ORIGINAL RESEARCH


https://doi.org/10.5005/jp-journals-10024-3249
The Journal of Contemporary Dental Practice
Volume 22 | Issue 12 | Year 2021

Psychological Impact of the COVID-19 Pandemic on Dental Hygiene Students in Saudi Arabia: A Nation-wide Study

Mushir Mulla

Department of Oral and Dental Health, College of Applied Health Sciences in Arrass, Qassim University, Saudi Arabia

Corresponding Author: Mushir Mulla, Department of Oral and Dental Health, College of Applied Health Sciences in Arrass, Qassim University, Saudi Arabia, Phone: +966 561691518, e-mail: m.mulla@qu.edu.sa

How to cite this article: Mulla M. Psychological Impact of the COVID-19 Pandemic on Dental Hygiene Students in Saudi Arabia: A Nation-wide Study. J Contemp Dent Pract 2021;22(12):1426–1433.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Aim: Worldwide healthcare professionals are experiencing constant stress during their day-to-day work due to coronavirus disease-2019 (COVID-19) pandemic. Students’ anxiety tendency has also been increased due to the disturbance of education. This study aims to evaluate the anxiety and depression levels of dental hygiene students in Saudi Arabia during COVID-19 lockdown period.

Materials and methods: A cross-sectional study was conducted among the dental hygiene students in Saudi Arabia to assess the psychological impact of the COVID-19 outbreak. Questionnaire was distributed to the students, which consisted questions regarding demographics, knowledge, and fear related to COVID-19 and validated self-reported anxiety screening scale (GAD-7), to assess the psychological impact. All the data were then subjected to statistical analysis.

Results: Students from King Abdul Aziz University and Prince Sattam University showed statistically higher anxiety score when comparing the GAD-7 questions. Students whose parents were unemployed during pandemic and the students from rural area had statistically greater anxiety level when compared to others. Also, anxiety levels were found to be significantly higher among students who slightly feared contacting the disease because of their profession.

Conclusion: The present results demonstrate that dental hygiene students suffered from some form of anxiety ranging from mild anxiety to severe anxiety, reporting that they frequently felt nervous and were scared that something terrible would happen. Psychological well-being of healthcare professionals is necessary for the optimal treatment of patients.

Clinical significance: Anxiety is considered as an important factor for healthcare students that may influence negatively on their personal and academic life. Thus appropriate assessment and offering immediate treatment will prove beneficial to prevent serious consequences.

Keywords: Anxiety, COVID-19, Dental hygiene student, Psychological impact, Saudi Arabia.

INTRODUCTION

Novel coronavirus disease-2019 (COVID-19) is one of the devastating and deadly outbreaks that has been seen to challenge researchers and healthcare systems.1 The COVID-19 outbreak was declared as a global pandemic by the World Health Organization (WHO) in March’ 2020. Now the WHO approves COVID-19 to be an important healthcare problem at an international level.24 Considering the rapid spread of COVID-19, most of the governments worldwide took several measures to slow down the spread and contain the epidemic. Likewise, to control this pandemic, various important measures were taken in the Kingdom of Saudi Arabia such as social distancing, quarantine applications, travel constraints, etc. Various social areas were also closed such as educational institutions, restaurants, sports clubs, malls, and gyms. Further to these precautions, it was also recommended that all the educational institutions must switch to online education.5

According to the data from the previous epidemics, highly infectious diseases may have a noteworthy impact on stress-related symptoms, mental health, and increased anxiety of both patients and healthcare workers.6 Worldwide healthcare professionals are experiencing constant stress during their day-to-day work due to COVID-19 pandemic. This stress is related to risk of infection, exhaustion, frustration, and social isolation.7

Research has been conducted to study the psychological impact of the infectious disease epidemics like SARS and MERS on students. One study in Saudi Arabia documented mild to moderate levels of anxiety in almost 25% of medical students during SARS and MERS epidemics.8 In Hong Kong, another study documented the anxiety levels in medical students significantly higher than the nonmedical students.9

It is important to have the knowledge on the psychological impact of this COVID-19 pandemic on students. After the COVID-19 outburst, studies have been carried out to study the impact of this pandemic on the psychological well-being of the students in Saudi Arabia10,11 but none of the studies were conducted on Dental Hygiene students in Saudi Arabia.

