Assessment of Psychosocial Risks and Mental Health Status in a Faculty of Dentistry

Betül Akkaya; Mine Esin Ocaktan

doi:10.4274/atfm.galenos.2025.80775

Abstract

Objectives

It was aimed to evaluate the psychosocial risks, mental health status of the employees and related factors in a faculty of dentistry.

Materials and Methods

In this cross-sectional study, no sample was selected. It is planned to include all employees at the faculty of dentistry between November 2021 and January 2022. The data collection form included questions on socio-demographic characteristics, working life characteristics and Coronavirus disease-2019, the Turkish Copenhagen Psychosocial Questionnaire (COPSOQ-TR) and the General Health Questionnaire-12. Data were collected using a survey method under observation in the participant’s workplace. Chi-square test and logistic regression analysis were applied in statistical analysis. Ethical approval was obtained for the study.

Results

Three hundred three (80% participation rate) employees were included in the study. The percentage of participants with high psychosocial risk scores is highest in the dimensions of lack of job satisfaction, insecurity over working conditions and work pace. The majority (52%) had poor mental health. Those with high risk scores in most dimensions of COPSOQ-TR have significantly poorer mental health status. In regression analysis, the variables of occupational group, access to adequate and appropriate personal protective equipment, lack of predictability, and burnout predicted poor mental health status.

Conclusion

It was found that the most important psychosocial risks are lack of job satisfaction, insecurity over working conditions and work pace. It has been demonstrated that the mental health status of the majority is poor and psychosocial risks are related to the mental health status of the participants.

Keywords:

Occupational health, psychosocial factors, risk assessment, dentistry, mental health

Introduction

Psychosocial hazards are defined as factors that arise from inappropriate job design, organization and management and can lead to physical and mental illnesses in employees or managerial problems such as lack of productivity and absenteeism (1). Psychosocial risk is the probability that a psychosocial hazard will cause harm (2). However, the concepts of psychosocial hazard and risk, which are intertwined in many sources, are used interchangeably in the literature (3). The concepts of psychosocial risk and work-related stress, one of these risks, are often treated synonymously in the literature (3, 4).

A quarter of employees in Europe report experiencing work-related stress. The most common psychosocial hazards are related to the employee’s task type and work intensity (5). Different professions tend to involve different types of hazards (3). Work-related psychosocial hazards can have negative effects on the personal and professional relationships, physical and mental health of dental professionals (6). In their study in Taiwan, Lee et al. (7) reported that work stress and professional burnout were common among dental professionals. Severe acute respiratory syndrome-Coronavirus-2, spread rapidly all over the world and caused the coronavirus disease-2019 (COVID-19) pandemic. Although the global public health emergency was declared over in May 2023, the pandemic continues (8). In this process, healthcare workers have been exposed to additional psychological difficulties such as fear of infecting their families, being discriminated against by society as potential virus carriers, interruption of education and research activities, personal protective equipment (PPE) shortage and working under heavy workload and time pressure despite inadequate PPE (9, 10). With the COVID-19 pandemic, psychosocial risks in the dental work environment have become even more important. During this period, dental professional practices were interrupted, new practices were introduced in dental procedures, and some dental treatments were postponed (9, 11).

Psychosocial risks, like other important health and safety issues, can be managed effectively by applying an appropriate risk management approach (12). Risk assessment, the core element of the risk management process (13), is a systematic step-by-step approach (2).

Lee et al. (7) reported that job stress and burnout are common among dental professionals in their study in Taiwan. Various studies have found high levels of burnout in dentists (14-16). With the COVID-19 pandemic, psychosocial risk factors in the dentistry work environment have gained even more importance. During this period, dentistry professional practices were interrupted, new practices were implemented in dental procedures due to the high risk of cross-infection, and some dental treatments were postponed (11, 17). COVID-19 has been a major concern among dental health workers because they work in close contact with the oral cavity and frequently perform aerosol-generating procedures (18). It has been observed that the number of studies examining psychosocial risks in the field of dentistry is limited, especially during the COVID-19 pandemic. Also in the literature review, there are a limited number of studies examining workplace psychosocial risks and employees’ mental health status together. For these reasons, this study aims to evaluate psychosocial risks, mental health status and related factors at the faculty of dentistry; it was also aimed to determine the relationship between psychosocial risks and the mental health status of employees.

Materials and Methods

The cross-sectional study was conducted Ankara University Faculty of Dentistry. The universe consists of all employees working between November 2021 and January 2022. The sample was not selected. It was planned to include all people making up the universe within the scope of the research. Informed consent of the employees was obtained. Ethical approval was obtained from Ankara University Rectorate Ethics Committee (approval no.: 18/198, date: 22.11.2021), and necessary permissions were obtained from the faculty of dentistry and the Ministry of Health. Additionally, scale usage permissions were obtained. This article was extracted from the medical speciality thesis titled “Evaluation of Psychosocial Risks and General Health of Employees in a Faculty of Dentistry” prepared in Ankara, Türkiye in 2023.

Dependant variables are the scores employees received by the Turkish Copenhagen psychosocial questionnaire (COPSOQ-TR) dimensions and the general health questionnaire-12 (GHQ-12). Independent variables are the socio-demographic, health and working life characteristics of the employees, the status of being assigned to the unit related to COVID-19, the ability to access sufficient and appropriate PPE, the possibility of flexible/remote working during the COVID-19 pandemic, the status of having COVID-19 and the most stressful work-related situations experienced by employees during the COVID-19 pandemic. In comparisons made with GHQ-12 scores, the scores received by employees from the COPSOQ-TR dimensions were treated as independent variables.

Data were collected by survey method under observation. The data collection form consists of COPSOQ-TR and GHQ-12, as well as questions regarding socio-demographic, health and working life characteristics and COVID-19.

COPSOQ is a scale developed by Kristensen and Borg to collect valid and reliable information about basic psychosocial risk factors (19). The Türkiye validity and reliability study of the COPSOQ-3 scale (3^rd edition) was conducted by Şahan et al. (20) in 2018. It was made by and named COPSOQ-TR. COPSOQ-TR consists of 25 dimensions and 87 items (1). The dimensions included in COPSOQ-TR are examined by dividing into five themes. These themes are: the demands theme, impact and development theme, interpersonal relations and leadership theme, other parameters theme and results theme (20). The Cronbach’s alpha values of the lack of freedom at work and lack of predictability dimensions are 0.54 and 0.66, respectively. Cronbach’s alpha values of the other 23 COPSOQ-TR dimensions are above 0.70 (20). In the analysis conducted in our research, the Cronbach’s alpha value of all 25 dimensions is 0.70 and above. The scoring of each dimension was calculated on its own. Lack of job satisfaction was scored on a 4-point Likert scale, and all other dimensions were scored on a 5-point Likert scale. Scores at or above the median value, which is the cut-off point, indicate that the psychosocial risk in the relevant dimension is high, while scores below the median value indicate that the psychosocial risk in the relevant dimension is low (1, 21).

GHQ-12 was developed by Goldberg to measure acute mental health problems common in society. Türkiye validity and reliability study was conducted by Kilic (22). While the Cronbach’s alpha value in reliability calculations for GHQ-12 is 0.78 (22), it is 0.87 in the analysis conducted in our research. Likert type scoring method was used in our research (22). According to this scoring method, the highest score that can be obtained from the scale is 36, and a higher score indicates poorer mental health (23). The median value of the GHQ-12 total score is the cut-off point. Those with this value and above are categorised as having poor mental health, while those below that value are categorised as having good mental health (21).

Statistical Analysis

Data analysis was done using SPSS^© statistics 25 programme. The suitability of numerical variables for normal distribution was evaluated using histograms, probability graphs and the Kolmogorov-Smirnov test. The first stage of an effective psychosocial risk assessment is job analysis (1). For this purpose, three categories are defined for the tasks performed by employees. Chi-square test was applied to compare categorical variables. Bonferroni correction was made from post-hoc tests. Variables predicting poor mental health status were evaluated using Backward Logistic Regression analysis. Multicollinearity between the numerical and ordinal variables in the model was evaluated with the Spearman correlation test. Variables with a significant relationship (p<0.05) in univariate analyses and in the literature, and variables with a p<0.25 although there was no significant relationship, were included in the model. Modelling was done with 29 variables in total. Since the Hosmer-Lemeshow test p-value=0.75, the final model was considered to have a good fit to the data. Statistical significance level was taken as p<0.05 (24, 25).

Results

In this study, 305 (80%) people out of 380 people who made up the population were reached. One person was excluded from the research due to insufficient data and another person was excluded from the study due to the fact that she had only been working at the faculty for one day. Ultimately, 303 (80% participation rate) people were included in the research.

Table 1 presents the socio-demographic and working life characteristics of the participants. The average age of the participants is 38.36 (±11.18). The youngest participant is 23 years old, the oldest is 65 years old, 54% are women, 62% are married, 55% have children, 80% are higher education graduates and 18% have at least one of the following chronic physical illness, mental illness or disability.

In the faculty, 23% of employees stated that they were assigned to a unit related to COVID-19, 66% stated that they had access to sufficient and appropriate PPE during the pandemic, 76% stated that they had the opportunity to work flexibly/remotely during this period and 19% stated that they had COVID-19. One person stated that he had never been vaccinated and 91% of employees have received at least three doses of the COVID-19 vaccine and 99% have received at least two doses. In the study, 80% of the participants stated that the concern of infecting the family with the virus, 55% stated that the fear of contracting COVID-19, 48% stated that uncertainty in working conditions, and 33% stated that the reduced social interaction due to measures requiring physical distancing was one of the most stressful work-related situations during the COVID-19 pandemic.

Table 2 shows the distribution of risk scores of employees according to COPSOQ-TR dimensions. The dimensions with the highest median psychosocial risk score are cognitive demands, work pace and burnout, respectively (median value=75.00, 66.67, 62.50 respectively). When the scores received by employees from the COPSOQ-TR scale are categorised, the highest percentage of participants in the high-risk group is in the dimensions of lack of job satisfaction (57%), insecurity over working conditions (55%) and work pace (54%).

COPSOQ-TR dimension scores were compared according to the participants’ occupational group and task. The occupational group was found to be associated with the participants’ risk levels of quantitative demands, emotional demands, work-life conflict, lack of influence at work, lack of possibilities for development, lack of predictability, role conflicts, lack of social support from colleagues and lack of social support from superiors (p<0.05). Quantitative demands, emotional demands, work-life conflict, lack of influence at work, lack of possibilities for development, lack of predictability, role conflicts, lack of social support from colleagues, lack of social support from superiors and burnout risk levels were found to be associated with the employee’s task (p<0.05).

Comparison of participants’ mental health status according to their characteristics related to working life and the COVID-19 pandemic is presented in Table 3. The median of the scores the participants received from the GHQ-12 scale is 12. When evaluated by categorising the GHQ-12 score, 52% of the participants (n=151) had a poor mental health condition. There is no statistically significant difference between the mental health status of the participants according to socio-demographic characteristics (p>0.05). The mental health status of those without a chronic disease or disability is significantly worse than that of people with the relevant condition (p<0.05).

Comparison of the participants’ mental health status according to their COPSOQ-TR dimension scores is presented in Table 4. The mental health status of those with a high risk of quantitative demands, cognitive demands, emotional demands, work-life conflict, lack of influence at work, lack of freedom at work, meaninglessness of work, lack of commitment to the workplace, lack of predictability, lack of role-clarity, role conflicts, lack of quality of leadership, lack of social support from superiors, lack of organizational justice and respect, insecurity over employment, insecurity over working conditions, lack of job satisfaction and burnout is significantly worse than those with a low risk (p<0.05).

Table 5 presents the logistic regression analysis last step results regarding the effects of some characteristics of the participants and COPSOQ-TR dimensions on mental health status. It was found that the variables of occupational group, access to adequate and appropriate PPE, lack of predictability and burnout significantly affected the poor mental health status (p<0.05).

Discussion

It has been found that the most important psychosocial risks in the faculty are lack of job satisfaction, insecurity over working conditions, work pace, and the majority have poor mental health status. The strengths of our research are that it evaluates many problems at the same time and, as far as is known, it is the first study in the field of dentistry where psychosocial risks, mental health status and factors related to the COVID-19 pandemic are examined together in all professional groups. Additionally, the risk assessment made a contribution to routine occupational health services. Since the number of studies conducted with COPSOQ for all employees in the field of dentistry is limited, it was thought that the discussion was incomplete in this respect.

Due to the nature of the COPSOQ-TR scale, the workplace must be evaluated within itself (1). Lack of job satisfaction, insecurity over working conditions and work pace, which are the dimensions with the highest percentage of participants in the high-risk group, are the most important psychosocial risks in the faculty. This may be due to reasons such as difficult working conditions, high risk of COVID-19 transmission, frequent changes in instructions, prolongation of practices due to new procedures, necessity to work with PPE, assignments outside their field, unintentional changes in working hours. In some studies conducted on healthcare workers, the most important psychosocial risks at work are often different from our study (26-28).

Psychosocial risks of dentists and academic staff in academic units are high in the dimensions that appear significant in the theme of demands. Previous studies have also reported that dentists have high risk levels in terms of demands (29-31). This may be due to the high amount of work dentists have to do in a limited time, the fact that they are faced with patient demands, the high probability of doing many tasks, including management, and the fact that dentists are mostly assigned during the pandemic.

It is noteworthy that the risk of lack of influence at work and lack of possibilities for development differs according to occupational groups, both in our research and in the relevant literature, and that the risk is lowest in the dentist/physician group (26, 29, 32). This may be due to the fact that dentists/physicians are generally in a supervisory position and education and research activities are mainly carried out among dentists. The risk of lack of influence at work and lack of possibilities for development for those working academically in academic units is significantly lower than other groups. The significant difference in the same dimensions of the theme of demands and impact and development according to occupational group and task is probably due to the fact that 98% of those working in academic units are dentists.

In the dimensions that are significant in the theme of interpersonal relations and leadership, mostly those who are not healthcare professionals and those who work in administrative positions have high psychosocial risks. Findings are diverse, especially in previous studies where evaluations were made according to occupations (29, 31-33). The high risk of lack of predictability for those who are not healthcare professionals and those who work in administrative positions suggests that they may have been left in the background in terms of notification of decisions and information, due to reasons such as the fact that most of the managers are dentists and the education network is mainly among dentists. The risk of lack of social support from colleagues and superiors is also high in these groups. Those working in administrative units are more likely to work at a desk and have the opportunity to work flexibly/remotely, and they are thought to have less contact with their colleagues. The risk of role conflicts for dentists and academic staff in academic units is higher than other professions and task groups. This finding may be due to their low seniority as the majority of the relevant groups are research assistants, their specialist training in addition to clinical work, and the responsibilities imposed by the pandemic.

While the risk of burnout in the results theme was found to be significantly higher in academic staff in academic units, findings in previous studies are diverse (34-36). This may be due to the fact that this group is more likely to be a healthcare member than the comparison groups.

The mental health status of participants with high psychosocial risk is significantly poor in most dimensions of the themes of demands, interpersonal relations and leadership, and in all dimensions of the themes of impact and development, other parameters and results. Our findings are consistent with previous studies conducted in healthcare workers (34, 37-40).

Being a dentist, lack of access to adequate and appropriate PPE, lack of predictability and high risk of burnout increase the likelihood of poor mental health. In a study conducted among nurses, the likelihood of poor mental health was increased by a high risk of burnout, similar to our study, and by a high risk of cognitive demands, lack of social support from colleagues, and insecurity over working conditions (37). Although the findings in previous studies are diverse, it is noteworthy that, unlike our study, the mental health status of healthcare workers other than physicians/dentists is worse (30, 41-43). In one study, the mental health status of healthcare workers who reported not being provided with adequate PPE was worse, consistent with our research (34).

Study Limitations

Since our study is cross-sectional, the cause-effect relationships between the variables are not strong.

Our results represent the employees of the dentistry faculty where the research was conducted and cannot be generalized to the society.

Although the employees were informed that personal information would be kept confidential, no connection would be established between personal information and individuals through the data, and that they would not encounter any negative situations, many participants did not want to specify the units they worked in detail; therefore, detailed unit analysis could not be conducted.

Conclusion

As a result, in order to manage psychosocial risks that may have significant consequences in terms of both worker health and safety and work efficiency, infrastructure should be prepared in workplaces with the participation of all parties, within the framework of a positive occupational health and safety culture, and practices should be continuous. The resilience of the workforce should be improved, uncertainties should be avoided, and effective teamwork should be carried out. It is thought that the number of studies examining psychosocial risks and mental health in dental assistant health personnel is insufficient, and studies should be planned to include all professional groups working in this field.

Ethics

Ethics Committee Approval: The ethical approval was obtained from Ankara University Rectorate Ethics Committee (approval no.: 18/198, date: 22.11.2021).

Informed Consent: Informed consent of the employees was obtained.

Authorship Contributions

Concept: B.A., M.E.O., Design: B.A., M.E.O., Data Collection and/or Processing: B.A., Analysis and/or Interpretation: B.A., M.E.O., Literature Search: B.A., Writing: B.A.

Conflict of Interest: There is no potential conflict of interest to declare.

Financial Disclosure: This study received no financial support.

References

Sahan C, Demiral Y. In: Copenhagen psychosocial risk assessment guideline. Sahan C, Demiral Y, editors. Psychosocial Risk Assessment at Work. 1st ed. İzmir: Occupational Hygienists Association (İHİDER); 2020. p.3-31.

Metzler YA, von Groeling-Müller G, Bellingrath S. Better safe than sorry: methods for risk assessment of psychosocial hazards. Saf Sci. 2019;114:122-139.

Vatansever C. A new dimension in risk assessment: psychosocial hazards and risks. Work Soc. 2014;40:117-138.

Leka S, Jain A. World Health Organization Health impact of psychosocial hazards at work: an overview.WHO; 2010: 4-89.

Eurofound and EU-OSHA. Psychosocial risks in Europe: prevalence and strategies for prevention. Publications Office of the European Union. Luxembourg. 2014:6.

Rada RE, Johnson-Leong C. Stress, burnout, anxiety and depression among dentists. J Am Dent Assoc. 2004;135:788-794.

Lee C-Y, Wu J-H, Du J-K. Work stress and occupational burnout among dental staff in a medical center. J Dent Sci. 2019;14:295-301.

WHO. Coronavirus disease (COVID-19) pandemic [Internet]. [Retrieved on 2024]. Available from: https://www.who.int/europe/emergencies/situations/covid-19

Mekhemar M, Attia S, Dörfer C, et al. Dental nurses’ mental health in Germany: a nationwide survey during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18:8108.

Vergara-Buenaventura A, Chavez-Tuñon M, Castro-Ruiz C. The mental health consequences of Coronavirus Disease 2019 pandemic in dentistry. Disaster Med Public Health Prep. 2020;14:e31-34.

Derruau S, Bouchet J, Nassif A, et al. COVID-19 and dentistry in 72 questions: an overview of the literature. J Clin Med. 2021;10:779.

Cox T, Griffiths A, Stavroula L. Work organization and work‐related stress. In: Gardiner K, Harrington JM, editors. Occupational Hygiene. 3rd ed. Wiley Online Library; 2005. p. 421-432.

World Health Organization. PRIMA-EF : guidance on the European framework for psychosocial risk management : a resource for employer and worker representatives. 2008. https://iris.who.int/handle/10665/43966

Osborne D, Croucher R. Levels of burnout in general dental practitioners in the south-east of England. Br Dent J. 1994;177:372-377.

Slabšinskienė E, Gorelik A, Kavaliauskienė A, et al. Burnout and ıts relationship with demographic and job-related variables among dentists in lithuania: a cross-sectional study. Int J Environ Res Public Health. 2021;18:3968.

Jin M-U, Jeong S-H, Kim E-K, et al. Burnout and its related factors in Korean dentists. Int Dent J. 2015;65:22-31.

Mekhemar M, Attia S, Dörfer C, et al. The psychological impact of the COVID-19 pandemic on dentists in Germany. J Clin Med. 2021;10:1008.

Sarialioglu Gungor A, Donmez N, Uslu YS. Knowledge, stress levels, and clinical practice modifications of Turkish dentists due to COVID-19: a survey study. Braz Oral Res. 2021;35:1-12.

COPSOQ Network. COPSOQ ınternational network [Internet]. [Retrieved on January 23, 2023]. Available from: https://www.copsoq-network.org/

Sahan C, Baydur H, Demiral Y. A novel version of Copenhagen psychosocial questionnaire-3: Turkish validation study. Arch Environ Occup Health. 2019;74:297-309.

Sahan C. Adaptation of the Copenhagen psychosocial risk assessment scale into Turkish (Public Health Master’s Thesis). İzmir, Türkiye. Dokuz Eylul University Institute of Health Sciences. 2016.

Kilic C. General health questionnaire: reliability and validity study. Turkish J Psychiatry. 1996;7:3-9.

Liang Y, Wang L, Yin X. The factor structure of the 12-item general health questionnaire (GHQ-12) in young Chinese civil servants. Health Qual Life Outcomes. 2016;14:136.

Hayran M, Hayran M. Basic statistics for health research second edition. Omega Research Education Consultancy Limited Company; 2018; p.8-363.

Field A. Discovering statistics using IBM SPSS statistics. SAGE Publications Ltd; 4th edition. 2013;293-814.

Sato TD, de Faria BS, Albuquerque BB, et al. Poor health conditions among brazilian healthcare workers: the study design and baseline characteristics of the HEROES cohort. Healthcare (Basel). 2022;10:1-12.

Gouveia PA, Lopes D, Henriques AR, et al. Psychosocial risks among the healthcare workforce working in COVID services: findings from a cross-sectional study on psychosocial risks. Eur Psychiatry. 2022;65:253-254.

Bozdag F, Kurt AO, Bugdayci BN, et al. Evaluation of psychosocial risks of employees of a university hospital. In: 3 International 21 National Public Health Congress; 26-30 November, 2019; Antalya, Türkiye. Ankara; HASUDER. p.454-460.

Berthelsen H, Westerlund H, Hakanen JJ, et al. It is not just about occupation, but also about where you work. Community Dent Oral Epidemiol. 2017;45:372-379.

Gorter RC, Freeman R. Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol. 2011;39:87-95.

Karatuna I, Owen M, Westerlund H, et al. The role of staff-assessed care quality in the relationship between job demands and stress in human service work: the example of dentistry. Int J Environ Res Public Health. 2022;19:12795.

Wagner A, Rieger MA, Manser T, et al. Healthcare professionals’ perspectives on working conditions, leadership, and safety climate: a cross-sectional study. BMC Health Serv Res. 2019;19:53.

Koch P, Zilezinski M, Schulte K, et al. How perceived quality of care and job satisfaction are associated with ıntention to leave the profession in young nurses and physicians. Int J Environ Res Public Health. 2020;17:2714.

Turkili S, Aslan E, Tot S. Examination of difficulties, anxiety, depression and burnout syndrome among healthcare professionals in Türkiye due to the coronavirus outbreak. Mersin Univ J Heal Sci. 2022;15:74-87.

Chang HE, Cho S-H. The ınfluence of social support on the relationship between emotional demands and health of hospital nurses: a cross-sectional study. Healthcare (Basel). 2021;9:115.

Ozaydın O, Vural A, Balcı N, et al. Job satisfaction of healthcare workers during the COVID-19 epidemic. Gumushane Univ J Heal Sci. 2022;11:54-62.

Birdane G. Examining the psychosocial risks of nursing staff in a university hospital using the Copenhagen psychosocial risk assessment questionnaire and its relationship with mental well-being. (PhD Thesis). Ankara, Türkiye. Hacettepe University Institute of Health. 2022.

Freimann T, Merisalu E. Work-related psychosocial risk factors and mental health problems amongst nurses at a university hospital in Estonia: a cross-sectional study. Scand J Public Health. 2015;43:447-452.

Malinauskienė V, Leišytė P, Malinauskas R. Psychosocial job characteristics, social support, and sense of coherence as determinants of mental health among nurses. Medicina (Kaunas). 2009;45:910-917.

Puriene A, Aleksejuniene J, Petrauskiene J, et al. Self-perceived mental health and job satisfaction among lithuanian dentists. Ind Health. 2008;46:247-252.

Tunc S, Kose S. The frequency and determining factors of psychiatric symptoms in healthcare professionals. Psychiatry Behav Sci. 2019;9:94-101.

Bettinsoli ML, Di Riso D, Napier JL, et al. Mental health conditions of ıtalian healthcare professionals during the COVID-19 disease outbreak. Appl Psychol Heal Well-Being. 2020;12:1054-1573.

Eldridge LA, Estrich CG, Gurenlian JR, et al. US dental health care workers’ mental health during the COVID-19 pandemic. J Am Dent Assoc. 2022;153:740-749.