was no evidence for an indirect effect of sugar consumption.
Conclusion
In this group of young, African-American caregivers with low socioeconomic status, dental caries was associated with emotional distress. This association was explained by poor oral hygiene and strengthened among those who reported a chronic health condition.
Oral healthOral health is an important but usually neglected healthHealth issue. Such as other aspects of healthHealth, it is under the influence of several factors at various levels. Thus, promoting the populationPopulation’s oral healthOral health requires an interdisciplinaryInterdisciplinary and multi-dimensional approach. This chapter defines oral healthOral health, and its relation to general healthGeneral health will be presented. It reviews disciplinesDiscipline that contribute to oral health promotionOral health promotion. Then, the conceptsConcept of oral health promotionOral health promotion will be reviewed, and finally, the teamwork approachTeamwork approach in the oral healthcare deliveryHealthcare delivery system will be emphasized. A schematic illustration to show how the implementation of interdisciplinaryInterdisciplinary and interprofessionalInterprofessional approaches will help to promote the populationPopulation’s oral and general healthGeneral health. The code of this chapter is 01110010 01,101,10101,101,11001,101,11101,101,11101,101,00101,101,11101,110,100 01,010,000.
Objective
This prospective study investigated the cross-sectional association between impaired oral health-related quality of life (OHRQoL) and the prevalence of depressive symptoms, and the longitudinal association between impaired OHRQoL and development of depressive symptoms among older adults.
Background
Previous studies have shown a relationship between poor oral health and depression among older adults; however, findings are inconsistent.
Materials and Methods
Participants were 669 community-dwelling older Japanese individuals aged≥55 years (mean: 67.8 ± 7.2 years). Data of 296 participants were used for longitudinal analyses. OHRQoL was evaluated using the Oral Impacts on Daily Performances scale. Impaired OHRQoL was defined as the presence of at least one impact on the scale. Depressive symptoms were assessed using the Japanese version of the Zung self-rating depression scale with a cut-off score of 40.
Results
The cross-sectional logistic regression model demonstrated that impaired OHRQoL was significantly associated with depressive symptoms (odds ratio [OR], 5.17; 95% confidence interval [CI], 2.99-8.95) independent of age, sex, body mass index, hypertension, cerebrovascular/cardiovascular disease, smoking, drinking alcohol, education, cognitive function, objective oral health (dentition status) and oral health behaviour (dental visit within 1 year). Similarly, impaired OHRQoL predicted the development of depressive symptoms within 4 years in a fully adjusted longitudinal model (OR, 6.00; 95% CI, 1.38-26.09).
Conclusion
Impaired OHRQoL was identified as a potential comorbidity of depressive symptoms and a predictor for depressive disorder later in life. OHRQoL may be a useful clinical outcome for elder patients with regard to their mental and oral health.
Previous evidence suggests the association of lower educational attainment and depressive symptoms with tooth loss. The hypothesis of this study was that these factors may exacerbate the effect on tooth loss beyond the sum of their individual effects. We aimed to clarify the independent and interactive effects of educational attainment and depressive symptoms on the number of missing teeth among community residents. Cross-sectional data of 9,647 individuals were collected from the general Japanese population. Dental examination was conducted by dentists. Educational attainment was categorized into 3 levels based on the number of educational years: ≤9, >9 to ≤12, and >12 y. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms; a total score of ≥16 and/or the use of medications for depression indicate the presence of depressive symptoms. In the multivariate analysis with adjustment for conventional risk factors, educational attainment was identified as a determinant of the number of missing teeth (>9 to ≤12 y of education: coefficient = 0.199, 95% confidence interval [CI], 0.135 to 0.263, P < 0.001; ≤9 y of education: coefficient = 0.318, 95% CI, 0.231 to 0.405, P < 0.001: reference, >12 y of education). An analysis that included interaction terms revealed that the relationship between “≤9 y of education” and the number of missing teeth differed depending on the depressive symptoms, indicating a positive interactive association (coefficient for interaction = 0.198; 95% CI, 0.033 to 0.364, P for interaction = 0.019: reference, >12 y of education). Our study suggests the presence of a significant association between educational attainment and tooth loss, as well as a partial interactive association between “≤9 y of education” and “depressive symptoms” in the general Japanese population.
