{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T14:16:08Z","timestamp":1778422568703,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,2,10]],"date-time":"2020-02-10T00:00:00Z","timestamp":1581292800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012095","name":"Scottish Government","doi-asserted-by":"publisher","award":["121.804485"],"award-info":[{"award-number":["121.804485"]}],"id":[{"id":"10.13039\/100012095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Comm Dent Oral Epid"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To test a theoretical mediation model and investigate whether drug use and\/or dental anxiety act as mediating factors between depression and dental decay experience among prisoners.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A cross\u2010sectional survey was conducted on a convenience sample of 300 prisoners across three prison establishments in Scotland. Depression and dental anxiety were measured using the Centre for Epidemiological Studies Depression Scale and the Modified Dental Anxiety Scale, respectively. Drug use was assessed using three yes (scoring 1)\/ no (scoring 0) questions: \u2018ever taken (illegal) drugs\u2019, \u2018injecting drugs\u2019 and \u2018ever participated in a rehabilitation programme\u2019. Participants had an oral examination to determine dental caries experience (missing [MT] and untreated decay [D<jats:sub>3cv<\/jats:sub>T]) in all four quadrants. Latent variable path analysis was conducted to test the mediation model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 342 prisoners participated, of which 298 yielded a complete data set. Depression was associated with missing teeth and untreated decay (D<jats:sub>3<\/jats:sub>T) through an indirect pathway (Total standardized indirect effects\u00a0=\u00a00.11, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) via drug use and dental anxiety (X<jats:sup>2<\/jats:sup> [71]\u00a0=\u00a089.8, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.07; Root Mean Square Error of Approximation: 0.03; Comparative Fit Index: 0.994 and Tucker\u2010Lewis index: 0.992). Twenty\u2010two percent of the variance in untreated decay and missing teeth was explained by both drug use and dental anxiety; however, the strongest predictor was drug use (total standardized direct effects\u00a0=\u00a00.45, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A relatively simple model to assist understanding dental decay experience of people in prison has been proposed. The data collected were consistent with our specified model. Drug use acted as the primary mediator and dental anxiety as a secondary mediator between depression and dental decay experience. Given the co\u2010morbidity between mental health and drug use and dental decay experience, an integrated or shared approach is proposed. We recommend that future research should concentrate on building a firmer picture by replicating and extending the framework presented.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cdoe.12522","type":"journal-article","created":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T02:20:30Z","timestamp":1581387630000},"page":"248-255","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Depression, drugs and dental anxiety in prisons: A mediation model explaining dental decay experience"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1722-0942","authenticated-orcid":false,"given":"Garima","family":"Arora","sequence":"first","affiliation":[{"name":"Dental Health Services Research Unit School of Dentistry University of Dundee Dundee UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4601-8834","authenticated-orcid":false,"given":"Gerry","family":"Humphris","sequence":"additional","affiliation":[{"name":"School of Medicine University of St Andrews St Andrews UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3457-4611","authenticated-orcid":false,"given":"Satu","family":"Lahti","sequence":"additional","affiliation":[{"name":"Department of Community Dentistry University of Turku Turku Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Richards","sequence":"additional","affiliation":[{"name":"Dental Health Services Research Unit School of Dentistry University of Dundee Dundee UK"},{"name":"Dental Public Health South East Scotland NHS Forth Valley Stirling UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-1253","authenticated-orcid":false,"given":"Ruth","family":"Freeman","sequence":"additional","affiliation":[{"name":"Dental Health Services Research Unit School of Dentistry University of Dundee Dundee UK"},{"name":"Public Health NHS Tayside Dundee UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,10]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"An Action Plan for Improving Oral Health and Modernising NHS Dental Services in Scotland","author":"Scottish Executive","year":"2005"},{"key":"e_1_2_7_3_1","unstructured":"Scottish Public Health Network (ScotPHN).Better health better lives for prisoners: a framework for improving the health of Scotland's prisoners.2012.https:\/\/www.scotphn.net\/wp-content\/uploads\/2015\/10\/A-framework-for-improving-the-health-of-Scotlands-prisoners-Volume-1.pdf. 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