Perceived stress, coping styles and periodontitis: A cross cultural analysis

Background. Psychosocial factors such as stress, depression, feelings of hopelessness, and hostility are known to be associated with physical health. Similar associations have been believed to be true for stress and periodontal diseases as well.;Objectives. The purpose of this study was to explore the relationships between perceived stress and periodontal disease in samples of US and Syrian adults and to assess whether coping behaviors modify this relationship.;Methods. This cross-sectional study included 321 patients between 35-75 years of age in the dental clinics at the University of Michigan-School of Dentistry in Ann Arbor, MI., USA, and 311 patients (between 30-70 years of age) in the dental clinics at the University of Damascus, Syria. The subjects completed the Perceived Stress Scale (PSS) and the Brief Cope Scale. Periodontitis was assessed using clinical attachment level (CAL). Total PSS and Brief Cope were included in a logistic model to evaluate their relationship with periodontitis. Age, gender, smoking, and diabetes were used in regression models to control for confounding effects.;Results. The reliability coefficients and internal consistencies for all the subscales of the Brief Cope were moderate, with Cronbach's alpha ranging from 0.67 to 0.89 for the US sample and from 0.50 to 0.94 for the Syrian sample. Cronbach's alpha for the PSS was 0.86 and 0.76 for the US and Syrian samples respectively. Logistic regression analyses indicated that perceived stress was significantly associated with greater attachment levels for the Syrian and US samples (odds ratio, OR = 1.05; 95% CI = 1.01 to 1.09; OR = 1.06; 95% CI = 1.01 to 1.11, respectively) after adjusting for age, gender, diabetes, and cigarette smoking. Using stress as a categorical variable, only those respondents who used cognitive coping style were found to have greater odds of periodontitis when exposed to stress (OR = 5.34; p < 0.05, and OR = 10.84; p < 0.01 for the Syrian and US samples respectively).;Conclusions. These findings lead to the conclusion that perceived stress is moderately associated with periodontitis in both the Syrian and the US samples and that cognitive coping style moderate the relationship between stress and periodontitis.