The correlation of perceived stress and professional concerns during COVID-19 pandemic among Iranian dentists: the mediating role of cognitive flexibility

Afrooz Afshari, Seyedehsareh Hashemikamangar, Sedighe Sadat Hashemikamangar


Objective: To evaluate the association of perceived stress and dental work-related concerns regarding to COVID-19 by mediating role of cognitive flexibility among dentists during pandemic outbreak of COVID-19 in Iran.

Methods: This study was a cross sectional survey conducted by means of a confidential on-line survey on 174 Iranian dentists. COVID-19 related questions were divided to three parts: dentists’ perspective about their career future, virus contagion and concerns of getting infected COVID-19 from patients, and paucity of information and facilities to control the spread of the virus. Perceived stress and psychological flexibility were assessed by PSS (Cohen et al., 1983) and CFI (Dennis et al., 2010). To analyze data path analysis method was used.

Results: Perceived stress significantly predicted psychological flexibility (both alternatives and control subscales) and COVID-19 factors related to dental work In addition, control subscale significantly predicted dentists’ concerns toward their career future and fear of COVID-19 contagion. Hence, control subscale of cognitive flexibility mediated the relationship of perceived stress and professional concerns of dentists during COVID-19 pandemic.

Conclusion: Given these results, elevated stress during an infectious disease outbreak can effect (have impact on) perceived stress and professional concerns among dentists. Different aspects of dentists’ lives can be affected by those concerns and stress. Interventions to enhance the cognitive flexibility should be applied to reduce the psychological burden of the crisis for dentists.


COVID-19; dentists; professional concerns; perceived stress; psychological flexibility

Full Text:



Lu C-w, Liu X-f, Jia Z-f. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet (London, England). 2020;395(10224):e39.

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. International Journal of Oral Science. 2020;12(1):1-6.

Tsamakis K, Rizos E, Manolis AJ, Chaidou S, Kympouropoulos S, Spartalis E, et al. [Comment] COVID-19 pandemic and its impact on mental health of healthcare professionals. Experimental and Therapeutic Medicine. 2020;19(6):3451-3.

Huang L, Wang Y, Liu J, Ye PF, Cheng BC, Xu HY, et al. Factors Associated with Resilience Among Medical Staff in Radiology Departments During The Outbreak of 2019 Novel Coronavirus Disease (COVID-19): A Cross-Sectional Study. Medical Science Monitor. 2020;26.

Bohlken J, Schomig F, Lemke MR, Pumberger M, Riedel-Heller SG. COVID-19 Pandemic: Stress Experience of Healthcare Workers A Short Current Review. Psychiatrische Praxis. 2020;47(4):190-7.

Xu J, Xu QH, Wang CM, Wang J. Psychological status of surgical staff during the COVID-19 outbreak. Psychiatry Research. 2020 Jun;288:112955.doi: 10.1016/j.psychres.2020.112955. Epub 2020 Apr 11.

Balasubramanian A, Paleri V, Bennett R, Paleri V. Impact of COVID-19 on the mental health of surgeons and coping strategies. Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. 2020 Jul;42(7):1638-1644

Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance. 2020;25(5):2000062.

Jahić IM, Bukejlović J, Alić-Drina S, Nakaš E. Assessment of Stress among Doctors of Dental Medicine. Acta Stomatologica Croatica. 2019;53(4):354.

Stangvaltaite‐Mouhat L, Pūrienė A, Chałas R, Hysi D, Katrova L, Nacaite M, et al. Self‐reported psychological problems amongst undergraduate dental students: A pilot study in seven European countries. European Journal of Dental Education. 2020;24(2):341-50.

Salazar FBC, Sipiyaruk K, White S, Gallagher JE. Key determinants of health and wellbeing of dentists within the UK: a rapid review of over two decades of research. British dental journal. 2019;227(2):127-36.

Shacham M, Hamama-Raz Y, Kolerman R, Mijiritsky O, Ben-Ezra M, Mijiritsky E. COVID-19 Factors and Psychological Factors Associated with Elevated Psychological Distress among Dentists and Dental Hygienists in Israel. International Journal of Environmental Research and Public Health. 2020;17(8):2900.

Lazarus RS. Stress and emotion: A new synthesis. Springer Publishing Company; 2006 May 4.

Dennis JP, Vander Wal JS. The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research. 2010;34(3):241-53.

Gabrys RL, Howell JW, Cebulski SF, Anismana H, Matheson K. Acute stressor effects on cognitive flexibility: Mediating role of stressor appraisals and cortisol. Stress. 2019;22(2):182-9.

Crum AJ, Akinola M, Martin A, Fath S. The role of stress mindset in shaping cognitive, emotional, and physiological responses to challenging and threatening stress. Anxiety, stress, & coping. 2017;30(4):379-95.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of health and social behavior. 1983:385-96.

Safaei M, Shokri O. Assessing stress in cancer patients: Factorial validity of the perceived stress scale in Iran. IRANIAN JOURNAL OF PSYCHIATRIC NURSING (IJPN). 2014;2(1):13-22.

Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis (Vol. 6): Pearson Prentice Hall Upper Saddle River.

S Farrukh, W Hussain, ZS Siddiqui. Assessment of Anxiety among Healthcare Professionals Working on Frontline against COVID-19. Biomedica 2020 Vol. 36, Special Issue, 256 – 260


Copyright (c) 2021 Afrooz Afshari, Seyedehsareh Hashemikamangar, Sedighe Sadadat Hashemikamangar

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.