Dental hygiene students are at high-risk group for COVID-19 infection due to their close proximity to the patients, aerosols generating procedures, and lack of knowledge about infection control practices.1214 High risk of contamination may be the worrying factor which affects the psychological states of dental hygiene students. It was also observed that due to the disturbance of education, students’ anxiety tendency has increased, which in return has lessened their motivation about studying.15,16 According to author’s best knowledge, there is no literature regarding the psychological well-being of dental hygiene students in Saudi Arabia. Our study aims to cover this gap in the literature by evaluating the anxiety and depression levels of dental hygiene students in Saudi Arabia during COVID-19.

METHODOLOGY

A cross-sectional study was conducted among the dental hygiene students in Saudi Arabia to assess the psychological impact of the COVID-19 outbreak. Ethical clearance was obtained from the institutional ethical committee of Qassim University prior to the commencement of the study. The students from various Dental hygiene programs across the Kingdom were invited to participate in this study. The survey was conducted during the lockdown period between May 2020 and June 2020. To ensure maximal participation, students were asked to forward the questionnaire to their colleagues (Convenience and snowball sampling). Sample size of 138 participants was calculated after using a 95% confidence level (α = 0.05), 5% confidence interval, and statistical power of 0.85 to obtain a statistically significant result.

Email and social media platforms were used to distribute the online questionnaire (google forms) randomly among the dental hygiene students in Saudi Arabia. The questionnaire included a statement of anonymity and consent. Submitted questionnaire were considered as a consent by the students to participate in this study. To avoid questionnaires’ bias, submission of completely answered questionnaires was only accepted. Only single submission by each participant was allowed. To avoid sampling bias, the questionnaire was distributed through various online media thus increasing the visibility among the respondents. In addition, reminders through e-mail and text messages were also done.

A structured questionnaire comprising 14 items was used for this study. Questions were focused mainly into three domains, such as demographics, knowledge, and fear related to COVID-19 and validated self-reported anxiety screening scale, to assess the psychological impact.

The first domain included questions related to demographic details such as gender, institution, educational level, parental source of income, and residing area (categorized as urban or rural). The second domain included questions assessing the knowledge and fear related to COVID-19 on a 4-point Likert scale (not at all, slight, moderate, very much). Lastly, the third domain included generalized anxiety disorder scale (GAD-7) to measure the anxiety among dental hygiene students over the last 2 weeks during the lockdown period. Seven questions were included in the GAD-7 anxiety scale which were assessed by the 4-point Likert-type scale (not at all, several days, more than half the days, and nearly every day). The total score for the seven items of GAD-7 ranges from 0 to 21. Scores of 0–5 were represented as mild anxiety, 6–10 as moderate anxiety, 11–15 as moderately severe anxiety, and 16–21 were represented as severe anxiety.17

All the data were then tabulated and subjected to statistical analysis to assess the association between the variation in anxiety levels and various variables. The data on GAD-7 scale for individual questions are presented as mean and standard deviation (SD) and the data on categorical variables are shown as n (% of respondents). The intergroup statistical comparisons of distribution of categorical variables were tested using Chi-square test or Fisher’s exact probability test if more than 20% cells have expected frequency less than 5. The intergroup statistical comparisons of distribution of means of continuous variables across two group were done using independent sample t test and analysis of variance (ANOVA) was used for more than two group. Before subjecting the study variables to t test and ANOVA, the underlying normality assumption was tested. P-values of less than 0.05 were considered to be statistically significant. Statistical Package for Social Sciences (SPSS ver 22.0, IBM Corporation, USA) for MS Windows was used to statistically analyze the entire data.

RESULTS

The study was conducted to assess the psychological impact of the COVID-19 pandemic on dental hygiene students in Saudi Arabia. In total there are six dental hygiene colleges in the Kingdom of Saudi Arabia. Students from all the academic years as well as interns from these colleges were invited to participate in this study. The questionnaire was completed by 140 dental hygiene students.

In this study, 96 (68.6%) were males and 44 (31.4%) were females. Of which 43.6% respondents were from Qassim University. 26.4% respondents were from first year, 17.1% respondents were from second year, 27.9% respondents were from third year, and 28.6% respondents were interns. Major students (67.9%) were from urban area. Source of parental income was government job for 42.9% students. 41.6% students were not at all afraid to be infected with COVID-19 because of their profession and only 8.6% were very afraid to be infected with COVID-19 because of their profession. 42.1% of the dental hygiene students confirmed that they had acquired only slight knowledge through seminars, lectures, information leaflet, etc., since the COVID-19 outbreak, regarding maintaining a safe working environment. Table 1 summarizes the results of domain 1 and 2 of the questionnaire.

