Mental Status, Attitude, Awareness among Dental Students towards Covid Lockdown and Virtual Learning

Jyosthna A^*, Evan Clement, Dharmisha, Navaneetha Nambi, Xavier Dhayanandh and Pirathiba

^*Correspondence: Jyosthna A, Department of Orthodontics, Sathyabama Dental College and Hospital, India, Email:

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Introduction

Covid 19 outbreak has led people to engage in social distancing, as a critical way to flatten the curve. In addition to the uncertainty and stress of the global outbreak, spending time in lockdown could take a serious mental toll such as insomnia, anxiety and depression. It can make people to feel isolated and lonely and also it can precede long term effects such as mental stress and disorder [1,2]. The World Health Organization (WHO) defines Stress as a “result of certain external physical or mental factors that affect an individual’s physical and psychological wellbeing” and depression as "a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite and feelings of tiredness and poor concentration. It can be long-lasting or recurrent, substantially impairing a person’s ability to function at work, school or cope with daily life" [3].

Impact on dental education

During the present pandemic crisis where the entire globe is sailing amid the storm, technology has played a pivotal role. Technological development and the internet have changed the lives of people immensely and have also brought a huge change in various fields [4]. Especially in the education system virtual learning has been found to be a significant tool for effectively continuing the teachinglearning process during the lockdown. The mediums of Elearning and principles of artificial intelligence are gradually gaining popularity in the world as a new form of schooling [5,6]. The pros and cons of the system are always relative to the student. Since dentistry is primarily a profession in clinical practice, the use of stratagems in virtual learning remains as a challenge for universities around the world.

Commendations issued by WHO

In the current COVID 19 pandemic, Dentists, auxiliaries as well as patients undergoing dental procedures are at high risk of cross-infection. Most dental procedures particularly aerosol generating procedures require close contact with the patient’s oral cavity, saliva, blood, and respiratory tract secretions. So, it is suggested that all patients visiting a dental office must be treated with due precautions [7].

Maintain a Physical/Social distancing, Do Telephone triage to all patients, Take temperature readings, Install physical barriers, use of 1% hydrogen peroxide to rinse, Dental settings should follow standard operatory protocols describing safe donning/doffing PPE, use of N95 face masks and protective eyewear/face shield.

Avoid aerosol-generating procedures whenever possible and consider the use of a portable HEPA air filtration unit as a preventive measure.

And, it’s of paramount importance, to fumigate regularly in clinical setup.

Although there is surplus of studies published regarding COVID-19, there is a paucity of published data regarding the mental health status of the students during lockdown and virtual learning. Therefore the present survey was intended to assess the mental status of the dental students, attitude towards virtual learning and awareness towards the standard operating procedures after COVID lockdown.

Materials and Methods

Study design

This survey was conducted in the Department of Orthodontics and Dentofacial Orthopedics, Sathyabama Dental College, Chennai in August 2020. Ethical approval was obtained from the Institutional Review Board (150/ IRB-IBSEC/SIST) at Sathyabama Dental College. This was a pan-Indian online survey for assessing the mental status, attitude and awareness towards COVID lockdown among dental students. A pre structured selfadministered, web-based questionnaire was designed using Google forms and disseminated among undergraduate and postgraduate dental students through several social media forums. Anonymity was ensured and no personal identifications were collected. The survey rendered 5000 responses. The data was analyzed using the percentages of the total and Chi-square test. This survey contains 28 questions with multiple choice answers and divided into four sections.

Socio-demographic characteristics.

Mental status during COVID lockdown.

Attitude towards virtual learning.

Awareness towards the standard operating procedures after COVID lockdown.

Eligibility criteria

Inclusion criteria

Undergraduate dental students.

Postgraduate dental students.

Exclusion criteria

General population.

Practicing doctors.

Academicians.

Sample size calculation

For this survey, z value at a confidence level of 95% (z) was 3.4, with the prevalence of awareness about COVID was 0.3 (p), and error (ε) of 3.2% was used to calculate the sample size. Estimated minimum sample size required was 4280.

Validity and reliability of the questionnaire

The face validity of the questionnaire was evaluated the ease of understanding questions. Cronbach’s alpha was used to measure the reliability and gave a score of 0.991, which indicated good reliability.

A clinical psychiatrist opinion was taken for content validation of the questions under mental status category to ensure firmness.

Results

This study encompassed a total of 5000 dental students. 44.7 % were undergraduate students and 55.3 % were postgraduate students, 55.4% were females and 44.6%were males.

Their age ranged from 18-40 years of age and it was seen that most of the respondents were aged between 20-30 years (79.8%) (Table 1).

Table 1: Sociodemographic variables.

A comparison was made among the undergraduates and post graduates dental students. Most of the undergraduate students felt depressed and isolated in this lockdown (79.3%) and also they stated that spending excessive time on social media (89.7%), alteration in their sleeping pattern (90.2%) and eating pattern (84.6%). And also they reported they had a negative feelings like blue mood, despair and depression more often (86.8%). And, most of the undergraduate students feel upset about joining dental school (51.5%), and they feel they are losing their clinical skills with time (52.7%). Whereas, most of the postgraduate students were under mental pressure of upcoming exams (89.6%) and worried about their patients missing appointments (37.6%). Significant differences were observed between both the groups for the entire variable (Table 2).

