JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 58, NO.
Depressive Symptoms, Stress, and Social
Support Among Dental Students at a
Historically Black College and University
Brian Laurence, DDS, PhD; Carla Williams, PhD; Derrick Eiland, DDS
Abstract. Objective: The authors measured the prevalence of
depressive symptoms among dental students at a historically black
college in the United States to determine how depressive symp-
toms, stress, and social support influence each other within this
student population. Participants: Dental students (n = 143) com-
pleted a self-administered survey to assess depressive symptoms,
stress, and social support, using validated and reliable instruments.
Participants also reported demographic variables. Methods: The
authors used multivariable linear regression controlling for poten-
tial confounding. Results: The prevalence of depressive symptoms
was 16.7%. There were significantly higher levels of stress for
students with depressive symptoms compared with those without
A
such symptoms (p < .01), and students with depressive symptoms
had significantly lower levels of social support (p < .01). Results
show higher levels of depressive symptomatology to be related
to decreased social support at both high and low stress levels
(p < .01). Conclusions: Stress and social support are associated
with depressive symptoms among dental students.
Keywords: dental, depression, mental health, social support,
stress, students
N
umerous studies have shown that dental students
have higher levels of stress and mood disturbance
than the general population.1–9 In the general popu-
lation, major depressive disorder is reported among 4.7% of
18–25 year olds and 4.4% of 25–34 year olds.10 In contrast,
nearly 19% of college students report experiencing depres-
sive symptoms during the past 12 months, and 15% report
experiencing depressive symptoms substantial enough to
Dr Laurence is Assistant Dean for Research in the Department
of Restorative Services, College of Dentistry, at Howard University
in Washington, DC. Dr Williams is an assistant professor with the
Cancer Center, Department of Medicine, at Howard University.
Dr Eiland is an assistant professor with Oral and Diagnostic
Services, College of Dentistry, at Howard University.
Copyright © 2009 Heldref Publications
56
impair academic performance.11 Nearly one-third of col-
lege and university students report that stress has adversely
affected their academic performance.11 The social, academ-
ic, and financial demands of higher education may result
in high levels of stress that eventually lead to depression in
some students.
Studies to date have suggested that dental students, along
with medical and other graduate or professional students,
may be at an elevated risk for depression and depressive
symptoms, compared with the general population.12–19 In
a survey of 453 graduate and professional students, 25%
reported elevated depressive symptoms.13 Specific stressful
events and their sequelae account for much of the relation-
ship between stress and depression or stress and depressive
symptoms.20 Students may be especially prone to the onset
of depressive symptoms resulting from specific events. For
example, a poor grade on an exam may increase pressure
to meet high academic standards, decrease self-esteem, and
prompt reduction in time spent in recreational activity. The
resulting isolation and negative self-image may increase the
risk for depressive symptoms.
Increased academic pressure and financial concerns
are common precipitants of depressive symptoms among
medical students,21,22 and dental students likely experience
similar reactions to school-related stress. Among dental
students, issues such as exams, fear of falling behind in
coursework, shortage of clinical time, and career uncer-
tainty are common sources of stress.7 Dental student stress
levels tend to increase with each successive year of study,
and stress levels have been associated with higher levels of
psychological distress.7
Research has demonstrated a link between increased
prevalence of depressive symptoms and reduced academic
performance among both medical and undergraduate uni-
versity students.23–25 Depression is likely to have similarly

adverse effects on academic productivity in dental students.
Despite the importance of the impact of depression on
student well-being and academic performance, only a few
studies have specifically examined the prevalence of depres-
sive symptoms among dental students.3,13,15,26
Newbury-Birch and colleagues conducted a longitudinal
study of dental students in the United Kingdom that demon-
strated that changes in academic demands were associated
with changes in the levels of depressive symptoms.15 Among
men, the rates of elevated depressive symptoms increased
from 6.2% among second-year students to 11.5% by the time
those students were reevaluated during their final year of
study. However, after 1 year of working as qualified dentists,
elevated symptoms were not observed in any of the male
respondents. Similarly, elevated depressive symptoms were
found among 19.4% of female students during their second
year of study and in 16.7% of female students in their final
year of study. However, after 1 year of practice, only 4.2%
of female respondents still demonstrated elevated depressive
symptoms. Thus, there are clearly aspects of the rigorous
clinical and academic demands of dental school that place
students at risk for increased depressive symptoms.
