Psychological Impacts of COVID-19 in Dental Patients are Moderated and Mediated by Hospital-Infection-Control-Policy and Satisfaction-with-Life: A Prospective Observational Dental-COVID Study

Figures & data

Figure 1 The hypothetical schema for dental-COVID study. (A) Confidence on hospital-infection-control-policy and satisfaction-with-life (SWL) moderate relationship between fear of COVID-19 (FCV-19) and psychological impact (dental anxiety perceived stress). (Double moderation process model 2). (B) COVID-19 risk perception mediates the relationship between fear for COVID-19 (FCV-19) and psychological impact (dental anxiety, perceived stress) with survey group and satisfaction-with-life (SWL) as a moderator. (Dual moderated mediation, process model 21).

Abbreviation: CV, covariates.

Table 1 Cut-off Distribution of All Study Variable (COVID-19 Risk Perception, Hospital Infection Policy for COVID-19, Fear of COVID-19, Dental Anxiety, Perceived Stress, and Satisfaction with Life) Based on Demographic Factor (Age, Gender), Dental Procedure (Extraction and Root Canal Treatment; RCT) and Survey Group (Unlock 1.0); Restrained Confinement; (Unlock 2.0) Mild Confinement

Variable	Total	Gender		Age Group				Type of Dental Procedure		Survey Group		p (chi)*
		Male (%)	Female (%)	19–29 (%)	30–39 (%)	40–49 (%)	>50 (%)	Extraction (%)	RCT (%)	Unlock 1.0 (%)	Unlock 2.0 (%)
COVID-19 risk perception
Beyond cutoff of 60%	50.7	41.9	26.5	13.2	19.1	11.8	24.3	43.4	25	45.6	22.8	<0.001*
Dental hospital infection control policy for COVID-19
Beyond cutoff of 60%	72.1	40.4	31.6	15.4	23.5	11.0	22.1	51.5	20.6	27.9	44.1	<0.001*
Fear of COVID-19
Beyond cutoff of 47.14%	72.8	44.9	27.9	13.2	20.6	12.5	26.5	48.5	24.3	50.7	22.1	0.185
Dental anxiety
% Beyond cutoff 19	35.3	14.0	21.3	5.1	7.4	8.1	14.7	24.3	11.0	22.4	12.9	<0.001*
Perceived stress
Medium	50.7	23.5	27.2	8.8	14.7	7.4	19.9	30.9	19.9	16.2	34.6	<0.001*
High	40.4	14.7	25.7	8.8	12.5	6.5	12.5	33.1	7.4	34.6	5.9	0.016*
Satisfaction with life
Extremely dissatisfied	50.7	30.1	20.6	11.8	19.9	5.1	14.0	38.2	12.5	13.2	37.5	<0.001*

Notes: *p value was considered significant at <0.05 between survey group (unlock 1.0 and unlock 2.0), significance level analysis was performed through chi-square (chi) test. All significant values have been marked in bold text.

Figure 2 Difference [mean, standard deviation, effect size, and significance (p < 0.05)] in Unlock 1.0 and Unlock 2.0 for all the study variables: (A) COVID-19 risk perception; (B) hospital-infection-control-policy; (C) fear for COVID-19 (FCV-19); (D) dental anxiety; (E) perceived stress; (F) Satisfaction-with-life (SWL). [Std Dev: standard deviation; η² (effect size) which measures the strength of relationship between two variables].

Table 2 Summary Representation of Pearson Correlation of Significant Continuous Variables as Depicted in Figure 3

Variable	Fear for COVID-19	Dental Anxiety	Perceived Stress
COVID-19 risk perception	0.547**	0.550**	0.460**
Dental hospital infection control policy for COVID-19	−0.357**	−0.565**	−0.550**
Fear of COVID-19	1	0.689**	0.465
Dental anxiety	0.689**	1	0.752**
Perceived stress	0.465**	0.752**	1
Satisfaction with life	−0.254**	−0.338**	−0.482**

Note: **Correlation was significant at p value 0.001 level (two tailed).

Figure 3 Pearson correlation analysis of patients included in the study with all the study variables: COVID-19 risk perception; hospital-infection-control-policy; fear for COVID-19 (FCV-19); dental anxiety; perceived stress; satisfaction-with-life (SWL) in the survey group (A) Unlock 1.0 (restrained confinement); (B) Unlock 2.0 (partial confinement).

Note: Blue colour normal distribution (bell curve) depicts perfect positive correlation between two variables.

