Correlation between the event of the COVID-19 pandemic and symptoms of anxiety, depression and temporomandibular disorder in university students: cross-sectional study

Soares, Lélio Fernando Ferreira; Castro, Jordanna Victtória; Andrade, Loren dos Santos; Ramos, Marcela de Come; Almeida, Daniel Augusto de Faria; Haddad, Marcela Filié

doi:10.5935/2595-0118.20230070-en

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ORIGINAL ARTICLE • BrJP 6 (3) • Jul-Sep 2023 • https://doi.org/10.5935/2595-0118.20230070-en copy

Correlation between the event of the COVID-19 pandemic and symptoms of anxiety, depression and temporomandibular disorder in university students: cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

HIGHLIGHTS

78.2% of participants with symptoms of anxiety and 54.5% of participants with symptoms of depression reported a high level of parafunction, while 71.5% of participants who reported painful TMD symptoms had symptoms of anxiety and 52% of depression.
The presence of anxiety symptoms was more prevalent than depression among participants with painful symptoms associated with TMD.
This study has provided insights into the impact of the COVID-19 pandemic on painful TMD symptoms in university students and the influence of psychological factors such as anxiety and depression.
The results observed in this study indicate consequences that may perpetuate after the COVID-19 pandemic period and instigate further studies.

ABSTRACT

BACKGROUND AND OBJECTIVES:

The COVID-19 pandemic has been shown to be a probable aggravator of psychological responses such as anxiety and depression. This study aimed to assess the correlation between symptoms of anxiety and depression during the COVID-19 pandemic and the existence of symptoms associated with temporomandibular dysfunction (TMD) in a Brazilian university population.

METHODS:

This epidemiological, cross-sectional clinical study evaluated its variables of interest using the COVID-19 Fear Scale, Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Diagnostic Criteria for Temporomandibular Dysfunction (DC/TMD) and Oral Behavior Checklist (OBC) questionnaires.

RESULTS:

A total of 373 participants (females = 273) with a mean age of 23.8±5.45 years were included in this study. In addition, 78.2% of participants with anxiety symptoms and 54.5% of participants with depression symptoms reported a high level of TMD-related parafunction (p<0.01). The presence of anxiety symptoms increased the odds of developing intense fear of COVID-19 by 14.9 times (p<0.001) and the odds of developing moderate fear of COVID-19 by 3.5 times (p<0.001). The presence of an intense fear of COVID-19 increased the chances of developing anxiety symptoms by 17.15 times (p<0.001), while the presence of a moderate fear increased these chances by 3.12 times (p<0.001). In addition, the presence of intense (p=0.01) or moderate (p=0.018) COVID-19 fears increased the odds of developing TMD-related pain symptoms by 2.47 and 1.84 times, respectively, in this population.

CONCLUSION:

The presence of painful TMD symptoms was possibly influenced by fear of COVID-19. This, in turn, was related to the presence of anxiety and depression symptoms reported by the target population of this study.

Keywords:
Anxiety; COVID-19; Depression; Temporomandibular joint dysfunction syndrome

Areas of knowledge		HADS-A		Total	p-value†	HADS-D		Total	p-value†
Areas of knowledge		Anxiety	Absence of anxiety	Total	p-value†	Depression	Absence of depression	Total	p-value†
Biological and health sciences		142	100	242		91	151	242
Biological and health sciences	%_a	58.7%	41.3%	100.0%		37.6%	62.4%	100.0%
Exact sciences and engineering		58	39	97		39	58	97
Exact sciences and engineering	%_a	59.8%	40.2%	100.0%		40.2%	59.8%	100.0%
Human sciences and languages		24	10	34		22	12	34
Human sciences and languages	%_a	70.6%	29.4%	100.0%		64.7%	35.3%	100.0%
Total		224	149	373	0.413ns	152	221	373	0.011^* * Significant = p<0.05; ns = not significant; active = p>0.05.
Total	%_a	60.1%	39.9%	100.0%		40.8%	59.2%	100.0%

COVID fear		HADS-A		Total	p-value†	HADS-D		Total	p-value†
COVID fear		Anxiety	Absence of anxiety	Total	p-value†	Depression	Absence of depression	Total	p-value†
High fear		49	4	53		34	19	53
High fear	%_a	92.5%	7.5%	100.0%		64.2%	35.8%	100.0%
Mild fear		105	47	152		64	88	152
Mild fear	%_a	69.1%	30.9%	100.0%		42.1%	57.9%	100.0%
Low fear		70	98	168		54	114	168
Low fear	%_a	41.7%	58.3%	100.0%		32.1%	67.9%	100.0%
Total		224	149	373	< .001^* * Significant = p<0.05.	152	221	373	< .001^* * Significant = p<0.05.
Total	%_a	60.1%	39.9%	100.0%		40.8%	59.2%	100.0%

