Assessment of Fear and Anxiety towards Covid 19 among Dental Students in Malaysian Private University

Lim Yi Theng¹, Lim Yi Han¹, Ling Jing Er¹, Loh Chooi Joy¹, Priyadarshini Karthikeyan¹*,

Ramesh Kumaresan¹, Suganya Mahadeva Rao², Siddharthan Selvaraj¹

¹Faculty of Dentistry, AIMST University, Bedong 08100, Kedah, Malaysia.

²PEOPLE’S College of Dental Sciences and Research Centre, PEOPLE’S University Bhopal, MP India.

*Corresponding Author E-mail: priyadrkarthi@gmail.com

ABSTRACT:

Background: The World Health Organization (WHO) declared a global pneumonia crisis of universal concern on January 30, 2020, because of the rapidly growing number of cases and evidence of human-to-human viral transmission. Dentists are more prone to get infected to covid 19 infection, in addition the sources of stress and anxiety for dentists during this crisis have been brought up, and they may be partially related to the elevated danger of exposure to COVID-19 while performing routine dental procedures. It would be helpful to assess the tension and anxiety that dental students experience when they return to their training in dental colleges in the COVID-19 period. Aim: To assess the level of fear and anxiety towards covid 19 among dental students in AIMST university. Methods: A cross sectional study was carried out among 348 dental students by simple random sampling technique to evaluate the fear and anxiety level. The response to each question was recorded in a YES or NO format, Comparison of mean fear score was done using t-test for 2 variables and ANOVA for 3 or more than 3 variables. P < 0.05 was considered statistically significant. Results: There was significant association between fear and gender towards Covid 19 among Dental Students terms of gender (P value <0.005). Furthermore, there was a significant association between anxiety and sociodemographic factors like gender and year of study towards Covid 19 among Dental Students terms of gender. Conclusions: The present study demonstrates cross-sectional data of fear and anxiety among dental students towards COVID-19. Our study findings showed that students were anxious and were afraid of covid 19. It can be said that it’s the right time to educate and instill knowledge on various infectious diseases and management strategies for the same.

KEYWORDS: Anxiety, Fear, COVID-19, Dental Students, Pandemic.

INTRODUCTION:

The World Health Organization (WHO) declared a global pneumonia crisis of universal concern on January 30, 2020, because of the rapidly growing number of cases and evidence of human-to-human viral transmission. This pneumonia was first identified as a novel coronavirus (2019-nCOV), the seventh group of coronaviruses, and it originated in Wuhan (China).

This severe, debilitating respiratory ailment was referred to as coronavirus disease 2019 and new coronavirus (2019-nCo) (COVID-19). While more contagious than SARS-CoV and the Middle East respiratory illness coronavirus, this virus is comparable to the group of infections that cause severe acute respiratory syndrome (SARS) (MERS-CoV) ¹.

The COVID-19 infected patient's clinical symptoms include fever, hacking cough, myalgia, or weakness, as well as abnormal chest x-ray results and less often occurring symptoms including diarrhea, hemoptysis, headaches, or sputum production. COVID19 spreads when a person touches a surface or object and subsequently touches his mouth, nose, or eyes, or when he inhales contagious aerosols that an infected individual releases through speaking, breath, and sneezes. Mild to severe pneumonia that results in death can result from COVID-19 infection, which can also induce asymptomatic illness ².

The objective of this study is to assess the level of fear and anxiety towards covid 19 among dental students in AIMST university as stress is a typical psychological and physical response to life's demands, and when things gradually return to normal, it's common for everyone to experience anxiety and have their own anxieties. Everyone responds to challenging circumstances differently, therefore it's acceptable to have tension and fear during the COVID-19 pandemic. The sources of stress and anxiety for dentists during this crisis have been brought up, and they may be partially related to the elevated danger of exposure to COVID-19 while performing routine dental procedures. It would be helpful to assess the tension and anxiety that dental students experience when they return to their training in dental colleges in the COVID-19 period.

Due to their frequent interaction with ill people, healthcare workers are more likely than the general population to become infected with COVID-19. During pandemics, dental practitioners are particularly susceptible to infections³. Dental academics, or instructors who instruct dentistry students, have high levels of stress due to intense workloads and a mismatch between their capacity for action and expectations ⁴. Due to the increased danger of infection during treatment provided at the dental office, particularly during pandemics, they are additionally vulnerable to worry and panic ⁵. Moderate anxiety is normal, aids in goal-directed work performance, and may encourage pandemic prevention strategies ⁶.