Oral diseases produce enormous productivity loss. However, epidemiological evidence of work stress and tooth loss is scarce. The aim of this study was to examine the association of work stress, according to effort–reward imbalance (ERI), with tooth loss. We conducted a cross-sectional study using data obtained between 2010 and 2011 in Japan. This study included 1,195 employees aged 25–50 years old (response rate=32%). The dependent variable was self-reported tooth loss (having or not). The independent variable was a dichotomized ERI ratio (>1.4 and ≤1.4). Age, sex, sociodemographic variables, work-related factors, and health-related variables were adjusted. Psychological distress was used as a potential mediator. We also examined an additive interaction between support from supervisors and ERI. The median age was 37, and 48% were women. After adjusting for the covariates, ERI was still associated with tooth loss (prevalence ratio=1.20 [95% confidence interval=1.01, 1.42] from Poisson regression models with a robust error variance). Psychological distress partially explained the association, and support from supervisors significantly attenuated the association. In conclusion, high ERI ratio was still associated with an increased risk of tooth loss among working adults.
Objectives:
To determine whether oral health status predicts depressive symptoms in older Japanese people.
Design:
Longitudinal study.
Setting:
Twenty-four municipalities in Japan.
Participants:
Community-dwelling individuals aged 65 years and older who responded to mail surveys performed by the Japan Gerontological Evaluation Study in 2010 and 2013 (N = 14,279).
Measurements:
Depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Multiple imputations were used to deal with missing data. After excluding participants with depressive symptoms (GDS ≥ 5) at baseline, odds ratios (ORs) and 95% confidence intervals (CIs) for incident depressive symptoms in 2013 were estimated using logistic regression models.
Results:
After adjusting for sex, age, educational attainment, equivalized household income, marital status, present illness, exercise, frequency of going out, and visits for dental treatment, the following ORs (95% CIs) were observed in simultaneously added oral health variables: 10-19 teeth (OR 1.16, 95% CI 0.99-1.37, reference: ≥20 teeth); 1-9 teeth (1.14, 0.94-1.38, reference: ≥20 teeth); no teeth (1.28, 1.03-1.60, reference: ≥20 teeth); more difficulty chewing tough foods now than 6 months ago (1.24, 1.04-1.47); choking when drinking tea or soup (1.02, 0.84-1.23); feelings of thirst (1.17, 0.99-1.40); difficulty eating food (0.98, 0.80-1.21), difficulty speaking clearly (1.19, 0.89-1.60); problems with smiling (1.24, 0.94-1.65); problems with emotional stability (1.32, 0.86-2.04); and problems enjoying oneself around family, friends, or other people (0.86, 0.42-1.78).
Conclusion:
These findings suggest that having no teeth and oral health problems may play a role in the development or worsening of depressive symptoms.
Introduction:
More than one in five American adults has a disability, the most common being mobility impairment (MI). People with MI face significant barriers to healthcare access and are more likely to experience psychological distress. This study examined disparities in access to medical and dental care among people with MI and examine the mediational role of psychological distress on this relationship.
Methods:
Analyses were conducted on 36,697 adults (aged ≥18 years) responding to the 2014 National Health Interview Survey (analyzed in 2015). MI was defined as needing special equipment and having difficulty walking a quarter mile without equipment. Outcomes included having lost all natural teeth (edentulous), unmet dental needs, annual dental visit, and annual medical visit. Psychological distress was measured using the Kessler psychological distress (K6) scale.
Results:
Compared with adults without MI, adults with MI had greater odds of being edentulous (OR=2.10, 95% CI=1.82, 2.43), having unmet dental needs (OR=1.99, 95% CI=1.66, 2.40), and lower odds of having annual dental visits (OR=0.62, 95% CI=0.54, 0.71). However, adults with MI were significantly more likely to have annual medical visits (OR=2.31, 95% CI=1.90, 2.81) than adults without MI. Psychological distress partially, yet significantly, mediated the relationship between MI and outcomes.
Conclusions:
People with MI have significant oral health needs and poor access to dental care, which are partially mediated by psychological distress. Results suggest that mental health services should be considered for inclusion in interventions and medical visits can be leveraged to improve oral health outcomes in this population.
