Skip to main content
Download PDF

Resilience and psychological factors among dentistry students who received face-to-face lectures during the COVID-19 pandemic

BMC Medical Education volume 24, Article number: 446 (2024) Cite this article

Abstract

Background

This research evaluated whether the relationships between factors of resilience, self-esteem, depression, and anxiety in dental students with changes in teaching and learning methods. We also studied the psychological impact of face-to-face lectures during the COVID-19 pandemic.

Methods

This cross-sectional descriptive study used Google Forms to collect data with the Rosenberg Self-Esteem Scale (RSE), Connor-Davidson Risk Resilience Scale (CD-RISC), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI and BDI-II). An open-ended question was also asked about important learning difficulties.

Results

The analysis revealed very high levels of resilience (30.23 ± 5.84), self-esteem in the normal range (29.08 ± 4.03), minimal depression levels (12.32 ± 8.05), and low anxiety levels (17.20 ± 12.41). There were no significant differences between sociodemographic variables ranges in regard to all psychological questionnaires. No high levels of depression and anxiety were found.

Conclusions

The levels were low compared to other studies in which online teaching was used, which is explained by the fact that the students retained adequate resilience and self-esteem thanks to being able to contact teachers and, above all, their own peers.

Peer Review reports

Introduction

At the end of 2019 and beginning of 2020, a new upper-respiratory infection appeared in Wuhan, China. The pathogen was a new type of highly contagious coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). The disease it caused is called COVID-19 (coronavirus disease 2019) [1]. The rapid spread of the virus forced the World Health Organization (WHO) to declare a pandemic status in early March 2020 [2].

In response, several countries, including Spain, adopted restrictive measures aimed at reducing close contact between people and stopping the spread of the virus through quarantine and isolation strategies [3]. These measures also affected academic institutions and especially dental schools due to the high risk of students in this health profession for exposure to contaminated material and transmission through aerosols [4]. During the time in which in-person teaching was interrupted, online teaching strategies were implemented and posed a challenge for both students and teachers [5]. The initial teaching models in many universities were online, in which students were isolated and classes could not be taught face-to-face. As the health situation improved, hybrid teaching models were implemented, in which half of the students could attend in person, while others did so online [6].

However, the specific characteristics of the dental profession require dental students to develop skills in a clinical environment and in person, so not being able to attend classes and practice normally could be a factor in restlessness and stress related to graduating and subsequent unemployment [7]. Although the overload of stress and difficulties of dental students have been the subject of study [8], the appearance of COVID-19 and its implications in the interruption of studies, the adaptation to new teaching models, and the reduction of clinical practice in the last years of training have generated new destabilizing factors that are of interest for analysis [9].

In many universities and university programs, the number of students was too high to maintain sanitary measures that guaranteed the safety of the students [10]. Despite this, in some centres with a very small number of dental students, face-to-face teaching could be maintained with appropriate health measures. This fact is of special interest for analysing the extent to which in-person teaching has affected the students during the pandemic period, in which the majority of healthcare students in other degrees had online or hybrid classes. For these reasons, the main objective of this research was to evaluate whether there is a relationship between factors such as resilience, self-esteem, depression, and anxiety in dental students due to changes in teaching and learning methods. We also studied the possible psychological impact on these students of face-to-face lectures during the COVID-19 pandemic.

Methods

Design and setting

A cross-sectional descriptive study was done with non-random sampling of dentistry students who had face-to-face learning during the COVID-19 pandemic. The data were collected using Google Forms which included consent, demographic variables (age, gender, marital status, weight, height, occupation, children, dependents, and whether they had COVID-19 at the time of the study), and selected questionnaires: (1) the Rosenberg Self-Esteem Scale (RSE) [11, 12], (2) the Connor-Davidson Risk Resilience Scale (CD-RISC) [13, 14], (3) the Beck Anxiety Inventory (BAI) [15], and (4) the Beck Depression Inventory (BDI and BDI-II) [16]. Finally, an open-ended question was asked about learning difficulties that were important to the respondent.

Sample

Participants were dental students at the University of Rey Juan Carlos in Spain. The study was conducted from October 1, 2021, to November 29, 2021. The sample size was calculated with software from Unidad de Epidemiología Clínica y Bioestadística, Complexo Hospitalario Universitario de A Coruña, Universidade A Coruña (www.fisterra.com). The final number of participants needed was calculated as 92 from a sample of 120 people with an alpha error of 0.05, a confidence interval (CI) of 95%, and 50% variance. The final sample consisted of 92 dental students. The inclusion criteria were (1) dental students from University of Rey Juan Carlos and (2) adequate knowledge of the Spanish language in oral and written form. The exclusion criterion was not full filling out the survey.

