Multidimensional predictors of psychological distress in dental education: the mediating role of academic stress a structural equation modelling study with competing model specification
- 1Basic Medical Sciences, Department of Biostatistics and Medical Informatics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Türkiye Turkey
- 2Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Türkiye Turkey
- 3Faculty of Dentistry, Karadeniz Technical University, Trabzon, Türkiye Turkey
Abstract
Background: Dental students experience disproportionately high levels of psychological distress, with prevalence rates of clinically significant stress ranging from 22 to 50% across international samples. Academic stress has been identified as the primary mediating pathway through which sociodemographic and lifestyle factors influence mental health outcomes. However, it remains unclear whether psychological distress in dental students is better represented by a transdiagnostic mental distress construct or by disorder-specific measures such as GAD-7 within structural equation modelling frameworks. This study aimed to test a structural equation model (SEM) in which sociodemographic and lifestyle factors predict psychological distress through the mediating role of academic stress, and to compare a transdiagnostic Mental Distress model (Model 1) with a GAD-7 anxiety-specific model (Model 2).
Methods: A cross-sectional survey was administered to 303 dental students (years 1–5) in a Turkish dental school. Instruments included the Academic Stress Scale (ASÖ; 5 items), the GAD-7, and the DASS-21 (Depression and Anxiety subscales). Structural equation modelling was conducted in AMOS 24.0 with 5,000 bootstrap iterations and bias-corrected 95% confidence intervals.
Results: Both models demonstrated acceptable fit. Academic stress fully mediated the relationship between all examined predictors and psychological distress outcomes. Economic status emerged as the strongest predictor of academic stress, followed by gender and year of study. Poor sleep quality was associated with elevated academic stress. The competing model incorporating GAD-7 as an additional latent construct showed comparable fit, confirming the robustness of the mediation structure.
Conclusions: Academic stress acts as a central full mediator between modifiable and sociodemographic factors and psychological distress in dental students. The transdiagnostic model offers superior theoretical fit, while the GAD-7 model provides practical clinical utility for early screening. Interventions targeting economic support, sleep hygiene, and routine GAD-7 screening are recommended.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09957-3.
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BibTeX
@article{kalaycı2026multidimensional,
title = {{Multidimensional predictors of psychological distress in dental education: the mediating role of academic stress a structural equation modelling study with competing model specification}},
author = {Mehmet Erşan Kalaycı and Abdulrahman Neccaroğlu and Elsu Yaşar and Davut Çelik},
journal = {BMC Medical Education},
year = {2026},
month = jul,
doi = {10.1186/s12909-026-09957-3},
url = {https://doi.org/10.1186/s12909-026-09957-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Multidimensional predictors of psychological distress in dental education: the mediating role of academic stress a structural equation modelling study with competing model specification
AU - Mehmet Erşan Kalaycı
AU - Abdulrahman Neccaroğlu
AU - Elsu Yaşar
AU - Davut Çelik
PY - 2026
DA - 2026/07/31
JO - BMC Medical Education
DO - 10.1186/s12909-026-09957-3
UR - https://doi.org/10.1186/s12909-026-09957-3
AB - Background: Dental students experience disproportionately high levels of psychological distress, with prevalence rates of clinically significant stress ranging from 22 to 50% across international samples. Academic stress has been identified as the primary mediating pathway through which sociodemographic and lifestyle factors influence mental health outcomes. However, it remains unclear whether psychological distress in dental students is better represented by a transdiagnostic mental distress construct or by disorder-specific measures such as GAD-7 within structural equation modelling frameworks. This study aimed to test a structural equation model (SEM) in which sociodemographic and lifestyle factors predict psychological distress through the mediating role of academic stress, and to compare a transdiagnostic Mental Distress model (Model 1) with a GAD-7 anxiety-specific model (Model 2). Methods: A cross-sectional survey was administered to 303 dental students (years 1–5) in a Turkish dental school. Instruments included the Academic Stress Scale (ASÖ; 5 items), the GAD-7, and the DASS-21 (Depression and Anxiety subscales). Structural equation modelling was conducted in AMOS 24.0 with 5,000 bootstrap iterations and bias-corrected 95% confidence intervals. Results: Both models demonstrated acceptable fit. Academic stress fully mediated the relationship between all examined predictors and psychological distress outcomes. Economic status emerged as the strongest predictor of academic stress, followed by gender and year of study. Poor sleep quality was associated with elevated academic stress. The competing model incorporating GAD-7 as an additional latent construct showed comparable fit, confirming the robustness of the mediation structure. Conclusions: Academic stress acts as a central full mediator between modifiable and sociodemographic factors and psychological distress in dental students. The transdiagnostic model offers superior theoretical fit, while the GAD-7 model provides practical clinical utility for early screening. Interventions targeting economic support, sleep hygiene, and routine GAD-7 screening are recommended. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09957-3.
SN - 1472-6920
ER -