Abstract
Background: The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems.Aim: To investigate features of health and well-being as an outcome of the uncertainties surrounding COVID-19 for dentists and dental health professionals in primary dental care and for those in training. In addition, the study examined the well-being indices with reference to normative values. Finally a theoretical model was explored to explain depressive symptoms and investigate its generalisability across dentists and dental health professionals in primary dental care and those in postgraduate training.Methods: A cross-sectional survey of dental trainees and primary dental care staff in Scotland was conducted in June to October 2020. Assessment was through “Portal,” an online tool used for course bookings/management administered by NHS Education for Scotland. A non-probability convenience sample was employed to recruit participants. The questionnaire consisted of four multi-item scales including: preparedness (14 items of the DPPPS), burnout (the 9 item emotional exhaustion subscale and 5 items of the depersonalisation subscale of the MBI), the 22 item Impact of Event Scale-Revised, and depressive symptomatology using the Patient Health Questionnaire-2. Analysis was performed to compare the levels of these assessments between trainees and primary dental care staff and a theoretically based path model to explain depressive symptomology, utilising structural equation modelling.Results: Approximately, 27% of all 329 respondents reported significant depressive symptomology and 55% of primary care staff rated themselves as emotionally exhausted. Primary care staff (n = 218) felt less prepared for managing their health, coping with uncertainty and financial insecurity compared with their trainee (n = 111) counterparts (all p's < 0.05). Depressive symptomology was rated higher than reported community samples (p < 0.05) The overall fit of the raw data applied to the theoretical model confirmed that preparedness (negative association) and trauma associated with COVID-19 (positive association) were significant factors predicting lowered mood (chi-square = 46.7, df = 21, p = 0.001; CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). Burnout was indirectly implicated and a major path from trauma to burnout was found to be significant in primary care staff but absent in trainees (p < 0.002).Conclusion: These initial findings demonstrate the possible benefit of resourcing staff support and interventions to assist dental staff to prepare during periods of high uncertainty resulting from the recent COVID-19 pandemic.
Highlights
Reports of anxieties concerning litigation, fears for family welfare and general uneasiness surrounding the impact of the COVID-19 pandemic on dental practice have recently been noted in dentists from cross-sectional surveys conducted in various countries [1, 2]
Focusing on the “ongoing uncertainty” and reliance on Protective Equipment (PPE), Albott et al [9] proposed that the elements of providing health care during COVID-19 was analogous to “battlefield conditions.”
To determine an appropriate sample size for the three objectives we argued that group differences between staff groupings would be confirmed with a small to medium effect size (0.35) with a sample of approximately 260 participants on our outcome variable namely: depressive symptomology Alternatively, an additional power analysis indicated that with a sample size of 300 participants and a multi-variable linear model that explains 40% of the variance of the outcome the ability to detect an improvement of R square of 2.5% with the inclusion of a further covariate would be detected reliably employing a conventional alpha level of 5% with 80% power
Summary
Reports of anxieties concerning litigation, fears for family welfare and general uneasiness surrounding the impact of the COVID-19 pandemic on dental practice have recently been noted in dentists from cross-sectional surveys conducted in various countries [1, 2]. Other reports point to a similar pattern of emotionality in the face of providing quality care during the current COVID-19 pandemic [7, 8]. The outcome of repeated stressful encounters, was stress inoculating In their opinion, being physically and emotionally prepared for practice during periods of high uncertainty such as the current pandemic could, paradoxically, reduce anxiety and improve coping. The COVID-19 pandemic has placed increased demands on clinical staff in primary dental care due to a variety of uncertainties. Current reports on staff responses have tended to be brief enquiries without some theoretical explanation supported by developed measurement systems
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