Attitudes toward Adolescent Mental Health Screening in a Dental Setting: A Mixed-Methods Study.

Introduction: Adolescents have experienced increasing levels of anxiety (AD) and depressive disorders (DD) in recent years. This study assessed the current attitudes of pediatric dentists and orthodontists on incorporating screenings for mental health disorders for their adolescent patients.

Methods: A sequential mixed-methods approach was used. A 35-item survey was sent to 5,538 pediatric dentists and orthodontists that included questions about attitudes and current screening practices for AD and DD. Multivariate logistic regression analysis was performed to examine factors associated with dentists' willingness to incorporate screening and discuss results with patients for AD and DD. Subsequently, we interviewed 16 orthodontists and pediatric dentists, conducted thematic analysis, and identified themes and subthemes.

Results: Based on 305 responses, >80% of respondents viewed screening for AD and DD as important, but <15% conducted screenings for them. Moreover, for those not screening, the odds of future screening for AD (odds ratio [OR]: 0.18, confidence interval [CI]: 0.08-0.43) and DD (OR: 0.23; CI: 0.09-0.56) were lower as the perceived importance of screening increased. Their willingness to screen for both AD (OR: 0.26, CI: 0.08-0.82) and DD (OR: 0.18, CI: 0.05-0.71) was also lower if they perceived this to negatively affect their patients' perception of them. The thematic analysis identified 3 main themes: (1) provider attitudes around mental health, (2) barriers to incorporating mental health screening, and (3) opportunities to integrate screening. Barriers included lack of training, access to mental health resources, and provider and patient stigma.

Conclusions: Our study showed that while most pediatric dentists and orthodontists understand the importance of screening their adolescent patients for AD and DD, many are unlikely to conduct screenings in the future. Obstacles such as inadequate training and stigma must be addressed for wider adoption. Further research and initiatives are crucial to tackle these challenges.

Knowledge transfer statement: The findings of this study offer insights to clinicians and policy makers into the attitudes, barriers, and facilitators among dentists-specifically pediatric dentists and orthodontists-who regularly treat adolescent patients, regarding mental health screenings for these individuals. This information can guide the development of initiatives, policy changes, and future research aimed at creating a more integrated dental care system that emphasizes the overall health of adolescent patients.