Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Gomaa, Noha

2nd Supervisor

Anderson, Kelly K.

Co-Supervisor

Abstract

Psychosocial factors may be a common pathway that increases the susceptibility to co-occurring oral health conditions and other non-communicable chronic conditions. This thesis aimed to investigate the role of psychosocial stress in the co-occurrence of oral health conditions and systemic chronic conditions. First, a scoping review was conducted which found psychosocial stress to be positively associated with both oral and other chronic diseases. Next, a cluster analysis of oral health and multimorbidity profiles was conducted which showed middle-aged and older Canadians to have varying health profiles based on their oral health and multimorbidity status. We also found that individuals with inadequate oral health and multimorbidity to be more likely to report experiencing psychological distress or adverse childhood experiences. Further research can be directed to better understand the contribution of factors of psychosocial stress to the co-occurrence of oral health and multimorbidity in Canadians over the life-course.

Summary for Lay Audience

As the number of adults aged 65 and older in our population continues to grow, the prevalence of oral disease and multimorbidity, or the co-existence of two or more chronic conditions, is also projected to increase, highlighting the importance of understanding the risk factors that contribute to the co-occurrence of these conditions around aging. Psychosocial stress has been shown to increase the risk of both oral diseases and other chronic conditions such as heart diseases and diabetes. However, the relationship between psychosocial stress and the co-occurrence of oral health conditions and multimorbidity is less understood. The overall aim of this thesis was to explore the role of psychosocial stress in the co-occurrence of oral health conditions and multimorbidity. The first study was a scoping review which compiled findings from 30 studies examining indicators of psychosocial stress and their relationship with oral and systemic diseases. Indicators of psychosocial stress included perceived stress, emotional distress, lifestyle conditions, childhood adversity, and the stress hormone cortisol. We found that high stress was associated with both oral and non-oral diseases. The majority of studies (70%) included only one systemic disease, and only one study investigated the role of childhood adversity. The second study used data from the Canadian Longitudinal Study on Aging (CLSA)—a Canada-wide, on-going cohort study of adults aged 45-85 years at the time of recruitment. In this cluster analysis, we identified five distinct groups of individuals based on their oral health and multimorbidity status. We found that individuals with poor oral health and/or high rates of multimorbidity were more likely to report experiencing psychological distress or adverse childhood experiences compared to participants with good oral health and low rates of multimorbidity. Further research is needed to fully understand how stress contributes to the co-occurrence of oral health conditions and multimorbidity among Canadians to help develop better strategies to prevent these health issues and promote overall well-being.

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