title: Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people.
abstract: OBJECTIVE
  The objective of the study was to determine the effect of dental health status, dental anxiety and oral-health-related quality of life (OHRQoL) upon homeless people's experience of depression.
  
  
  METHODS
  A cross-sectional survey was conducted on a sample of homeless people in seven National Health Service Boards in Scotland. All participants completed a questionnaire to assess their depression, dental anxiety and OHRQoL using reliable and valid measures. Participants had an oral examination to assess their experience of tooth decay (decayed and missing teeth). Latent variable path analysis was conducted to determine the effects of dental health status on depression via dental anxiety and OHRQoL using intensive resampling methods.
  
  
  RESULTS
  A total of 853 homeless people participated, of which 70% yielded complete data sets. Three latent variables, decayed and missing teeth, dental anxiety (Modified Dental Anxiety Scale: five items) and depression (Center for Epidemiological Studies Depression Scale: two factors), and a single variable for OHRQoL (Oral Health Impact Profile total scale) were used in a hybrid structural equation model. The variable decayed and missing teeth was associated with depression through indirect pathways (total standardised indirect effects=0.44, P<.001), via OHRQoL and dental anxiety (χ²=75.90, df=40, comparative fit index=0.985, Tucker-Lewis index=0.977, root mean square error of approximation=0.051 [90% confidence interval: 0.037-0.065]).
  
  
  CONCLUSIONS
  Depression in Scottish homeless people is related to dental health status and oral-health-related factors. Decayed and missing teeth may influence depression primarily through the psychological constructs of OHRQoL and, to a lesser extent, dental anxiety.
authors.affiliation: Dental Health Services and Research Unit, University of Dundee, Scotland, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Coles
authors.forename: Karen
authors.initials: K
authors.lastname: Chan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Collins
authors.forename: Gerry M
authors.initials: GM
authors.lastname: Humphris
authors.forename: Derek
authors.initials: D
authors.lastname: Richards
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.forename: Ruth
authors.initials: R
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016854:Dental Anxiety / Q000175:diagnosis / Q000523:psychology*; D003731:Dental Caries / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D011788:Quality of Life; D012606:Scotland; D011795:Surveys and Questionnaires; D016388:Tooth Loss / Q000523:psychology*; D057085:Tooth Wear / Q000523:psychology