Oral Health-Related Quality of Life and Depression in Patients with Schizophrenia: The Mediating Roles of Oral Health Literacy and Oral Health-Related Self-Efficacy in a Cross-Sectional Structural Equation Analysis.

Abstract

Background: The factors affecting depression in schizophrenia are complex and diverse and have been well reported in the literature. However, few studies have investigated the relationship and potential mediating pathways between oral health-related quality of life (OHRQoL), internal protective factors of oral health such as oral health literacy (OHL) and oral health-related self-efficacy (OH-SE) and depression in patients with schizophrenia. This study adopts structural equation model (SEM) to explore the hypothesized model of the interrelationship among OHRQoL, internal protective factors of oral health and depression in patients with schizophrenia.

Methods: Patients with schizophrenia (n = 300) were conveniently recruited from a psychiatric hospital in China between September and November 2024, based on their availability and willingness to participate. Four validated self-report scales (Oral Health Impact Profile Scale (OHIP-14), Short-Form Health Literacy Dental Scale (HeLD-14), Self-Efficacy Scale for Self-Care (SESS), Self-Rating Depression Scale (SDS)) were used to collect data. We adopted SEM, mediation analyses and path analyses to explore the relationships among OHRQoL, OHL, OH-SE, and Depression.

Results: The hypothesized model demonstrated acceptable model fit parameters: χ²/df = 1.721 (P< 0.001), root mean square error of approximation (RMSEA) = 0.049 (90% CI, 0.035-0.062), comparative fit index (CFI) = 0.975, goodness of fit index (GFI) = 0.939, adjusted goodness of fit index (AGFI) = 0.914. OH-SE and OHL mediated the influence of OHRQoL on depression, including a chain mediating effect where OHRQoL influenced depression through both OH-SE and OHL sequentially. Additionally, OH-SE mediated the relationship between OHRQoL and OHL, while OHL also mediated the effect of OH-SE on depression.

Conclusion: This study provides novel evidence for the pathway OHRQoL → OH-SE → OHL → Depression. Clinicians may use this model as theoretical evidence to formulate targeted pathway-based interventions that enhance internal protective factors of oral health, which may improve OHRQoL while alleviating depressive symptoms, although causal inferences cannot be drawn from this cross-sectional study.