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Relationship between anxiety/depression and oral health-related quality of life in inpatients of convalescent hospitals

  • Kanako Hayashi
  • Maya Izumi
  • Yuhei Mastuda
  • Ayaka Isobe
  • Sumio AkifusaEmail author
Original Article


The aim of this study is to examin the association between anxiety/depressive tendency and oral health-related quality of life in inpatients of convalescent wards. This cross-sectional study included inpatients of convalescent wards (age range 34–100 years). Data on age, sex, functional independence measure, number of teeth, odontotherapy status, and primary disease for which hospitalization was required were collected. The Hospital Anxiety and Depression Scale (HADS) was used to assess emotional distress. The oral health-related quality of life was evaluated by the Geriatric Oral Health Assessment Index (GOHAI). Oral hygiene level was assessed by the Oral Health Assessment Tool (OHAT). We performed a multiple regression analysis to assess relationships among HADS, GOHAI, and OHAT. Following the analysis, causal connections of these factors were evaluated with structural equations modeling. The scores of GOHAI and OHAT in the caseness cohort (HADS score > 11) were significantly worse than those in the non-caseness cohort (HADS score < 7). Multiple regression analysis revealed that GOHAI was a statistically significant predictor of HADS score (p = 0.012), and that HADS and OHAT scores were predictors of GOHAI (p = 0.012 and < 0.001, respectively), adjusted by sex and age. We found that a model connected from OHAT to HADS through GOHAI was a good fit for the data of inpatients. Oral health-related quality of life, affected by oral hygiene status, was strongly associated with emotional distress in inpatients of convalescent wards. Daily oral care and assessment by healthcare professionals can reduce the emotional distress of inpatients in convalescent wards.


Convalescent care HADS GOHAI OHAT Oral care 



Functional independence measure


Geriatric (general) Oral Health Assessment Index


Hospital Anxiety and Depression Scale


Subscale for Anxiety of Hospital Anxiety and Depression Scale


Subscale for Depression of Hospital Anxiety and Depression Scale


Oral Health Assessment Tool



The authors thank two hospitals (Nishino hospital and Kokura rehabilitation hospital) for their cooperation in conducting this study.


This study was not supported by any funding agency.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

10266_2018_394_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 KB)


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Copyright information

© The Society of The Nippon Dental University 2018

Authors and Affiliations

  1. 1.School of Oral Health SciencesKyusyu Dental UniversityKitakyushuJapan
  2. 2.Department of Oral and Maxillofacial Surgery, Faculty of MedicineShimane UniversityIzumoJapan

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