Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

Morenike Oluwatoyin Folayan; Maha El Tantawi; Olakunle Oginni; Elizabeth Oziegbe; Boladale Mapayi; Olaniyi Arowolo; Abiola Adetokunbo Adeniyi; Nadia A Sam-Agudu

doi:10.1371/journal.pone.0247073

. 2021 Feb 25;16(2):e0247073. doi: 10.1371/journal.pone.0247073

Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

Morenike Oluwatoyin Folayan ^1,^*, Maha El Tantawi ², Olakunle Oginni ³, Elizabeth Oziegbe ¹, Boladale Mapayi ³, Olaniyi Arowolo ⁴, Abiola Adetokunbo Adeniyi ⁵, Nadia A Sam-Agudu ^6,⁷

Editor: Frédéric Denis⁸

PMCID: PMC7906320 PMID: 33630858

Abstract

Background

Oral health is a less-recognized correlate of overall and mental wellbeing. This study aimed to assess the relationship between suicidal behavior (ideation and attempt) and oral health practices and status, and to determine the effect of sex on these associations among Nigerian adolescents.

Methods

Household survey data were collected from 10 to 19-year-old adolescents in southwestern Nigeria. Dependent variables were daily tooth brushing, daily consumption of refined carbohydrates between meals, and oral hygiene status (measured by plaque index). The independent variable was lifetime suicidal ideation/attempt, dichotomized into ‘yes’ and ‘never’. ‘Daily tooth brushing’ and ‘daily consumption of refined carbohydrates between meals’ were included in two separate logistic regression models, and ‘oral hygiene status’ was included in a linear regression model. The models were adjusted for sex, age, and socioeconomic status. The linear regression model was also adjusted for frequency of daily tooth-brushing and of consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/suicide attempt in association with dependent variables were assessed. Significance was set at 5%.

Results

We recruited 1,472 participants with mean age (standard deviation) of 14.6 (2.6) years. The mean plaque index was 0.84 (0.56), and 66 (4.5%) adolescents reported ever having suicidal ideation/attempt. Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91), higher likelihood of consuming refined carbohydrates between meals (OR = 2.30, 95% CI: 1.29, 4.10), and having poor oral hygiene (B = 0.18, 95% CI: 0.05, 0.32). Among males, suicidal ideation/attempt was associated with less likelihood of eating refined carbohydrates between meals (OR = 0.96, 95% CI: 0.35, 2.61). Conversely, it was associated with a significantly higher likelihood of this outcome (OR = 4.85, 95% CI: 2.23, 10.55) among females.

Conclusion

The study findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for risk of suicidal behavior for adolescents in Nigeria, while high sugar consumption may be an additional risk factor for adolescent females. These findings support the role of dental practitioners as members of healthcare teams responsible for screening, identifying and referring patients at risk for suicidal ideation/attempt.

Introduction

Suicide was the second leading cause of death in 2017 among adolescents age 15 to 19 years globally [1]. Known risk factors include a family history of suicidal behavior; childhood and family adversity; mental disorders (untreated depression, substance use and psychotic disorders); exposure to stressors and adverse circumstances; sexual or gender minority status; previous suicide attempt; history of suicidal ideation [2–4].

A history of suicidal ideation/suicide attempt is associated with sugar addiction in adolescence [5]. While high sugar consumption has been associated with diminished cognitive function among the elderly [6], animal studies suggest that excessive consumption in adolescence is associated with overstimulation of the reward pathways [7], which may have negative effects on cognitive and emotion processing similar to the effects of substances of abuse [8]. High sugar consumption may result from neuroadaptations associated with depression [9,10], which is associated with increased risk for suicidal ideation/attempt and completed suicide [11]. High sugar consumption is also a risk factor for plaque accumulation and poor oral hygiene, which are risk factors for several oral and general health problems [12]. Depression leads to reductions in energy and self-esteem, which may lead to poor oral hygiene behaviors and health status [13,14]. Poor oral health is also a risk factor for depression [15]. Depression may therefore be a mediating factor between suicidal ideation/attempt and poor oral hygiene.

Studies have demonstrated associations between poor oral health, stress, depression, substance use disorders, and psychotic disorders [16]. The associations have been behavior- linked: mental health disorders are associated with poor self-care, including poor oral health care [17]. Few studies have examined the association between oral health and suicidal ideation: a study of Korean adults demonstrated no significant association [18], whereas a study of Aboriginal Australian young adults demonstrated an association [15].The disparate findings may indicate age, genetic, and/or social/environmental differences.

There are currently no studies on the relationship between suicidal behaviors and oral health status/behavior from African countries. In sub-Saharan Africa especially, adolescents are highly exposed to stressors and adverse childhood and family circumstances [19], and have a high prevalence of depression and other mental health problems [20,21], which are risk factors for suicidal ideation. Suicidal ideation/behavior is also common in the region: Nigeria has a 12.4% to 17% prevalence of suicidal ideation and 7.8% for suicide attempts among adolescents [22,23]. These figures are higher than the reported 3.2% for suicidal ideation across several African countries: 1.0% for planned suicide, and 0.7% for attempted suicide [24]. Caries and poor oral hygiene, which are both consequences of high sugar consumption [25], are highly prevalent among adolescents across Africa [26] and in Nigeria [27].

This study is based on theories of hopelessness [28], which link suicidal ideation/attempts with psychopathological constructs such as depressive symptoms and hopelessness with their negative impact on agency thinking [29–31]. The hopelessness-low self-esteem-depression link is also associated with poor self-care [17], which includes oral health practices.

