Lin, Feiou, Yan He, Zhenyu Ni, Richard Olive, Manman Ren, Linjie Yao, & Qingsong Ye (2017, July). Individualized intervention to reduce anxiety in adult orthodontic patients based on Q methodology. American Journal of Orthodontics and Dentofacial Orthopedics, 152(2), 161-170. (doi: 10.1016/j.ajodo.2016.12.015) (Link:

Abstract: Introduction: In this study, we used Q methodology to assess the concerns of adults seeking orthodontic treatment and to determine individualized interventions to reduce their anxiety. Methods: Statements of concern were derived by in-depth interviews with 70 adult patients. Q sorting methodology was then used to identify the main factors associated with anxiety in a cohort of 40 adults who had not been involved in the first part of the study. The final stage involved a randomized study in which 160 new adult patients were recruited and randomized into intervention and control groups. Participants in the intervention group sorted the statements, after which individualized interventions were implemented. Participants in the control group received routine treatment. The State-Trait Anxiety Inventory was used to measure changes in participants’ anxiety levels before and during treatment. Results: In total, 41 statements were identified, and participants were classified according to 5 factors. Factor 1 participants were concerned about the lack of treatment information; factor 2 represented concerns about cost and other people’s opinions; factor 3 represented concerns about impact on work related to wearing braces; factor 4 encompassed concerns about treatment effects, pain, and dental fears; and factor 5 reflected concerns about side effects and finding a partner. The mean state anxiety inventory scores for both the intervention and control groups were highest 24 hours after bonding (intervention group, 44.63 ± 4.49; control group, 49.43 ± 5.42). The intragroup state anxiety inventory scores differed significantly across the 6 time points (P <0.01), with the state anxiety inventory scores of the intervention group significantly lower than those of the control group (P <0.01) at all time points except baseline. No significant intergroup or intragroup differences were found in relation to trait anxiety. Conclusions: Adult orthodontic patients expressed diverse concerns. Individualized interventions based on Q methodology may reduce anxiety in this patient population.

Feiou Lin is in the Department of Orthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, China. Yan He is in the Department of Biomedical Engineering, University of Groningen, Groningen, The Netherlands.

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