Associations of dental anxiety, depression, and general anxiety: A structural equation modeling study in the Northern Finland Birth Cohort 1986

We aimed to estimate the associations between anticipatory and treatment-related dental anxiety and depression and general anxiety at the latent level. This cross-sectional study analyzed data from 3320 adults aged 33-35 years in the Northern Finland Birth Cohort 1986. Dental anxiety was measured with the Modified Dental Anxiety Scale and general anxiety and depression with the Hopkins Symptom Checklist-25. Confirmatory factor analyses supported a two-factor model with a residual correlation for dental anxiety (comparative fit index [CFI] = 0.999, root mean square error of approximation [RMSEA] = 0.038). Structural equation modeling was used to estimate primary latent correlations between anticipatory dental anxiety, treatment-related dental anxiety, depression, and general anxiety. Secondary models adjusted for sex, education, and smoking. Depression and general anxiety correlated strongly (r = 0.72). Both anticipatory and treatment-related dental anxiety showed modest associations with general anxiety (r = 0.16-0.18), whereas associations with depression were weaker and attenuated after adjustment. The two dental anxiety constructs were strongly interrelated (r = 0.85). Female sex, lower education, and smoking predicted higher dental anxiety. These findings support the distinctiveness of the two constructs of dental anxiety from depression and general anxiety, though partly overlapping with the latter. Future research should further clarify their developmental pathways and shared mechanisms.