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Assessment of stress burden among dental students: A systematic literature review and meta-analysis of data.

BACKGROUND
The education of dentists is associated with high levels of stress among students. This phenomenon is observed in many countries.


OBJECTIVES
The aim of the study was to sum up the knowledge about stress burden among dental students and to determine the causal factors on the basis of a quantitative systematic review of the literature.


MATERIAL AND METHODS
The PubMed/MEDLINE and Cochrane Library databases were reviewed, and the literature was manually searched for the following keywords: 'stress'; 'dental student'; 'dental education'; and 'DES questionnaire'. The inclusion criteria for the systematic literature review were original papers and literature reviews, published after 1990, written in English, containing the analysis of the DES questionnaires, and on the topic of stress among students of dentistry. The inclusion criteria for the meta-analysis were publications with the same thematic structure of the DES questionnaire and with the number of survey participants provided.


RESULTS
A total of 36 original papers were found, out of which 29 met the inclusion criteria, and thus were included into the systematic literature review analysis. Taking all the papers into consideration, the highest level of stress was caused by grades and examinations, and the atmosphere created by clinical professors. Nearly half of the studies demonstrated higher levels of stress in women. Also, students of higher years were characterized by higher stress indicators. The statistical analysis comprised data from 11 European universities that met the inclusion criteria. The highest mean scores were obtained for 'performance pressure', while the lowest mean scores for 'relationship with sex/race'.


CONCLUSION
There was a great heterogeneity among the pooled estimates, which could be attributed to the varying levels of stress among dental students. The students' ethnicity and cultural indicators have a decisive influence on the stress levels of dental students, not the characteristics of the field of study.