In addition to understanding the risk of depression in
dental students, it is important to gain an understanding of
how other psychosocial factors could modify or otherwise
influence the levels of depressive symptoms in dental stu-
dents. The prevalence of depression and depressive symp-
toms is higher among those students who report lower
levels of social support.27 Studies have shown that reduced
social support and increased stressful life circumstances
can affect the progression of depressive symptoms, but
the manner in which these variables interact is not clearly
understood.28–31 Although lack of social support has been
identified as an independent risk factor for depression,
social support has also been shown to have a buffering
effect among university students.32
The benefits of social support may be particularly impor-
tant for student populations, because students typically
share many common concerns and experiences related to
academic life. Social support from peer groups may be
especially important for buffering the effects of school-
related stressors.
To date, only 1 study has examined how depression, stress,
and social support may influence each other among dental
students, but this study was limited by a small sample size
(n = 40) and did not focus on dental students, but on gradu-
ate and professional students as a whole.13 Therefore, our
primary aims in the present study were the following: (1) to
measure the prevalence of depressive symptoms among den-
tal students at a historically black college/university (HBCU)
in the Northeast, and (2) to determine how depressive symp-
toms, stress, and social support influence each other within
this student population. We hypothesized the following: (1)
dental students at an HBCU will have a higher prevalence
of depressive symptoms compared with the general Afri-
can American population, (2) dental students with a higher
prevalence of depressive symptoms will have higher levels
VOL 58, JULY/AUGUST 2009
Depressive Symptoms at a Historically Black Dental College
of stress compared with dental students who do not have an
increased prevalence of depressive symptoms, and (3) dental
students with a higher prevalence of depressive symptoms
will have lower levels of social support compared with dental
students who do not have an increased prevalence of depres-
sive symptoms. As a secondary exploratory aim, we sought
to examine whether the buffering hypothesis,33,34 which sug-
gests that social support is related to depressive symptoms
only for those participants experiencing high levels of stress,
is supported in this student population.
METHODS
Participants
This study was based on analyses of cross-sectional data
collected from October 2007 to December 2007. Students
from years D1–D4 (freshman through senior) in the College
of Dentistry at an HBCU in the northeastern US were invit-
ed to participate. Students from each year were individually
asked to complete a self-administered questionnaire at the
beginning or end of classes on 3 separate days; thus, each
class was approached 3 times to encourage student par-
ticipation. Most participants completed the questionnaire
in about 10 minutes. In addition to information about the
dependent and independent variables, information on the
student’s age, sex, ethnic background, enrollment year, and
marital status were obtained using the self-reported ques-
tionnaire. Students were under no obligation to participate
in this study, and participation was voluntary. Approval was
obtained from the Institutional Review Board at the univer-
sity prior to data collection.
In all, 126 out of 315 students (40.0%) participated in the
survey. Questionnaires were returned from 143 students,
but 17 were missing various values for the instrument used
to measure the prevalence of depressive symptoms; these
participants were excluded from analysis. Response rates dif-
fered substantially among the student groups, with the highest
rate among first-year students (90.0%, or 75 of 83) and the
lowest among third-year students (21.9%, or 16 of 73). The
second-year students had a response rate of 32.6% (28 of 86),
and the fourth-year students had a response rate of 28.8% (21
of 73). The mean age of the participating dental students was
25.9 years (SD = 3.8), with 51.0% men and 49.0% women.
