Childhood attachments relationship to dental anxiety and deprivation
Research type
Research Study
Full title
Is attachment style predictive of dental anxiety, its risk factors or its management? Is there a relationship between attachment style and deprivation or other demographic factors?
IRAS ID
321529
Contact name
Kirsty Skye Dickson
Contact email
Sponsor organisation
University of Edinburgh
Duration of Study in the UK
0 years, 3 months, 12 days
Research summary
The study aims to understand if a relationship exists between a child's attachment style and any dental anxiety they may experience. Childhood attachment theory was developed by Bowlby who relates a child perception/understanding of the world and their relationships, to their style of attachment to their parent/care giver. Attachment is seen as a Childs interest in close communication while feeling safe and feeling happy in an individual’s presence. Bowlby’s theory originated from an attachment study which classifies individuals in to the three categories of attachment: secure, insecure avoidant and insecure ambivalent. 60% of those studied displayed secure attachment; children were upset when the caregiver left the room, although they would be happy on their return. 20% displayed insecure avoidant attachment; children were initially not interested when the carer was in the room. When the carer left, they would not get upset upon their departure, and they would not be happy or excited on their return. The final 10-15% of children identified as insecure ambivalent attachment.
Dental anxiety is characterised by a physical and/ or emotional response to a perceived threat. Studies have shown a relationship between anxiety and attachment style; although, a link has yet to be investigated in a dental setting for children. It is important to understand where anxiety arises from and any factors which may lead to an increased chance of anxiety. This will help us plan treatment for patients and create methods of preventing dental anxiety.
This study will use two questionnaires to identify if, and what level of, dental anxiety a child presents with, alongside their attachment style. We will also collect routine data on their treatment, what diagnosis they presented with and demographic information (age, address, ethnicity). We will analyse deprivation and demographic factors for any link to attachment.
Lay summary of study results: Thirty-six participants, between the ages of 8-16 years, completed the study. Anxiety was measured using a questionnaire which classifies a child as having either dental anxiety (state anxiety) , severe phobia (severe dental anxiety) or no anxiety. The majority reported dental anxiety with 14% (5/36) reporting severe phobic disorder, 52% (19/36) reporting state anxiety and 34% (12/36) reporting no anxiety.
Attachment style was measured using a questionnaire which classifies participants into secure and insecure attachment. Insecure attachment includes both avoidant and anxious attachment styles. The majority of participants were classified as having secure attachment (58%), with 28% (10/36) reporting an avoidant attachment style and 14% (5/36) reporting an anxious attachment style. Participants were more likely to report dental anxiety if they had insecure attachment compared to secure attachment (80% vs. 57%, p=0.0407). Notably, every patient that reported severe phobic disorder also reported insecure attachment.
Poor prior experience-
Carers reported 21 (58.3%) participants had a poor prior experience.
Of the 24 (66%) who scored as having anxiety, 14 (58.3%) had a prior poor experience in the dental setting. Of the 12 (33%) who scored as having no anxiety, 5 (41.7%) had a poor prior experience in the dental setting.
Of the 21 (58%) who reported secure attachment, 13 (62%) reported a poor prior experience. Of the 15 (42%) who reported insecure attachment, 8 (53%) reported a poor prior experience.Deprivation-
The Scottish index of multiple deprivation was used to classify socioeconomic status. This rates every postcode into quintiles with those in quintile one being the most affluent and those in decile 5 being the least affluent.
SIMD results were: 9 participants (25%) were from SIMD 1, 7 (19%) were from SIMD 2, 9 (25%) were from SIMD 3, 5 (14%) were from SIMD 4 and 6 (17%) were from SIMD 5. The results for SIMD, attachment style and dental anxiety are displayed in table two. ANOVA was used to a significance level of p=0.05 and no statistically significant differences were seen.Conclusions-
The results show a higher level of dental anxiety and insecure attachment amongst the population referred to paediatric secondary care. Patients were more likely to report dental anxiety if they were found to display insecure attachment with socioeconomic status having no effect on the results. However, the small sample size requires further research in the field to understand the relationship between attachment and anxiety.REC name
London - South East Research Ethics Committee
REC reference
23/PR/0953
Date of REC Opinion
9 Oct 2023
REC opinion
Further Information Favourable Opinion