Understanding mental health Dental Asia speaks with Dr Adrian Loh , senior consultant psychiatrist at Promises Healthcare, to understand the determinants of mental health.
Could you share your background and expertise as a psychiatrist? Dr Loh: I am currently a psychiatrist at Promises Healthcare, working in the private sector. Before this, I worked for about fifteen years in the public sector, doing clinical work at the Institute of Mental Health, different psychiatry departments in restructured hospitals, and with the Singapore Armed Forces. I have also had the privilege to treat a handful of dentists as patients; beyond that, I have also had the opportunity to get to know many more as colleagues and had the chance to understand their unique concerns. Could you break down the determinants of mental health and how stress in the profession can contribute to poor mental health? Dr Loh: Mental health issues and stress in the dental profession have been increasingly recognised as significant concerns, driven by the intrinsically demanding nature of the job and exacerbated by recent global events such as the Covid-19 pandemic. National and international dental organisations have responded with initiatives aimed at addressing these growing concerns. Below is a breakdown of the determinants of mental health in dentistry and an explanation of how stress within the profession can contribute to poor mental health. Singapore is notorious for a fast pace of living, a country where your career helps to define you. With career advancement already firmly ensconced within our list of priorities for the average citizen, many tend to devote a good part of their waking hours to work, with less and less time being set apart for leisure and recreation. It makes sense, then, that we should look to the workplace as a concept just as deeply implicated in our happiness, or lack thereof, as home and family.
Multiple determinants of mental health in dentistry exist, such as work-related stress. Dentistry involves high-stakes work requiring precision and a deep understanding of complex procedures. The fear of making mistakes and the need to maintain a high level of concentration for long stretches of time are significant stressors. The demanding workload, including both clinical and administrative responsibilities, often leads to long hours and fatigue. Time pressure, especially in busy practices, can compromise the quality of care and increase stress levels. As it stands, many dentists are highly conscientious by nature and this personality trait can predispose them towards having exacting standards of themselves as well as their colleagues. Managing anxious or difficult patients is a common challenge that adds emotional strain to the dental practice. 1 This stress can contribute to burnout, especially when coupled with the fear of patient dissatisfaction and potential litigation. The financial aspects of running a dental practice, such as overhead costs and debt management, are significant stressors. The Covid-19 pandemic further exacerbated these pressures by reducing patient flow and increasing operational costs due to heightened infection control standards. Dentists may struggle to balance the demands of their practice with personal life, leading to work-life imbalance and neglect of personal health. This imbalance is a significant contributor to stress and burnout. The pandemic was also large with the introduction of new stressors, including the risk of viral exposure and the strain of adhering to new infection control protocols. 1 A post-pandemic survey of Welsh dentists found that one-third of participants increased their alcohol consumption frequency,
highlighting the detrimental coping mechanisms that can arise under prolonged stress. 2 These stresses can lead to poor mental health by influencing conditions such as burnout, anxiety depression or, in extreme cases, suicidal ideation. Heavy use of social media, for both personal and professional purposes, can also encourage users to develop an unhealthy habit of comparing their lives with others. Constant exposure to social media posts emphasising visible signs of success amongst peers may contribute to anxiety that they are not doing well enough. Dental professionals are vulnerable to burnout, characterised by emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. Burnout progresses through stages, starting with fatigue and emotional exhaustion and potentially leading to severe mental health issues like depression and anxiety. Fortunately, in Singapore, the reported prevalence of burnout is comparatively low. As seen in a survey published on Pubmed, overall, low to moderate levels of burnout were reported by the 210 survey respondents. 3 Since effective measures to prevent burnout exist, efforts should be made to implement these strategies and prevent any attrition due to burnout. Addressing these issues requires a concerted effort from dental organisations, beginning with dental schools and extending to major dental employers and professional bodies. These efforts should include increasing awareness, reducing stigma, and providing better access to mental health resources. The evidence strongly supports the need for proactive stress management strategies to safeguard the health and wellbeing of dental practitioners.
14 DENTAL ASIA SEPTEMBER / OCTOBER 2024
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