Exploring the Effect of the COVID-19 Pandemic on the Dental Team: Preparedness, Psychological Impacts and Emotional Reactions

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.

Prediction of emotional exhaustion over the course of the COVID-19 pandemic in primary care dental staff: an intensive longitudinal study

“…We presented a detailed model of how features of burnout relate to depressive symptomatology and other important related issues of preparedness and trauma, in dental staff working in primary care and trainees. 2 Results from our cross-sectional survey in Scotland provided some support, although we recognise that more research is needed to confirm and develop the conceptual model.…”

“… 21 The development of emotional exhaustion over shorter periods of months is of specific interest theoretically to determine if changes are detectable and predictable in the shorter term. For example, in our previous report, 2 our model highlighted the importance of dental staff being prepared for delivery of their service during the COVID-19 pandemic. In addition, the staff’s ratings of trauma experiences and depressive symptomatology were linked to burnout levels.…”

“… 27 A full description of the items and factorial structure is provided in our previous publication. 2 The subscale of seven items was named: P-Qual-C19. It was created from the 14 items of the DPPPS which had the stem: ‘In the current COVID-19 pandemic, how well are you prepared for?’ Respondents checked one rating from the five available categories: ‘unprepared’ (1), ‘not well prepared’ (2), ‘prepared’ (3), ‘well prepared’ (4), ‘extremely well prepared’ (5).…”

“…This file was merged with the baseline survey data reported previously. 2 The distributional properties of the derived slopes and predictor variables (mental health, trauma and preparedness) were inspected to check assumptions. Path analysis 34 was performed ( sem procedure in STATA V.15), adopting the a priori model in figure 1 , to explain the trajectory variance in the diary volunteer respondents.…”

“…Our research group has reported a cross-sectional survey of dental staff in primary care and trainees. 2 The focus of the survey was to assess levels of preparedness of clinical staff in primary dental care for the pandemic as well as preparedness to deliver care, associated emotional trauma, burnout and depressive symptomatology. Results indicated a significant burden of burnout, especially emotional exhaustion, as well as depressive symptomatology.…”