On the other hand, severe anxiety is linked to physical symptoms such muscle tightness, hyperventilation, elevated heart rate, sweating, shaking, exhaustion, difficulties sleeping, gastrointestinal disturbances, as well as cognitive impairment ⁷. Chronic, severe anxiety may have an impact. Physical and psychological health ^8-11

MATERIALS AND METHODS:

An online cross-sectional survey was conducted using Google forms and circulated through WhatsApp among dental students in AIMST University. The completion of the questionnaire and submission of it signified informed consent; participation was voluntary. Throughout the poll, confidentiality and anonymity were upheld. Dental students who have a smartphone with the WhatsApp app installed and gave their agreement to participate in the study met the inclusion criteria. The AIMST University review board of ethical committee gave its clearance for the study. For recording anxiety and terror, Ahmed et al questionnaire was used. Age, gender, academic year, and ethnicity were the demographic information assessed.

The Wan Arifin sample size calculator was used to calculate the sample size. Using data from earlier research by Ahmed and his colleagues, the sample size needed for this investigation was 348. Each question received a minimum score of 0 and a maximum score of 1, with the response being recorded as YES (Score one, 1) or NO (Score zero, 0). With a maximum score of 9, the sum of all question scores was used to determine the result. Calculations were made to create a frequency distribution of the replies expressed as percentages and numbers. The t-test for two variables and analysis of variance (ANOVA) for three or more factors were used to compare the mean fear score. Statistics were deemed significant at P value 0.05 SPSS software was utilized to analyze the data.

RESULTS:

Table 1 illustrates the coding of the study variables. A total of 348 complete responses were received of which most of the participants were 23 years of age (83; 23.90%), female (258; 74.20%), Chinese (264; 75.90%) and Year 4 of study (83; 23.80%) (Table 2). Figure 1 shows the frequency of demographic profile of the study population.

Table 1. Coding of variable

Variable	Coding
Age	1.21 years 2.22 years 3.23 years 4.24 years 5.25 years
Gender	1.Male 2.Female
Ethnicity	1.Malay 2.Chinese 3.Indian 4.Others
Year of Study	1.Year 1 2.Year 2 3.Year 3 4.Year 4 5.Year 5
Responses	1.Yes 2.No

Table 2. Sociodemographic profile of study participants (n=348)

No	Variable	Categories	Frequency	%
1	Age	21 years 22 years 23 years 24 years 25 years	71 74 47 83 73	20.4 21.3 13.5 23.9 20.9
2	Gender	Male Female	90 258	25.8 74.2
3	Race	Malay Chinese Indian Others	3 264 80 1	0.9 75.9 23.0 0.2
4	Year of Study	Year 1 Year 2 Year 3 Year 4 Year 5	71 74 47 83 73	20.4 21.3 13.5 23.8 21.0

Table 3 represents the frequency on fear towards Covid 19 among Dental Students which reveals majority of responses (>65%) in the form of “YES” recorded for Questions (Qs) 1, 2, and 4. On the contrary, Q 3 majority (61.80 %) gave “NO” response. Figure 2 illustrates the frequency of responses on fear towards covid 19 among dental students.

Figure 1. Frequency of sociodemographic profile of study participants

Table 3. To assess the fear towards covid 19 among dental students (n=348)

No	Questions	Responses	Frequency	%
1	Are you afraid of getting infected with COVID-19 from a patient and co-worker?	Yes No	240 108	68.9 31.1
2	Are you anxious when providing treatment to a patient who is coughing or suspected of being infected with COVID-19?	Yes No	291 57	83.6 16.4
3	Do you feel nervous when talking to patients in close vicinity?	Yes No	133 215	38.2 61.8
4	Do you be afraid that you could carry the infection from your dental practice back to your family?	Yes No	270 78	77.5 22.5

Figure 2. Frequency of responses on fear towards covid 19 among dental students

Table 4. To assess the anxiety towards covid 19 among dental students (n=348)

No	Questions	Responses	Frequency	%
1	Are you afraid of getting quarantined if get infected?	Yes No	190 158	54.6 45.4
2	Are you anxious about the cost of treatment if you get infected?	Yes No	196 152	56.3 43.7
3	Do you feel afraid when you hear that people are dying because of COVID-19?	Yes No	256 92	73.6 26.4
4	Do you feel safer for being vaccinated from COVID-19?	Yes No	297 51	85.3 14.7

Figure 3. Frequency of responses on anxiety towards covid 19 among dental students

Table 5. Association of Sociodemographic factors on fear and anxiety towards Covid 19 among Dental Students

Variable

Fear

P- value

Anxiety

P-value

Mean ± SD

Age**

21 years

22 years

23 years

24 years

25 years

3.58±1

4.11±1.39

3.9±1.38

3.97±1.4

4.04±1.49

0.71

3.94±1.47

4.05±1.19

3.97±1.38

3.73±1.53

3.77±1.33

0.31

Gender*

Male

Female

258

6.52±1.96

5.75±2.39

0.03

6.53±1.99

5.04±2.12

0.001

Race**

Malay

Chinese

Indian

Others

264

3.92±1.4

3.36±1.54

4.1±1.3

4±1.63

0.52

8.36±2.09

8.54±1.67

8.22±1.99

8.38±1.43

0.65

Year of Study**

Year 1

Year 2

Year 3

Year 4

Year 5

3.85±1.46

4.01±1.53

3.97±1.39

3.88±1.32

3.98±1.4

0.42

7±2.49

8.77±1.54

8.32±1.75

8.38±1.72

8.09±2.23

0.008

**ANOVA * T test

SD – Standard deviation #p-value of < 0.05 was taken statistically significant.

