Drink, drugs and depression in dental students

Key Points

• An insight into the lifestyle of dental colleagues-to-be.

• To open up a debate on health-related issues concerning the dental profession.

• Potential problems that the profession and the individual may have to deal with.

Abstract

Objective

To investigate alcohol and illicit drug use in a cohort of dental undergraduates through to VT year.

Setting

A UK dental school (with a medical school comparison group).

Subjects and methods

A cohort of dental students anonymously completed a lifestyle questionnaire about drinking and smoking, illicit drug use, stress, anxiety and depression in the spring of 1995 and 1998 as second and final year undergraduate students respectively, and in the summer of 1999 after one year working as qualified dentists. A parallel cohort of medical students also anonymously completed the questionnaire at the same time points in their undergraduate course as for the dental students, and at the end of a year working as Pre-Registration House Officers (PRHOs).

Results

The proportion of dental students in Newcastle drinking above the recommended low risk limits of alcohol declined from 47% as second year students to 25% as final year students and then it increased to 41% as qualified dentists, whilst in medical students it steadily increased over the three time points of the survey (33% to 43% to 54%). A greater proportion of dental students were drinking at hazardous levels at all three time-points, compared with medical students. Experimentation with illicit drugs ranged from 47% as second year students to 54% as final year students and to 51% as dentists. The prevalence of illicit drug use in medical students was similar to that in dental students. Forty seven per cent of the dental student cohort as second year students, 67% as final year students and 16% as dentists suffered from possible pathological anxiety, compared with 47%, 26% and 30% in the medical student cohort. The proportion of dentists suffering from stress decreased from 72% as final year students to 19% as dentists. In the medical student group, the proportion increased from 32% as final year students to 39% as PRHOs.

Conclusion

This longitudinal study revealed that a high proportion of dental students from Newcastle continue to drink excessively and experiment with illicit drugs both as undergraduates and as practising dentists. A significant proportion also suffer from anxiety and stress. Further measures are needed in order to reduce alcohol and substance misuse and stress and anxiety among dental students and dentists.

Main

The changing patterns of drinking, illicit drug use, stress, anxiety and depression in dental students in a UK dental school: a longitudinal study. D. Newbury-Birch, R. J. Lowry and F. Kamali Br Dent J 2002; 192: 646–649

Comment

This longitudinal study revealed that a high proportion of Newcastle dental students drink excessively and experiment with illicit drugs including heroin and ecstasy both as undergraduates and during their first year as practising dentists. Significant proportions also suffer from anxiety and stress particularly during their final undergraduate year. There is no reason to believe that the situation is any different at the other UK dental schools.

An important research priority will be to follow these young graduates for another 4–5 years when the realities of life including mortgages and young families may start to moderate their behaviour.

The headlines will no doubt concentrate on the illicit drug-use, but I am not convinced that this is the most important message. Alcohol abuse is costing the UK economy £4–£6 billion per year: up to £3 billion to the NHS and another £3 billion to industry; 30,000 deaths per year are related to alcohol abuse. The financial cost of tobacco use are rather less but deaths are higher at around 120,000 per year. In the short term illicit use of drugs causes around 2,000 deaths per year but the long-term effects are unknown and may be serious.¹

The low levels of tobacco smoking among young dentists (6% in this study) are welcome for two reasons. First because these young graduates may be more likely to pursue non-smoking strategies in their own practices and secondly because it re-emphasises Sir Richard Doll's finding that professions can change their behaviour and adopt more healthy life styles.²

High levels of anxiety (67%) and stress (72%) among the final year dental students contrasts sharply with the situation 1 year later when they are in dental practice (anxiety 16%; stress 19%) and contrasts with the situation among final year medical students (26% anxiety). Dental schools should be planning to become the natural focus for dentists' life-long learning; that dentists may associate their former schools with such high levels of stress and anxiety suggests that the dental schools face an uphill struggle. The Nuffield Report into Dental Education in 1980 complained that the dental school 'ground' their students through the course. Things may not have changed that much and the Council of Dental Deans should consider whether dental schools need to change.

The authors make two recommendations. First, the introduction of random alcohol and drug testing in the workplace; it is absolutely unacceptable that a patient's treatment should be compromised because the student operator is still hung-over, and transparent and regular random testing within University Dental Hospitals would reinforce that message. Secondly the authors rightly emphasise the importance of health education; in the longer term young dentists and doctors will come to accept, just as they have with tobacco, that excessive alcohol and drug use is undesirable and unacceptable.