Table 1: Distribution of responses to the questions of domain 1 and 2 of the questionnaire
  No. of respondents % of respondents
Gender    
  Male 99 68.6
  Female 44 31.4
University    
  Qassim University 61 43.6
  Prince Sattam University 11 7.9
  Al Baha University 17 12.1
  King Saud University 15 10.7
  King Abdul Aziz University 22 15.7
  Mustaqbal University/Buraida Private College 14 10.0
Academic year    
  First year 37 26.4
  Second year 24 17.1
  Third year 39 27.9
  Intern 40 28.6
Area    
  Rural 45 32.1
  Urban 95 67.9
Source of parental income    
  Government job 60 42.9
  Private job 43 30.7
  Self employed 19 13.6
  Unemployed 18 12.9
Are you afraid to be infected with COVID-19 because of your profession?
  Slightly afraid 42 30.0
  Moderately afraid 28 20.0
  Very afraid 12 8.6
  Not at all 58 41.4
Acquired sufficient knowledge on COVID-19 outbreak
  Slightly 59 42.1
  Moderate 34 24.3
  Very much 17 12.1
  Not at all 30 21.4

The features of GAD-7 scale are presented in Tables 2 and 3 and Figure 1. Of 140 respondents, 50 (35.7%) had mild anxiety, 38 (27.1%) had moderate anxiety, 41 (29.3%) had moderate to severe anxiety, and 11 (7.9%) had severe anxiety. The association between the GAD-7 score and other domains of the questionnaire is presented in Tables 4 and 5.

Table 2: GAD-7 scale (anxiety test) of the dental hygiene students
  No. of respondents % of respondents
Did you experience feeling nervous, anxious, or on edge within the last 2 weeks?
Not at all 42 30.0
Several days 55 39.3
More than half the days 23 16.4
Nearly every day 20 14.3
Mean ± SD 1.15 ± 1.01  
Did you experience not being able to stop or control worrying within the last 2 weeks?
Not at all 56 40.0
Several days 36 25.7
More than half the days 26 18.6
Nearly every day 22 15.7
Mean ± SD 1.10 ± 1.10  
Did you experience worrying too much about different things within the last 2 weeks?
Not at all 59 42.1
Several days 33 23.6
More than half the days 30 21.4
Nearly every day 18 12.9
Mean ± SD 1.05 ± 1.07  
Did you have trouble relaxing within the last 2 weeks?
Not at all 46 32.9
Several days 37 26.4
More than half the days 39 27.9
Nearly every day 18 12.9
Mean ± SD 1.21 ± 1.04  
Did you experience being so restless that it’s hard to sit still within the last 2 weeks?
Not at all 59 42.1
Several days 34 24.3
More than half the days 21 15.0
Nearly every day 26 18.6
Mean ± SD 1.10 ± 1.15  
Becoming easily annoyed or irritable within the last 2 weeks
Not at all 69 49.3
Several days 25 17.9
More than half the days 28 20.0
Nearly every day 18 12.9
Mean ± SD 0.96 ± 1.10  
Feeling afraid as if something awful might happen within the last 2 weeks
Not at all 66 47.1
Several days 28 20.0
More than half the days 25 17.9
Nearly every day 21 15.0
Mean ± SD 1.01 ± 1.12  
Higher mean value indicates higher level of anxiety and vice-versa