The majority of students (62.9%) were of African descent or
were African American, 17.5% were Asian/Pacific Islander,
11.2% were white, 4.9% were Hispanic, 2.1% were Middle
Eastern, and 1.4% described themselves as other. Most stu-
dents (76.2%) had never been married, 22.4% were married,
and 1.4% were separated or divorced.
Instruments and Procedures
Depressive Symptomatology
The prevalence of depressive symptoms was measured
using the Zung Depression Scale (ZDS).35,36 The ZDS is
a 20-item self-rated scale for the assessment of depressive
symptoms in adults and is one of the most commonly used
scales for measuring depressive symptomatology. It has
57
Laurence, Williams, & Eiland
been shown to be a valid and reliable instrument among
various study populations, including college students.37,38
Participants respond on a 4-point Likert-type scale rang-
ing from 1 (none or a little of the time) to 4 (most or all of
the time), with higher scores indicating greater depressive
severity. Possible total scores range from 20 to 80, and 10 of
the items are reverse scored. The ZDS addresses a variety of
somatic symptoms, such as sleep disturbance, weight loss,
constipation, tachycardia, fatigue, and depressed appetite.
For the purposes of these analyses, we scored the preva-
lence of depressive symptoms as a dichotomous outcome,
with a raw score of 50 or below indicating normal, and a
score of greater than 50 indicating the presence of depres-
sive symptomatology.35,39,40
Social Support
Social support was measured using the Multidimen-
sional Scale of Perceived Social Support (MSPSS).33,34 The
MSPSS is a valid, reliable 12-item self-rated measure of
social support that has been used among college students;
the authors have reported a test–retest reliability of .85 over
a 2–3 month period.33 Responses are measured using a
7-point Likert-type scale ranging from 1 (very strongly dis-
agree) to 7 (very strongly agree). The final score is derived
by summing the individual items and dividing by the
number of items. Possible scores range from 12 to 84, with
higher scores indicating higher perceived social support; a
score can be obtained for the total scale and each of the 3
subscales. The MSPSS evaluates social support from fam-
ily, friends, and significant others and quantifies the degree
to which respondents perceive support from each of these
3 sources. For the present study, we used the MSPSS as a
continuous outcome and report the raw scores including the
means and standard deviations.
Stress
We measured psychological stress using the Perceived
Stress Scale (PSS).8,41,42 The PSS is a 10-item instrument
designed to measure the degree to which situations in one’s
life are perceived as stressful. The PSS assesses global
perceptions of stress with the rationale that stressful events
can increase the risk of health problems when they are per-
ceived as threatening or otherwise demanding. The items
are scored on a 5-point Likert-type scale ranging from 0
(never) to 4 (very often). Scores for the PSS range from 0 to
40, with higher scores indicating greater levels of perceived
stress. Furthermore, the scale has been shown to have a
test–retest reliability of .85 and .55 at 2 days and 6 weeks,
respectively. The PSS has previously been used in a study
of stress levels in dental students.8 For the present study, we
report the PSS using the raw scores as a continuous mea-
sure. For the analyses of our second exploratory aim, PSS
scores were dichotomized at the median value to create 2
categories—high stress level and low stress level.33
Analyses
For the analysis of our first aim, we compared the base-
line characteristics of those students with a high prevalence
58
of depressive symptoms (ZDS > 50) with those without
depressive symptoms (ZDS ≤ 50; referred to as normal),
using the chi-square test for categorical outcomes and the t
test for continuous outcomes. For the analysis of our sec-
ond aim, we modeled the association of depressive symp-
toms with stress using linear regression. In the first model,
the presence of depressive symptoms was modeled as the
primary independent variable and stress level as the depen-
dent variable. In the second model, the effect of social sup-
port was analyzed by adding this variable to the model as an
independent variable. For both models, demographic vari-
ables found to be independently associated with both stress
and a high prevalence of depressive symptoms in a separate
bivariate analysis at a p value of < 0.05 were included in the
final models. The reliabilities of the ZDS, the PSS, and the
MSPSS in this dental student population were .86, .92, and
.91, respectively, as measured using Cronbach’s alpha.
