Community Dent Oral Epidemiol 2014; 42; 451–459 All rights reserved

Ó 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

Impact of mood disorders on oral health-care utilization among middle-aged and older adults

Anjali Mago1 and Thankam P. Thyvalikakath2,3 1 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, 2Dental Informatics Core, Indiana University School of Dentistry, Indianapolis, IN, USA, 3Regenstrief Institute, Inc., Indianapolis, IN, USA

Mago A, Thyvalikakath TP. A population-based study of the impact of mood disorders on oral health-care utilization among middle aged and older adults in Canada. Community Dent Oral Epidemiol 2014; 42: 451–459. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Abstract – Background: Good oral health improves quality of life and is an integral part of active aging. Similar to some other systemic diseases, mood disorders are more prevalent in middle to older ages and have an associated risk of developing poor oral health. Consequently, people with mood disorders need to have regular dental care. There is scarce evidence in Canada linking mood disorders to the use of professional oral care services. The purpose of this study was to investigate the association between mood disorders and utilization of oral health-care services in a population-based sample of middle aged and older adults in Canada. Methods: Data were extracted from Canadian Community Health Survey – Healthy Aging, 2008. Multinomial logistic regression was used to investigate the association between mood disorders and oral care utilization, adjusted for the confounders. Results: Among 30 354 respondents included in our sample, 2162 (6.9%) reported having mood disorders. After adjusting for age, sex, education, marital status, and dental insurance status, the respondents who had mood disorders had a significant increased odds of not visiting a dental professional in the past year (OR:1.21, 95% CI: 1.08–1.35). The association of never visiting a dental professional and mood disorders was even stronger (OR: 1.49, 95% CI: 0.91–2.46). Conclusion: Mood disorders were found to have a strong association with underutilization of oral care services among aging adults of Canada. Given the associated poor oral health risks for elderly with mood disorders, oral health planners should strengthen the implementation of surveillance programs directed toward better oral health for this disadvantaged subpopulation.

Mood disorders are among the most common mental health problems worldwide and are diagnosed as depression, bipolar disorder, mania, or dysthymia (1). The World Health Organization reported that major depression will be the leading cause of disability adjusted life years worldwide in 2020 (2). The percentage of Canadians reporting diagnosed mood disorders rose from 5.3% in 2003 to 6.3% in 2009 (3). Currently, 10% of the Canadian population is affected by mood disorders (4). Further, the prevalence of mood disorders is reported to be doi: 10.1111/cdoe.12102

Key words: dental health; epidemiology; geriatrics; mood disorder; oral care utilization; public health policy Anjali Mago, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada Tel.: 604 822 2772 Fax: 604 822 4994 e-mail: [email protected] Submitted 7 March 2013; accepted 18 January 2014

higher in the 35–64 year age group than in the overall population, indicating the impact of aging on this disease (3). Mood disorders have a major effect on individuals, their families, the health-care system and the economy in the form of health-care utilization, economic valuation of work lost and health-related quality of life (1, 5). Mood disorders are also associated with other adverse health behaviors and health outcomes such as sleep and appetite disorders, irritability, daily fatigue, migraine, asthma,

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allergies, and suicide ideation (6–8). Persons with mood disorders are reported to have poor oral health due to the higher prevalence of some of the common risk factors for poor oral health such as smoking (9), neglected oral hygiene (10, 11), carbohydrate-rich diet (12), and drug and alcohol abuse (13). The relationship between mood disorders and poor oral hygiene suggests that there is a need of extended and frequent use of oral health-care services among this population (14, 15). A study performed in US reports that dental care services were utilized less frequently by people with mood disorders even though they were being treated in a clinical setting, as compared to the general population (11). To our knowledge, there are no populationbased studies examining oral health-care utilization among older Canadians with mood disorder. Our study is focused on aging population because the aging population is more vulnerable to mood changes and depression as an impact of factors associated with aging such as loss of loved ones, chronic diseases, and physical changes (16, 17). Given the fact that the Canadian population is aging at a fast rate (18) and a higher prevalence of mood disorders in the aging population, it becomes an important public health issue to explore it further. Oral health is imperative for successful aging, and it directly affects the quality of life in terms of healthy diet, appearance, and relationship to the systemic health (19–22). The Public Health Agency of Canada recently stated the crucial need for monitoring specialist health-care services received by people suffering from mood disorders (1). The purpose of the current study is to investigate the association between mood disorders and utilization of oral health-care services in a populationbased sample of aging adults in Canada. The long-term goal is to address the need for improved surveillance of health-care utilization among older Canadians with mental disorders and to improve oral health-care management.

Methods Brief description of data source Data for this study were extracted from the Canadian Community Health Survey – Healthy Aging (CCHS – HA), conducted by Health Statistics Division of Statistics Canada. The CCHS – HA was a focus content, cross-sectional survey that collected responses from persons aged 45 years and over liv-

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ing in private residences in the ten provinces of Canada (23). The information collected in this survey was related to health, social, and economic determinants that contribute to healthy aging. Residents living on three territories or remote regions, in Indian reserves or Crown lands, in institutions and full-time members of Canadian forces, were excluded from the sampling frame. Study-related ethics approval was covered by publically available data clause of the University of British Columbia’s policy #89 – Research and Other Studies Involving Human Subjects. CCHS – HA survey data were collected between December 2008 and November 2009. Computer-assisted personal interviewing was administered to 30 865 participants. For the CCHS – HA 2008–2009 survey, there was an overall response rate of 74.4%. A detailed description of sampling technique and survey methodology is accessible from Statistics Canada (23).

Analytic sample Our analysis is based on the data from public use microdata files that were developed to produce the most useful data possible at the provincial or regional level while ensuring the respondent confidentiality. Our sample included all the respondents to the aging survey. However, we excluded the participants’ data with missing or unknown values for the study variables. This exclusion criteria reduced the sample size from 30 865 to 30 354.

Study variables The outcome of interest was oral health-care utilization. Survey respondents were asked, ‘When was the last time you saw a dental professional?’ Available response categories were ‘

Impact of mood disorders on oral health-care utilization among middle-aged and older adults.

Good oral health improves quality of life and is an integral part of active aging. Similar to some other systemic diseases, mood disorders are more pr...
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