Associations between fear of COVID-19, dental anxiety, and psychological distress among Iranian adolescents

Objectives: To evaluate the association of fear of COVID-19 with dental anxiety, oral health-related quality of life (OHRQoL), and psychological distress (depression, anxiety, stress), and to examine the mediating role of dental anxiety in the association of fear of COVID-19 with OHRQoL and psychological distress among Iranian adolescents. Methods: Cross-sectional study of high-school adolescents in Qazvin, Iran (two-stage cluster sampling) using a self-administered survey assessing fear of COVID-19, depression, anxiety, stress, OHRQoL, and dental anxiety. Structural equation modelling (SEM) evaluated hypothesised associations and model fit. Results: 2,429 adolescents participated. The conceptual model fit the data well. Fear of COVID-19 had direct effects on dental anxiety (B=0.316; 95% CI=0.282, 0.349), depression (B=0.302; 95% CI=0.259, 0.347), anxiety (B=0.289; 95% CI=0.246, 0.334), stress (B=0.282; 95% CI=0.237, 0.328), and OHRQoL (B=−0.354; 95% CI=−0.530, −0.183). Dental anxiety mediated the association of fear of COVID-19 with depression, anxiety, stress, and OHRQoL. Conclusions: Higher fear of COVID-19 was associated with higher dental anxiety, greater psychological distress, and poorer OHRQoL. Dental anxiety also mediated the relationships between fear of COVID-19 and both psychological distress and OHRQoL.