To investigate the physical function of elderly people in Korea using quantitative and objective tools and to assess the impact of declined physical function on their quality of life.
Depression is one of the most significant public health problems in Korea. The lifetime prevalence rates of major depressive disorder (MDD) in Korean adults have ranged from 3.3% to 5.6%, which are lower than those of western countries. Point prevalence rates of MDD in Korean elders from 4.6% to 7.5%, which are relatively higher than those of Western countries and other Eastern countries, have been reported. The prevalence rate of probable depression (depressive symptoms defined by the cutoff point of 16 on the Center for Epidemiologic Studies Depression Scale was lowest in the age group of 40 to 49 years at 7.6%, and highest in the age group of 15 to 18 years at 46.8%. The prevalence of probable depression in Korean elders increased with age and was highest in the group aged 80 years and over, at 35.4%. There is relatively consistent evidence that being female, having low income, no education, prior MDD, dementia and history of cerebrovascular attack increased the risk of depression. Although it is difficult to come to consistent conclusions on the epidemiology of depression in Korea due to methodological differences between studies, depression is already common and will become more common in Korea. Tremendous sociocultural, economic, and political changes along with rapid population aging have contributed and will contribute to the prevalence and impacts of depression in Korea.
OBJECTIVE: To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters.
METHODS: Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearson's correlation coefficient, Student's t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05.
RESULTS: Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain.
CONCLUSIONS: Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.
The Center for Epidemiological Studies Depression Scale (CES-D) has been widely used in studies of late-life depression. While the CES-D is convenient to use in most settings, it can present problems for elderly respondents who may find the response format confusing, the questions emotionally stressful, and the time to complete burdensome. A briefer 10-item version has been proposed, but there are few data on its properties as a screening instrument.
The 10-item CES-D was administered in 2 studies. In study 1, a stratified sample of middle-aged depressed patients (n = 40) and comparison controls (n = 43) were administered the CES-D to determine an optimal cutoff score. In study 2, the accuracy of the CES-D optimal cutoff score was tested in a sample of adults older than 60 years (n = 68). Major depression diagnoses were derived from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, with consensus diagnoses using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Reliability statistics with the 10-item CES-D were found to be comparable to those reported for the original CES-D. Using an optimal cutoff score of 4 in study 1, the sensitivity of the 10-item CES-D was 97%; specificity, 84%; and positive predictive value, 85%. In the study 2 sample of older adults, the sensitivity of the CES-D was 100%; specificity, 93%; and positive predictive value, 38%.
The 10-item CES-D has excellent properties for use as a screening instrument for the identification of major depression in older adults.
Cigarette smoking is associated with some anxiety disorders, but the direction of the association between smoking and specific anxiety disorders has not been determined.
To investigate the longitudinal association between cigarette smoking and anxiety disorders among adolescents and young adults.
The Children in the Community Study, a prospective longitudinal investigation.
Community-based sample of 688 youths (51% female) from upstate New York interviewed in the years 1985-1986, at a mean age of 16 years, and in the years 1991-1993, at a mean age of 22 years.
Participant cigarette smoking and psychiatric disorders in adolescence and early adulthood, measured by age-appropriate versions of the Diagnostic Interview Schedule for Children.
Heavy cigarette smoking (>/=20 cigarettes/d) during adolescence was associated with higher risk of agoraphobia (10.3% vs 1.8%; odds ratio [OR], 6.79; 95% confidence interval [CI], 1.53-30.17), generalized anxiety disorder (20.5% vs 3.71%; OR, 5.53; 95% CI, 1.84-16.66), and panic disorder (7.7% vs 0.6%; OR, 15.58; 95% CI, 2.31-105.14) during early adulthood after controlling for age, sex, difficult childhood temperament; alcohol and drug use, anxiety, and depressive disorders during adolescence; and parental smoking, educational level, and psychopathology. Anxiety disorders during adolescence were not significantly associated with chronic cigarette smoking during early adulthood. Fourteen percent and 15% of participants with and without anxiety during adolescence, respectively, smoked at least 20 cigarettes per day during early adulthood (OR, 0.88; 95% CI, 0.36-2.14).
