Demographic Information
A total of 332 dental students and interns completed the online survey. The demographic information of the participants is presented in Table 1. Of the sample, 230 (69.3%) were female and the majority (n=272, 81.9%) were from Jordan University of Science and Technology. By level of education, 149 (44.9%) participants were fourth-year students, 144 (43.4%) students were fifth-year students, and 39 (11.7%) were interns.
Knowledge about COVID-19
The participants relied on many sources to get information about the COVID-19. The two primary sources used by participants were TV channels (72.1%) and social media outlets (68.8%), followed by publications and journals (46.8%), search engines (30%), lecture webinars (26.7%), and lastly YouTube (18.9%). The majority of students rated their knowledge regarding cross-infection control measures related to COVID-19 outbreak and pandemics generally as sufficient (n=223, 67.2%), 76 (22.9%) as very good, 31 (9.3%) as limited, and 2 (.6%) as weak.
Guidance and Support from Academic Institutions
More than half of the participants (57.8%) expressed that the guidance and support offered by their university during the COVID-19 outbreak is insufficient to ensure the safe delivery of dental care after the outbreak. In addition, the majority of the participants (67.5%) expressed their interest in receiving more lectures and guidance on COVID-19 from their university.
Perceptions about COVID-19
About one-third of the students reported their confidence while performing dental procedures is negatively affected because of the concern of contracting COVID-19 as definite (n= 115, 34.6%), 153 (46.1%) to some extent, and 64 (19.3%) not at all. In addition, when asked whether their concerns about the disease negatively influence their efficiency in doing procedures, 77 (23.2%) of the students answered yes, 135 (40.7%) answered maybe, and 120 (36.1%) answered no.
On a scale from 0-10, students reported a high potential influence of COVID-19 outbreak on dental practice in the short term (mean 8.9 ± 1.7) and a low comfortability with resuming the dental training and clinical sessions after the outbreak (mean 3.7 ± 3.3). Using the same scale, students expected that COVID-19 will affect the dentist-patient relationship (mean 6.9 ± 2.4) and that patients will be more anxious about visiting a dentist after the COVID-19 (mean 8.2 ± 2.0).
Students also reported a moderate potential influence of the COVID-19 outbreak on dental practice in the long term (6.9 ± 2.3) on a scale from 0-10. The percentage of students who reported recommending studying dentistry to a friend or relative decreased from 199 (59.9%) to 176 (53.0%) after the pandemic. Thirty-five (10.5%) students considered giving up dental training or career because of fear associated with the pandemic. For future career plans, more than half of the students expressed their interest in having further specialty training (n=178, 53.6%), 81 (24.4%) wanted to work in private practice, 56 (16.9%) wanted to pursue an academic career, and 17 (5.1%) wanted to work in research and basic science. Only thirty-three (9.9%) students reported that they had different career plans before the COVID-19 pandemic.
DASS Scores
Table 2 shows the descriptive statistics, Cronbach’s alpha, and correlation between DASS subscales. The participants showed moderate levels of depression (mean 19.0 ± 12.2), anxiety (mean 10.4 ± 9.9), and stress (mean 19.6 ± 12.4). Stress had strong correlation with anxiety (r = 0.810, p<.001) and depression (r = 0.828, p<.001), and there was also a strong correlation between anxiety and depression (r = 0.707, p<.001). The Cronbach’s alpha scores for the depression, anxiety, and stress subscales were above 0.7 (0.89, 0.84, and 0.92, respectively), and the item loadings from the confirmatory factor analysis on the three constructs were above 0.3, indicating the adequacy of measurement models.
Compared to males, female participants had higher mean levels of depression (20.3 vs 15.8, p=.002), anxiety (11.3 vs 8.3, p=.01), and stress (21.2 vs 16.1, p<.001) (Figure 1A). The ANOVA tests showed significant differences between the fourth-year, fifth-year, and intern students in all the three DASS subscales (Figure 1B). The post-hoc analyses indicate that interns had lower mean levels of stress compared to fourth-year (12.6 vs 19.0, p=.009) and fifth-year students (12.6 vs 22.2, p<.001). Similarly, interns had a lower mean for anxiety levels than fourth-year (6.1 vs 10.7, p=.03) and fifth-year students (6.1 vs 11.2, p=.01). However, interns had lower depression levels compared to fifth-year (13.9 vs 20.7, p=.005) but not the fourth-year students (13.9 vs 18.6, p=.08). There were no significant differences in the three subscales between the different locations.
The Association between DASS Scores and Perceptions about COVID-19
The students' perception of the potential influence of the COVID-19 outbreak on dental practice in the short term showed a positive but weak correlation with depression (r=0.11, p=0.04), but not with stress or anxiety. However, the perception about the potential influence of the COVID-19 outbreak on dental practice in the long term was positively correlated with depression (r=.15, p=.005), anxiety (r=.23, p<.001), and stress (r=.20, p<.001).
Figure 2 shows the DASS anxiety, anxiety, depression, and stress scores for students by their future career plans. Students who plan for specialty careers had the lowest DASS scores, followed by those who expressed their plan for an academic career, academic practice, and research programs and basic science. The ANOVA tests confirmed the differences between the future career plan groups with regards to the depression (F (328,3) =3.06, p=.03), anxiety (F (328,3) =4.75, p=.003), and stress scores (F (328,3) =3.29, p=.02).