title: Structural equation modeling to assess gender differences in the relationship between psychological symptoms and dental visits after dental check-ups for university students.
abstract: OBJECTIVE
  Some studies have shown a relationship between psychological symptoms and oral health behaviors. However, it is unknown whether gender differences affect the relationship between psychological symptoms and oral health behaviors. In addition, gender differences in the relationship between dental anxiety and dental visits for treatment or regular check-up are unclear. The objective of the present study was to explain the relationships among gender differences, psychological symptoms, oral health behaviors, dental anxiety and 'expectation of dental visit', evaluated as 'dental visits when treatments are recommended' in university students.
  
  
  METHODS
  A total of 607 students (311 males, 296 females) aged 18-38 years old were examined. The information was collected via questionnaire regarding gender, psychological symptoms and oral health behaviors. Psychological symptoms were assessed using the Hopkins Symptom Checklist. Structural equation modeling was used to test pathways from these factors to 'expectation of dental visit'. Multiple-group modeling was also conducted to test for gender differences.
  
  
  RESULTS
  Psychological symptoms were related to low expectation of dental visit in females, but there was no such relationship in males. Oral health behaviors were related to expectation of dental visit in both genders.
  
  
  CONCLUSIONS
  Psychological symptoms were directly related to expectation of dental visit in females and oral health behaviors were related to expectation of dental visit in both genders. To promote dental visits after dental check-ups at school, it might be necessary to improve oral health behaviors in both genders and to evaluate psychological symptoms, especially in females.
authors.affiliation: Department of Preventive Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Mizutani
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ekuni
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tomofuji
authors.forename: Koichiro
authors.initials: K
authors.lastname: Irie
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Azuma
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Manabu
authors.initials: M
authors.lastname: Morita
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D016854:Dental Anxiety / Q000523:psychology; D003729:Dental Care / Q000523:psychology*; D003742:Dental Devices, Home Care; D003863:Depression / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009909:Oral Health; D012737:Sex Factors; D013334:Students / Q000523:psychology*; D011795:Surveys and Questionnaires; D014099:Toothbrushing / Q000523:psychology; D014495:Universities; D055815:Young Adult
keywords: behavioral science; cross-sectional studies; psychological symptoms; structural equation modeling; university students