Association between psychological stress, anxiety and oral health status among college students during the Omicron wave: a cross-sectional study

BACKGROUND: Within 3 years of the COVID-19 pandemic, increasing interest has been given to its potential influence on health status due to lockdowns caused by the pandemic. However, the impact is inadequately understood, especially for college students. This study aimed to investigate the potential association between psychological stress, anxiety and oral health of college students during the Omicron wave of the COVID-19 pandemic. METHODS: An online survey with measurements of psychological stress, anxiety and oral health was completed by 1770 Chinese college students. The Perceived Stress Scale-14 (PSS-14) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure psychological stress and anxiety, respectively. Oral health status was self-reported including toothache, gingival bleeding, and oral ulcer. Multivariable logistic regressions were performed to determine underlying associations for outcome variables. Structural equation modeling (SEM) was performed to confirm the relationship between mental and oral health status. RESULTS: Of the 1770 subjects, 39.2% presented high psychological stress and only 41.2% expressed no anxiety. A significant association was found between psychological stress, anxiety and oral health status. Anxiety has significant impacts on toothache (OR = 0.36; 95%CI: 0.23–0.55; p < 0.01), gingival bleeding (OR = 0.43; 95%CI: 0.29–0.65; p < 0.01), and oral ulcer (OR = 0.54; 95%CI: 0.36–0.80; p < 0.01). Anxiety significantly mediated the association between psychological stress and self-reported oral symptoms. CONCLUSIONS: Anxiety may be a significant risk indicator for mental health among college students and demonstrates a significant relationship with the occurrence of self-reported oral symptoms. Concerns about academic and life changes caused by the pandemic were the two most significant sources of stress.