Factors related to occupational stress among private sector dentists in the first year of the COVID-19 pandemic

Pacheco, Elis Carolina; Avais, Letícia Simeoni; Ditterich, Rafael Gomes; Silva-Junior, Manoelito Ferreira; Baldani, Márcia Helena

doi:10.1590/1413-812320232810.09652023EN

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLE • Ciênc. saúde coletiva 28 (10) • Oct 2023 • https://doi.org/10.1590/1413-812320232810.09652023EN copy

Factors related to occupational stress among private sector dentists in the first year of the COVID-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This cross-sectional study examined factors associated with occupational stress among 384 dentists working in the private sector in the first year of the COVID-19 pandemic in Brazil. Data were collected from August to October 2020 through an online form. Two outcomes - (1) anxiety and worry and (2) preparation and safety for work during the pandemic - constituted a proxy for occupational stress. The independent variables were grouped according to the explanatory theoretical model into individual, organisational and extra-organisational factors. Associations were tested by bivariate and multivariate logistic regression. Although prepared and confident, dentists felt anxious and worried about providing clinical care. Women, younger respondents and those who received no guidance on safety measures were more likely to report insecurity and unpreparedness. Younger professionals, those who did not participate in decision-making and who only sometimes had an assistant for four-hand work, were more likely to feel anxious and worried. In addition to individual factors, work organisation factors were associated with occupational stress among dentists in the first year of the pandemic.

Key words:
COVID-19; dentists; private sector; occupational stress

Variable (total responses)	n (%)	CI95%
Gender (n = 384)
Female	287 (74.7)	69.8-78.9
Male	97 (25.3)	21.1-30.2
Age* (n = 384)
Up to 39 years	196 (51.0)	45.6-56.0
40 years or older	188 (49.0)	44.0-54.4
Risk factors for severe forms of COVID-19 (n = 384)
No	349 (90.9)	88.0-93.8
Yes	35 (9.1)	6.3-12.2
Tested for COVID-19 (n = 384)
No	275 (71.6)	66.9-76.0
Yes	109 (28.4)	23.7-32.8
Withdrew from working at a dental clinic during the pandemic (n = 384)
No	60 (15.6)	12.5-19.0
Yes	324 (84.4)	80.5-88.0
Had access to official COVID-19 prevention and control guidelines (from government agencies or boards of dentistry) (n = 384)
Yes	324 (84.4)	80.5-87.8
No	27 (7.0)	4.4-9.6
Received workplace guidance on measures to be taken during the COVID-19 pandemic**
Yes	292 (77.5)	73.2-82.0
No	85 (22.5)	18.0-26.8
Felt prepared and secure to work properly in the dental practice during the COVID-19 pandemic*** (n = 382)
Yes	298 (78.0)	73.8-81.9
No	84 (22.0)	18.1-26.2
Felt anxious and worried about working properly in the dental practice during the COVID-19 pandemic*** (n = 381)
Yes	247 (64.8)	60.1-69.6
No	134 (35.2)	30.4-39.9

During the pandemic, in the workplace:	Always/Often (score 5 and 4)	Sometimes (score 3)	Almost never/never (score 1 and 2)	Median scores*	Interquartile range*
During the pandemic, in the workplace:	n (%)	n (%)	n (%)	Median scores*	Interquartile range*
Organisation of the work process
Elective procedures have been suspended and appointments are restricted to urgency/emergency.	114 (29.7)	132 (34.4)	136 (35.4)	3	2
Participated in decision-making about changes at work during the pandemic.	290 (75.5)	36 (9.4)	57 (14.9)	5	1
Respiratory infection symptoms are investigated for when scheduling appointments.	320 (83.4)	31 (8.1)	31 (8)	5	1
Emergency is defined on the basis of pre-established clinical protocols.	264 (69.2)	11 (2.9)	70 (18.2)	4	2
Digital tele-guidance or tele-monitoring tools are used.	201 (52.3)	52 (13.5)	121 (31.5)	4	3
Biosafety in the dental clinic	309 (80.5)	24 (6.3)	47 (12.2)	5	1
Environment is cleaned and disinfected by a trained professional, who has and uses appropriate PPE.	242 (63.0)	39 (10.2)	86 (22.4)	4	2
Suction hoses are cleaned and disinfected at each appointment.	164 (42.7)	65 (16.9)	150 (39.0)	3	3
Sterile handpieces are used at every dental appointment.	154 (40.1)	49 (12.8)	181 (47.1)	3	3
Four-hand dental procedures are performed.	123 (32.0)	91 (23.7)	148 (38.5)	3	2
Rubber dam is used in high-speed procedures.	102 (26.6)	92 (24.0)	189 (49.2)	3	2
Aerosol-generating procedures are avoided.	281 (73.2)	32 (8.3)	69 (18.0)	5	2
Doffing after each appointment is performed in the recommended sequence.
Personal Protective Equipment (PPE)	294 (76.6)	26 (6.8)	62 (16.1)	5	1
Enough N95/PFF2 masks are available.	262 (68.2)	35 (9.1)	83 (21.6)	5	2
Enough waterproof aprons are available.	328 (85.4)	29 (7.6)	23 (6.3)	5	1
Face shield is used during patient care.

