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 Table of Contents  
Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 110-116

Association of anxiety with oral health-related quality of life among Kashmiri Residents

1 Department of Public Health Dentistry, I.T.S Dental College-CDSR, Ghaziabad, Uttar Pradesh, India
2 Department of Public Health Dentistry, Narsinhbhai Patel Dental College and Hospital, Visnagar, Gujarat, India
3 Department of Public Health Dentistry, I.T.S Dental College, Noida, Uttar Pradesh, India

Date of Submission29-Mar-2022
Date of Decision16-Jun-2022
Date of Acceptance06-Jul-2022
Date of Web Publication9-Aug-2022

Correspondence Address:
Sana Bashir
I.T.S Dental College-CDSR, Muradnagar, Ghaziabad, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_35_22

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Introduction: Along with other healthcare indicators, psychological well-being of the population worldwide has been greatly affected after outbreak of covid-19. Almost all states in India including Jammu and Kashmir suffered during COVID-19. Thus this study was planned to determine the association of anxiety and its impact on oral health-related quality of life (14-item Oral Health Impact Profile [OHIP-14]) among residents of four districts of Jammu and Kashmir state during COVID-19. Materials and Methods: A self-administered questionnaire consisting of OHIP-14 along with a 7-item Generalized Anxiety Disorder Scale (GAD-7 Scale) was distributed among the residents of Kashmir via e-mails, WhatsApp groups, and Facebook using Google Forms. Results: Majority of the participants were males (53%) over 18 years of age. The most frequently experienced problems were discomfort during eating food (75%) and physical pain in the mouth such as aching in the mouth (60%). A highly statistically significant negative correlation was found between OHIP-14 and GAD among painful aching in the mouth (−0.044) (0.154**) **p<0.001. Half (50%) of the participants reported minimal anxiety. Conclusion: There is an unmet and immediate need to escalate the mental health services in Jammu and Kashmir state of India, which consisted of community participation, awareness programs, and mental health rehabilitation services.

Keywords: Anxiety, COVID-19, Generalized Anxiety Disorder-7 Scale, healthcare, life quality, oral health

How to cite this article:
Bashir S, Menon I, Gupta R, Sharma A, Arora V, Rohatgi L. Association of anxiety with oral health-related quality of life among Kashmiri Residents. Asian J Pharm Res Health Care 2022;14:110-6

How to cite this URL:
Bashir S, Menon I, Gupta R, Sharma A, Arora V, Rohatgi L. Association of anxiety with oral health-related quality of life among Kashmiri Residents. Asian J Pharm Res Health Care [serial online] 2022 [cited 2022 Sep 27];14:110-6. Available from: http://www.ajprhc.com/text.asp?2022/14/2/110/353624

  Introduction Top

The Kashmir region has been under political turmoil for many years and that imposes an everlasting psychological impact on the Jammu and Kashmiri population.[1] Throughout the thirty years of insurgence, it's been calculable that quite 7000, Kashmiri folks lost their lives 2 and quite 8000 folks are reported missing together with tortures, rapes, forced labor, and kidnappings thanks to the political turmoil.[2]

Following the partition of India in 1947, the Jammu and Kashmir region has been subject to continual political insecurity and in progress conflict.[3] In 1989, associate degree insurgence began resulting in the displacement of over a hundred, Kashmiri Pandits and 27 years of militant and military activity.[4]

The loss of human life, state coercion, and the ensuing context of occurring inferior strife had an impression on Kashmir's population. Additionally, the explosive outburst of the pandemic COVID-19 in 2020. Also, confounders like widespread impoverishment, uncertainty, grief, oppression, and worry in addition to a high state with restricted development of employment-generating sectors[5] together with extended faculty closures cause intense stress and anxiety for kids already jittery from years of unsettled education, dispute, and civil strife. A ground-breaking world crisis like COVID-19, prolonged isolation imprisonment, and consistent violence have crushed the mental state of Kashmiris like never before.[2],[6],[7],[8]

This conflict has not solely exposed the population to traumatic violent episodes. but has conjointly impacted negatively on the social and material of society.

Poor oral health has long been theorized to cause the pathology of alternative essential physical systems.[9] A growing body of proof has come back to support the existence of such an associate degree oral–systemic relationship.[10],[11],[12] A shared impetus for the events of each oral and general unwellness could also be the presence of stress. As stress is a typical risk issue for non communicable diseases (e.g., cancer disorder, diabetes, and metastasis disease) stress reduction has become an essential part of novel general attention advancement techniques.[13]

Chronic stress contributes to the fast, long-term development of oral unwellness through a minimum of two divisible pathways. First, stress will encourage people to cope in unhealthy ways in which encourage oral unwellness (e.g., substance use, together with illicit medicine, alcohol and tobacco, poor diet, and inactive behavior). Second, chronic stress contributes to a high allosteric load which will result in the pathology of physiological systems essential to physiological condition and thus will have an effect on the underlying mechanisms of unwellness progression, a lot of the time.[14]

Underlying feelings of depression, anxiety, or alternative feelings are not recognized or acknowledged by a person. Or, the person could also be aware that all the physical activities correlates of those underlying difficulties.[15] It is projected that these two conditions will cause oral and dental issues because emotional changes will influence the oral mucosa.[16] Many studies have conjointly shown a relationship between anxiety and dental medicine health.[17],[18] The complete closure of dental clinics and hospitals due to lockdown throughout COVID-19 has caused additional strain among the residents of Jammu and Kashmir as they may not get acceptable oral healthcare as needed. Therefore, the current study was conducted to assess the association of anxiety and impact on quality of life (14-item Oral Health Impact Profile [OHIP-14]) among residents of Jammu and Kashmir throughout COVID-19.