Fig. 1: Distribution of level of anxiety among the respondents

Table 3: Distribution of level of anxiety among the respondents
Anxiety GAD-7 score No. of respondents % of respondents
Mild 0–5 50 35.7
Moderate 6–10 38 27.1
Moderately severe 11–15 41 29.3
Severe 16–21 11 7.9
Total   140 100.0
Table 4: Distribution of responses (mean scores) of GAD-7 scale questions according to various parameters of domain 1 and 2 of the questionnaire
  Q1 (feeling nervous, anxious, or on edge) Q2 (not being able to stop or control worrying) Q3 (worrying too much about different things) Q4 (trouble relaxing) Q5 (so restless that it’s hard to sit still) Q6 (easily annoyed or irritable) Q7 (feeling afraid as if something awful might happen)
  Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD Mean ± SD
Gender              
  Male 1.19 ± 1.04 1.09 ± 1.11 1.08 ± 1.09 1.19 ± 1.04 1.16 ± 1.18 0.92 ± 1.07 0.99 ± 1.16
  Female 1.07 ± 0.95 1.11 ± 1.08 0.98 ± 1.04 1.25 ± 1.06 0.98 ± 1.07 1.07 ± 1.17 1.05 ± 1.03
  p value 0.518NS 0.921NS 0.590NS 0.743NS 0.393NS 0.452NS 0.786NS
University              
  Qassim University 1.11 ± 1.00 0.77 ± 0.96 0.85 ± 1.05 1.10 ± 1.03 0.97 ± 1.09 0.77 ± 1.00 0.77 ± 1.07
  Prince Sattam University 1.55 ± 1.21 1.27 ± 0.79 1.73 ± 0.90 1.18 ± 0.87 2.09 ± 1.22 1.18 ± 0.98 2.00 ± 1.09
  Al Baha University 1.41 ± 1.00 1.35 ± 1.17 1.41 ± 1.12 1.53 ± 1.12 1.12 ± 1.22 0.82 ± 1.13 1.12 ± 1.17
  King Saud University 0.87 ± 0.99 1.47 ± 1.25 0.87 ± 0.74 1.40 ± 1.21 1.07 ± 1.28 1.47 ± 1.12 1.27 ± 1.10
  King Abdul Aziz University 1.05 ± 0.99 1.77 ± 1.19 1.32 ± 1.17 1.36 ± 1.05 1.23 ± 1.02 1.09 ± 1.19 0.91 ± 1.10
  Mustaqbal University/Buraida Pvt College 1.14 ± 0.95 0.64 ± 0.93 0.71 ± 1.14 0.86 ± 1.03 0.71 ± 0.99 1.07 ± 1.33 1.00 ± 1.04
  p value 0.510NS 0.001*** 0.039* 0.435NS 0.050* 0.295NS 0.026*
Academic year              
  First year 1.08 ± 0.89 1.16 ± 1.14 1.27 ± 1.12 1.30 ± 1.05 1.19 ± 1.17 1.19 ± 1.15 0.95 ± 1.13
  Second year 1.25 ± 0.99 0.79 ± 0.93 0.92 ± 1.02 1.13 ± 0.99 1.00 ± 1.06 0.88 ± 1.19 0.79 ± 0.98
  Third year 0.90 ± 1.05 1.21 ± 1.13 0.95 ± 1.05 1.13 ± 1.00 1.03 ± 1.16 0.82 ± 1.07 1.05 ± 1.15
  Intern 1.40 ± 1.06 1.13 ± 1.14 1.02 ± 1.09 1.25 ± 1.13 1.15 ± 1.19 0.95 ± 1.04 1.15 ± 1.19
  p value 0.151NS 0.503NS 0.519NS 0.872NS 0.888NS 0.504NS 0.641NS
Area              
  Rural 1.29 ± 1.06 1.47 ± 1.18 1.40 ± 1.05 1.53 ± 1.19 1.27 ± 1.23 1.07 ± 1.09 1.22 ± 1.26
  Urban 1.08 ± 0.99 0.93 ± 1.02 0.88 ± 1.05 1.05 ± 0.93 1.02 ± 1.10 0.92 ± 1.11 0.91 ± 1.04
  p value 0.264NS 0.006** 0.008** 0.010** 0.238NS 0.451NS 0.119NS
Source of income              
  Government job 1.07 ± 1.04 0.90 ± 1.02 0.93 ± 1.07 1.07 ± 1.00 0.88 ± 1.07 0.82 ± 0.98 0.87 ± 1.06
  Private job 1.07 ± 0.91 1.16 ± 1.07 1.02 ± 0.99 1.16 ± 0.89 1.30 ± 1.17 1.05 ± 1.13 1.19 ± 1.16
  Self employed 1.00 ± 1.05 1.05 ± 1.03 1.21 ± 1.08 1.32 ± 1.16 1.21 ± 1.23 0.63 ± 0.95 0.95 ± 1.08
  Unemployed 1.78 ± 0.94 1.67 ± 1.37 1.33 ± 1.28 1.67 ± 1.28 1.22 ± 1.21 1.61 ± 1.33 1.11 ± 1.28
  p value 0.043* 0.073NS 0.497NS 0.181NS 0.278NS 0.024* 0.528NS
Are you afraid to be infected with COVID-19 due to profession?
  Slightly afraid 0.83 ± 0.85 1.00 ± 1.04 1.00 ± 1.04 1.02 ± 0.92 0.88 ± 1.13 0.74 ± 0.99 0.86 ± 1.05
  Moderately afraid 1.39 ± 0.96 1.04 ± 1.04 1.04 ± 1.07 1.32 ± 1.02 1.07 ± 1.05 1.21 ± 1.03 1.07 ± 0.90