Assessment scales

Rosenberg Self-Esteem Scale (RSE)

The RSE questionnaire consists of 10 questions scored from 1 to 4 (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree). Five statements are positive, and five statements are negative. The survey authors set limits for this scale, and a score of 20 to 30 is generally considered normal. A score above the normal range indicates high self-esteem, while a result below the normal range indicates low self-esteem. The RSE has been shown to be positively correlated for both men and women across ethnic groups [17]. The scale is reliable with test–retest correlations in the range of 0.82 to 0.88 [11] and 0.87 for the Hispanic population [12].

Connor-Davidson Risk Resilience Scale (CD-RISC)

Resilience was assessed using the abbreviated version of the CD-RISC, which was validated in Spanish by Notario-Pacheco et al. [14]. The scale consists of 10 items (items 1, 4, 6, 7, 8, 11, 14, 16, 17, and 19 from the original scale developed by Connor et al. [13]). Using this measure, participants were asked to respond about the extent to which they agree with each statement presented to them (for example, Item 1: "I can change it"). The response is a five-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree). Resilience was defined with a weighted scale of 0.48 to 0.76 and a Cronbach's alpha of 0.85 [14].

Beck Anxiety Inventory (BAI)

The BAI uses a list of 21 symptoms of anxiety rated on a 4-point Likert scale with results ranging from not being anxious to being severely anxious. The inventory shows how much each symptom has affected the respondent in the past week. The values ​​of each score are summed up, and a total score between 0 and 63 points is obtained. A total score of 0–7 is defined as the lowest anxiety level, 8–15 is mild, 16–25 is moderate, and 26–63 indicates severe anxiety [18].

In a Mexican population, the scale had good correlation with a Cronbach's alpha coefficient of 0.92 and test–retest reliability of 0.75. The internal consistency of the BAI is high (Cronbach's alpha is 0.90 to 0.94). The correlation between each item and the total score is between 0.30 and 0.71. The test–retest reliability ranged from 0.67 to 0.93 after one week and was 0.62 after 7 weeks [19].

Beck Depression Inventory (BDI and BDI-II)

The BDI is a 21-item scale with all questions answered on a Likert scale. The internal consistency measure alpha is 0.78. Examples of items for topics such as sadness include "I'm often sorry" or "I'm not sad". The original BDI-II [16] proposed the following cut-off values and corresponding depression scales: 0–13 for minimal depression, 14–19 for mild depression, 20–28 for moderate depression, and 29–63 for severe depression. The Spanish version by Sanz et al. [20] used the cut-off scores of Beck et al. [16], and they concluded that the reliability of the instrument was high in terms of consistency (Cronbach's alpha coefficient = 0.83) and reliability (test–retest correlations of 0.60 and 0.72 for three different groups from all samples).

Ethical considerations

All participants confirmed their eligibility before filling out the questionnaire. This study was approved by the Rey Juan Carlos University Ethics Committee (number: 2910202121221).

Data analysis

All variables were tested for normal distribution using the Kolmogorov–Smirnov test, and data were considered normally distributed at p > 0.05. Analysis was performed using the mean and variance for multiple variables and using counts and percentages for differences. Spearman correlation was used to evaluate the strength of the relationship between variables, and Pearson correlation and the Mann–Whitney U test were used to analyse the relationship between variables. All statistics were considered significant at p < 0.05 (SPSS for Windows, version 20.0; SPSS Inc., Chicago, IL).

We reviewed the open-ended question using the program Nvivo™ 8 to explain the answers, findings, and interpretation of the digital pressure graph. Answers were analysed in several stages, including selecting terms, grouping them according to lexical criteria, creating groups and categories, and establishing word clouds. The clouds formed a spiral layer, and most of the answers appeared in capital letters and in the middle of the cloud.

Results

Different variables showed non-normal and normal distributions, as shown in Table 1. The analysis of the descriptive data of each scale revealed very high levels of resilience (30.23 ± 5.84), self-esteem in the normal range (29.08 ± 4.03), minimal depression levels (12.32 ± 8.05), and low anxiety levels (17.20 ± 12.41). As shown Tables 2, 3, 4 and 5, we did not find significant differences between sexes, socioeconomic statuses, way of living (alone, with family, etc.), and age ranges regarding all psychological questionnaires.

