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J Public Health Dent. 2015 Spring;75(2):134-41. doi: 10.1111/jphd.12081. Epub 2014 Dec 30.

Serious psychological distress as a barrier to dental care in community-dwelling adults in the United States.

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School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.



To examine whether serious psychological distress (SPD), a nonspecific indicator of past year mental health problems, was associated with subsequent dental care utilization, dental expenditures, and unmet dental needs.


We analyzed data from panel 13 thru 15 of the Medical Expenditure Panel Survey -Household Component (n=31,056). SPD was defined as a score of 13 or higher on the Kessler Psychological Distress Scale (K6). Logistic regression, zero-inflated negative binomial model, and generalized linear model (GLM) with a gamma distribution were used to test the study hypotheses.


Adults with SPD had, in the subsequent year, 35 percent lower odds of adhering to annual dental checkups and a twofold increase in the odds of having unmet dental needs. Although adults with SPD did not have significantly more dental visits than those without SPD, they spent 20 percent more on dental care.


SPD was a modest independent risk factor for lack of subsequent preventive dental care, greater unmet dental needs, and greater dental expenditures. In addition to expanding adult dental coverage, it is important to develop and evaluate interventions to increase the utilization of dental care particularly preventive dental services among people with mental illness in order to improve oral health and reduce dental expenditures among this vulnerable population.


dental care; health expenditures; mental disorders; psychological distress

[Indexed for MEDLINE]

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