Table 3 Conditional Direct Model of Satisfaction with Life and Dental Hospital Infection Control Policy Through Fear of COVID-19 and Double Moderated Effect of Psychological Impact (Perceived Stress and Modified Dental Anxiety)

Effect	Coeff.	SE	t	95% Cl for Estimated Mean		p*	Coeff.	SE	t-test	95% Cl for Estimated Mean		p*
				LL	UL					LL	UL
	Perceived Stress Scale						Modified Dental Anxiety Scale
Constant	2.14	0.62	3.45	0.92	3.37	<0.00	1.80	0.86	2.09	0.09	3.51	<0.000
Fear of COVID 19 (X)	0.28	0.14	1.95	−0.00	0.56	<0.00	0.56	0.19	2.81	0.16	0.95	0.005
Dental Hospital Infection Control Policy (Mod 1)	−0.01	0.01	−0.53	−0.03	0.02	<0.00	−0.53	0.02	−2.43	−0.09	−0.01	0.010
Interaction 1 (X*Mod 1)	0.01	0.00	0.44	−0.01	0.01	<0.00	0.13	0.00	2.36	0.00	0.02	0.002
Satisfaction with Life (Mod 2)	−0.23	0.13	−1.77	−0.49	0.02	0.03	−0.15	0.18	0.84	−0.20	0.51	0.005
Interaction (X*Mod 2)	0.02	0.04	0.68	−0.05	0.10	0.02	−0.53	0.05	−1.05	0.15	0.04	0.004
Age	0.00	0.00	0.11	−0.00	0.00	<0.00	−0.01	0.01	0.63	0.05	0.024	0.002
Gender^a	0.01	0.05	0.25	−0.09	0.12	0.79	−0.61	0.49	1.23	1.58	0.365	0.218
Survey Group^b	−0.88	0.08	−1.91	−1.04	−0.72	<0.00	−0.99	0.84	−1.18	−2.64	0.662	0.237
	R^2 =0.66, F (8127) =102.93; p < 0.00						R^2 =0.75, F (8127) =92.84; p < 0.00

Notes: *p value was significant at <0.05. All significant values have been marked in bold text. ^aMale = 1, female = 2; ^bUnlock 1.0 =1, unlock 2.0 =2.

Abbreviations: SE, standard error; CI, confidence interval; LL, lower limit; UL, upper limit; DV, dependent variable.

Table 4 Conditional Indirect Model with Mediating Effects of COVID-19 Risk Perception and Double Moderating Effects of Satisfaction with Life and Survey Group Besides Perceived Stress as Dependent Variable

Effect	Coeff.	SE	t	95% Cl for Estimated Mean		p*	Coeff.	SE	t-test	95% Cl for Estimated Mean		p*
				LL	UL					LL	UL
	Survey Group						Perceived Stress (DV)
Constant	3.03	0.38	8.05	2.29	3.78	<0.00	1.62	0.42	3.88	0.79	2.44	<0.00
Fear of COVID-19 (X)	0.15	0.09	1.69	−0.03	0.32	<0.00	0.19	0.11	1.69	−0.03	0.41	0.01
COVID-19 Risk Perception (Med)							0.02	0.00	3.39	0.01	0.03	<0.00
Survey Group (Mod 1)
Interaction (X*Mod 1)	0.07	0.05	1.30	−0.04	0.18	<0.00
Satisfaction with life (Mod 2)							−0.26	0.11	−2.30	−0.48	−0.04	0.02
Interaction (Med*Mod 2)							0.04	0.03	1.46	−0.02	0.10	0.05
Age	0.001	0.004	0.46	−0.01	0.10	0.65	0.00	0.00	0.55	−0.01	0.01	0.19
Gender^a	0.07	0.14	0.48	−0.21	0.34	0.63	0.24	0.15	1.62	−0.05	0.53	0.11
	R^2 =0.63, F (2132) =103.9; p < 0.00						R^2 =0.39, F (2132) =112.90; p < 0.00

Notes: *p value was significant at <0.05. All significant values have been marked in bold text. ^aMale = 1, female = 2.

Abbreviations: SE, standard error; CI, confidence interval; LL, lower limit; UL, upper limit; DV, dependent variable.

Table 5 Conditional Indirect Model with Mediating Effects of COVID-19 Risk Perception and Double Moderating Effects of Satisfaction with Life and Survey Group Besides Dental Anxiety as Dependent Variable

Effect	Coeff.	SE	t	95% Cl for Estimated Mean		p*	Coeff.	SE	t-test	95% Cl for Estimated Mean		p*
				LL	UL					LL	UL
	Survey Group						Modified Dental Anxiety Scale (DV)
Constant	0.65	0.67	0.97	−0.68	1.99	0.033	0.27	0.61	0.77	0.14	1.49	0.006
Fear of COVID-19 (X)	0.88	0.16	1.60	0.57	1.20	0.000	0.81	0.16	4.98	0.49	1.14	0.000
COVID-19 Risk Perception (Med)							0.01	0.01	1.20	0.01	0.02	0.003
Group (Mod 1)
Interaction (X*Mod 1)	0.06	0.10	0.58	0.05	0.14	0.042
Satisfaction with Life (Mod 2)							0.08	0.17	0.17	0.06	0.30	0.030
Interaction (Med*Mod 2)							0.09	0.04	0.13	0.08	0.18	0.002
Age	0.00	0.00	−0.79	−0.01	0.00	0.43	0.00	0.01	−0.55	−0.01	0.01	0.59
Gender^a	−0.16	0.10	−1.64	−0.36	0.03	0.10	0.24	0.15	1.62	−0.05	0.53	0.11
	R^2 =69, F (2132) =59.01; p < 0.00						R^2 =0.39, F (2132) =28.44; p < 0.00

Notes: *p value was significant at <0.05. All significant values have been marked in bold text. ^aMALE = 1, female = 2.

Abbreviations: SE, standard error; CI, confidence interval; LL, lower limit; UL, upper limit; DV, dependent variable.