Figure 4.a illustrates the overall percentage (67.09 %) of fear towards covid 19 among dental Students among dental students and figure 4.b illustrates the overall percentage (67.45 %) of anxiety towards covid 19 among dental students.

Figure 4. (a) Overall percentage of fear towards Covid 19 among dental students

Figure 4. (b) Overall percentage of anxiety towards Covid 19 among dental students

DISCUSSION:

The current public health crisis brought on by COVID-19 has sparked a great deal of tension, anxiety, and dread that is endangering the mental health of many different populations. The current study was conducted since there isn't enough research on dental students' concern of coronaviruses, and it aims to provide light on their anxiety and worry of COVID-19. Due to the unavailability of a standardized questionnaire, the present study used Ahmed et al.'s, which was straightforward, thorough, usable, objective, and had good validity (0.74).

According to earlier studies, Covid 19 can be spread through fomites, aerosols, and droplets, dentists are among the medical professionals who are most vulnerable to this illness ^12,13. Dentists are in the high-risk group because of the SARS-CoV2 virus load in human saliva, which has been shown to be quite high and transmission even by asymptomatic carriers ¹².

Dental professionals' psychological health may be impacted, which may show up as a fear of contracting an infection from coworkers or patients who are extremely anxious while receiving treatment. One of the most important causes of dread across various segments of the population is higher mortality rates linked to COVID-19, with females more prone to higher levels of stress and worry ^14-16. The gender of the participants was seen as a significant factor influencing fear and anxiety towards the infection which was in line with earlier reported findings ¹⁷. In addition, the students gain knowledge and get exposure towards the clinical and other professional skills when they progress in their study period from year 1 to year 5, hence there was a relationship between the anxious behavior towards the covid 19 infection in our study ¹⁸. Only gender factor was mutually associated with the fear and anxiety towards covid 19 among the study participants. There was no significance seen on association among age and race towards fear and anxiety on Covid 19.

The results of our study showed > 65% of dental students responded favorably when asked about their fear towards covid 19. In a similar vein, 90% of respondents in a global survey that examined dental phobia across 30 nations expressed concern about contracting an infection from clients or coworkers ^19,20.

Social distancing is one of the simplest and most effective ways to lessen the spread of the virus. Nonetheless, basic dental procedures necessitate close contact with patients. On the contrary in our findings, only 38 % of respondents reported that they are feared to get their patients treated with close vicinity.

Approximately 80% of our study population worried about carrying infection back home. It is simple for the virus to spread and cause cross-infection since it can survive on inanimate surfaces for hours to days with a long incubation period ^17.According to a similar study, 92% of dentists surveyed across 30 nations indicated worry of carrying infection back home, which could greatly contribute to infection being taken back home and be a major cause of fear among dentists ¹⁸.

Malaysia's Ministry of Health set up isolation facilities for the treatment of infected and suspected patients. Isolation and quarantine have been linked to confusion, dread, and anxiety, according to the literature ². The dread of being quarantined, which has been highlighted in the current study with more than 55% of the respondents admitting the fear of quarantine, thereby impacts the entire family. Around 84% of the study's participants were optimistic about the creation of a COVID-19 vaccine that might be essential for containing the pandemic.

CONCLUSION AND RECOMMENDATIONS:

The current study found that the COVID-19 pandemic had a significant psychological influence on dental students, which was directly related to fear and anxiety towards infection and concerns about professional duties. It is the right time to take steps to change the behavior towards any sort of uneventful situations like pandemic should be considered by the concerned authorities.

Authorities at dental schools and medical education should be more involved in the process of developing protocols and processes for implementation before dental students may return to training. Many years before the unique coronavirus, dental workers were always exposed to illnesses. As a result, they must proceed with extreme caution and regard everyone as a possible risk without increasing worry and reassure employees, students, and patients that they are dedicated to maintaining the highest levels of counselling, infection control, sanitization, and availability to personal protective equipment.

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

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Received on 14.05.2023 Modified on 02.06.2023

Research J. Pharm. and Tech 2023; 16(6):2699-2704.

DOI: 10.52711/0974-360X.2023.00443