title: Psychological stress and health in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools.
abstract: Psychological stress in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools.
  
  
  OBJECTIVE
  To compare the levels of a series of health-related indicators from a cohort of fifth year dental students from five European schools with their first year scores, and to investigate the relationship between these follow-up measures.
  
  
  METHODS
  Burnout was measured using the Maslach Burnout Inventory (MBI), consisting of three scales: Emotional Exhaustion (EE, alpha = 0.90), Depersonalisation (alpha = 0.80) and Personal Accomplishment (alpha = 0.72). Physical health was measured by the Physical Symptoms Questionnaire (alpha = 0.82), psychological distress was measured using the General Health Questionnaire (GHQ, alpha = 0.89) and student stress was captured using seven subscales of the Dental Environment Stress questionnaire (DES, alpha = 0.92). A total of 132 fifth year students responded from five dental schools (Manchester, Belfast, Cork, Helsinki and Amsterdam), a 51% response.
  
  
  RESULTS
  Fifth year students showed relatively high mean MBI scores when compared with first year results, especially on EE; 39% could be labelled 'high scorers'; 44% of the students met the criteria for 'cases' on the GHQ. Highest mean scores on the DES were obtained on the subscales: Study Obligations, Patient-Related Aspects and Study Pressure respectively. Between schools interesting differences were detected on all variables. As hypothesised, a clear direct effect of stress on both burnout and physical symptoms was shown. An indirect effect of stress on mental health via burnout was shown.
  
  
  CONCLUSIONS
  Dental students showed a negative development through the years from first to fifth year with regard to EE and psychological distress. Both burnout constructs related to physical and mental health. It is recommended that dental faculty focus on the importance of prevention and intervention of stress amongst undergraduates.
authors.affiliation: Department of Social Dentistry & Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands. r.gorter@acta.nl
authors.forename: R
authors.initials: R
authors.lastname: Gorter
authors.forename: R
authors.initials: R
authors.lastname: Freeman
authors.forename: S
authors.initials: S
authors.lastname: Hammen
authors.forename: H
authors.initials: H
authors.lastname: Murtomaa
authors.forename: A
authors.initials: A
authors.lastname: Blinkhorn
authors.forename: G
authors.initials: G
authors.lastname: Humphris
mesh_terms: D000328:Adult; D004739:England; D005260:Female; D005387:Finland; D005858:Germany; D006801:Humans; D007494:Ireland; D008297:Male; D017533:Marital Status; D005222:Mental Fatigue / Q000523:psychology; D009426:Netherlands; D009660:Northern Ireland; D011602:Psychophysiologic Disorders / Q000523:psychology; D012575:Schools, Dental; D012931:Social Environment; D013315:Stress, Psychological; D013335:Students, Dental / Q000523:psychology*; D011795:Surveys and Questionnaires; D013732:Test Anxiety Scale