From the beginning of COVID-19, its rapid outbreak and unknown nature have turned it into a new and critical research topic worldwide (1). This pandemic, as a global health crisis of our time, was considered as the greatest challenge humanity has encountered since World War II (2).

Research findings show that emergence of stressful stimuli at home, such as long-term fear of developing COVID-19 can cause permanent effects on individuals' mental health during the current pandemic (3–5). Due to the contagious nature of this disease, it turned into a pandemic throughout the world causing a high mortality rate as well as great concern and anxiety (6). In health crises and disease outbreaks, Dental staffs are at great risk since they are at forefront of the rapid response group. In early stages of the current pandemic, Dental staff accounted for 29% of all patients admitted to hospitals due to COVID-19 (7). Mental health problems in the Dental staff can cause attention loss, impede cognitive function, and disturb clinical decision-making (8, 9), leading to increased medical errors and accidents that can endanger patients' life (10–12). Dental staff, including the faculty members and students, are easily exposed to viral diseases, such as COVID due to face-to-face contact with patients and exposure to their saliva, blood, and body fluids, and use of sharp tools. Despite the exponential incidence and mortality rates of COVID-19, enough scientific evidences are not available on the psychological effects of this disease on dental staff. Therefore, the present study aimed to investigate the mental health status and death anxiety among the Dental staff and students with regard to COVID-19 outbreak. Our findings can be used by authorities to take appropriate educational, counseling, and treatment measures in order to reduce psychological complications caused by the disease, for this reason we to determine the mental health and death anxiety among dental staff and students in school of dentistry during COVID-19 pandemic.

The mean age of students and Dental staff was 23.96 ± 3.04 and 40.08 ± 5.82 years, respectively. The highest frequency of students was related to the third-year students (27%), while their lowest frequency was attributed to the first- and second-year students (4.3%). Furthermore, we found that variables of death anxiety and mental health status had no significant relationship with demographic variables (including age, gender, marital status, academic year, age groups, and province of residence) (Table 1).

Findings from comparisons between the study groups showed that death anxiety was higher in dental staff, while students were in better mental health status. The correlation coefficient between death anxiety and mental health status was 0.366 among students (p < 0.001), while it was 0.429 among dental staff (p < 0.001), showing a medium relationship between death anxiety and mental health in both groups (Table 2).

The present study aimed at determining the mental health status and death anxiety among the Dental staff and students during COVID-19 pandemic. In students, the mean score of death anxiety and mental health status was 6.02 and 14.78, respectively. In the Dental staff, the mean score of death anxiety and mental health status was 8.53 and 9.18, respectively. Higher scores of mental health status in students indicate their critical and inappropriate psychological condition.

The correlation coefficient between the two variables of death anxiety and mental health status was 0.366 among dental students (p < 0.001). Given the value of Spearman correlation coefficient (0.366), a strong significant correlation was found between death anxiety and mental health status among students. In line with these results, White et al. reported that people with high death anxiety had significantly higher levels of mental health status compared to people with low death anxiety (17). The correlation coefficient between death anxiety and mental health status was 0.429 among Dental staff (p < 0.001), showing a significant relationship between these two variables. The Spearman correlation coefficient value of −0.429 indicates a medium correlation between death anxiety and mental health status, but the negative sign indicates the inverse relationship of death anxiety score with mental health status in Dental staff. In other words, Dental staff with higher death anxiety scores had lower mental health status scores. The fact that death anxiety showed a significant negative relationship with mental health status implies that people who reported less psychological symptoms (such as stress) had higher death anxiety. This discrepancy may indicate that the etiology of death anxiety may have a variety of environmental, familial, biological, and social causative factors. In other words, some confounding variables may have played role in this correlation. These findings are consistent with other studies (18), but are different from those reported by Belsky et al., Stevens et al., and Masoudzadeh et al. (19–21). Among the most important reasons for students' anxiety, worrying about the effect of COVID-19 on their future education, future job status, and reduced social relationships can be mentioned (22). Anxiety in some students may be due to problems in providing university tuition caused by loss of financial resources followed by unemployment and job loss (23). Acute conditions of COVID-19 have also caused important psychological disorders such as mental health status, anxiety, and symptoms of mental disorders among Dental staff (24). The fact that Dental staff should stay away from their family members in the pandemic conditions may affect their mental health. Even in the case that Dental staff visit their family, they may experience extreme anxiety and fear about transmitting the disease to their family members (22). They can also develop similar psychological disorders caused by the fear of being infected by COVID-19 via patients and clients who refer to the health care centers (22, 24, 25).

Continuation of COVID-19 pandemic has exposed many people to death anxiety and low mental health status causing great concerns in the health care community. Consequently, scientific interventional programs are required to reduce psychological complications of COVID-19 among the Dental staff and students.

According to the findings, a significant but contradictory relationship was observed between mental health status and death anxiety among the Dental staff and students in COVID-19 pandemic. This indicates the impact of confounding factors in this area, which can be investigated by future researchers and planners to design health promotion interventions. Also, dental staff and students may receive less attention in the current high-risk situation under influence of the highly contagious COVID-19. Therefore, appropriate remote methods of psychotherapy should be applied via video conferencing and online programs using appropriate applications or even phone calls to treat anxiety, depression, and post-traumatic stress disorder among the Dental staff.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ahvaz Jundishapur University of Medical Sciences Ethics Committee. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

MC and KR were principal investigators of the study. MC and MS were advisors of the study. MJ was collected the data and drafted the manuscript. MC performed the statistical analysis. All authors contributed to the design, data analysis and assisted in the preparation of the final version of the manuscript, and read and approved the final version of the manuscript.

This study was as part of dissertation by Ms. Mahtab Jazaieri in School of Dentistry. This study was supported by Social Determinants of Health Research Center in Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (SDH-9906).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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