Mediating Role of Psychological Resilience on Illness Perception in Dental Patients

Öz

Abstract Aim: The study aimed to explore how dental patients perceived illness and assessed the influence of psychological resilience on illness perception during dental treatment. Methods: This cross-sectional study was carried out with 360 dental patients. Data were collected by a questionnaire regarding Illness Perception Revised for Oral Health (IPQ-R-OH), Brief Resilience Scale (BRS), self-reported oral health status (good vs poor), levels of dental pain (absent vs present) and dental anxiety (0 point: No anxiety-10 points: Severity). General health status (0: poor health-100 points: excellent health) were assessed by visual analogue scale. Results: All IPQ-R-OH subscale scores were adversely affected in the presence of “poor oral health and dental pain” (p<0.05). The females exhibited higher score in the IPQ-R-OH Emotional Representations (F/M: 18.65±7.16/14.27±5.48) and lower scores of BRS (F/M: 3.10±0.87/3.50±0.69) and general health status (F/M: 68.69±19.13/74.75±18.64) than males (p<0.05). In the parallel mediation analysis, the IPQ-R-OH Emotional Representations score was positively associated with higher dental anxiety scores and negatively associated with lower BRS scores among females (p<0.05). In the simple mediation analysis, the elevated IPQ-R-OH Emotional Representations score was directly mediated by “poor oral health and dental pain” in line with decrease in the BRS score, indirectly (p<0.05). IPQ-R-OH was found to be reliable and valid tool for the screening of illness perceptions. Conclusion: Patient empowerment strategies regarding gender, dental pain, poor oral health and dental anxiety must be developed to improve the IPQ-R-OH Emotional Representations. Keywords: Illness Perception, Oral Health, Dental Pain, Dental Anxiety, Psychological Resilience

Anahtar Kelimeler

• Illness Perception
• Oral Health
• Dental Pain
• Dental Anxiety
• Psychological Resilience

Diş Hekimliğine Başvuran Hastaların Hastalık Algısı Üzerinde Psikolojik Dayanıklılığın Aracılık Rolü

Öz

Amaç Bu çalışma, diş hastalarının hastalığı nasıl algıladıklarını incelemeyi ve psikolojik dayanıklılığın diş tedavisi sırasında hastalık algısı üzerindeki etkisini değerlendirmeyi amaçlamıştır. Yöntem Bu kesitsel çalışma 360 diş hastasıyla gerçekleştirilmiştir. Veriler; Ağız Sağlığı için Revize Edilmiş Hastalık Algısı Ölçeği (IPQ-R-OH), Kısa Psikolojik Dayanıklılık Ölçeği (BRS), öz-bildirimle değerlendirilen ağız sağlığı durumu (iyi/kötü), dental ağrı düzeyi (yok/var) ve dental anksiyete (0 puan: hiç anksiyete yok – 10 puan: şiddetli anksiyete) ile toplanmıştır. Genel sağlık durumu ise 0 (kötü sağlık) ile 100 (mükemmel sağlık) puan arasında görsel analog ölçek ile değerlendirilmiştir. Bulgular “Kötü ağız sağlığı ve dental ağrı” varlığında tüm IPQ-R-OH alt ölçek puanları olumsuz etkilenmiştir (p<0,05). Kadınlar IPQ-R-OH Duygusal Temsiller puanında daha yüksek (K/E: 18,65±7,16 / 14,27±5,48), BRS (K/E: 3,10±0,87 / 3,50±0,69) ve genel sağlık puanlarında daha düşük değerler göstermiştir (p<0,05). Paralel aracılık analizinde kadınlarda yüksek Duygusal Temsiller puanı, dental anksiyete ile pozitif, düşük BRS puanları ile negatif ilişkili bulunmuştur (p<0,05). Basit aracılık analizinde, yüksek Duygusal Temsiller puanının, BRS puanındaki düşüşle paralel olarak kötü ağız sağlığı ve dental ağrı tarafından dolaylı olarak aracılık edildiği görülmüştür (p<0,05). IPQ-R-OH ölçeği, hastalık algısını değerlendirmede güvenilir ve geçerli bir araç olarak bulunmuştur. Sonuç Cinsiyet, dental ağrı, kötü ağız sağlığı ve dental anksiyete ile ilişkili hasta güçlendirme stratejilerinin geliştirilmesi, IPQ-R-OH Duygusal Temsiller boyutunun iyileştirilmesi açısından önemlidir. Anahtar Kelimeler Hastalık Algısı, Ağız Sağlığı, Dental Ağrı, Dental Anksiyete, Psikolojik Dayanıklılık

