Saudi Journal of Oral Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 8  |  Issue : 1  |  Page : 9--13

Screening for depression among dental patients in Benin city sub population of Nigeria


Ekaniyere Benlance Edetanlen1, Ameh Joseph Ogbikaya2, Chinedu Clement Azodo3,  
1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
2 Department of Dentistry, Stella Obasanjo Hospital, Benin City, Edo State, Nigeria
3 Department of Dentistry, Stella Obasanjo Hospital; Department of Periodontics, Faculty of Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria

Correspondence Address:
Dr. Ekaniyere Benlance Edetanlen
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medical Sciences, University of Benin, Benin City, Edo State
Nigeria

Abstract

Introduction: Oral health has been significantly associated with the wellness of an individual which includes physical and psychological wellbeing. In the recent past due to various reasons, depression has been noted to be evident in population. The patients visiting dental clinics are of no exclusion to have experienced depression. Aim: to determine the prevalence of depression among dental outpatients in an secondary health facility in Benin City using the Patient Health Questionnaire-9 (PHQ-9). Materials and Methods: This cross-sectional study mixed observational and clinical study using questionnaire and clinical oral examination was conducted among patients attending the dental outpatient clinic of Stella Obasanjo Hospital between December 2018 and January 2019. Results and Discussion: About one-quarter (28.6%) had depression of the mild severity. Depression was highest among the 31–40 years, females, those with primary education and those that earn less the 30,000 naira monthly and nonindigenous participants. Participants with mild depression presented more with acute apical periodontitis, dental caries, and periodontal disease than those without depression. Conclusion: Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. Further studies on patients with symptomatic chronic dental condition are recommended.



How to cite this article:
Edetanlen EB, Ogbikaya AJ, Azodo CC. Screening for depression among dental patients in Benin city sub population of Nigeria.Saudi J Oral Sci 2021;8:9-13


How to cite this URL:
Edetanlen EB, Ogbikaya AJ, Azodo CC. Screening for depression among dental patients in Benin city sub population of Nigeria. Saudi J Oral Sci [serial online] 2021 [cited 2021 Jun 24 ];8:9-13
Available from: https://www.saudijos.org/text.asp?2021/8/1/9/299966


Full Text



 Introduction



Depression, which is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness, and poor concentration, is a highly prevalent debilitating mental disorder (MD) worldwide.[1] It affects all persons irrespective of age, gender, race, culture, background, and dwelling place.[2] Globally, an estimated 300 million people are affected by depression with more female affection than male and an increase of >18% (18%) between 2005 and 2015.[3] Depression can be long-lasting or recurrent, affects families and communities and is associated with daily life coping impairment, substantial work impairment, lost work days, and reduced productivity. It has been quoted by the 2010 Global Burden of Disease Study as the second leading cause of years lived with disability (YLD), constituting 8.2% of global YLDs, and the leading cause of disability adjusted life years with a percentage of 2.5%.[3]

Depression is a common but Grave disease which cannot be ignored because it is a substantial contributor to suicide. It is distressful and disabling yet many affected individuals never look for treatment mainly due to stigma. Depression can be reliably diagnosed and treated in primary care with medications, psychotherapies, and other methods such as maintenance or reactivation of social networks and social activities is important.[4] Dental health professionals, may be the first providers in a health system to identify depression.

Dental health-care settings had been cited as a unique venue for the screening of chronic medical conditions which may include hypertension and diabetes mellitus. Screening for depression in dental setting may help chart early course of treatment for affected individuals and also help improve their oral health indices and outcomes. It has been stated that approximately 45% of individuals who committed suicide visited a primary care provider in the month preceding their death.[5] Dentist as a primary care provider may detect this condition, facilitate early referral and treatment with favorable outcome, and ultimately reduce the suicide rate among depressed persons.

Xerostomia, impaired immune function and increased risk of oral infections in undiagnosed depression culminate to poor oral health status and unfavorable oral health outcomes.[6] Reduced energy and motivation associated with depression can affect oral health by neglecting oral hygiene procedures, which leads to an increased risk oral disease. Cariogenic nutrition, avoidance of necessary dental care, and antidepressant-induced xerostomia worsens the oral health indices of depressed persons.[7] McFarland and Inglehart[8] and[9] reported poorer oral hygiene, more carious teeth with fewer restored teeth, declined salivary quantity, more chewing problems, higher speaking difficulties, and worse self-reported oral health status among depressed patients. Depression also has the potential to intensify perceived pain and reduce an individual's capacity to tolerate pain.[9]

Patient Health Questionnaire-9 (PHQ-9) is a depression screening tool with a sensitivity of 88% and a specificity of 88%. It comprises nine questions based on the Diagnostic and Statistical Manual of MDs (DSM-IV) diagnostic criteria. The PHQ-9 was originally designed to improve the detection of depression in primary care and nonpsychiatric settings.[10]

PHQ-9 is brief, has useful diagnostic properties and serve as a valid tool in assessing severity and uniquely serve as a way to track patients' response to treatment.[11] The PHQ-9 is a self-administered scale that was drawn from the Primary Care Evaluation of MDs, and it is based on the DSM-IV5 (American Psychiatric Association, 2000) criteria for major depressive disorder. The burden of depression being on the rise globally and World Health Assembly resolution passed in May 2013 calling for a comprehensive, coordinated response to MDs at the country level.[12] Thus a research question was raised to identify the association of depression and its impact on orodental structures. The objective of this study was to determine the prevalence of depression among dental outpatients in a Secondary health facility in Benin City.

