Mental Health, Socioeconomic Position, and Oral Health: A Path Analysis

Abstract

Introduction: Mental health conditions and poor oral health outcomes share bidirectional links, and both are linked to factors related to socioeconomic position (SEP). We used nationally representative survey data to describe the complex interplay of SEP, mental health, oral health behaviors, dental treatment seeking, and oral health.

Methods: We used data from the 2022 State of Oral Health Equity in America survey, which collects data from US adults on prior depression diagnosis and current depressive symptoms via the Patient Health Questionnaire-9 and demographic characteristics (age, sex/gender, race, ethnicity), SEP (education, income, employment, home ownership, dental insurance), oral health behaviors (brushing and flossing frequency), dental treatment seeking (time since last visit, plans for visit in the coming year), and self-rated oral health (feeling self-conscious due to poor oral health, having symptoms of poor oral health). We used structural equation modeling to identify latent variables and fit the path analytic models.

Results: In the total sample (N = 5,682), SEP was significantly associated with dental treatment seeking (standardized parameter estimate [SE] = 0.55 [0.05]), oral health behaviors (standardized parameter estimate [SE] = 0.34 [0.04]), and mental health (standardized parameter estimate [SE] = 0.59 [0.05]). These factors, in turn, were significantly associated with self-rated oral health (estimates ranging from 0.20 to 0.54, SEs ranging from 0.04 to 0.05).

Conclusion: SEP, which involves several major social determinants of health, is directly associated with mental health and indirectly associated with self-rated oral health status, with mental health modifying the relationship between SEP and self-rated oral health. Findings emphasize the need to integrate medical, dental, and behavioral health with the goal of providing comprehensive person-centered care.

Figure 1

Theoretical model of proposed pathways linking socioeconomic position, dental treatment seeking, oral health behaviors, mental health, and self-rated oral health with OHRQoL. Abbreviations: PHQ-9, Patient Health Questionaire-9; OHRQoL, oral health–related quality of life.

Figure 2

Final model with standardized parameter estimates of pathways linking socioeconomic position (SEP), dental treatment seeking, oral health behaviors, and mental health with self-rated oral health. Dotted lines indicate fixed parameter factor loading. Solid lines indicate predictive relationships between variables and that changes in the predictor variable are associated with changes in the outcome variable. Abbreviations: PHQ-9, Patient Health Questionaire-9; OHRQoL, oral health–related quality of life.