  Materials and Methods Top

Study design

A cross-sectional survey was conducted among 300 residents of Jammu and Kashmir to assess the association of anxiety with oral health and its impact on quality of life within the months of October 2020 to December 2020.

Ethical approval

The study protocol was approved by the institutional moral and review board of ITS-CDSR Dental Faculty and Analysis Centre, Muradnagar, Ghaziabad province.

Pilot study

Before the commencement of the study, a pilot study was conducted among 20 participants to visualize the practicability of the survey form. The respondents were asked for feedback on the clarity of the queries and whether or not there had been any difficulties in responding to the queries, and thus, modifications were created consequently within the final form. The participants of the pilot study were not enclosed within the final sample.

Sample size determination and sampling procedure

Jammu and Kashmir is splitted into six districts. Out of its six districts, two districts (Budgam and Baramulla) are arbitrarily elite. The mode of distribution of the form was through e-mails and WhatsApp teams by means of Google Forms. The participant's responses were registered within the study. Convenience sampling was followed in this survey.

Data collection


A structured, self-administered, closed-ended form was used to collect the information. The form meant for this study was sent as a link to the respondents. The form was divided into three components. The first section of the form collected the participants' sociodemographic profile, such as their name, age, gender, level of education, profession, income, and number of relations. Later half collected the responses concerning the standard of life employing OHIP-14 whereas anxiety symptoms were assessed the 7-item Generalized Anxiety Disorde Scale (GAD-7 Scale).

Oral Health Impact Profile-14

OHIP-14 scale was used. The responses were rated on a 5-point Likert scale: zero = never; one = hardly ever; two = occasionally; three = fairly often; four = terribly often/every day. The OHIP-14 scores will vary from 0 to 56 and be calculated by summing the ordinal values for the 14 things. The domain scores will vary from 0 to 8. Higher OHIP-14 scores indicate worse and lower scores indicate higher OHIP.

Generalized Anxiety Disorder-7 Scale

A GAD-7 Scale was used. The response was rated on a 4-point Likert scale: 0 = not in the slightest degree certain, 1 = several days, 2 = over (*p< 0.05) [*fr1] the times, 3 = nearly a day. The interpretation was done by adding all the responses, and also, the interpretation was calculated as per scores between (0–4) gentle, (5–9) moderate, (10–14) severe, and (15–21) severally.

Inclusion criteria

Participants were registered in this survey if they were permanent residents of the chosen district in Jammu and Kashmir and were currently residing in the same neighborhood.

Exclusion criteria

Participants below 18 years older.

Statistical analysis

All information collected was entered intto MS Excel version 2013 and analyzed using SPSS version 21.0 for Windows. SPSS Inc., Chicago 2, USA, 2001. Descriptive statistics were expressed in a variety of frequencies and tables; Spearman's coefficient of correlation was used to interpret the association. Chi-square test was used to assess the association between the variables. Normality of the data was assessed by Shapiro–Wilk test, and the data were not normally distributed. Comparison of variables among the various levels of anxiety was assessed by one-way ANOVA analysis.

  Results Top

The majority of the participants in the survey were males (53%), and all the participants belonged to Kashmir part of Jammu and Kashmir State of India. The majority (43.7%) of the participants were in the age group of 18–27 years. The mean age group was 30.91 ± 11.143 years [Table 1].
Table 1: Demographic distribution of the participants

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The majority (75%) of the participants responded that they hardly ever have experienced trouble while pronouncing words. About 70% of the participants responded that their sense of taste has never worsened. 25% of the participants responded that they hardly ever had pain in their mouth. Nearly 25% of the participants responded positively that they felt uncomfortable while eating. 14% of the participants responded that they actually occasionally felt tense because of their oral problems. Almost 12% of the participants reported having occasional issues with their diet mode. Majority (65%) of the participants responded that they fairly often get interrupted during having meals. Almost 22% of those polled said that it is difficult for them to relax because of dental issues [Table 2].
Table 2: Distribution of the response rate of the Oral Health Impact Profile

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Nearly 22% of the participants responded that nearly every day, they were worried during COVID-19. About 15% of the participants reported that they were so restless over the days that they were not able to sit even. Nearly 20% of the participants responded that they usually became easily irritable during the COVID-19 breakdown period. About 20% of the participants responded that for several days, they were in fear that something awful might happen [Table 3].
Table 3: Modification of the Generalized Anxiety Disorder Scale which was used