Table 2: Mental status of the dental students in this lockdown.

98.2% of postgraduate students reported that virtual classes are efficient and interactive. Whereas, most of the undergraduates described they face difficulties in understanding the concepts, visualising and correlating them (62.8%). But when we questioned about whether the virtual learning is taking a serious toll on physical health unanimously both the postgraduates (90.2%) and undergraduates (91.9%) agreed to it. And also (37.2%) of the undergraduates reported that their academic pursuits has declined. Significant differences were observed between both the groups for the entire variable (Table 3).

Table 3: Attitude towards virtual learning.

Results showed 91.4% of dental students feel that dentists are being at a high risk of getting infected. And when we questioned about the telephonic triage, physical distancing in class rooms and clinical laboratories, recording patients temperature using non- contact Infrared thermometer and standard operating procedures like donning and doffing of PPE, wear of N95 and fumigation protocols postgraduates exhibited a better awareness compared to undergraduate students. Also 95.3% of postgraduates feel that use of HEPA filters will prevent contamination during aerosol procedures. 69.8% of postgraduates reported that awareness towards covid is sufficient and 5.6% of postgraduates feel negative about the future of dentistry after Corona Virus Pandemic. Significant differences were observed between both the groups for the entire variable (Table 4).

Table 4: Awareness towards the standard operating procedures after COVID lockdown.

Discussion

All pandemics that may occur or have occurred in the past are periodic in nature. In order to curtail this pandemic situation, the lockdown has been implemented [8]. The social or physical distancing and other COVID19 restrictions have caused significant disruption globally [9]. This altered mental health status stems from several aspects of disturbance from routine. The fear and anxiety related to pandemic also influence the behaviour of the people in the community mainly healthcare professionals and dentists and most importantly dental students [10,11]. Hence, this survey provides an insight on the mental status, attitude towards virtual learning and level of awareness and perception on infection control with a special emphasis on COVID-19 outbreak in 2020.

We have noticed that quarantine due to the COVID-19 pandemic has caused stress and changes in the learning behaviours of dental students. Both undergraduate dental students and postgraduate dental students exhibited deterioration in their study and work performance. In a study conducted by Ahmad et al. [12], stated that 25.3% of respondents are feeling depressed and anxious about this ongoing Covid situation. Whereas, Hawryluck et al. [13] conducted a study on psychological effects during lockdown, and reported that people exhibited a high prevalence of psychological distress and depression 31.2%. In our present study 54.3% of respondents felt depressed and anxious and 79.2% of respondents stated that they spend excessive amount of time on social media (Facebook, Twitter, Instagram, Youtube, etc.) in order to distract themselves from the prevailing pandemic. In a study conducted by Absar Ahmad et al., stated that 15% of the respondents reported that their sleeping cycle has changed. In this present study, 72.3% of respondents presented variations in their sleeping pattern and 57.2% showed variations in eating pattern. In a study by Cao et al [14], reported 0.9% of the respondents were experiencing severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety, whereas in our study, 54.2% of the respondents were experiencing severe negative feelings, 36.5% of the respondents were experiencing moderate anxiety and 9.3% of the respondents were experiencing mild anxiety. In addition to this, in our study most of the postgraduate respondents 89.6% reported that they are under mental pressure of upcoming exams and 37.6% reported that they are worried about their patients missing appointments.

Education is one of the key factors in building a good nation [15]. The outbreak of the COVID-19 virus has caused a sudden suspension of schools, colleges and universities. Despite these hard times, teachers have been utilising virtual learning platforms to educate the students. In a study by Radha et al. [16,17], stated that 42.2% of respondents reported that virtual learning is better than the conventional learning, whereas in our study 89.9% of respondents reported that virtual learning is efficient and interactive than class room learning. In a study by Radha et al, stated that 47% of respondents reported that they face difficulties in virtual learning, whereas in our study, 91% of the students reported the major difficulty in virtual learning is its taking a serious toll on physical health and 55.3% of the students feel difficulties in understanding and visualising the concepts. In a study by Radha et al, stated that 41.1% of respondents reported that their academic pursuits have declined. A study by Cao et al., stated that approximately 25% of their sample reported experiencing anxiety symptoms, which were positively correlate with increased concerns about academic delays. In a study by Sultan Ayoub et al stated that 84% of the respondents reported deterioration in their academics. But in our study 35.4% of respondents reported that their academics had declined.

Airborne transmission may occur by any medical or dental procedures which generate respiratory aerosols. The results for Ahmed et al. stated that, 87% were aware of being high risk to get infected with COVID-19, in our study 91.4% of respondents were aware of being high risk to get infected with COVID-19. And also in our study, 94.6% of respondents reported that it would be better to fix appointments through phone, 88% of the respondents feel it is mandatory to scan and record patients temperature before commencing any dental procedures, 88.4% of respondents reported it would be advantageous in changing the seating arrangement, 95.3% of respondents reported that HEPA filters would be appropriate for aerosol generating procedures to prevent contamination.

