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Park, Sohn, Lee, Jin, Lee, and Kim: The mediation effects of psychological factors in the relationship between mouth dryness and oral health related quality of life
Original Article

J Korean Acad Oral Health 2014;38(1):31-40.

Published online: 12 March 2014

DOI: https://doi.org/10.11149/jkaoh.2014.38.1.31

The mediation effects of psychological factors in the relationship between mouth dryness and oral health related quality of life

Hee-Jung Park1, Minsung Sohn1, Jun Hyup Lee1, Bo-Hyoung Jin2, Sophia Lee3, Tae-Il Kim3

1BK21Plus Program in Public Health Sciences, Department of Health Sciences, Korea University Graduate School, Seoul, Korea

2Department of Preventive & Social Dentistry, Seoul National University School of Dentistry, Seoul, Korea

3Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea

Corresponding Author: Tae-Il Kim Department of Periodontology, School of Dentistry, Seoul National University, 28 Yeongun-dong, Jongro-gu, Seoul 110-749, Korea Tel: +82-2-2072-2642 Fax: +82-2-744-1349 E-mail: periopf@snu.ac.kr

Received 10 January 2014       Revised 12 February 2014       Accepted 26 March 2014

Copyright © 2014 Journal of Korean Academy of Oral Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The aim of this study was to investigate the role of psychological factors as mediators in the casual relationship between mouth dryness and oral health-related quality of life of adults and to explore gender differences in what psychological factors play an important role in mediating the path of mouth dryness to quality of life.

Methods

Self-administered questionnaires were distributed to 321 adults who are above 20 and under 65 years of age. Collected data were analyzed via statistical packages using a multi-group analysis through the SEM (Structural Equation Model).

Results

Based on the statistical analysis, stress was a major psychological factor in male subjects. While depression served as a main mediator in female subjects. We discovered that the path coefficients of the following paths showed significant gender differences: mouth dryness → depression, depression → quality of life, stress → quality of life.

Conclusions

A gender-specific approach regarding effective prevention of stress and depression may be important for understanding the relationship between mouth dryness and quality of life.

Keywords: Depression, Mouth dryness, Oral health, Quality of life, Stress

References

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Fig. 1.
Structural model based on estimation of standardized path coefficients in male. *P<0.05, **P<0.01, ***P<0.001. †Solid lines=significant direct effect, Dashed line=no significant direct effect. ‡OHIP-14, Oral Health Impact Profile.
jkaoh-38-31f1.tif
Fig. 2.
Structural model based on estimation of standardized path coefficients in female. *P<0.05, **P<0.01, ***P<0.001. †Solid lines=significant direct effect, Dashed line=no significant direct effect. ‡OHIP-14, Oral Health Impact Profile.
jkaoh-38-31f2.tif
Table 1.
Descriptive statistics of variables by gender (N=321)
Variables Male (N=103) Female (N=218) Total (N=321)
N (%) N (%) N (%)
Age (yr)
Mean (SD) 37.67 (11.58) 39.46 (11.47) 38.88 (11.52)
Obtained range: 20-64 (yr)
Education Attainment
≤High school 18 (17.5) 65 (29.8) 83 (25.9)
≥College 85 (82.5) 153 (70.2) 238 (74.1)
Economic activity
Currently working (Employment) 44 (42.7) 123 (56.4) 167 (52.0)
Self-employed/ employer 26 (25.2) 22 (10.1) 48 (15.0)
Unpaid family worker 3 (2.9) 10 (4.6) 13 (4.0)
Unemployment 1 (1.0) 2 (0.9) 3 (.9)
Student 29 (28.2) 18 (8.3) 47 (14.6)
Full-time housewife - 43 (19.7) 43 (13.4)
Marital status
Not married 50 (48.5) 88 (40.4) 138 (43.0)
Married 49 (47.6) 115 (52.8) 164 (51.1)
Divorced/seperation/widowed by death 4 (3.9) 15 (6.9) 19 (5.9)
Table 2.
Means, standard deviations (SD), and ranges for study model variables
Variables Mean SD Range
Mouth dryness 19.44 10.87 6-66
Depression 32.93 8.79 23-77
Stress 53.34 5.26 18-71
OHIP-14 24.44 8.50 14-61

*OHIP-14, Oral Health Impact Profile.

Table 3.
Evaluation of the overall fit of model
Fit indices χ 2 df P-value GFI TLI CFI RMSEA
Value 332.341 79 0.000 0.897 0.912 0.933 0.090
Recommended value 0.05 ≥0.9 ≥0.9 ≥0.9 ≤0.08

*df, degree of freedom; GFI, goodness of fit index; CFI, comparative fit index; RMSEA, root mean square error of approximation.

Table 4.
Indirect effect of the model
Paths Male Female
Indirect effect P-value Indirect effect P-value
Mouth dryness → Depression → OHIP-14 - - 0.101 0.035
Mouth dryness → Stress → OHIP-14 .111 0.016 - -

*Bootstrap two tailed significant test.

† OHIP-14, Oral Health Impact Profile.

Table 5.
Mediator effect of the model
Paths Male Female
Z P-value Z P-value
Mouth dryness → Depression → OHIP-14 - - 3.016 0.003
Mouth dryness → Stress → OHIP-14 3.150 0.002 - -

*Z=Sobel coefficient.

† OHIP-14, Oral Health Impact Profile.

Table 6.
Measurement invariance of unconstrained and constrained models
Fit indices Model fit
χ 2 df P-value CFI RMSEA
Unconstrained 418.752 132 0.000 0.914 0.083
Measurement weights 426.055 142 0.000 0.915 0.079
Recommended value P<0.05 ≥.90 ≤.08

*CFI, comparative fit index; RMSEA, root mean square error of approximation.

† Significant level: ∆χ

2 >18.307/df=10.

Table 7.
Gender difference in multi-group analysis of various paths
Path Constrained β χ 2 df ∆χ 2/df
Unconstrained Model Male Female 418.752 132
Mouth dryness OHIP-14 → 0.426 0.503 419.152 133 0.400
Mouth dryness Depression → 0.148 0.492 423.473 133 4.721*
Mouth dryness OHIP-14 → ―0.113 0.264 424.602 133 5.850*
Mouth dryness Stress → 0.301 0.483 418.818 133 0.066
Mouth dryness OHIP-14 → 0.425 ―0.049 427.393 133 8.641*

*Significant level: ∆χ

2 >3.84/df=1.

† β: standardized coefficients.

‡ OHIP-14, Oral Health Impact Profile.

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