TMD pain		HADS-A		Total	p-value†	HADS-D		Total	p-value†
TMD pain		Anxiety	Absence of anxiety	Total	p-value†	Depression	Absence of depression	Total	p-value†
Absent		136	114	250		88	162	250
Absent	%_a	54.4%	45.6%	100.0%		35.2%	64.8%	100.0%
Present		88	35	123		64	59	123
Present	%_a	71.5%	28.5%	100.0%		52.0%	48.0%	100.0%
Total		224	149	373	0.001^* * Significant = p<0.05.	152	221	373	0.002^* * Significant = p<0.05.
Total	%_a	60.1%	39.9%	100.0%		40.8%	59.2%	100.0%

OBC		COVID fear			Total	p-value†
OBC		High fear	Mild fear	Low fear	Total	p-value†
High parafunction		33	77	55	165
High parafunction	%_a	20.0%	46.7%	33.3%	100.0%
Low parafunction		19	74	107	200
Low parafunction	%_a	9.5%	37.0%	53.5 %	100.0%
Absence of parafunction		1	1	6	8
Absence of parafunction	%_a	12.5%	12.5%	75.0%	100.0%
Total		53	152	168	373	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.
Total	%_a	14.2%	40.8%	45.0%	100.0%

OBC		HADS-A		Total	p-value†	HADS-D		Total	p-value†
OBC		Anxiety	Absence of anxiety	Total	p-value†	Depression	Absence of depression	Total	p-value†
High parafunction		129	36	165		90	75	165
High parafunction	%_a	78.2 %	21.8 %	100.0 %		54.5 %	45.5 %	100.0 %
Low parafunction		92	108	200		59	141	200
Low parafunction	%_a	46.0 %	54.0 %	100.0 %		29.5 %	70.5 %	100.0 %
Absence of parafunction		3	5	8		3	5	8
Absence of parafunction	%_a	37.5 %	62.5 %	100.0 %		37.5 %	62.5 %	100.0 %
Total		224	149	373	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	152	221	373	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.
Total	%_a	60.1 %	39.9 %	100.0 %		40.8 %	59.2 %	100.0 %

COVID-19 Fear Scale	Variable	EV (SE)	p-value	OR [CI 95%]
High fear - Low fear	(Intercept)	-3.230 (0.512)	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	0.0395 [0.0145; 0.108]
	HADS-D:
	Depression - Absence of depression	0.265 (0.374)	0.479ns	1.3028 [0.6261; 2.711]
	HADS-A:
	Anxiety - Absence of anxiety	2.701 (0.578)	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	14.8904 [4.7933; 46.257]
Mild fear - Low fear	(Intercept)	-0.714 (0.179)	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	0.4898 [0.3446; 0.696]
	HADS-D:
	Depression - Absence of depression	-0.219 (0.280)	0.435ns	0.8037 [0.4640; 1.392]
	HADS-A:
	Anxiety - Absence of anxiety	1.250 (0.275)	< .001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	3.4895 [2.0343; 5.986]

Variable	EV (SE)	p-value	HADS-A OR [CI 95%]
Intercept	-0.336 (0.156)	0.032^* * Significant = p<0.05; ns = not significant; active = p>0.05.	0.714 [0.526; 0.971]
COVID Fear:
High fear - Low fear	2.842 (0.543)	<.001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	17.150 [5.916; 49.717]
Mild fear - Low fear	1.140 (0.235)	<.001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	3.128 [1.973; 4.959]

Variable	EV (SE)	p-value	HADS-D OR [CI 95%]
Intercept	-0.747 (0.165)	<.001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	0.474 [0.343; 0.655]
COVID Fear:
High fear - Low fear	1.329 (0.331)	<.001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	3.778 [1.976; 7.223]
Mild fear - Low fear	0.429 (0.233)	0.066ns	1.535 [0.973; 2.424]

Variables	EV (SE)	p-value	TMD Pain Screening OR [CI 95%]
Intercept	-1.470 (0.224)	<.001^* * Significant = p<0.05; ns = not significant; active = p>0.05.	0.230 [0.148; 0.357]
HADS-A:
Anxiety - Absence of anxiety	0.259 (0.289)	0.371ns	1.296 [0.735; 2.284]
HADS-D:
Depression - Absence of depression	0.445 (0.262)	0.089ns	1.561 [0.934; 2.609]
COVID Fear:
High fear - Low fear	0.906 (0.352)	0.010^* * Significant = p<0.05; ns = not significant; active = p>0.05.	2.475 [1.242; 4.932]
Mild fear - Low fear	0.611 (0.258)	0.018^* * Significant = p<0.05; ns = not significant; active = p>0.05.	1.842 [1.112; 3.053]

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[1] Conflict of interests: none - Sponsoring sources: none.