Interactive Effects of COVID-19 Infection and Psychological Factors on Oral Health-Related Quality of Life in Myanmar

Background: The complex association between COVID-19 and psychological factors may significantly impact oral health, including oral health-related quality of life (OHRQoL). Despite their interconnected nature, literature regarding their collective impact on OHRQoL is limited.

Objective: This study aims to assess the independent and interactive effects of COVID-19 infection and psychological factors on OHRQoL.

Materials and methods: The cross-sectional study included 158 participants from a health centre in Yangon city. Participants were categorised into three groups based on their COVID-19 infection history, hospitalisation and oxygen supply: 'not experienced', 'experienced, non-hospitalised' and 'experienced, hospitalised'. Validated instruments, including Depression, Anxiety and Stress Scale-21 (DASS-21) to measure emotional states and the Oral Health Impact Profile-14 (OHIP-14) to assess OHRQoL, were employed. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, linear regressions and interaction analysis were computed.

Results: The median OHIP-14 score was 7.2. Among 85 confirmed COVID-19 cases, 38.8% (n = 33) received hospitalisation and oxygen supply. Multivariable regression analysis identified 'experienced, hospitalised' (95% CI: 6.36, 11.76), difficulty falling asleep (95% CI: 2.65, 7.18), depressive symptoms (95% CI: 7.38, 12.44), anxiety symptoms (95% CI: 2.93, 7.52) and stress symptoms (95% CI: 4.55, 11.11) as predictors of OHIP-14. Interaction analysis revealed their associations varied by hospitalisation history. In non-hospitalised individuals, depressive symptoms were positively interacted with OHRQoL (95% CI: 1.34, 9.02). Significant associations were observed between 'experienced, hospitalised' × 'depressive, anxiety and stress symptoms' and OHRQoL in both univariable and multivariable analyses.

Conclusion: A COVID-19 infection history and psychological distress significantly affect OHRQoL in Myanmar participants. Moreover, a strong interactive association was observed between hospitalisation during infection and symptoms of psychological distress.