Relationship of stress, distress, and inadequate coping behaviors to periodontal disease
Relationship of stress, distress, and inadequate coping behaviors to periodontal disease
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DOI：
10.1902/jop.1999.70.7.711
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发表时间：
1999-07-01
影响因子：
4.3
通讯作者：
Tedesco, LA
中科院分区：
文献类型：
--
作者：
Genco, RJ;Ho, AW;Tedesco, LA
背景资料：协会的压力，痛苦，应对行为与牙周diseases.Methods：一个横断面研究的1,426名受试者之间的年龄为25和74岁的伊利县，纽约，进行了评估这些关系。受试者被要求完成一套5心理社会问卷，测量心理特征和态度，包括离散的生活事件及其影响;慢性压力或日常紧张;苦恼;应对方式和策略;和麻烦和提升。对龈上菌斑、牙龈出血、龈下牙石、探诊深度、临床附着水平（CAL）和X线牙槽嵴高度（ACH）进行临床评估，并对龈下植物群中的8种假定细菌病原体进行测量。所有分量表在所用工具上的受试者回答和内部检验的信度都很高，Cronbach的α值范围从0.88的财务压力到0.99的工作压力，提升和麻烦。Logistic回归分析表明，在调整年龄、性别和吸烟后，在所有日常应变调查中，只有经济应变与更大的附着和牙槽骨丢失显著相关（比值比，OR = 1.70，95%CI = 1.09至2.65和OR = 1.68，95%CI = 1.20至2.37）。当评估应对行为时，发现那些经济压力更大的人是高情绪集中的应对者，（一种应对不足的形式）有更高的风险有更严重的依恋丧失（OR = 2.24，95%CI = 1.15 ~ 4.38）和牙槽骨丢失（OR = 1.91，95%CI = 1.15 ~ 3.17），调整年龄、性别、和吸烟。在AL（OR = 2.21，95%CI = 1.11 ~ 4.38）和ACH（OR = 2.12，95%CI = 1.28 ~ 3.51）的低问题关注型患者中发现了类似的结果。然而，高水平的经济压力谁报告了高水平的问题为基础的应对（被认为是足够或良好的应对）没有更多的牙周病比那些低水平的财政紧张，这表明压力对牙周病的影响可以缓和适当的应对行为。结论：我们发现，与经济紧张和痛苦相关的心理社会压力指标表现为抑郁，在年龄调整模型中，性别（男性）、吸烟、糖尿病、B.牙龈卟啉单胞菌和牙龈卟啉单胞菌也是重要的风险指标。相当有趣的是，充分的应对行为，如高水平的问题为基础的应对，可以降低压力相关的风险。还需要进一步的研究来帮助建立压力、痛苦和应对不足与牙周病发病和进展的时间过程，以及解释这种关联的机制。
Background: The association of stress, distress, and coping behaviors with periodontal disease was assessed.Methods: A cross-sectional study of 1,426 subjects between the ages of 25 and 74 years in Erie County, New York, was carried out to assess these relationships. Subjects were asked to complete a set of 5 psychosocial questionnaires which measure psychological traits and attitudes including discrete life events and their impact; chronic stress or daily strains; distress; coping styles and strategies; and hassles and uplifts. Clinical assessment of supragingival plaque, gingival bleeding, subgingival calculus, probing depth, clinical attachment level (CAL) and radiographic alveolar crestal height (ACH) was performed, and 8 putative bacterial pathogens from the subgingival flora measured.Results: Reliability of subjects' responses and internal consistencies of all the subscales on the instruments used were high, with Cronbach's alpha ranging from 0.88 for financial strain to 0.99 for job strain, uplifts, and hassles. Logistic regression analysis indicated that, of all the daily strains investigated, only financial strain was significantly associated with greater attachment and alveolar bone loss (odds ratio, OR = 1.70, 95% CI = 1.09 to 2.65 and OR = 1.68, 95% CI = 1.20 to 2.37, respectively) after adjusting for age, gender, and cigarette smoking. When coping behaviors were evaluated, it was found that those with more financial strain who were high emotion-focused copers (a form of inadequate coping) had a higher risk of having more severe attachment loss (OR = 2.24, 95% CI = 1.15 to 4.38) and alveolar bone loss (OR = 1.91, 95% CI = 1.15 to 3.17) than those with low levels of financial strain within the same coping group, after adjustment for age, gender, and cigarette smoking. Similar results were found among the low problem-focused copers for AL (OR = 2.21, 95% CI = 1.11 to 4.38) and ACH (OR = 2.12, 95% CI = 1.28 to 3.51). However, subjects with high levels of financial strain who reported high levels of problem-based coping (considered adequate or good coping) had no more periodontal disease than those with low levels of financial strain, suggesting that the effects of stress on periodontal disease can be moderated by adequate coping behaviors.Conclusions: We find that psychosocial measures of stress associated with financial strain and distress manifest as depression, are significant risk indicators for more severe periodontal disease in adults in an age-adjusted model in which gender (male), smoking, diabetes mellitus, B. forsythus, and P gingivalis are also significant risk indicators. Of considerable interest is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studies also are needed to help establish the time course of stress, distress, and inadequate coping with respect to the onset and progression of periodontal disease, and the mechanisms that explain this association.