Table 1 Descriptive data of the participants
Full size table
Table 2 Descriptive data based on different assessment scales between sexes
Full size table
Table 3 Descriptive data based on different assessment scales between socioeconomic statuses
Full size table
Table 4 Descriptive data based on different assessment scales for way of living (alone, with family, etc.)
Full size table
Table 5 Descriptive data based on different assessment scales between age ranges (18 to 21 years versus 22 to 52 years)
Full size table

The analysis showed significant negative correlations between CD-RISC, BDI-II, and BAI (p < 0.001). In addition, the RSE showed significant negative correlations with the BDI-II and BAI (p < 0.001). Finally, there were significant positive correlations between the BDI-II and BAI and between the RSE and CD-RISC (p < 0.001), as shown in Table 6.

Table 6 Correlation and differences between scales (Spearman’s correlation coefficient (p-value))
Full size table

Open question

The open-question responses shared emotions and experiences. The main topic was that the students did not have stress or academic stress at all. The few students that had written feelings wrote about the complex protocol of caring for patients, little time to study, lack of control in the face of unexpected situations, and the impossibility of separating personal life from educational life so that it does not affect academic performance (Fig. 1).

Fig. 1
figure 1

Stressors in dentistry students with face-to-face teaching during the COVID-19 pandemic

Full size image

Discussion

This study examined how modifications in teaching methods could have affected the levels of stress, anxiety, depression, and resilience of dental students and whether there was any psychosocial impact on them during full face-to-face teaching during the COVID-19 pandemic. The results showed that the dental students had high levels of resilience along with low levels of anxiety in normal ranges. The results are similar to those of German and Saudi studies, in which levels of anxiety, stress, and depression were normal or mild [21, 22]. However, most studies show high levels that even reach depression values at rates of 60.7% and 75.3% [23, 24].

Başağaoğlu et al. compared stress and anxiety levels in dental students who received online instruction versus those who did face-to-face classes [25]. High levels of both stress and anxiety were found in the first group, but no statistically significant differences were found with the group that received face-to-face instruction. The disparity in results between studies may be due to cultural differences [26] or differences in teaching models that existed before the COVID-19 pandemic [27].

Regarding self-esteem, in a study carried out in the USA, a direct relationship with stress was found in dental students. High levels of stress were associated with significant self-esteem problems, especially in students between the ages of 25 and 34 and those who were further away from finishing their education [28]. In our study, resilience and empathy were protective factors against anxiety and depression, regardless of gender or academic year. Regarding sociodemographic variables, a greater association between higher levels of depression and female sex has been observed [27]. However, we did not find data in our results that indicate a higher prevalence in terms of sex.

Age was also not indicative of higher levels of depression or anxiety. Only one study compared the levels between students and dentists who have graduated. Higher levels of depression were found in the student group, but there were no statistically significant differences between the two groups [29].

One of the limitations of this study is that there was a small sample of dentistry students due to the small number of dental students who enter the university each year. It would be interesting to compare similar studies in other universities where dentistry is studied. However, the teaching models are not the same, and it is impossible to obtain comparable samples.

Conclusions

In the present study, high levels of depression and anxiety were not found in dental students who had face-to-face teaching during the COVID-19 pandemic. The level of depression and anxiety was low compared to other studies in which online teaching was used. This is explained by the fact that students retain adequate resilience and self-esteem thanks to being able to have contact with teachers and especially with their own classmates. Due to these results, we consider that if we had to return to a situation similar to the COVID-19 pandemic, we should maintain face-to-face teaching with small groups as long as the health situation allows it in order to reduce the levels of depression and anxiety of students.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

References

  1. Atzrodt CL, Maknojia I, Mccarthy RDP, Oldfield TM, Po J, Ta KTL, Stepp HE, Clements TP. A Guide to COVID-19: A Global Pandemic Caused by the Novel Coronavirus SARS-CoV-2. FEBS J. 2020;287:3633.

    Article  Google Scholar 

  2. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91:157–60.

    Google Scholar 

  3. Klaassen H, Ashida S, Comnick CL, Xie XJ, Smith BM, Tabrizi M, Arsenault K, Capin OR, Scully AC, da Mata C, et al. COVID-19 Pandemic and its Impact on Dental Students: A Multi-Institutional Survey. J Dent Educ. 2021;85:1280–6.

    Article  Google Scholar 

  4. Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020;46:584–95.