Our results suggest that cigarette smoking may increase risk of certain anxiety disorders during late adolescence and early adulthood. JAMA. 2000;284:2348-2351.
Background:
Moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial. We performed a meta-analysis of prospective studies on alcohol dosing and total mortality.
Methods:
We searched PubMed for articles available until December 2005, supplemented by references from the selected articles. Thirty-four studies on men and women, for a total of 1 015 835 subjects and 94 533 deaths, were selected. Data were pooled with a weighed regression analysis of fractional polynomials.
Results:
A J-shaped relationship between alcohol and total mortality was confirmed in adjusted studies, in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality, maximum protection being 18% in women (99% confidence interval, 13%-22%) and 17% in men (99% confidence interval, 15%-19%). Higher doses of alcohol were associated with increased mortality. The inverse association in women disappeared at doses lower than in men. When adjusted and unadjusted data were compared, the maximum protection was only reduced from 19% to 16%. The degree of association in men was lower in the United States than in Europe.
Conclusions:
Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.
Although the benefits of regular physical activity on morbidity and mortality are established, relationships between recommended levels of physical activity and health-related quality of life (HRQOL) have not been described. The authors examined whether recommended levels of physical activity were associated with better HRQOL and perceived health status.
Using data from 175,850 adults who participated in the 2001 Behavioral Risk Factor Surveillance System survey, the authors examined the independent relationship between recommended levels of moderate or vigorous physical activity and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, race/ethnicity, sex, education, smoking status, and body mass index.
The proportion of adults reporting 14 or more unhealthy days (physical or mental) was significantly lower among those who attained recommended levels of physical activity than physically inactive adults for all age, racial/ethnic, and sex groups. After multivariate adjustment, the relative odds of 14 or more unhealthy days (physical or mental) in those with the recommended level of activity compared to physically inactive adults was 0.67 (95% CI: 0.60, 0.74) for adults aged 18-44 years, 0.40 (95% CI: 0.36, 0.45) for adults aged 45-64 years, and 0.41 (95% CI: 0.36, 0.46) for adults aged 65 years or older. The results persist even among adults with a chronic condition such as arthritis.
These results highlight the need for health programs to increase participation in regular physical activity.
To assess the impact of oral health on quality of life in elderly Brazilians and to evaluate its association with clinical oral health measures and socioeconomic and general health factors.
Cross-sectional study.
Population-based cohort study on health, well-being, and aging.
Eight hundred fifty-seven participants representing 588,384 community-dwelling elderly adults from the city of São Paulo, Brazil.
Self-perceived impact of oral health on quality of life was measured using the Geriatric Oral Health Assessment Index (GOHAI), with scores categorized as good, moderate, or poor, indicating low, moderate, and high degrees of negative impact on quality of life, respectively.
Nearly half of the individuals had good GOHAI scores (44.7% of overall sample, 45.9% of dentate participants, and 43.4% of edentulous participants). In the overall sample, those with poor self-rated general health and a need for dental prostheses were more likely to have poor and moderate GOHAI scores. Individuals with depression were significantly more likely to have poor GOHAI scores. No socioeconomic variables were related to the outcome, except self-perception of sufficient income, which was a protective factor against a poor GOHAI score in dentate participants.
Moderate and high degrees of negative impact of oral health on quality of life were associated with general health and clinical oral health measures, independent of socioeconomic factors.
Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and ma-jor depression share a common genetic diathesis, but the anxiety disorders themselves are genetically hetergeneous. Sophisticated phenotypic models have also emerged, with data converging on an integrative hierarchical model of mood and anxiety disorders in which each individual syndrome contains both a common and a unique component. Finally, considerable progress has been made in understanding cognitive aspects of these disor-ders. This work has focused on both the cognitive content of anxiety and de-pression and on the effects that anxiety and depression have on information processing for mood-congruent material.
The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss.
Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI).
The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1-5 missing teeth, 9.7% (SE, 0.2%) for 6-31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1-5, 6-31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1-5 teeth removed, 6-31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14-1.59; AOR = 1.83; 95% CI = 1.51-2.22; and AOR = 1.44; 95% CI = 1.11-1.86, respectively). The adjusted odds of being in the 1-5 teeth removed and 6-31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders.
Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders.
Social and emotional well-being is an important component of overall health. In the Indigenous Australian context, risk indicators of poor social and emotional well-being include social determinants such as poor education, employment, income and housing as well as substance use, racial discrimination and cultural knowledge. This study sought to investigate associations between oral health-related factors and social and emotional well-being in a birth cohort of young Aboriginal adults residing in the northern region of Australia's Northern Territory.
Data were collected on five validated domains of social and emotional well-being: anxiety, resilience, depression, suicide and overall mental health. Independent variables included socio-demographics, dental health behaviour, dental disease experience, oral health-related quality of life, substance use, racial discrimination and cultural knowledge.
After adjusting for other covariates, poor oral health-related items were associated with each of the social and emotional well-being domains. Specifically, anxiety was associated with being female, having one or more decayed teeth and racial discrimination. Resilience was associated with being male, having a job, owning a toothbrush, having one or more filled teeth and knowing a lot about Indigenous culture; while being female, having experienced dental pain in the past year, use of alcohol, use of marijuana and racial discrimination were associated with depression. Suicide was associated with being female, having experience of untreated dental decay and racial discrimination; while being female, having experience of dental disease in one or more teeth, being dissatisfied about dental appearance and racial discrimination were associated with poor mental health.
The results suggest there may be value in including oral health-related initiatives when exploring the role of physical conditions on Indigenous social and emotional well-being.
To determine oral health status and identify predictors of oral health in a representative sample of psychiatric in-patients in Serbia.
The study included 186 psychiatric in-patients and 186 control participants without psychiatric illness matched to the study group by age, sex, marital status, education level, employment, and monthly income. Dental examinations were done in both groups to measure the following indices of oral health: decayed, missing, and filled teeth (DMFT) index; community periodontal index; and plaque index. Participants were also interviewed about their dental health behavior and their medical records were examined.
Psychiatric in-patients had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than controls. The average DMFT score in the patient group was 24.4 and 16.1 in the control group (P<0.001). Periodontal diseases were significantly more prevalent among psychiatric in-patients than among controls (P<0.001). The average plaque index for patients was 2.78 and 1.40 for controls (P<0.001). Multiple regression analysis demonstrated that 1) DMFT index was associated with age, male sex, duration of mental illness, use of antidepressants, time since the last visit to the dentist, and snacking frequency; 2) community periodontal index was associated with male sex; and 3) plaque index was associated with age, male sex, education level, employment, monthly income, tooth brushing technique, and snacking frequency.
Psychiatric in-patients in Serbia have poorer oral health than healthy controls. It is necessary to intensify preventive dental care in this vulnerable population.
Research on the comorbidity between cigarette smoking and major depression has not elucidated the pathways by which smoking is associated with depression.
To examine the causal relationships between smoking and depression via fixed-effects regression and structural equation modelling.
Data were gathered on nicotine-dependence symptoms and depressive symptoms in early adulthood using a birth cohort of over 1000 individuals.
Adjustment for confounding factors revealed persistent significant (P<0.05) associations between nicotine-dependence symptoms and depressive symptoms. Structural equation modelling suggested that the best-fitting causal model was one in which nicotine dependence led to increased risk of depression. The findings suggest that the comorbidity between smoking and depression arises from two routes; the first involving common or correlated risk factors and the second a direct path in which smoking increases the risk of depression.
This evidence is consistent with the conclusion that there is a cause and effect relationship between smoking and depression in which cigarette smoking increases the risk of symptoms of depression.
We investigated the influence of social support on health, quality of life (QOL), and the risk of depression in elderly Korean people.
This study was conducted as a part of the Korean Longitudinal Study on Health and Aging (KLoSHA). A total of 787 nondemented community-dwelling elderly aged 65 years or older were recruited and underwent clinical evaluations for dementia and psychiatric disorders conformed to Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Clinical Assessment Battery (CERAD-K) and the Korean version of the Mini-International Neuropsychiatric Interview (MINI), respectively. Social support was assessed using the Medical Outcome Study Social Support Survey (MOS-SSS). Poor social support (PSS) was defined as having a MOS-SSS score below the 25(th) percentile of the entire sample. General health status was comprehensively evaluated using the modified Cumulative Illness Rating Scale (CIRS), the Korean version of the Geriatric Depression Scale (GDS-K), Mini-Mental Status Examination (MMSE-KC), Korean Activities of Daily Living (KADL), and Korean Instrumental Activities of Daily Living (KIADL). Health-related QOL was evaluated using the Short Form 36 (SF-36).