Anahtar Kelimeler

• Hastalık Algısı
• Ağız Sağlığı
• Diş Ağrısı
• Dental Aksiyete
• Psikolojik Dayanıklılık

Kaynakça

1. Ali AR, Kapoor A, Chatterjee D, et al. (2022) Psychometric approach to evaluate periodontal disease using Revised Illness Perception Questionnaire. Journal of Indian Society of Periodontology 26(1). Medknow: 69–74. https://doi.org/10.4103/jisp.jisp_831_20
2. Ashley L, Smith AB, Keding A, et al. (2013) Psychometric evaluation of the revised Illness Perception Questionnaire (IPQ-R) in cancer patients: confirmatory factor analysis and Rasch analysis. Journal of psychosomatic research 75(6). Elsevier: 556–562. https://doi.org/10.1016/j.jpsychores.2013.08.005
3. Baiju RM, Peter E, Varghese NO, et al. (2017) Oral health and quality of life: current concepts. Journal of clinical and diagnostic research: JCDR 11(6): ZE21. https://doi.org/10.7860/JCDR/2017/25866.10110
4. Chaudhary FA and Ahmad B (2021) The relationship between psychosocial distress and oral health status in patients with facial burns and mediation by oral health behaviour. BMC Oral Health 21: 172. https://doi.org/10.1186/s12903-021-01532-0
5. Cui T, Qiu L and Hou D (2025) Association between psychological resilience, social support and oral health behaviours in patients with implant dentures. BMC Oral Health 25(1): 34. https://doi.org/10.1186/s12903-024-05226-1
6. Doğan T (2015) Adaptation of the Brief Resilience Scale into Turkish: A validity and reliability study. The Journal of Happiness & Well-Being 3(1): 93. https://cir.nii.ac.jp/crid/1370289848637686784
7. Donoff RB and Daley GQ (2020) Oral health care in the 21st century: It is time for the integration of dental and medical education. Journal of Dental Education 84(9): 999–1002. https://doi.org/10.1002/jdd.12191
8. Dye BA, Tan S, Smith V, et al. (2007) Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital and health statistics. Series 11, Data from the national health survey (248): 1–92. https://europepmc.org/article/med/17633507

