A longitudinal study on the mental health status of young and middle-aged orthodontic patients
DOI:
https://doi.org/10.2340/aos.v85.46107Keywords:
young and middle-aged, orthodontics, mental health, influencing factors, longitudinal studiesAbstract
Objectives: To assess the mental health trajectory and its influencing factors in young and middle-aged orthodontic patients.
Methods: In a longitudinal study, 154 patients were recruited from Nantong Stomatological Hospital (March 2023–October 2024). A 1:1 propensity score matching (PSM) control cohort was established to balance demographic characteristics. Data on general information, social support (Social Support Rating Scale), and psychological distress (Kessler 10 scale) were collected at eight time points from treatment initiation to 15 months. Mental health trajectories were analyzed using generalized estimating equations (GEE).
Results: The GEE model indicated a significant temporal trend in mental health scores (Wald χ² = 304.51, p < 0.001). Significant factors included female gender (β = 6.12, p < 0.001), student status (β = 2.18, p = 0.020), higher monthly household income (>10,000 RMB (China’s currency): β = –3.51, p < 0.001), higher education (Bachelor’s degree or above: β = –1.89, p < 0.001), unmarried status (β = 3.05, p = 0.010), severe malocclusion (Class III: β = 1.23, p = 0.018), and social support (β = –0.35, p < 0.001), which was a protective factor.
Conclusions: The mental health of young and middle-aged orthodontic patients follows a dynamic trajectory, associated with a combination of sociodemographic and clinical factors. Patients who are female, students, unmarried, or have severe malocclusion are at higher risk, whereas strong social support is protective. These findings highlight the need for timely psychological monitoring and personalized interventions for at-risk individuals throughout orthodontic care.
Downloads
References
World Dental Federation. From strictly aesthetics to an integral part of oral health: a brief history of orthodontics through the ages [Internet]. [cited 2022 Jun 2]. Available from: https://www.fdiworlddental.org/strictly-aesthetics-integral-part-oral-health-brief-history-orthodontics-through-ages
Egic B. Prevalence of orthodontic malocclusion in schoolchildren in Slovenia. A prospective a epidemiological study. Eur J Paediatr Dent. 2022;23(1):39–43.
Xin Z, Lei Z. To evaluate the effect of orthodontic micro-implants on dental aesthetics, oral structure and periodontal microenvironment in Class II malocclusion patients. Chin Med Cosmetol. 2024;14(5):73–6.
Xi W, Xie W. Negative emotional state and its relationship with perfectionism tendency in adolescents before orthodontic treatment. Int J Psychiatry. 2023;50(1):114–17.
Lei J, Yap AU, Zhang M, Fu KY. Temporomandibular disorder subtypes, emotional distress, impaired sleep, and oral health-related quality of life in Asian patients. Community Dent Oral Epidemiol. 2021;49(6):543–9. DOI: https://doi.org/10.1111/cdoe.12643
Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJ, et al. Braces versus Invisalign(R): gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health. 2015;15:69. DOI: https://doi.org/10.1186/s12903-015-0060-4
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72(3):341–8. DOI: https://doi.org/10.4088/JCP.10m06176blu
Liao C-S, Ye Y, Qian Z. Investigation of orthodontic demand and orthodontic anxiety level in workplace population [Internet]. J Tongji Univ. 2023;44(2):265–70. Available from:
Wen L. Investigation on influencing factors of dental anxiety in orthodontic patients and expression of salivary cortisol and SAA. HuNan: Hunan University of Chinese Medicine; 2023.
Pu D, Zhang S, Hu S, Zhang Y, Xiong X, Du S. Orthodontic patients with poor oral health-related quality of life are more likely to have emotional distress: a cross-sectional study. Patient Prefer Adherence. 2023;17:3047–56. DOI: https://doi.org/10.2147/PPA.S433076
Alanko O, Tuomisto MT, Peltomaki T, Tolvanen M, Soukka T, Svedstrom-Oristo AL. A longitudinal study of changes in psychosocial well-being during orthognathic treatment. Int J Oral Maxillofac Surg. 2017;46(11):1380–6. DOI: https://doi.org/10.1016/j.ijom.2017.05.004
Vulugundam S, Abreu LG, Bernabe E. Is orthodontic treatment associated with changes in self-esteem during adolescence? A longitudinal study. J Orthod. 2021;48(4):352–9. DOI: https://doi.org/10.1177/14653125211006113
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: an update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc. 2009;18(1):23–33. DOI: https://doi.org/10.1017/S1121189X00001421
Cheng-chao z, Jie C,Ting W,Qianqian P, Jiangjiang P, Wengui Zheng. To evaluate the reliability and validity of the Chinese version of the Kessler10. Chin J Clin Psychol. 2008;16(6):627–9.