Healthcare workers are constantly battling the COVID-19 pandemic. Keeping healthcare providers safe, healthy and available to work in this pandemic is critical. The consistent use of appropriate personal protective equipment-PPE will help assure the safety of the health care workers. A study by Ahsan Ali Siddiqui [18] reported that any PPE should not be used without proper training or a workshop and also he stated that one training in using PPE may not be good enough, as many problems may exist all the way. In our study 81.5% of respondents report that they are aware of donning and doffing procedures of PPE. There are three types of masks namely single-use mask (single layer), surgical mask, and pollution mask (respirators) which prevent 90% of virussized particles. The respirators may include ratings such as N95, KN95, FFP1, FFp2, and FFP3. The N95 mask may prevent particles up to the size of 0.3μm [19]. In our study 80.9% of the respondents feel it is better to cover N95 mask by surgical mask to improve the lifespan of N95. Fumigation is a process of disinfecting or purifying an area with the fumes of chemicals. It is better to fumigate clinical areas habitually to prevent contamination. In our study, 59.3% of respondents reported that it is necessary to fumigate the clinics/ laboratories on a regular basis. 25.8% of the respondents feel that the awareness regarding COVID 19 prevention is insufficient and so they required training for the patient management and 20.9% of the respondents feel negative about the future of dentistry after Corona Virus Pandemic. The findings of above study, state that both the undergraduate and postgraduate dental students feel virtual learning is effective. When the mental status was assessed it shows that undergraduate students feel more recessed when comparing to the postgraduate students. So, we suggest that undergraduate students need to be engaged in more of academic activities in order to overcome the present torment. The results also revealed that both the group students had a fair knowledge regarding the Standard operating procedures which needs to followed during clinical routines. Training in institutions regarding the usage of Personnel protective equipment’s before the clinical postings for all students should be mandatory.

References

1. Wang C, Pan R, Wan X, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020; 17:1729.

Indexed at, Google Scholar, Cross Ref

2. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395:912-20.

Indexed at, Google Scholar, Cross Ref

3. http://www.who.int/topics/depression/en/.
4. Nadikattu RR. Information technologies: Rebooting the world activities during COVID-19. SSRN 2020; 1-10.

Google Scholar, Cross Ref

5. Misko J, Choi J, Hong SY, et al. E-Learning in Australia and Korea: Learning from Practice. National Centre for Vocational Education Research (NCVER) 2004.

Indexed at, Google Scholar

6. Soni VD. Challenges and solution for artificial intelligence in cybersecurity of the USA. SSRN 2020; 1-17.

Indexed at, Google Scholar, Cross Ref

7. Suri S, Vandersluis YR, Kochhar AS, et al. Clinical orthodontic management during the COVID-19 pandemic. Angle Orthod 2020; 90:473-484.

Indexed at, Google Scholar, Cross Ref

8. Pandey S, Kulkarni R, Bhavsar K, et al. Impact of the lockdown on mental health of dentists of India-a survey study. Biomed Sci J 2020; 1.

Google Scholar

9. Usher K, Bhullar N, Jackson D. Life in the pandemic: Social isolation and mental health. J Clin Nurs 2020.

Indexed at, Google Scholar, Cross Ref

10. Gonzalez-Diaz JM, Lozano-Lesmes L, Campo-Arias A. Comment on “mental health: Why it still matters in the midst of a pandemic”. Bra J Psychiat 2020.

Indexed at, Google Scholar, Cross Ref

11. Silva DA, Pimentel RF, Merces MC. Covid-19 and the pandemic of fear: reflections on mental health. Rev Saude Pub 2020; 54.

Indexed at, Google Scholar, Cross Ref

12. Ahmed MA, Jouhar R, Ahmed N, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (COVID-19) outbreak. Int J Environ Res Public Health 2020; 17:2821.

Indexed at, Google Scholar, Cross Ref

13. Hawryluck L, Gold WL, Robinson S, et al. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004; 10:1206-1212.

Indexed at, Google Scholar

14. Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatr Res 2020; 287:112934.

Indexed at, Google Scholar, Cross Ref

15. Baiyere A, Li H. Application of a virtual collaborative environment in a teaching case. In AMCIS 2016: Surfing the IT Innovation Wave-22nd Americas Conference on Information Systems 2016.

Google Scholar

16. Radha R. Swami vivekananda’s mission on man making education. Int J Emerging Technol Innovative Res 2019; 6:111-114.

Google Scholar

17. Radha R. Education for man making and character building: Inspirations from Swami Vivekananda. Swami Vivekananda Centre for Higher Research and Education 2019.

Google Scholar

18. Siddiqui AA. The role of personal protective equipment (PPE) in prevention of COVID-19 novel corona virus and fatalities occur due to non-availability of the PPE. Am J Biomed Sci Res 2020; 14:2642-1747.

Google Scholar, Cross Ref

19. https://smartairfilters.com/en/blog/comparison-maskstandards-rating-effectiveness/