Elsevier

Journal of Affective Disorders

Volume 274, 1 September 2020, Pages 67-72
Journal of Affective Disorders

Research Paper
Associations between mental and oral health in Spain: a cross-sectional study of more than 23,000 people aged 15 years and over

https://doi.org/10.1016/j.jad.2020.05.085Get rights and content

Highlights

  • Positive association between mental health and oral health.

  • Significant interaction between any psychiatric condition and marital status.

  • The association was stronger in those participants who were not married.

  • Being married has some protective benefits.

Abstract

Background

This study aimed to investigate associations between mental health and several parameters of oral health, controlling for a variety of important covariates, in a large representative sample of Spanish people.

Methods

Data from the Spanish National Health Survey 2017 were analysed. Mental (i.e., depression, chronic anxiety, other psychiatric disorders) and oral health (i.e., dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material, missing tooth) were evaluated. Control variables included sex, age, marital status, education, smoking, alcohol consumption, and physical multimorbidity. Associations between psychiatric conditions (independent variables) and the number of poor oral health outcomes (dependent variable) were assessed using Poisson regression models. The associations were investigated in the overall population, in married participants and in those who were single/widowed/divorced/separated.

Results

There were 23,089 participants [54.1% women; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of at least one psychiatric condition was 15.4% in the overall sample, while the mean (standard deviation) number of poor oral health outcomes was 2.9 (1.4). There was a positive association between any psychiatric condition and the number of poor oral health outcomes [incidence rate ratio (IRR)=1.10; 95% confidence interval: 1.07-1.12], and there was a significant interaction between any psychiatric condition and marital status. The association was stronger in those participants who were single/widowed/divorced/separated.

Limitations

Cross-sectional study. Oral and mental health were assessed with Yes/No questions. Exposure, outcome and covariates were self-reported.

Conclusions

Those with poor mental health have worse oral health but being married has some protective benefits.

Introduction

Psychiatric conditions are common and present a global public health concern. For example, in a recent review, it was found that common mental disorders had a pooled one-year period prevalence estimate of 17.6% [95% confidence interval (CI): 16.3–18.9%] across 59 countries, while the pooled lifetime prevalence of common mental disorders was 29.2% (95% CI: 25.9–32.6%) (Steel et al., 2014). Psychiatric conditions are related to psychological and physical stress and thus may increase the risk of developing and alter the course and outcome of chronic diseases (Firth et al., 2019; Rugulies, 2002; Suls and Bunde, 2005; Wittchen and Jacobi, 2005). While there is a plethora of literature on the relationship between psychiatric conditions and physical chronic diseases such as obesity (Martin-Rodriguez et al., 2015), heart disease (De Hert et al., 2018) and cancer (Goldacre et al., 2007; Penninx et al., 1998), little is known about the association between psychiatric conditions and poor oral health (e.g., dental caries, periodontal diseases, oro-dental trauma) (World Health Organization, 2018).

Poor oral health is highly frequent throughout the globe and Europe. Figures suggest that dental caries vary from 20% to 90% among young children in Europe, while almost one third of people aged 65-74 years have no natural teeth (World Health Organization, 2018). Thus, it is important to identify population groups who are at high risk of poor oral health to inform the implementation of interventions to prevent against such conditions. One population group who are likely to be at increased risk are those with poor mental health likely owing to this group exhibiting poorer lifestyle behaviours (Khalid et al., 2016; Rebar AL et al., 2015; Wootton et al., 2019) and experiencing higher levels of psychological stress. Some literature does show that those with poor mental health are at an increased risk of worse oral health (Ababneh et al., 2010; Arnaiz et al., 2011; Bell et al., 2012; Delgado‐Angulo et al., 2015; Jovanović et al., 2010; Okoro et al., 2012; Purandare et al., 2010; Saman et al., 2014; Wennström et al., 2013). However, this research has some important limitations. First, to the best of our knowledge, no study adjusted the analyses for multimorbidity, although it is known to be associated with both mental (Langan et al., 2013) and oral health (Islas-Granillo et al., 2019). Second, studies have included only one or two oral health outcomes, and this may not accurately depict overall oral health status. Third, no study has analysed the role of marital status in the relationship between mental and oral health, although marital status is associated with both conditions (Marcenes and Sheiham, 1996; Spiker, 2014). It is plausible that poor mental health may have a lower impact on oral health in married couples because there is someone to take care of the individual with poor mental health (such as providing appropriate nutrition and assisting in oral hygiene practices). Finally, only one study on the relationship between mental and oral health has been carried out in Southern Europe (Arnaiz et al., 2011), where lifestyles such as diet are different to the rest of the globe.

Therefore, the present study aimed to investigate associations between mental health and several parameters of oral health, controlling for a variety of important covariates, in a large representative sample of Spanish people aged 15 years and over. The hypothesis of the study was that those with poor mental health would have worse oral health.

Section snippets

The Survey

Data from the Spanish National Health Survey 2017 were analysed. This survey was undertaken in Spain between October 2016 and October 2017. Details of the survey method have been previously published (Ministerio de Sanidad, Consumo y Bienestar Social and Instituto Nacional de Estadística 2017a, b). In brief, for the data collection, a stratified three-stage sampling was used in which the census sections were first considered, then the family dwellings, and then an adult (15 years or more) was

Results

There were 23,089 people aged 15 years and over included in the present study [54.1% women; mean (standard deviation) age 53.4 (18.9) years; Table 1]. The prevalence of at least one psychiatric condition was 15.4% in the overall sample, while the mean (standard deviation) number of poor oral health outcomes was 2.9 (1.4). Female gender, single/widowed/divorced/separated, ≤primary education, never smoking, no alcohol, and physical multimorbidity were more frequent in individuals with than in

Discussion

In this large representative sample of Spanish people aged 15-103 years, it was found that after controlling for important covariates, including multimorbidity, those with any psychiatric condition had a higher number of poor oral health outcomes than those without any psychiatric condition. Moreover, the association was stronger in participants who were single/widowed/divorced/separated compared to those who were married.

The present findings support those of previous work that found poor

Funding

None.

Contributors

All authors have made a substantial, direct and intellectual contribution to the work. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

Role of the Funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

None.

Acknowledgement

Ethics: All participants signed an informed consent form before responding to the survey questions. This research was conducted in accordance with the Declaration of Helsinki of 1961 and subsequent amendments (revised in Tokyo in 1989 and in Edinburgh in 2000).

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