 Materials and methods



This cross-sectional study was conducted using random sampling among patients attending the dental outpatient clinic of Stella Obasanjo Hospital between December 2018 January 2019 after obtaining ethical committee approval from the university with ADM/E22/A/VOL.VILL/14830987.

Sample size: Sample size was estimated to be 385 to represent the population of Benin city of 1.46 million using software for sample size calculation. However sample collected were limited to 105 after exclusion of patients who did not consent for the study, children less than 14 years and mentally retarded patients which would bias the study

 Results



About one-third (30.5%) of the participants were aged 21–30 years and two-thirds (66.7%) were females. About half (54.3%) of the participants have attained tertiary level of education, and about one-third (38.1%) earn 30–100 thousand naira [Table 1].{Table 1}

About one-quarter (28.6%) had depression of the mild severity [Figure 1]. More than half (57.1%) of the participants had acute apical periodontitis and about one-tenth (10.5%) of the participants had dental caries [Table 2]. Depression was the highest among the 31–40 years, females, those with primary education and those that earn less the 30,000 naira monthly [Table 3]. Participants with mild depression presented more with acute apical periodontitis, dental caries, and periodontal disease than those without depression [Table 4].{Figure 1}{Table 2}{Table 3}{Table 4}

 Discussion



In this study, 28.6% of the participants reported depression of mild severity. Comparison of the prevalence of depression obtained in this study with the prevalence of depression assessed with PHQ-9 in the general population in Nigeria was not possible because such data did not exist in the literature. However, the prevalence of depression in this study was lower than 58.2% reported among students of a Nigerian University assessed using same tool, PHQ-9.[13] The low prevalence of mild depression among the dental patients may be due to the fact that the individuals with chronic medical conditions were excluded,[14],[15] and none of the respondents had any chronic debilitating dental conditions. The low prevalence of depression in this study may be due to the fact that this study was in an urban setting because depression has been reported to be more in rural than urban setting.[16],[17] Although the prevalence of depression in this study was low and severity only mild, the rapidly changing family and societal ecology favorable to the emergence of depression in Nigerian environment with the rising prevalence of socioeconomic deprivation remains a course for worry. Poverty has been documented to constitute a fertile environment for the genesis of depression, especially in those who are predisposed to depression.[15],[18] This reflected why participants with lower level of education and income earning power reported more depression. This is in tandem with adversity, stress, and reduced capacity to cope related to low income increase the risk of development of mental illness, particularly depression in concert with social causation rather social selection theory link between mental illness and income.[19] Unfavorable social conditions reflected in low levels of schooling and income, making the individual more susceptible to mental health problems such as depression. The close relationship between education and health is a concern, as it has been observed that educationally disadvantaged people are not particularly concerned with healthy living habits.

It has been reported individuals above 45 years are more likely to suffer from depression.[15],[20] However, in this study, depression was higher in participants aged 31–40 years which fall within the age of the majority of the bread winner who are burdened with challenges of supporting and ensuring success of their dependents in midst of unpredictable governmental policies and failure-laden uncertainties.

Females reported significantly more depression than male which may be due to the fact that women exhibit greater tendency to internalize stressful events, have different rights and status than males, and suffer various types of violence, resulting in a higher risk of depression. The higher burden of depression in females in this study could also be due socioenvironmental provoking experiences as females in Nigeria occupy many roles within the family, in the community, and at work. They carry the burden of domestic and household chores in addition to other work/social engagements and the married ones have additional burden of raising and caring for the children.[21] The frequent presence of factors such as low income and low level of schooling in females may also be the contributory explanation for the higher depression.

The nonindigenous people reported more depression than the indigenous people. This is supported by Emmanuel[22] report in Nigeria, and also Shao et al.[23] and Dunlop et al.[24] reports on depression in the United States of America. The differences in environment and resources are likely to contribute to the variations in depression as the ability to meet basic needs is more challenging to the nonindigenous people.

Participants with depression are more likely to have attended the dental clinic with acute apical periodontitis and dental caries. Although not assessed in this study, lower tooth brushing frequency and higher cariogenic nutrition, which are certified a risk factor dental caries, have been reported among depressed individuals.[25],[26],[27],[28],[29],[30] Park et al.reported more frequent incidents of toothache among patients with depression.[26]

 Conclusion



Data from this study on screening for depression among patients attending a secondary facility revealed the low prevalence of depression which was mild in severity. Reluctance of the dental patients to reveal information resulting in low sample size was noted to be the limitation of the study. Further research and enlightening of the population on depression and its impact on oro-dental health is necessary to establish generalizable results in Benin city. Further studies on patients with symptomatic chronic dental condition are recommended.

Acknowledgment

We thank our colleagues and other support staff in the department for allowing us to recruit their patients and for their support and co-operation, respectively.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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