Ding Y, Xu L, Wang X. Evaluation research on the Kessler10 scale in the mental health status of rural residents. Chin Health Serv Manage. 2009;26(09):632-633.
Shui X. The theoretical basis and research application of social support rating scale. J Clin Psychiatry. 1994;4(2):98-100.
Johal A, Alyaqoobi I, Patel R, Cox S. The impact of orthodontic treatment on quality of life and self-esteem in adult patients. Eur J Orthod. 2015;37(3):233–7. DOI: https://doi.org/10.1093/ejo/cju047
Roulias P, Vasoglou G, Angelopoulos G, Pandis N, Sifakakis I. Effect of aligners on patients’ oral health-related quality of life and anxiety: a prospective pilot study. BMC Psychol. 2024;12(1):346. DOI: https://doi.org/10.1186/s40359-024-01834-2
Cotrin P, Peloso RM, Oliveira RC, de Oliveira R, Pini N, Valarelli FP, et al. Impact of coronavirus pandemic in appointments and anxiety/concerns of patients regarding orthodontic treatment. Orthod Craniofac Res. 2020;23(4):455–61. DOI: https://doi.org/10.1111/ocr.12395
Ning H, Qin B. Analysis of stigma in patients with orthodontic treatment and its influencing factors [Internet]. J Nurs Admin. 2023;23(2):129–32. Available from: https://link.cnki.net/urlid/11.4716.C.20230413.1824.014
Medina M, Santos C, Lima BO, Ferreira MB, Normando D. Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study. Dental Press J Orthod. 2024;29(1):e242317. DOI: https://doi.org/10.1590/2177-6709.29.1.e242317.oar
Yang W, Xiong X, Wu Y, Zhu Y, Liu J, Ye C, et al. College students with oral habits exhibit worse psychological status and temporomandibular-related quality of life: a correlational study. Pain Res Manag. 2022;2022:6079241. DOI: https://doi.org/10.1155/2022/6079241
Santana LG, Gatti-Reis L, Paiva SM, Ramos-Jorge ML, Marques LS. Patient-centered factors associated with orthodontic treatment success: a scoping review. Braz Oral Res. 2025;39:e20. DOI: https://doi.org/10.1590/1807-3107bor-2025.vol39.020
Schmahl T, Steinhauser J, Goetz K. Association between orthodontic treatment and psychosocial factors in adolescents: a cross-sectional study. Eur J Orthod. 2024;47(1):cjae082. DOI: https://doi.org/10.1093/ejo/cjae082
Arvind PT, Jain RK. Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions – a systematic review and meta-analysis. Orthod Craniofac Res. 2021;24(1):52–61. DOI: https://doi.org/10.1111/ocr.12414
Ru H. Investigation and analysis of psychological status of patients with malocclusion. Gansu Med. 2024;43(1):27–9.
Yin H, Gao Z, Jia M, Jiang C, Wang Y, Xue D, et al. Diminished salivary cortisol response to mental stress predict all-cause mortality in general population. J Psychosom Res. 2025;189:112031. DOI: https://doi.org/10.1016/j.jpsychores.2024.112031
Nguyen T, Chung AM, Wu J, Rai R. Breaking the bamboo ceiling: empowering Asian pharmacy students for leadership. Curr Pharm Teach Learn. 2025;17(3):102227. DOI: https://doi.org/10.1016/j.cptl.2024.102227
Published
Issue
Section
License
Copyright (c) 2026 Xin-yun Miao, Ying Zhang, Bin Xiong, Meng-yao Liang
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