For the analysis of the secondary exploratory aim, after
dichotomizing the level of stress at the median value into
“high” and “low” stress categories,33 this study group exam-
ined the relationship between an increased prevalence of
depressive symptoms and social support within each stress
category, designating social support as the dependent vari-
able and depressive symptoms as the independent variable.
RESULTS
On the basis of the results from the 126 students who
completed all the items on the ZDS, the prevalence of
high depressive symptoms was 16.7% (21 of 126) among
all dental students. This supports our first hypothesis that
dental students at an HBCU would have a higher preva-
lence of depressive symptoms compared with the general
African American population.43–45 The prevalence of high
depressive symptoms was lower among second-year stu-
dents (8.0%) compared with first-year (18.5%), third-year
(20.0%), and fourth-year (22.2%) students. There were no
significant differences in age group, sex, ethnic background,
enrollment year, or marital status between the students who
reported high depressive symptoms and those who did not
(see Table 1). As a result, none of the demographic variables
were included in any further analyses.
The second hypothesis tested whether stress levels would
be higher among dental students with a higher prevalence
of depressive symptoms than among students without an
increased prevalence of depressive symptoms. We found
significantly higher levels of stress in dental students with
high depressive symptoms compared with those without
elevated symptoms (p < .01). These findings support our
second hypothesis. We also found that dental students with
high depressive symptoms compared with normal dental
students had significantly lower levels of social support (p
< .01). These findings support our third hypothesis: levels
of social support will be lower among dental students with
a higher prevalence of depressive symptoms.
Results from the regression modeling procedures are
shown in Table 2. When stress was designated as the depen-
dent variable, students with high depressive symptoms scored
JOURNAL OF AMERICAN COLLEGE HEALTH
 Depressive Symptoms at a Historically Black Dental College

TABLE 1. Demographics of Normal Students (ZDS Score ≤ 50) and Students

With Increased Depressive Symptoms (ZDS Score > 50)

Students with increased

Normal students (n = 105) depressive symptoms (n = 21)
Demographic n % n %

Age (years)
21–23 27 25.7 6 28.6
24–25 30 28.6 10 47.6
26–27 18 17.1 1 4.8
28–46 30 28.6 4 19.0
Sex
Female 50 47.6 11 52.4
Male 55 52.4 10 47.6
Ethnic background
African descent 69 65.7 11 52.4
White or Caucasian 11 10.5 1 4.8
Asian or Pacific Islander 18 17.1 5 23.8
Hispanic or Latino 3 2.9 4 19.0
Middle Eastern 3 2.9 0 0.0
Other 1 1.0 0 0.0
Enrollment year
First 53 52.0 12 57.1
Second 23 22.5 2 9.5
Third 12 11.8 3 14.3
Fourth 14 13.7 4 19.0
Marital status
Single 79 75.2 16 76.2
Married 24 22.9 5 23.8
Separated or divorced 2 1.9 0 0.0
Stress*
M 17.3 27.5
SD 8.0 5.3
Social support*
M 72.6 61.9
SD 11.2 11.3

Note. Percentages may not add up to 100 because of rounding. ZDS = Zung Depression Scale.35,36 Dif-
ferences are statistically significant for stress and social support.
*
p ≤ .01.

10.19 points higher on the stress scale (PSS) compared with
normal dental students (p < .01). No demographic variables
were included in the analysis because they did not meet the
inclusion criteria to be considered as potential confounding
variables. We observed that approximately 20% of the varia-
tion in stress levels can be explained by the depressive status
of the dental students (R2 = .20). When social support was
included in the model, the difference between the groups did
not change; students with high depressive symptoms scored
9.81 points higher on the stress scale (PSS) compared with
normal students (p < .01). The adjusted R2 value showed no
measurable change.
