Relationship of stress, distress, and inadequate coping behaviors to periodontal disease

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 a nd 74 years in Erie County, New York, was carried out to assess these relat ionships. Subjects were asked to complete a set of 5 psychosocial questionn aires which measure psychological traits and attitudes including discrete l ife events and their impact; chronic stress or daily strains; distress; cop ing styles and strategies; and hassles and uplifts. Clinical assessment of supragingival plaque, gingival bleeding, subgingival calculus, probing dept h, clinical attachment level (CAL) and radiographic alveolar crestal height (ACH) was performed, and 8 putative bacterial pathogens from the subgingiv al flora measured. Results: Reliability of subjects' responses and internal consistencies of a ll the subscales on the instruments used were high, with Cronbach's alpha r anging from 0.88 for financial strain to 0.99 for job strain, uplifts, and hassles. Logistic regression analysis indicated that, of all the daily stra ins investigated, only financial strain was significantly associated with g reater 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 adjus ting for age, gender, and cigarette smoking. When coping behaviors were eva luated, it was found that those with more financial strain who were high em otion-focused copers (a form of inadequate coping) had a higher risk of hav ing more severe attachment loss (OR = 2.24, 95% CI = 1.15 to 4.38) and alve olar bone loss (OR = 1.91, 95% CI = 1.15 to 3.17) than those with low level s of financial strain within the same coping group, after adjustment for ag e, 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 (O R = 2.12, 95% CI = 1.28 to 3.51). However, subjects with high levels of fin ancial strain who reported high levels of problem-based coping (considered adequate or good coping) had no more periodontal disease than those with lo w levels of financial strain, suggesting that the effects of stress on peri odontal disease can be moderated by adequate coping behaviors. Conclusions: We find that psychosocial measures of stress associated with f inancial strain and distress manifest as depression, are significant risk i ndicators 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 interes t is the fact that adequate coping behaviors as evidenced by high levels of problem-based coping, may reduce the stress-associated risk. Further studi es also are needed to help establish the time course of stress, distress, a nd inadequate coping with respect to the onset and progression of periodont al disease, and the mechanisms that explain this association.