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The majority of the participants reported minimal anxiety (50.7%) followed by mild anxiety in 28.7% and moderate in 13.3%. Only 7.3% of the participants reported severe anxiety. The mean anxiety recorded was 1.77 ± 0.941 [Table 4].
Table 4: Distribution of the participants response rates of the Generalized Anxiety Disorder Scale

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[Table 5] reveals that on comparing the mean scores between OHIP-14 and GAD Scale in general, the anxiety disorders were severely observed in OHIP-4 (0.95 ± 0.844) and least in OHIP-2 (0.32 ± 0.646) and the results of the comparison was found to insignificant [Table 5].
Table 5: Comparison of mean Oral Health Impact Profile-=14 score and General Anxiety Disorder scores among the participants

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A statistically significant positive correlation was found between GAD Score and OHIP-14 score of the study subjects. Positive correlations were found among study subjects between GAD Scale and feelings of embarrassment due to dental problems (0.032) (0.221 **p<0.001), irritability due to dental problems (0.042) (0.138 *p< 0.05) with age, and inability to function due dental problems (0.006) (0.130*) with income. A statistically significant negative correlation was discovered between OHIP-14 and GAD in terms of painful aches in the mouth (−0.044) (0.154) and difficulty in performing routine job tasks (−0.035) (0.138*) with age [Table 6].
Table 6: Spearman's correlation coefficient between Oral Health Impact Profile-14 and Generalized Anxiety Disorder Scale

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  Discussion Top

Traumatic events have an intense impact on the emotional, cognitive, behavioral, and physiological functioning of a person.[19]

This current study is one of the few population-primarily–based studies that has investigated the correlation between short sort of OHIP with 14 customary scale queries and GAD among the Kashmiri population. During this study, we had assessed the OHIP-14 and its relationship with the generalized anxiety scale (GAD). The sample was chosen to be representative of the Kashmiri population. The results of the OHIP 14 showed that a considerable proportion of the Kashmiri population reported oral issues, which had an impression on their daily lives. The common fully fledged issues were discomfort while feeding food (75%) and physical pain within the mouth such as aching within the mouth (60%), and thus, the findings were similar to Einarson et al.,[20] Lahti et al.,[21] and Dahl et al.[22]

Oral health-related quality of life is based on the concept that functional and psychosocial measures affect quality of life. In accordance to this, Locker and Allen[23] stated that such measures and their frequency have an impact that emerge from oral disorders; however, these impacts does not demonstrate their importance.

Excessive stress can transform into a disorder, and ultimately, once it starts, it interferes with life. Excessive stress can transform into a disorder, and ultimately, once it starts, it interferes with life. They do not necessarily get worse with age, but people suffering from anxiety undergo changes across their lifespan and is common with older age and is most common among middle aged adults and due to number of reasons, including changes in the brain and nervous system as our age progress and experience stressful life events it accentuate anxiety,[24] and from the results of the study, it is evident that OHIP-14 and GAD Score are reciprocally associated with one another. Participants with high score of generalized anxiety symptoms have impaired quality of life, and therefore, the findings of our study were similar to the study conducted by Rapaport et al.[25]

COVID-19 has caused significant distress around the globe. Apart from the visible symptoms in infected cases, it has caused more damage to public mental health. The majority of anxiety, which was reported from the scores of Generalized Anxiety Scale in our study, was minimal (50.7%) and similar findings were reported from the study by Rehman et al.[24],[26]

Certain domains of our study showed a positive correlation as well as a negative correlation. The probable reason for this is that, after COVID-19 outbreak, people pay more attention to their physical, mental, and oral health and diet. Due to lockdown, people offered more attention toward them from their busy day-to-day schedules as a result of which the quality of life improved post-COVID-19. The fear of contracting the virus compelled them to maintain their overall health.

Moreover, Katschnig et al.[27] reported that there has been a growing interest within the analysis literature to assess the standard of life impairment in several psychological disorders. Because the focus is shifting away from a single target symptom severity and toward the broader impact of psychological disorders on people's lives, particularly people's perception of their quality of life, the importance of quality of life assessment in evaluating the impact of psychological disorders and their treatment is well known, as expressed by Bourland et al.[28] Frisch.[29] and Katschnig et al.[27]

In addition, depression on quality of life has a negative impact because it accentuates the importance of incorporating strategies for managing comorbid depression into treatment of anxiety disorders. Subjective quality of life assessment is used as an indicator of patient's satisfaction at the initial point of assessment, and it can also be valuable as outcome measures demonstrating the varied impacts of treatment beyond severity.[30]


Virtual workshops should be organized for community awareness regarding the importance of maintaining oral health and its impact on overall well-being.

  Conclusion Top

The findings conclude that individuals with greater perceived stress experience poor oral health. These findings permit greater attention be paid to the role of psychological stress in the development of oral disease, including as a cause of social inequalities in oral health, and health inequity, more generally. More research is needed to explain the relationship between current stress and oral health and to inform the layout of interventions for the uninsured and those disadvantaged in other ways.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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