The role of psychological distress in the relationship of financial strain with oral health and dental attendance in Dutch adults: A mediation analysis based on cross-sectional data

Naichuan Su; Denise Duijster; Geert J M G van der Heijden; Joost Oude Groeniger; Mariëlle A Beenackers

doi:10.1111/cdoe.12974

The role of psychological distress in the relationship of financial strain with oral health and dental attendance in Dutch adults: A mediation analysis based on cross-sectional data

Community Dent Oral Epidemiol. 2024 May 15. doi: 10.1111/cdoe.12974. Online ahead of print.

Authors

Naichuan Su¹, Denise Duijster¹, Geert J M G van der Heijden¹, Joost Oude Groeniger², Mariëlle A Beenackers²

Affiliations

¹ Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.
² Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.

PMID: 38750647
DOI: 10.1111/cdoe.12974

Abstract

Objectives: The study aimed to assess whether psychological distress mediates the association between financial strain and oral health and dental attendance in the Dutch adult population.

Methods: The study followed a cross-sectional design based on 2812 participants from the 2014 wave of the Dutch population-based GLOBE study. Financial strain was considered the exposure, while psychological distress measured with the Mental Health Inventory-5 (MHI-5) was the mediator. The outcomes included self-reported number of teeth, self-rated oral health, and self-reported dental attendance. Generalized regression analyses were used for the mediation analysis adjusted for several covariables.

Results: Greater financial strain was significantly associated with poorer self-rated oral health (total effect: 0.09, 95%CI: 0.05; 0.14) and restorative or no dental attendance (i.e. participants never visiting a dentist or only visiting a dentist for regular treatments or when they have complaints with their mouth, teeth, or prosthesis) (total effect: 0.05, 95%CI: 0.02; 0.09). Greater financial strain was not significantly associated with self-reported number of teeth (total effect: -0.14, 95%CI: -0.91; 0.64). Psychological distress significantly mediated the association of financial strain with self-rated oral health (average causal mediation effect [ACME]: 0.02, 95%CI: 0.01; 0.03) and self-reported dental attendance (ACME: 0.01, 95%CI: 0.00; 0.02), respectively. However, it did not significantly mediate the association of financial strain with self-reported number of teeth (ACME: -0.11, 95%CI: -0.25; 0.02). The estimated proportion of the total effect of financial strain on self-rated oral health and self-reported dental attendance that could be explained by psychological distress was respectively 24% (95%CI: 14%; 48%) and 19% (95%CI: 6%; 62%).

Conclusions: Psychological distress partly explains the association of financial strain with self-rated oral health and dental attendance, but not with self-reported number of teeth. Future studies using longitudinal data are necessary to confirm the results.

Keywords: dental attendance; financial strain; mediation analysis; oral health; psychological distress.