In accordance with our second aim, we explored the
buffer hypothesis, which suggests that social support is
related to depressive symptoms only for those participants
experiencing high levels of stress.33,34 At low stress levels,
students with high depressive symptoms scored 23.10
points lower on the social support scale as measured by
the MSPSS compared with normal students (p < .01). The
adjusted R2 at low stress levels was .09. At high stress lev-
els, students with high depressive symptoms scored 7.95
points lower on the social support scale compared with
normal students (p < .01), and the adjusted R2 showed no
significant change.
COMMENT
This study is 1 of the first to investigate the association
among depressive symptoms, stress, and social support
among dental students. As such, we found that dental stu-
dents from the northeastern HBCU had a higher prevalence
of depressive symptoms compared with African Americans
in the general population. We also found a strong associa-
tion between a high prevalence of depressive symptoms and
increased stress levels. Finally, we also found strong asso-
ciations between a high prevalence of depressive symptoms
and decreased social support at both high and low levels
of stress. The results from this study support all 3 of our
hypotheses.

VOL 58, JULY/AUGUST 2009 59

Laurence, Williams, & Eiland
TABLE 2. Linear Regression Analyses of
Increased Depressive Symptom Status on Stress
and Social Support Levels
Variable β Adj R2 p of the professional and graduate students surveyed sought
Stress
Constant 7.14
Depressive symptoms 10.19 .20 < .01
Constant 10.11
Depressive symptoms 9.81 < .01
Social support –0.04 .20 .57
Social support at low stress
Constant 96.69
Depressive symptoms –23.10 .09 < .01
Social support at high stress
Constant 79.00
Depressive symptoms –7.95 .10 < .01
Note. When modeling stress levels as the outcome, n = 122. When
modeling social support as the outcome at low stress levels, n = 64.
When modeling social support as the outcome at high stress levels,
n = 58. For increased depressive symptom status, ZDS > 50. ZDS =
Zung Depression Scale.
A recent study of the prevalence and distribution of
major depressive disorder in African Americans, Caribbean
blacks, and non-Hispanic whites found that the 12-month
prevalence of major depressive disorder was 10.4% among
African American adults aged 18 years and over and 12.8%
among African American adults aged 18 to 29 years.45
The authors analyzed data from the National Survey of
American Life, the largest study of mental health in the
African American population ever conducted in the United
States.46 Using data from the National Health and Nutrition
Examination Survey III, another recently published study
of the prevalence of major depressive disorder in the United
States, found that the prevalence of depression among Afri-
can Americans aged 15–40 years was 7.5%.43 Both of these
values are substantially lower than the 16.7% reported by
the dental student population at the northeastern HBCU.
The prevalence of depressive symptoms in this dental stu-
dent population was also higher than those reported in the
studies by Grandy et al,3,26 in which 7.5–12.5% of first-year
dental students and 13.0% of third-year dental students
reported depressive symptoms at a US dental school. How-
ever, these studies were limited by small sample sizes and a
lack of demographic descriptive information.
Compared with the study by Newbury-Birch et al15
that examined drinking, smoking, illicit drug use, stress,
anxiety, and depression among dental students and dentists
in the United Kingdom, the present study found a higher
prevalence of depressive symptoms among fourth-year
dental students (22.5% vs 14.0%), but a lower prevalence
among second-year students (8.0% vs 15.0%). However,
the prevalence of depressive symptoms in the present study
is lower than the results reported in a study by Stecker that
60
explored mental health needs of graduate and professional
students in the United States.13 According to Stecker, the
prevalence of depression among dental students was 24% (n
= 24) during the first wave of questionnaire administration
and 45% (n = 40) during the second wave. In addition, 29%
mental health services; suicidal thoughts were reported by
10% of the sample for the first wave.