9. Erdal S, Nalbantoğlu B, Gür MB, et al. (2021) HADS-depression score is a mediator for illness perception and daily life impairment in Takayasu’s arteritis. Clinical Rheumatology 40(10): 4109–4116. https://doi.org/10.1007/s10067-021-05719-2
10. Gholami M, Pakdaman A and Virtanen JI (2012) Common Perceptions of Periodontal Health and Illness among Adults: A Qualitative Study. ISRN Dentistry 2012: 1–6. https://doi.org/10.5402/2012/671879
11. Gibbons CJ, Kenning C, Coventry PA, et al. (2013) Development of a multimorbidity illness perceptions scale (MULTIPleS). PLoS One 8(12). Public Library of Science San Francisco, USA: e81852. https://doi.org/10.1371/journal.pone.0081852
12. Hajek A, Kretzler B and König H-H (2022) Oral Health, Loneliness and Social Isolation. A Systematic Review and Meta-Analysis. The Journal of nutrition, health and aging 26(7): 675–680. https://doi.org/10.1007/s12603-022-1806-8
13. Hashmi F, Haroon M, Ullah S, et al. (2022) Stress at home and female gender are significantly associated with non-adherence and poor illness perception among patients with rheumatoid arthritis. Cureus 14(6). Cureus. https://doi.org/10.7759/cureus.25835
14. Hu T, Zhang D and Wang J (2015) A meta-analysis of the trait resilience and mental health. Personality and Individual Differences 76: 18–27. https://doi.org/10.1016/j.paid.2014.11.039
15. Karacayli U, Adesanya A, Aksoy A, et al. (2022) The assessment of presenteeism and activity impairment in Behçet’s syndrome and recurrent aphthous stomatitis: a multicentre study. Rheumatology 61(4). Oxford University Press: 1538–1547. https://doi.org/10.1093/rheumatology/keab581
16. Mafla AC and Patiño MA (2019) Diferencias de sexo en severidad y factores de riesgo para caries dental y enfermedad periodontal. Revista nacional de odontología 15(28). https://doi.org/10.16925/2357-4607.2019.01.03
17. Mafla AC, Herrera‐López HM and Villalobos‐Galvis FH (2019) Psychometric approach of the revised illness perception questionnaire for oral health (IPQ‐R‐OH) in patients with periodontal disease. Journal of Periodontology 90(2): 177–188. https://doi.org/10.1002/JPER.18-0136
18. Mohd Khairuddin AN, Bogale B, Kang J, et al. (2024) Impact of dental visiting patterns on oral health: A systematic review of longitudinal studies. BDJ Open 10(1). Nature Publishing Group: 18. https://doi.org/10.1038/s41405-024-00195-7
19. Moss-Morris R, Weinman J, Petrie K, et al. (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychology & Health 17(1): 1–16. https://doi.org/10.1080/08870440290001494
20. Mumcu G, Lehimci F, Fidan Ö, et al. (2017) The assessment of work productivity and activity impairment in Behcet’s disease. Turkish journal of medical sciences 47(2): 535–541. https://doi.org/10.3906/sag-1603-161
21. Mumcu G, Yağar F, Alibaz-Öner F, et al. (2019) Does illness perception associate with disease symptoms in Behçet’s disease? Internal and Emergency Medicine 14(5): 691–697. https://doi.org/10.1007/s11739-018-1983-y
22. Nelson S, Albert JM, Liu Y, et al. (2019) The psychometric properties of a new oral health illness perception measure for adults aged 62 years and older. PloS one 14(4). Public Library of Science San Francisco, CA USA: e0214082. https://doi.org/10.1371/journal.pone.0214082
23. Rath H, Panda A and Mahapatra S (2025) Illness perception in patients with dental caries: A co-relational study in Odisha. Journal of Oral Biology and Craniofacial Research 15(1): 136–140. https://doi.org/10.1016/j.jobcr.2025.01.003
24. Richmond S, Chestnutt I, Shennan J, et al. (2007) The relationship of medical and dental factors to perceived general and dental health. Community Dentistry and Oral Epidemiology 35(2): 89–97. https://doi.org/10.1111/j.1600-0528.2007.00296.x
25. Rojas M, Rodriguez Y, Pacheco Y, et al. (2018) Resilience in women with autoimmune rheumatic diseases. Joint Bone Spine 85(6): 715–720. https://doi.org/10.1016/j.jbspin.2017.12.012
26. Sevimli E, Günay S, Aliyeva A, et al. (2024) Psychological resilience in patients with primary Sjögren’s syndrome: effect of involvement of major salivary and lacrimal glands. European Journal of Oral Sciences 132(6): e13022. https://doi.org/10.1111/eos.13022
27. Singh A and Rejeb A (2024) Illness perception: A bibliometric study. Heliyon 10(11). Elsevier. https://doi.org/10.1016/j.heliyon.2024.e31805
28. Smith BW, Dalen J, Wiggins K, et al. (2008a) The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine 15(3): 194–200. https://doi.org/10.1080/10705500802222972
29. Smith BW, Dalen J, Wiggins K, et al. (2008b) The brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine 15(3): 194–200. https://doi.org/10.1080/10705500802222972
30. Smith BW, Epstein EM, Ortiz JA, et al. (2013) The Foundations of Resilience: What Are the Critical Resources for Bouncing Back from Stress? In: Prince-Embury S and Saklofske DH (eds) Resilience in Children, Adolescents, and Adults. The Springer Series on Human Exceptionality. New York, NY: Springer New York, pp. 167–187. Available at: https://link.springer.com/10.1007/978-1-4614-4939-3_13 (accessed 7 August 2025). https://doi.org/10.1007/978-1-4614-4939-3_13
31. Vanhove AJ, Herian MN, Perez ALU, et al. (2016) Can resilience be developed at work? A meta-analytic review of resilience-building programme effectiveness. Journal of Occupational and Organizational Psychology 89(2): 278–307. https://doi.org/10.1111/joop.12123
32. Villalobos-Galvis FH, Mafla AC, Burbano-Trujillo WF, et al. (2017) Psychometric properties of the revised illness perception questionnaire for oral health. Caries Research 51(3). S. Karger AG Basel, Switzerland: 244–254. https://doi.org/10.1159/000468993
33. Weinman J, Petrie KJ, Moss-morris R, et al. (1996) The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychology & Health 11(3): 431–445. https://doi.org/10.1080/08870449608400270
34. Yankouskaya A, Boughey A, McCagh J, et al. (2019) Illness perception mediates the relationship between the severity of symptoms and perceived health status in patients with Behçet disease. JCR: Journal of Clinical Rheumatology 25(8). LWW: 319–324. https://doi.org/10.1097/RHU.0000000000000872