  Very afraid 2.58 ± 0.79 1.50 ± 1.24 1.75 ± 0.96 2.25 ± 0.87 2.50 ± 1.00 1.58 ± 1.31 2.33 ± 0.89
  Not at all 0.97 ± 0.92 1.12 ± 1.16 0.95 ± 1.09 1.07 ± 1.06 0.98 ± 1.05 0.88 ± 1.12 0.81 ± 1.15
  p value 0.001*** 0.568NS 0.126NS 0.002** 0.001*** 0.060NS 0.001***
  Acquired sufficient knowledge on COVID-19 outbreak
  Not at all 1.41 ± 1.02 1.31 ± 1.12 1.15 ± 1.08 1.29 ± 1.03 1.25 ± 1.15 1.15 ± 1.13 1.00 ± 1.02
  Minimal 1.00 ± 0.95 1.00 ± 1.10 0.82 ± 0.90 1.12 ± 0.95 1.03 ± 1.14 0.97 ± 1.06 1.21 ± 1.29
  Moderate 1.41 ± 1.18 0.94 ± 1.19 1.18 ± 1.33 1.53 ± 1.18 1.12 ± 1.17 1.06 ± 1.39 1.00 ± 1.12
  Very high 0.67 ± 0.76 0.90 ± 0.99 1.03 ± 1.09 0.97 ± 1.07 0.87 ± 1.14 0.53 ± 0.82 0.80 ± 1.13
  p value 0.005** 0.302NS 0.519NS 0.282NS 0.490NS 0.091NS 0.558NS
Higher mean value indicates higher level of anxiety and vice-versa. P value by ANOVA for more than two group and by independent sample t test for two group on the confirmation of normality assumption. P value <0.05 is considered to be statistically significant. *p value <0.05, **p value <0.01, ***p value <0.001; NS, statistically non-significant
Table 5: Distribution of level of anxiety (GAD-7 scale) according to various parameters of domain 1 and 2 of the questionnaire
  Level of Anxiety Total p value
Mild Moderate Moderate to severe Severe
n % n % n % n % n %
Gender                      
  Male 35 36.5 23 24.0 29 30.2 9 9.4 96 100.0 0.537NS
  Female 15 34.1 15 34.1 12 27.3 2 4.5 44 100.0  
University                      
  Qassim University 28 45.9 16 26.2 15 24.6 2 3.3 61 100.0 0.140NS
  Prince Sattam University 1 9.1 3 27.3 4 36.4 3 27.3 11 100.0  
  Al Baha University 5 29.4 5 29.4 5 29.4 2 11.8 17 100.0  
  King Saud University 3 20.0 6 40.0 4 26.7 2 13.3 15 100.0  
  King Abdul Aziz University 5 22.7 6 27.3 10 45.5 1 4.5 22 100.0  
  Mustaqbal University/Buraida Pvt College 8 57.1 2 14.3 3 21.4 1 7.1 14 100.0  
Academic year                      
  First year 11 29.7 10 27.0 15 40.5 1 2.7 37 100.0 0.158NS
  Second year 9 37.5 9 37.5 5 20.8 1 4.2 24 100.0  
  Third year 13 33.3 12 30.8 12 30.8 2 5.1 39 100.0  
  Intern 17 42.5 7 17.5 9 22.5 7 17.5 40 100.0  
Area                      
  Rural 10 22.2 13 28.9 16 35.6 6 13.3 45 100.0 0.076NS
  Urban 40 42.1 25 26.3 25 26.3 5 5.3 95 100.0  
Source of income                      
  Government job 25 41.7 16 26.7 15 25.0 4 6.7 60 100.0 0.523NS
  Private job 14 32.6 12 27.9 15 34.9 2 4.7 43 100.0  
  Self-employed 7 36.8 5 26.3 6 31.6 1 5.3 19 100.0  
  Unemployed 4 22.2 5 27.8 5 27.8 4 22.2 18 100.0  
Are you afraid to be infected with COVID-19 due to profession?
  Slightly afraid 18 42.9 13 31.0 9 21.4 2 4.8 42 100.0 0.001***
  Moderately afraid 7 25.0 10 35.7 10 35.7 1 3.6 28 100.0  
  Very afraid 0 0.0 1 8.3 5 41.7 6 50.0 12 100.0  
  Not at all 25 43.1 14 24.1 17 29.3 2 3.4 58 100.0  
Acquired sufficient knowledge on COVID-19 outbreak
  Not at all 15 25.4 20 33.9 19 32.2 5 8.5 59 100.0 0.437NS
  Minimal 14 41.2 8 23.5 8 23.5 4 11.8 34 100.0  
  Moderate 7 41.2 3 17.6 5 29.4 2 11.8 17 100.0  
  Very high 14 46.7 7 23.3 9 30.0 0 0.0 30 100.0  
p value by Chi-square test. P value <0.05 is considered to be statistically significant. ***p value <0.001; NS, statistically non-significant