The variations in rates of depressive symptoms reported
in studies of graduate and professional students may be
partially due to small sample sizes. Also, graduate and pro-
fessional education is a dynamic experience. The academic
milieu varies by class, school, and program. Student popu-
lations may be particularly sensitive to historical events that
impact student well-being at a given point in time. Measur-
ing depression or depressive symptoms in student popula-
tions may produce different results. Also, differences in
instrumentation produce different prevalence rates. Despite
these methodological issues, evidence from multiple stud-
ies indicates that graduate and professional students tend to
endorse depressive symptoms at higher rates than do same-
aged peers from the general population.
In the present study, we found higher levels of stress
among students with elevated depressive symptoms. Simi-
larly, Stecker found that depression was associated with
stress levels in a study of professional and graduate stu-
dents.13 In a study of medical students, Rosal and col-
leagues17 demonstrated that increases in perceived stress
during the first 2 years of medical school were associated
with increased depressive symptoms. Stress may precipitate
depression or depressive symptoms such as insomnia and
fatigue, whereas trouble concentrating may be a source of
stress for students. Although nonexperimental study designs
preclude causal inferences regarding stress and depression
in student populations, consistent associations between
stress and depression are demonstrated among graduate and
professional student populations.
In the present study, we hypothesized that dental stu-
dents with a higher prevalence of depressive symptoms
would have lower levels of social support compared with
nondepressed students. We also explored the extent to
which the association between social support and depres-
sive symptoms depends on the severity of stress. Stecker
found that adding social support to the model accounted
for an additional 9% of the variance.13 In contrast, adding
social support to the model in the present study did not
significantly change the results. The results of the present
study suggest that social support may play a stronger role
in mitigating stress levels among some dental student popu-
lations than it does among other populations. Comparison
between the findings of the present study and Stecker’s
study is limited because the latter provided no information
about the validity or reliability of the instruments used to
measure stress and social support.
In the present study, no differences were observed in the
prevalence of depressive symptoms based on gender. This
is in contrast with most studies that have found that women,
JOURNAL OF AMERICAN COLLEGE HEALTH

compared with men, exhibit a higher prevalence of depres-
sion or depressive symptoms.43,44 Male and female students
face many of the same challenges related to academic life;
thus, the shared experience may result in similar psycho-
logical responses. In fact, in 1 sample of dental students,
the associations between stress and psychological distress
were more pronounced in men than in women.7 Among
male students, stress from multiple domains (eg, living
situations, personal factors, educational environments, aca-
demic work, and clinical factors) were all related to higher
levels of psychological distress. In contrast, only clinical
factors were related to distress in female students. Thus,
male students are not protected by the social factors that
may result in lower rates of reported depression by men in
the general population. The lack of gender differences may
also be attributed to changes in broader social norms. For
example, Real Men, Real Depression is a public informa-
tion campaign launched by the National Institute of Mental
Health in 2003. This campaign, which focused on helping
men identify symptoms of depression, had an estimated
reach of over 40 million.47 Thus, it is possible that male stu-
dents’ endorsement of depressive symptoms at rates equal
to female students may represent responses to historical
factors that influence reporting patterns.
We also explored the buffering hypotheses (ie, that social
support is related to depressive symptoms only for those
subjects experiencing high levels of stress)33,34 by examin-
ing the association between prevalent depressive symptoms
and social support level in those reporting both higher and
lower stress levels. The results showed significant associa-
tions between increased depressive symptoms and reduced
social support at both low and high levels of stress; the
association appeared to be stronger at lower, rather than
higher, stress levels. These data suggest support for an
alternative model, the main effects model, that is often
used to explain how social support assists in coping with
stress.48,49 This model hypothesizes that social support has
a beneficial effect on an individual’s well-being, regardless
of one’s stress level, through several different mechanisms
including meeting a basic human need for intimacy and giv-
ing an individual a sense of belonging and reassurance of
his or her self-worth.48–50 Holahan and Moos, in a prospec-
tive study conducted over a 4-year period on the associa-
tion among depression, life stressors, and social resources
among 254 adults, used path analyses to examine the
relationship among the variables under high- and low-stress
conditions.51 These authors concluded that under high stress
conditions, resources (defined as “what a person draws on
in order to cope”) relate indirectly to psychological health
(including variables such as depression) through their link
to adaptive coping strategies, whereas under low-stress
conditions, resources relate directly to psychological health.