    Article  Google Scholar 

  5. Shrivastava, K.J.; Nahar, R.; Parlani, S.; Murthy, V.J. A Cross-Sectional Virtual Survey to Evaluate the Outcome of Online Dental Education System among Undergraduate Dental Students Across India Amid COVID-19 Pandemic. Eur. J. Dent. Educ. 2021.

  6. Rahman, K.; Wahid, A.H.; Afandi, I.; Bali, M.; Hakim, L. Effectiveness of Teams Teaching-Hybrid Learning (TTHL) in Higher Education. Proceedings of the Proceedings of 1st Workshop on Environmental Science, Society, and Technology, WESTECH 2018, December 8th, 2018, Medan, Indonesia 2019.

  7. Jum’ah AA, Elsalem L, Loch C, Schwass D, Brunton PA. Perception of Health and Educational Risks Amongst Dental Students and Educators in the Era of COVID-19. Eur J Dent Educ. 2021;25:506–15.

    Article  Google Scholar 

  8. Smolana A, Loster Z, Loster J. Assessment of Stress Burden among Dental Students: A Systematic Literature Review and Meta-Analysis of Data. Dent Med Probl. 2022;59:301–7.

    Article  Google Scholar 

  9. Zarzecka J, Zarzecka-Francica E, Gala A, Gębczyński K, Pihut M. Dental Environmental Stress during the COVID-19 Pandemic at the Jagiellonian University Medical College, Kraków, Poland. Int J Occup Med Environ Health. 2021;34:211–22.

    Article  Google Scholar 

  10. Losa-Iglesias ME, Calvo-Lobo C, Jiménez-Fernández R, Rodríguez-Sanz D, Corral-Liria I, Casado-Hernández I, Becerro-de-Bengoa-Vallejo R. Comparison between Virtual and Hybrid Education for Psychological Factors and Academic Stress in Freshman Nursing Students: A Case-Control Study. BMC Nurs. 2023;22:300–5.

    Article  Google Scholar 

  11. Rosemberg M. Society and the Adolescent Self-Image. Middletown, CT: Wesleyan University Press; 1989.

    Google Scholar 

  12. Atienza FL, Moreno Y, Balaguer I. Análisis De La Dimensionalidad De La Escala De Autoestima De Rosenberg En Una Muestra De Adolescentes Valencianos. Rev Psicol Universitas Tarraconensis. 2000;22:29–42.

    Google Scholar 

  13. Connor KM, Davidson JRT. Development of a New Resilience Scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76–82.

    Article  Google Scholar 

  14. Notario-Pacheco B, Solera-Martínez M, Serrano-Parra MD, Bartolomé-Gutiérrez R, García-Campayo J, Martínez-Vizcaíno V. Reliability and Validity of the Spanish Version of the 10-Item Connor-Davidson Resilience Scale (10-Item CD-RISC) in Young Adults. Health Qual Life Outcomes. 2011;9:63–63.

    Article  Google Scholar 

  15. Beck AT, Epstein N, Brown G, Steer RA. An Inventory for Measuring Clinical Anxiety: Psychometric Properties. J Consult Clin Psychol. 1988;56:893–7.

    Article  Google Scholar 

  16. Beck, A.T.; Epstein, N.; Brown, G. Manual for the Beck Depression Inventory-II., 1996.

  17. Robins RW, Hendin HM, Trzesniewski KH. Measuring Global Self-Esteem: Construct Validation of a Single-Item Measure and the Rosenberg Self-Esteem Scale. Pers Soc Psychol Bull. 2001;27:151–61.

    Article  Google Scholar 

  18. Beck, A.T.; Steer, R.A. Beck Depression Inventory Manual.; Psychological Corporation: San Antonio., 1993.

  19. Comeche Moreno, M.I.; Díaz García, M.I.; Vallejo Pareja, M.A. Cuestionarios, Inventarios Y Escalas : Ansiedad, Depresión Y Habilidades Sociales.; Fundación Universidad-Empresa: Madrid, 1995.

  20. Sanz, J.; Navarro, M.; Vazquez, C. Adaptación Española Del Inventario Para La Depresión De Beck-II (BDI-II): 1. Propiedades Psicométricas En Estudiantes Universitarios. Análisis y Modificación de Conducta 2003, 29, 239–288.

  21. Mekhemar M, Attia S, Dörfer C, Conrad J. Dental Students in Germany Throughout the COVID-19 Pandemic: A Psychological Assessment and Cross-Sectional Survey. Biology (Basel). 2021;10:611. https://doi.org/10.3390/biology10070611.