Distribution of Responses (Mean Scores) to the Questions of GAD-7 Scale According to Various Parameters of Domain 1 and 2 of the Questionnaire

According to Gender

Distribution of mean scores of all questions of GAD-7 scale did not differ significantly between male and female respondents (p-value >0.05 for all).

According to University

Distribution of mean scores of questions such as Q1, Q4, and Q6 of GAD-7 scale did not differ significantly between respondents from different university (p-value >0.05 for all). Distribution of mean scores of questions such as Q2, Q3, Q5, and Q7 of GAD-7 scale differs significantly between respondents from different university (p-value <0.05 for all).

According to Academic Year

Distribution of mean scores of all questions of GAD-7 scale did not differ significantly between group of respondents from various academic years (p-value > 0.05 for all).

According to Residential Area

Distribution of mean scores of questions such as Q1, Q5, Q6, and Q7 of GAD-7 scale did not differ significantly between group of respondents from rural and urban areas (p-value >0.05 for all). Distribution of mean scores of questions such as Q2, Q3, Q4 of GAD-7 scale differs significantly between group of respondents from rural and urban areas (p-value <0.05 for all).

According to Source of Income

Distribution of mean scores of questions such as Q2, Q3, Q4, Q5, and Q7 of GAD-7 scale did not differ significantly between group of respondents with various sources of income (p-value >0.05 for all). Distribution of mean scores of questions such as Q1 and Q6 of GAD-7 scale differs significantly between group of respondents with various sources of income (p-value <0.05 for all).

According to Fear of Infection of COVID-19

Distribution of mean scores of questions such as Q2, Q3, and Q6 of GAD-7 scale did not differ significantly between group of respondents with various levels of fear of infection of COVID-19 (p-value >0.05 for all). Distribution of mean scores of questions such as Q1, Q4, Q5, and Q7 of GAD-7 scale differs significantly between group of respondents with various levels of fear of infection of COVID-19 (p-value <0.05 for all).

According to Knowledge of COVID-19 Outbreak

Distribution of mean scores of questions such as Q2, Q3, Q4, Q5, Q6, and Q7 of GAD-7 scale did not differ significantly between group of respondents with various levels of knowledge of COVID-19 outbreak (p-value >0.05 for all). Distribution of mean scores of Q1 of GAD-7 scale differs significantly between group of respondents with various levels of knowledge of COVID-19 outbreak (p-value <0.05).

Distribution of Level of Anxiety (GAD-7 Scale) According to Various Parameters of Domain 1 and 2 of the Questionnaire

According to Gender

Male and female respondents did not show any significant difference in the distribution of level of anxiety (p-value >0.05).

According to University

Respondents from different universities did not show any significant difference in the distribution of level of anxiety (p-value >0.05).

According to Academic Year

Distribution of level of anxiety did not differ significantly between group of respondents from various academic years (p-value >0.05).

According to Residential Area

Group of respondents from Urban and Rural areas did not show any significant difference in the distribution of level of anxiety (p-value >0.05).

According to Source of Income

Group of respondents with various sources of income did not show any significant difference in the distribution of level of anxiety (p-value >0.05).

According to Fear of Infection of COVID-19

Distribution of level of anxiety differs significantly between group of respondents with various levels of fear of infection of COVID-19 (p-value <0.05).

According to Knowledge of COVID-19 Outbreak

Distribution of level of anxiety did not differ significantly between group of respondents with various levels of knowledge of COVID-19 outbreak (p-value >0.05).