The possible direct link between social support and depres-
sive symptoms at low stress levels may partially explain
why we observed a stronger association in the present study
between increased depressive symptoms and reduced social
support at low, compared with high, stress levels. Also, the
VOL 58, JULY/AUGUST 2009
Depressive Symptoms at a Historically Black Dental College
capacity for social support resources to buffer the relation-
ship between stress and depression may be constrained by
the magnitude of the stressors. Billings and Moos52 reported
that buffering effects of social resources were not found
among depressed patients with relatively high levels of
stress. As stress levels rise, the capacity for social resources
to absorb and partially mitigate the effects of stressors may
be reduced. Thus, as seen in the present sample, the benefi-
cial effects of social support may be more readily observed
at lower levels of stress. As stress levels increase, the mea-
surable relationships may be diminished.
The results from the current study examining depressive
symptoms, stress, and social support in minority dental
students suggest that depressive symptomotology may be
a serious psychological risk among dental students and
should be addressed. Stecker13 suggested a way to cope
with depression in a student population that uses group
settings to deal with academic issues and personal dif-
ficulties13,53 because group settings may reduce feelings
of isolation.13 Students often naturally form peer bonds
through study groups, social activities, and student welfare
organizations. The presence and visible activity levels of
such groups may be a possible indicator of the opportuni-
ties for social support available to students. It is important
that administrators understand the importance of student
activities and organizations to overall student well-being.
An alternative approach for treatment of depression in
dental students would be through the use of psychological
service providers within the academic environment through
collaboration with university counseling services.54 Brief
measures of social support should be integrated into student
wellness assessments. Future studies on the prevalence of
depression or depressive symptoms should be prospective
in design and follow students throughout the course of their
dental training. This will allow researchers to determine
how depressive symptoms change in response to clinical
and other factors to design more effective interventions.
The main limitations of this study include relatively few
survey responses from years D2–D4 compared with D1,
which resulted in the small sample size. Despite repeated
attempts to encourage student participation, the limited
responses from years D2–D4 limit the ability to make con-
clusions about the results.
This study is also limited by the lack of information
about potential confounding variables that could affect
the levels of depressive symptoms in dental students (par-
ticularly those related to academic or clinical performance)
and the fact that the study was based on survey data and is
therefore dependent on the reliability of the self-reported
data. In addition, the prevalence of depressive symptoms
was measured at 1 point in time, but it may fluctuate from
year to year. Finally, there are differences in the ethnic dis-
tribution in this dental school population and the majority
of dental schools in the United States that limit the external
validity of this study. It is possible that given the unique
nature of the dental student population at this northeastern
HBCU, the prevalence of depressive symptoms in students
61
Laurence, Williams, & Eiland
at most dental schools in the United States, who are pre-
dominantly white, may be significantly different. Last, the
PSS measures global stress; therefore, we cannot determine
which specific types of stress are of particular importance
for students.
Strengths of this study include the application of some
of the most valid and reliable instruments for self-reported
depressive symptoms, stress, and social support currently
in use and the unique demographics of the dental student
population. At present, there are only 2 HBCUs in the Unit-
ed States that have a dental school, and little research has
been conducted on the student populations unique to these
institutions. Although this may limit the external validity
of the study, as expressed earlier, the information from this
study population is worth reporting because the results may
differ significantly from most dental schools in the United
States. Future studies should attempt to see if the results are
replicated at other dental schools in the United States. Sub-
sequent studies should attempt to identify sources of stress
for students (eg, academic, financial, family). Future stud-
ies should also adequately measure coping methods used.
These data would help guide later development of programs
at dental schools to include, for example, the formation
of study groups13 and collaboration with student counsel-
ing and/or psychological service providers54 to reduce the
prevalence of depressive symptoms.
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