Explanatory variable	Feel prepared and safe* n (%)	p- value	Feel anxious and worried* n (%)	p-value
Individual factors
Gender		0.018		0.015
Male	84 (86.6)		53 (54.6)
Female	214 (75.1)		194 (68.3)
Age**		< 0.001		< 0.001
Up to 39 years	135 (69.2)		143 (73.7)
40 years or older	163 (87.2)		104 (55.6)
Years since qualifying (in 2020)		< 0.001		0.055
Up to 10 years	103 (68.2)		106 (70.7)
11 to 20 years	74 (75.5)		65 (66.3)
More than 20 years	121 (91.0)		76 (57.1)
Risk factors for severe forms of COVID-19		0.044		0.627
No	266 (76.7)		223 (64.5)
Yes	32 (91.4)		24 (68.6)
Tested for COVID-19		0.150		0.530
No	219 (79.9)		175 (63.9)
Yes	79 (73.1)		72 (67.3)
Extra-organisational factors
Withdrew from work at a dental clinic during the pandemic		0.685		0.020
No	44 (80.0)		31 (51.7)
Yes	250 (77.6)		216 (67.3)
Had access to official COVID-19 prevention and control guidelines (from government or boards of dentistry)		0.050		0.529
Yes	281 (79.2)		231 (65.3)
No	17 (63.0)		16 (59.3)
Organisational factors
Type of work relationship		0.188		0.171
Self-employed	246 (79.4)		196 (63.2)
Others	52 (72.2)		51 (71.8)
Received workplace guidance on measures to be taken during the pandemic ***		< 0.001		0.796
Yes	244 (84.1)		186 (64.4)
No	49 (57.8)		56 (65.9)
Work process organisation
Elective procedures have been suspended and appointments are restricted to emergencies.		0.035		0.037
Always/Almost always	96 (84.2)		84 (74.3)
Sometimes	105 (80.2)		82 (62.6)
Almost never/Never	96 (71.1)		80 (59.3)
Participated in decision-making about changes at work during the pandemic		< 0.001		0.010
Always/Almost always	241 (83.4)		177 (61.2)
Sometimes	25 (71.4)		24 (68.6)
Almost never/Never	31 (54.4)		46 (82.1)
Respiratory infection symptoms are investigated for when scheduling appointments.		< 0.001		0.147
Always/Almost always	263 (82.7)		201 (63.4)
Sometimes	17 (54.8)		19 (61.3)
Almost never/Never	17 (54.8)		25 (80.6)
Emergency is defined on the basis of pre-established clinical protocols.		< 0.001		0.562
Always/Almost always	196 (85.2)		148 (64.3)
Sometimes	37 (82.2)		30 (66.7)
Almost never/Never	46 (60.5)		54 (71.1)
Digital tele-guidance or tele-monitoring tools are used		< 0.001		0.434
Always/Almost always	173 (86.5)		127 (63.5)
Sometimes	40 (78.4)		35 (68.6)
Almost never/Never	78 (64.5)		85 (70.2)
Biosafety in the dental clinic
Environment cleaned and disinfected by a trained professional using appropriate PPE.		< 0.001		0.009
Always/Almost always	256 (83.4)		188 (61.2)
Sometimes	14 (58.3)		20 (83.3)
Almost never/Never	25 (53.2)		37 (78.7)
Suction hoses cleaned and disinfected at each appointment		< 0.001		0.282
Always/Almost always	207 (86.2)		149 (62.1)
Sometimes	30 (76.9)		27 (69.2)
Almost never/Never	50 (58.1)		61 (70.9)
Sterile handpieces used at every appointment.		< 0.001		0.306
Always/Almost always	147 (90.2)		99 (60.7)
Sometimes	51 (78.5)		46 (70.8)
Almost never/Never	96 (64.4)		99 (66.4)
Four-hand dental procedures performed.		0.002		< 0.001
Always/Almost always	133 (86.9)		81 (53.3)
Sometimes	37 (77.1)		37 (77.1)
Almost never/Never	128 (70.7)		129 (71.3)
Aerosol-generating procedures are avoided.		0.005		0.331
Always/Almost always	65 (90.3)		65 (63.7)
Sometimes	70 (81.4)		65 (71.4)
Almost never/Never	162 (72.6)		117 (62.6)
Doffing after each service follows the recommended sequence		< 0.001		0.445
Always/Almost always	238 (85.3)		177 (63.7)
Sometimes	25 (78.1)		24 (75.0)
Almost never/Never	34 (49.3)		45 (65.2)
Reuse of N95/PFF2 masks follows safety criteria		0.383		0.333
Always/Almost always	201 (78.2)		168 (65.6)
Sometimes	38 (86.4)		31 (70.5)
Almost never/Never	50 (75.8)		38 (57.6)
Personal Protective Equipment (PPE)
Enough N95/PFF2 masks available.		0.018		0.741
Always/Almost always	237 (80.9)		192 (65.5)
Sometimes	20 (80.0)		14 (58.3)
Almost never/Never	40 (64.5)		39 (62.9)
Enough waterproof aprons available.		0.046		0.753
Always/Almost always	212 (81.5)		167 (64.2)
Sometimes	27 (77.1)		24 (70.6)
Almost never/Never	57 (68.7)		53 (63.9)
Face shield used in patient care		0.955		0.001
Always/Almost always	254 (77.9)		222 (68.3)
Sometimes	22 (75.9)		11 (37.9)
Almost never/Never	19 (79.2)		12 (50.0)
Overall prevalence	298 (78.1)		247 (64.8)

