A survey on stress, anxiety, depression and coping styles in dental undergraduates from 34 universities in China

BACKGROUND: Dental students face intense academic and clinical pressures, yet large-scale studies utilizing rigorous theoretical frameworks to evaluate their mental health remain limited in China. OBJECTIVE: This study aimed to investigate the prevalence of depression, anxiety, and stress among Chinese undergraduate dental students, identify key sociodemographic and experiential correlates, and evaluate the associations of coping styles with mental health outcomes using a Directed Acyclic Graph (DAG) framework. METHODS: Following STROBE guidelines, a national cross-sectional survey was conducted among 1,712 dental undergraduates from 34 universities across five geographic regions. Psychological distress was assessed via the DASS-21, and coping mechanisms via the SCSQ. Multivariable analyses were employed-specifically, multiple linear regression for continuous subscale scores and ordinal logistic regression for categorical severity levels-to identify factors independently associated with psychological morbidity. RESULTS: The prevalence of at-risk symptoms was 46.1% for anxiety, 36.0% for depression, and 24.4% for stress. Significant regional disparities were observed, with students in the Western region reporting the highest distress levels (Mean total score = 17.81 ± 10.59; p < 0.001). In multivariable models, suboptimal physical health emerged as the strongest factor independently associated with distress (β = 0.37; AOR = 3.71-4.44). While positive coping exhibited a significant inverse association with symptom severity (AOR = 0.87-0.92, p < 0.001), negative coping, poor college adaptation (β = -0.15), appearance dissatisfaction (β = -0.13), and excessive family interference were associated with significantly increased psychological burden. CONCLUSION: Chinese dental undergraduates experience a substantial burden of psychological distress, characterized primarily by anxiety and depression. This distress is disproportionately distributed, with students in Western China and those reporting suboptimal physical health emerging as particularly vulnerable. Positive coping strategies act as vital buffers associated with better mental health, whereas negative coping, body image dissatisfaction, and poor college adaptation are linked to increased psychological burden. Dental education institutions must implement targeted, evidence-based psychological support systems prioritizing these vulnerable cohorts.