Low educational attainment and living alone were associated with PSS. Geriatric depression was more prevalent in the PSS group (OR=3.05, 95% CI=1.77-5.27) than in the normal social support (NSS) group. Among the various forms of social support, positive social interaction was significantly associated with risk of geriatric depression (OR=2.25, 95% CI=1.07-4.73). Although health-related QOL was lower in the PSS group than in the NSS group, the ADL and IADL scores of the subjects in the PSS group were better than those of the subjects in the NSS group. In the subjects with geriatric depression, PSS was associated with more severe depression, higher medical morbidity, and poor QOL.
PSS had a negative influence on the general health status and QOL among community-dwelling elderly and was an independent risk factor of geriatric depression.
To evaluate changes in health-related quality of life (HRQoL) after twelve months of smoking cessation.
This was a prospective study to evaluate the effectiveness of a smoking cessation program on the quality of life of 60 self-referred subjects, at a public hospital, during the period of August 2006 to December 2007. The program consisted of 2-h group sessions once a week during the first month and then every 15 days over six months, followed by monthly phone contacts for another six months. The treatment was based on behavior modification and the use of bupropion in combination with nicotinic replacement therapy. Abstinence was verified by exhaled CO measurements. Patient HRQoL was quantified using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire. Differences in quality of life scores between quitters and non-quitters at twelve months after the initial intervention were evaluated using analysis of covariance with baseline characteristics as covariates.
Self-reported quality of life scores were significantly higher among the 40 quitters than among the 20 non-quitters. The following SF-36 domains were most affected: role-emotional (p = 0.008); general health (p = 0.006); vitality (p < 0.001); and mental health (p = 0.002). At twelve months after the smoking cessation intervention, the SF-36 mental component and physical component summary scores were higher among quitters than among non-quitters (p = 0.004 and p = 0.001, respectively).
Our findings illustrate that smoking abstinence is related to better HRQoL, especially in aspects of mental health.
Stress and depression may affect the onset and progression of periodontal disease. However, to the best of our knowledge, no published study has established whether the mechanisms by which stress and depression influence periodontal disease are physiologic, behavioral, or both. This cross-sectional pilot study explored the associations between psychologic factors, markers of periodontal disease, psychoneuroimmunologic variables, and behavior.
This study included 45 periodontal patients referred by three dentists. Participants completed composite health, chronic stress, depression, and demographic questions, and salivary cortisol (CORT) was measured. A hygienist assessed the magnitude of periodontal disease.
Stress, depression, and CORT were correlated with measures of periodontal disease. In addition, oral care neglect during periods of stress and depression was associated with attachment loss and missing teeth. After controlling for age, family history, and brushing frequency, depression and CORT were significant predictors of the number of missing teeth. A similar model also predicted the number of teeth with clinical attachment loss >5 mm.
Stress and depression may be associated with periodontal destruction through behavioral and physiologic mechanisms. Addressing psychologic factors, such as depression, may be an important part of periodontal preventive maintenance.
The purpose of this manuscript is to describe the associations among current depression, as measured by the Patient Health Questionnaire 8, health-related quality of life, social support, life satisfaction, and disability status, using the 2006 Behavioral Risk Factor Surveillance System. A dose-response relationship exists between depression severity and mean number of days in the past 30 days of physical distress, pain, anxiety symptoms, and activity limitations as well as the prevalence of fair/poor general health, life dissatisfaction, inadequate social support, and disability. These profound associations underscore the need for recognition and treatment of depression in all healthcare settings.
Periodontal disease is common among adults in the US and is a potential source of chronic inflammation. Recent data have suggested an important role for chronic inflammation in the development of coronary heart disease (CHD).
To aid the United States Preventive Services Task Force (USPSTF) in evaluating whether periodontal disease is an independent novel risk factor for incident CHD.