Explanatory variables	ORcr (95% CI)	p-value	ORadj (95% CI)	p-value
Outcome 1: feeling prepared and safe ^a
Individual factors
Gender
Male	1.0		1.0
Female	0.5 (0.2 - 0.9)	0.020	0.4 (0.2 - 0.9)	0.036
Age*
40 years or older	1.0		1.0
Up to 39 years	0.3 (0.2 - 0.6)	< 0.001	0.5 (0.3 - 0.9)	0.024
Risk factors for severe forms of COVID-19
No	1.0		1.0
Yes	3.2 (1.0 - 10.9)	0.056	3.5 (0.9 - 13.6)	0.076
Tested for COVID-19
No	1.0		1.0
Yes	0.7 (0.4 - 1.1)	0.151	0.6 (0.3 - 1.1)	0.108
Organisational factors
Received workplace guidance on measures to be taken during the COVID-19 pandemic **
No	1.0		1.0
Yes	3.9 (2.3 - 6.6)	< 0.001	3.5 (1.9 - 6.3)	< 0.001
Biosafety in the dental clinic
Doffing after each service follows the recommended sequence
Always/Almost always	1.0		1.0
Sometimes	0.6 (0.2 - 1.5)	0.291	0.8 (0.3 - 2.1)	0.632
Almost never/Never	0.2 (0.1 - 0.3)	< 0.001	0.2 (0.1 - 0.4)	< 0.001
Outcome 2: feeling anxious and worried ^b
Individual factors
Age*
40 years or older	1.0		1.0
Up to 39 years	2.2 (1.4 - 3.4)	< 0.001	2.0 (1.2 - 3.2)	0.007
Organisational factors
Work process organisation
Elective procedures have been suspended and appointments are restricted to emergencies.
Always/Almost always	1.0		1.0
Sometimes	0.6 (0.3 - 1.0)	0.051	0.5 (0.3 - 0.9)	0.025
Almost never/Never	0.5 (0.3 - 0.9)	0.013	0.3 (0.2 - 0.6)	0.001
Participated in decision making about changes at work during the pandemic
Always/Almost always	1.0		1.0
Sometimes	1.4 (0.6 - 2.9)	0.401	1.1 (0.5 - 2.5)	0.798
Almost never/Never	2.9 (1.4 - 6.0)	0.004	3.0 (1.4 - 6.7)	0.006
Biosafety in the dental clinic
Four-hand dental procedures performed
Always/Almost always	1.0		1.0
Sometimes	3.0 (1.4 - 6.2)	0.004	2.6 (1.2 - 5.6)	0.020
Almost never/Never	2.2 (1.4 - 3.4)	0.001	1.6 (1.0 - 2.7)	0.054
Personal Protective Equipment (PPE)
Face shield used in patient care
Always/Almost always	1.0		1.0
Sometimes	0.3 (0.1 - 0.6)	0.002	0.3 (0.1 - 0.7)	0.005
Almost never/Never	0.5 (0.2 - 1.1)	0.071	0.4 (0.2 - 1.1)	0.086

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva