A new study published in the Journal of Dental Education this month found that, in a group of dental residents, 17% met the diagnostic criteria for PTSD. The study questionnaire was administered between September 2020 and April 2021.
For perspective, Metz at al. wrote that the rate of PTSD in the general US population is 4.7%, and among first responders worldwide, it is 10%. The study found a prevalence nearly twice that among dental residents. And, surprisingly, the source of the trauma wasn’t pandemic-related changes in dental education.
Dentist and dental residents are already known to have higher levels of stress and anxiety, the study authors noted, and are thus prone to develop mental health disorders. Complications from the pandemic, such as uncertainty about the completion of clinical training and research, worries about money and future employment, and exposure to coronavirus at work have further negatively impacted dental residents.1
The development of mental health issues, including PTSD, makes maintaining a career in dentistry difficult. PTSD has “long-term repercussions for professional effectiveness, such as heightened irritability, reduced concentration, alteration in sleep patterns, and increased absenteeism.”1
The role of personality
Among the survey participants, personality traits played a significant role in an individual’s risk of developing PTSD. The personality trait of neuroticism has been linked to PTSD, while traits such as extraversion and conscientiousness are protective. “Neurotic” may conjure up a Freudian psychoanalyst from the 1960s, but the term actually has clinical meaning today. It is considered one of the “Big Five” personality traits: openness, conscientiousness, extraversion, agreeableness, and neuroticism.2
The personality inventory used in the study was the Big Five Inventory. In their introduction, the authors explain that “numerous studies have linked the development of PTSD to traits such as high neuroticism and low conscientiousness. In contrast, high extraversion and high conscientiousness have been associated with positive mental health and adaptive coping skills and may be protective against PTSD.”1
Psychology Today writes that neuroticism is “typically defined as a tendency toward anxiety, depression, self-doubt, and other negative feelings… [it] isdefined somewhat differently by different psychologists, but at its core, it reflects a general tendency toward negative emotions.”3 The most recent Big Five Personality Inventory “relabeled” neuroticism as "Negative Emotionality” and separated the category “into three facets that each reflect a tendency to feel certain ways: anxiety, depression, emotional volatility.”3
Personal-life stress was more damaging
While education in dentistry was negatively impacted by the COVID-19 crisis (e.g., through school closures, suspension of research, etc.), these weren’t the main triggers of developing PTSD: “Residents who reported stress that was not related to their clinical role [emphasis added] during the pandemic had six times higher odds of reporting diagnostic PTSD scores.”1
After controlling for potential cofounders, the authors found there wasn't a correlation between stress on the job and PTSD. The connection was specific to personal stress.
What is the role of dental schools?
This study raises some difficult questions for dental education and the profession as a whole.
There is only so much an educational institution can (and should) do to protect residents from everyday or exceptional stress in their personal lives. However, among the surveyed residents, 39% weren’t aware of their school offering any mental health resources at all. Of the residents who were offered resources, wellness events (47%) and communication with program directors (46%) were the most common.
This study was conducted in the early to middle phase of the pandemic, when it was well known that students’ stress levels would have been very high. Even so, some of the schools had not done enough to make residents aware of resources or signs that they should be seeking treatment.
"During emergencies such as the COVID-19 pandemic, it is imperative that schools and programs take a more active role in managing the mental health of their students through screening and evidence-supported treatments," said the authors. “Overall, our findings suggest that the mental health needs of dental residents are not being met. Residency programs can help residents access mental healthcare, support, and other resources by providing confidential self-administered screening and decision support tools.”
Personality inventories can be helpful for reflecting on behaviors, but they are not a life sentence. While many traits such as neuroticism are consistent across a lifetime, the way we react to certain situations can be changed through self-awareness, and conditions such as anxiety, depression, and PTSD have many treatments.
Dentistry is a rewarding career but can be very stressful. By teaching students and residents to care for their mental well-being from the earliest days of their careers, educational institutions can ensure that dentistry has a thriving community of practitioners.
Learn more about PTSD screenings.
References
- Metz M, Whitehill R, Alraqiq HM. Personality traits and risk of posttraumatic stress disorder among dental residents during COVID-19 crisis [published online ahead of print, 2022 Jul 12]. J Dent Educ. 2022;10.1002/jdd.13034. doi:10.1002/jdd.13034
- Cherry K. The big five personality traits. VeryWellMind. Updated February 20, 2021. Accessed July 15, 2022. https://www.verywellmind.com/the-big-five-personality-dimensions-279542
- Neuroticism. Psychology Today. https://www.psychologytoday.com/us/basics/neuroticism