    Article  Google Scholar 

  22. Khanagar SB, Alfadley A. Psychological Impact of the COVID-19 Pandemic on Dental Interns in Riyadh, Saudi Arabia: A Cross-Sectional Survey. Int J Clin Pediatr Dent. 2020;13:508–12.

    Google Scholar 

  23. Keskin, G. Self-Report Measurement of Depression, Anxiety, and Stress Caused by Covid-19 Pandemic in Senior Undergraduate Dental Students. Pesquisa brasileira em odontopediatria e clínica integrada 2021, 21.

  24. Hakami Z, Khanagar SB, Vishwanathaiah S, Hakami A, Bokhari AM, Jabali AH, Alasmari D, Aldrees AM. Psychological Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Dental Students: A Nationwide Study. J Dent Educ. 2021;85:494–503.

    Article  Google Scholar 

  25. Başağaoğlu Demirekin, Z.; Buyukcavus, M.H. Effect of Distance Learning on the Quality of Life, Anxiety and Stress Levels of Dental Students during the COVID-19 Pandemic. BMC Med. Educ. 2022, 22, 309-y.

  26. Braz-José C, Morais Caldas I, de Azevedo Á, Pereira ML. Stress, Anxiety and Depression in Dental Students: Impact of Severe Acute Respiratory Syndrome-Coronavirus 2 Pandemic. Eur J Dent Educ. 2023;27:700–6.

    Article  Google Scholar 

  27. Santabárbara, J.; Ozamiz-Etxebarria, N.; Idoiaga, N.; Olaya, B.; Bueno-Novitol, J. Meta-Analysis of Prevalence of Depression in Dental Students during COVID-19 Pandemic. Medicina 2021, 57.

  28. Finch J, Gurumurthy T, Shrestha R, Ledingham L, Vu T, Mohajeri A, Freitas CMT, Patil S, Awan KH. COVID-19: Ramifications and Effects on University Healthcare Students. J Contemp Dent Pract. 2022;23:866–71.

    Google Scholar 

  29. Chirikov, I.; Soria, K.M.; Horgos, B. UC Berkeley SERU Consortium Reports Title Undergraduate and Graduate Students' Mental Health during the COVID-19 Pandemic Permalink Publication Date. 2020.

Download references

Funding

This research received no external funding.

Author information

Authors and Affiliations

  1. Department of Nursing and Stomatology, Faculty of Health Sciences, Rey Juan Carlos University, 28922, Alcorcón, Madrid, Spain

    Jesús Rodríguez-Molinero, Inmaculada Corral-Liria, Raquel Jiménez-Fernández, Rosario Ramírez-Puerta, Sara González-Martín, Esther Delgado-Somolinos, Marta Elena Losa-Iglesias & Antonio Francisco López-Sánchez

  2. IDIBO Research Group, Rey Juan Carlos University, Alcorcón, Madrid, Spain

    Jesús Rodríguez-Molinero & Antonio Francisco López-Sánchez

  3. IDRENF Research Group, Rey Juan Carlos University, Alcorcón, Madrid, Spain

    Inmaculada Corral-Liria, Raquel Jiménez-Fernández, Sara González-Martín & Marta Elena Losa-Iglesias

Authors
  1. Jesús Rodríguez-Molinero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Inmaculada Corral-Liria
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raquel Jiménez-Fernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosario Ramírez-Puerta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sara González-Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Esther Delgado-Somolinos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Elena Losa-Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonio Francisco López-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: M.L.-I., S.M.-G.; Resources: E.D.-S., R. R.-P.; Writing, Original Draft Preparation: J.R.-M., I.C.-L., E.D.-S., R.J.-F.; Writing, review and Editing: J.R.-M., A.F.L.-S., M.L.-I. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Inmaculada Corral-Liria.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

All participants marked the eligibility point before filling out the questionnaire on the Google link. This study was approved by the Rey Juan Carlos University Ethics Committee (number: 2910202121221).

Informed consent was obtained from all subjects and/or their legal guardian(s).

Consent for publication

Not applicable.

Competing interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rodríguez-Molinero, J., Corral-Liria, I., Jiménez-Fernández, R. et al. Resilience and psychological factors among dentistry students who received face-to-face lectures during the COVID-19 pandemic. BMC Med Educ 24, 446 (2024). https://doi.org/10.1186/s12909-024-05445-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12909-024-05445-8

Keywords

BMC Medical Education

ISSN: 1472-6920

Contact us