Investigating the relationship between depression and oral health among adults in the United States, 2017-2020

Poor oral health and depression are prominent conditions among adults in the United States. To advance the widespread efforts to fully adopt person-centered care as the vehicle for optimal health, it is necessary to understand the relationship between oral health and mental health.

In this cross-sectional study, the authors used 2017-March 2020 prepandemic National Health and Nutrition Examination Survey data. The exposure was a 9-item depression screening instrument (Patient Health Questionnaire-9) categorized into depressive symptom severity. The dichotomized outcomes were needed oral health care in the past year but could not get it, difficulty with job due to mouth pain, and self-rated mouth health. Weighted adjusted logistic regression analysis produced odds ratio (OR) estimates and 95% CIs.

After adjusting for covariates of education, relationship status, health insurance, sex, age, race and ethnicity, general health, alcohol consumption, smoking, and diabetes, people with moderately severe through severe depressive symptoms had increased odds of needing oral health care in the past year but were unable to get it (OR, 2.09; 95% CI, 1.17 to 3.75; P = .01), having difficulty with their job due to mouth pain (OR, 2.61; 95% CI, 1.44 to 4.73; P = .002), or self-rating mouth health as negative (OR, 1.68; 95% CI, 0.96 to 2.03; P = .07) compared with those with none through minimal depressive symptoms.

Poor oral health outcomes that negatively interfered with daily functioning were associated with moderately severe through severe depressive symptoms. Understanding oral health at depression severity levels provides a path toward person-centered care intervention strategies and implementation.

Systemic correlations and identifying indications for poor oral health, especially among subgroups of the general populations, are vital for guiding public health strategies and appropriate allocation of funding and support to achieve health equity.