DISCUSSION

American Psychological Association (APA) describes anxiety as “a feeling described by sentiments of strain, stressed considerations, and physical changes, for example, high level of blood pressure.” WHO describes depression as a “common mental disorder, characterized by misery, loss of intrigue or delight, feelings of blame or low self-esteem, disturbed sleep or hunger, and sentiments of sluggishness and poor concentration.”18 As per WHO, people who experience stress or depression have 10 years lesser life expectancy than general population.19,20 Furthermore, suicidal tendency has also been reported in 11.1% of all the medical students who are experiencing greater level of depression.21

COVID-19 has influenced many people and countries all over the world and it is becoming unstoppable. Thus, in the context of the COVID-19 outbreak, there is a need to document its effect on the physical and mental health. To the author’s knowledge, this study is the first to report the psychological effects of the COVID-19 pandemic on dental hygiene students in Saudi Arabia. But various studies have been published reporting the prevalence of anxiety among medical and pharmacy students in Saudi Arabia.2224

Generalized anxiety disorder (GAD) can lead to other major problems, such as severe depression and is one of the most common anxiety disorders. Early detection is crucial to overcoming this problem and improving quality of life.25 The GAD-7 scale, developed in 2006 by Spritzer et al., is highly considered as an effective tool for screening GAD and assessing its severity in various disciplines.17,26 Because the GAD-7 scale has been utilized in several previous publications,17,2730 the authors selected this tool.

An increased prevalence of anxiety among medical and health sciences students has been reported.2834 Various factors can be responsible for this. In previous research, sociodemographic factors, financial difficulties, and fulfilling responsibilities and roles were identified as the main sources of stress among college students. Present study also states that the students from rural area had statistically greater anxiety level.

To prevent the spreading of the infection amongst the students and teachers, the Saudi government had ordered a countrywide schools and universities closure as an emergency measure. Though these efforts and decisive actions are highly praiseworthy and necessary, there are also concerns that distance learning, home confinement, and school suspension may have adverse effects on students’ mental and physical health.35 Students from King Abdul Aziz University and Prince Sattam University showed statistically higher anxiety score when comparing the GAD-7 questions.

Some findings have also shown that loss of income and large-scale isolation measures have led to mental health problems among migrant workers during COVID-19 outbreaks.36 In this present study also, students whose parents were unemployed during pandemic were found to be more stressed compared to others. Various studies have reported that female have higher level of anxiety when compared to males.37,38 In this study, no relation was found between gender, academic year, and anxiety level.

Additionally, a series of issues such as frustration and boredom, fear of contagion, lack of private space at home, and inadequate information would continue to arise and escalate during the COVID-19 outbreak.35 Anxiety levels were significantly higher among students who slightly feared contacting the disease because of their profession (42.9%). Because of distance education, there might be changes in the communication between the students and teachers. As a result, the students might feel isolated which can be an important source of pressure for students. This might lead to inadequate knowledge regarding the COVID-19 pandemic, and thereby increasing the stress among the students.39 Also, healthcare professionals experiencing increased psychological pressure have found rise in their confidence with the availability of vaccine. Reports have suggested that there has been decrease in the anxiety and stress levels post vaccination.40 The questionnaire-based bias and the sample size are the likely limitations of this study, which the author is aware about. However, in spite of these limitations, this study illustrates the various causes for the increased anxiety levels among the dental hygiene students.

To facilitate for the psychological well-being of healthcare professionals and optimal treatment for patients, it is important to have the knowledge on the psychological impact of the pandemic on them. Education institutions can minimize the psychological stress among students by increased professional counselling and optimum academic advising especially during such pandemic outbreaks. Therefore, studies considering COVID-19-outbreak-related worries and emotional reactions among healthcare professionals from different populations and countries are required.4143

CONCLUSION

Anxiety is considered as an important factor for healthcare students that may influence negatively on their personal and academic life. The present results demonstrate that dental hygiene students suffered from some form of anxiety ranging from mild anxiety to severe anxiety, reporting that they frequently felt nervous and were scared that something terrible would happen. Offering immediate treatment has proven to be beneficial to prevent serious consequences. Thus, student counseling programs must be employed by all universities and students must be intervened when they face physical, behavioral, or mental health challenges.

DECLARATIONS

Ethics approval and consent to participate: Submitted questionnaire were considered as a consent by the students to participate in this study. This study was approved by the Institutional Ethics Committee of Qassim University, Saudi Arabia.

Availability of data and materials: The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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