Studies were identified by searching Medline (1966 through March 2008) and reviewing prior systematic reviews, reference lists, and consulting experts. Prospective cohort studies that assessed periodontal disease, Framingham risk factors, and coronary heart disease incidence in the general adult population without known CHD were reviewed and quality rated using criteria developed by the USPSTF. Meta-analysis of good and fair quality studies was conducted to determine summary estimates of the risk of CHD events associated with various categories of periodontal disease.
We identified seven articles of good or fair quality from seven cohorts. Several studies found periodontal disease to be independently associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including periodontitis, tooth loss, gingivitis, and bone loss) ranged from 1.24 (95% CI 1.01-1.51) to 1.34 (95% CI 1.10-1.63). Risk estimates were similar in subgroup analyses by gender, outcome, study quality, and method of periodontal disease assessment.
Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research in this important area of public health is warranted.
The purpose of the study was to develop an explanatory model of the exercise/ depression relationship using a rural-residing population of elderly aged 65 or older. Subjects were selected from the 3,673 persons who participated in the Iowa 65+ Rural Health Study. The 2,084 subjects with complete data, valid information about depressive symptoms, and ability to walk across a small room were divided into two cohort groups at baseline: those with few and those with more depressive symptoms. Logistic regression models using walking status, demographic variables, and chronic health conditions were developed to predict depressive symptoms for this population at a 3-year follow-up. Consistent with previous studies using mixed-age cohorts, physical activity was negatively associated with depressive symptoms. We concluded that the relationship between exercise and depressive symptoms may be manifested in both subjects with more and few depressive symptoms because both groups benefited from daily walking.
OBJECTIVE—This study investigated the associations of cigarette smoking and alcohol intoxication with major depressive episode.
DESIGN—Major depressive episode during the past 12 months was assessed in a national representative cross sectional study using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form).
SUBJECTS—A random sample of 5993 non-institutionalised Finnish people aged 15-75 years was interviewed as a part of the 1996 Finnish Health Care Survey.
RESULTS—In logistic regression models the factors associated with major depressive episode in the past 12 months were smoking 10 or more cigarettes daily (odds ratio (OR) 2.26; 95% confidence intervals (95% CI) 1.68, 3.04) and alcohol intoxication at least once a week (OR 2.99; 95%CI 1.70, 5.25). Their effects were independent of each other, and remained significant even after adjusting for other major risk factors (marital status, education, unemployment and chronic diseases). The attributable proportion (a measure of the impact of the risk factors of the disease on the population) for daily smoking of 10 or more cigarettes was 0.15, and for alcohol intoxication at least once a week 0.04.
CONCLUSION—Cigarette smoking and alcohol intoxication seem to be important risk factors for major depressive episode. In this population the impact of smoking was greater.
Keywords: depression; smoking; alcohol
Depression in old age is a pathological process, not a normal reaction to growing older. The majority of people cope with ageing, and many feel happy and fulfilled. However, there is a bias among health professionals and the community in general to accept lower functioning and more symptoms in older people (Alexopoulos, 1992). Depression tends to be denied by the current generation of elderly people, many of whom were raised in an atmosphere where showing feelings was discouraged, and this adds to diagnostic difficulties. Comorbid medical conditions, the tendency of patients to somatise, cognitive deterioration, and multiple life events, often of loss (e.g. bereavement, retirement, moving to smaller housing), all further complicate the diagnostic process.
Despite the fact that suicide and its prevention continues to be a priority area for health care in the UK, suicide in the elderly remains a neglected subject receiving little interest and research attention. The Green Paper Our Healthier Nation (Secretary of State for Health, 1998) maintained the concept of setting targets for suicide reduction originally proposed in The Health of the Nation strategy. The new target proposes that by the year 2010 the death rate from suicide and undetermined injury will be reduced by at least a further sixth (17%) from the baseline of 1996. The setting of such targets has always been a contentious issue among many psychiatrists, who have concerns that they may be used as a quality measure of psychiatric services, especially as some consider that social influences predominate over health care issues. The subsequent debate has focused on targeting specific at-risk groups, notably severely mentally ill young men, Asian women and those who deliberately harm themselves.