Mental Health, Socioeconomic Position, and Oral Health: A Path Analysis

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On the left-hand side of this figure, there are 5 rectangles, each with its own label: “home ownership,” “employment,” “education,” “household income,” and “dental insurance.” Immediately to the right of those 5 rectangles is an oval labeled “socioeconomic position.” From that oval are 5 arrows pointing left toward each of the 5 rectangles, showing that each of the 5 factors in those rectangles combine to create the variable of socioeconomic position. From the oval labeled “socioeconomic position” are 3 arrows pointing to 3 additional ovals, one labeled “dental treatment seeking,” one labeled “oral health behaviors,” and one labeled “mental health.” The oval labeled “dental treatment seeking” has 2 arrows pointing to 2 rectangles: one labeled “planned visit” and one labeled “last dental visit.” The oval labeled “oral health behaviors” has 2 arrows pointing to 2 rectangles, one labeled “floss” and one labeled “brush.” The oval labeled “mental health” has 3 arrows pointing to rectangles, one labeled “depression diagnosis,” one labeled “PHQ-9,” and one labeled “self-rated mental health.” The 3 ovals labeled “dental treatment seeking,” “oral health behaviors,” “and mental health” each have arrows pointing to the right toward a single oval labeled “self-rated oral health.” That oval, in turn, has an arrow pointing right toward another oval labeled “oral health related quality of life.” That oval, in turn, has arrows pointing to 2 rectangles: one labeled “self-conscious” and one labeled “number of missing permanent teeth.”

Figure 1.
Theoretical model of proposed pathways linking socioeconomic position, dental treatment seeking, oral health behaviors, mental health, and self-rated oral health with OHRQoL. Abbreviations: PHQ-9, Patient Health Questionaire-9; OHRQoL, oral health–related quality of life.

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On the left-hand side of this figure are 3 rectangles, labeled “household income,” “home ownership,” and “education.” In this figure, dotted arrows indicate fixed parameter factor loadings, while solid arrows indicate predictive relationships between variables, indicating the direction of causal influence. Immediately to the right of those 3 rectangles is an oval labeled “socioeconomic position.” There is a solid arrow pointing to the left from the “socioeconomic position” oval to the “household income” rectangle with a standardized parameter estimate label of 0.72. From the “socioeconomic position” oval to the “home ownership” rectangle, there is a dotted arrow pointing to the left with a standardized parameter estimate label of 0.47. From the “socioeconomic position” oval to the rectangle labeled “education,” there is a solid arrow pointing to the left with a standardized parameter estimate label of 0.56. From the “socioeconomic position” oval, there is a solid arrow pointing up and to the right toward an oval labeled “dental treatment seeking” with a standardized parameter estimate label of 0.55. From the “dental treatment seeking” oval, there is a solid arrow pointing up toward a rectangle labeled “planned visit” with a standardized parameter estimate label of 0.66. Also from the “dental treatment seeking” oval, there is a dotted arrow pointing up toward a rectangle labeled “last dental visit” with a standardized parameter estimate label of 0.91. From the “socioeconomic position” oval, there is an arrow pointing toward the right to another oval labeled “oral health behaviors”; this solid arrow has a standardized parameter estimate label of 0.34. The “oral health behaviors” oval, in turn, has a solid arrow pointing up toward a rectangle labeled “floss” with a standardized parameter estimate label of 0.51 and a dotted arrow pointing down to a rectangle labeled “brush” with a standardized parameter estimate label of 0.73. Lastly, from the “socioeconomic position” oval, there is a solid arrow with a standardized parameter estimate label of 0.55 pointing down and to the right toward an oval labeled “mental health.” This “mental health” oval, in turn, has a solid arrow pointing down and to the left to a rectangle labeled “PHQ-9” with a standardized parameter estimate label of 0.81, and a dotted arrow pointing down and to the right to a rectangle labeled “self-rated mental health” with a standardized parameter estimate label of 0.76. The 3 ovals labeled “dental treatment seeking,” “oral health behaviors,” “and mental health” all have solid arrows pointing to the right toward an oval labeled “self-rated oral health.” The arrow between “dental treatment seeking” and “self-rated oral health” has a standardized parameter estimate label of 0.25; the arrow between “oral health behaviors” and “self-rated oral health” has a standardized parameter estimate label of 0.20; and the arrow between “mental health” and “self-rated oral health” has a standardized parameter estimate label of 0.54. The oval labeled “self-rated oral health” has 3 arrows pointing to the right toward 3 rectangles labeled “self-conscious,” “symptoms of poor oral health,” and “self-rated oral health.” The dotted arrow between “self-rated oral health” and “self-conscious” has a standardized parameter estimate label of 0.71; between “self-rated oral health” and “symptoms of poor oral health” has a standardized parameter estimate label of 0.59; and between “self-rated oral health” and “self-rated oral health” has a standardized parameter estimate of 0.85.

Figure 2.
Final model with standardized parameter estimates of pathways linking socioeconomic position (SEP), dental treatment seeking, oral health behaviors, and mental health with self-rated oral health. Dotted lines indicate fixed parameter factor loading. Solid lines indicate predictive relationships between variables and that changes in the predictor variable are associated with changes in the outcome variable. Abbreviations: PHQ-9, Patient Health Questionaire-9; OHRQoL, oral health–related quality of life.

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