The study attempts to bridge a wide and longstanding gap in knowledge on interactions between oral health and mental health in Nigeria, the African region, and globally. The aim was to assess for associations between suicidal ideation/attempt and oral health practices/hygiene status, and to determine whether sex modified these associations. We hypothesized that there would be a negative association between suicidal ideation/attempt and oral health practices/oral hygiene status, whereby poor oral hygiene would be associated with higher-level risks of suicidal behavior, with sex likely modifying the association between these variables.

Materials and methods

Study design and study population

This is a secondary analysis of primary data collected to determine the association between the oral, mental, sexual, and reproductive health of adolescents’ resident in Ife Central Local Government Area of Osun, State Ile-Ife, a semi-urban community in southwestern Nigeria. The data were collected through a household survey conducted during December 2018 and January 2019. Adolescents age 10–19 years old from whom parental consent/assent/individual informed consent was appropriately obtained were eligible to participate in the study. Adolescents who were critically ill and could not give independent responses to the study survey were excluded from study participation.

Sample size and sampling technique

The minimum sample size for the study was calculated with the formula proposed by Araoye [32]. With a caries prevalence (proxy for oral hygiene status) of 13.9% among adolescents in the study community [33], a margin of error of 5%, and a confidence level of 95%, the minimum sample size was 1,323 adolescents. Adolescents were recruited with a multi-stage sampling technique. First, 70 of the 700 enumeration areas in Ife Central Local Government Area were sampled with the simple-random sampling technique. Next, every other household in the selected enumeration areas was identified as an eligible household. Finally, in each household, one adolescent who met the inclusion criteria was recruited for study participation. Whenever a household declined to participate, the next eligible household was substituted. Recruitment of participants continued until the minimum sample size for the study was reached.

Data collection

Data were collected through personal interview with a structured questionnaire that had been used in previous studies on oral health in Nigeria (S1 File) [41]. The instrument was administered by trained field workers who were themselves young people with experience in collecting data for national surveys. The field workers and clinicians were trained on the study protocol, the use of the data collection tools, sample selection (including household listing and selection), and all other aspects of clinical and fieldwork. Data collected for each adolescent were age, sex, and socioeconomic status. Age was determined in years as age at last birthday, while sex was determined as assigned sex at birth (male or female). Socio-economic status was measured with a proxy question that asked about average number of daily meals in the preceding month; the responses were categorized as ‘cannot guarantee one meal per day’, ‘one meal per day’, ‘two meals per day’, or ‘three meals per day’ [34].

Oral health practices

Information was generated on the frequency of tooth brushing and consumption of refined carbohydrate between meals. Respondents were also asked to indicate the frequency of tooth brushing using the following response options–‘irregularly or never’, ‘once a week’, ‘a few (2–3) times a week’, ‘once a day’, and ‘more than once a day’. Responses were further dichotomized into ‘once a day or greater’ and ‘less than once a day’.

Respondents were also asked to indicate the frequency of consuming sugar-containing snacks or drinks between main meals according to the following options–‘about three times a day or more’, ‘about twice a day’, ‘about once a day’, ‘occasionally’, ‘not every day’, ‘rarely’, or ‘never between meals’. Responses were dichotomized into ‘three times a day or more’ and ‘less than three times a day’.

Suicidal behavior assessment

Study participants’ suicidal behavior was assessed with the Suicide Behaviour Questionnaire–Revised (SBQ-R). This is an easily administered 4-item tool that evaluates the frequency of past and likelihood of future suicidal thoughts and behaviors with responses scored on 3-7-point Likert scales [35,36]. The total scores were derived and used for analyses. The tool has adequate internal consistency in a population of patients with mental disorders in an outpatient setting (Cronbach’s alpha 0.75) [37]. It has also been validated for use among undergraduate students in Nigeria (Cronbach’s alpha 0.80) [38].

Intra-oral examination

All participants had an oral examination conducted in their homes to determine the oral hygiene status. Each participant was examined sitting, under natural light, with sterile dental mirrors by trained dentists. The teeth were examined wet. Plaque Index [39] was used to determine the oral hygiene status. The Plaque Index score was based on six numerical determinations representing the amount of debris found on the surfaces of index permanent teeth 12, 16, 24, 32, 36, and 44. The mesial, distal, buccal, and lingual gingival areas of the index teeth are scored from 0 (no plaques) to 3 (abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin). The mean score for each tooth is obtained and the mean score for the individual is obtained by adding the indices for each tooth and dividing by the number of teeth examined.

Standardization of examiners

Clinical investigators were qualified dentists undergoing postgraduate residency training as pedodontists, who were calibrated on the study protocol and the clinical examination. Training was followed by practice on patients: each clinician examined and scored the adolescents for oral hygiene status as prescribed in the study protocol. Results were subjected to a Cohen’s weighted kappa score analysis to determine intra- and inter-examiner variability. The intra- and inter-examiner Cohen’s weighted kappa scores for the three dentists were all greater than 0.95.

Data analysis

Descriptive statistics were calculated as means and standard deviations or frequencies and percentages. There were three separate dependent variables: brushing at least once daily (yes, no), consumption of refined carbohydrates between meals three times a day or more daily (yes, no), and oral hygiene status (mean plaque index). The first two dependent variables were included in two separate logistic regression models, and the third dependent variable was included in a linear regression model. The independent variable was lifetime suicidal ideation/attempt dichotomized into ‘yes’ and ‘never’. The models were adjusted for sex, age, and socioeconomic status (measured using a proxy question that asked about average number of daily meals in the preceding month). These factors are associated with oral hygiene status and suicidal ideation/attempts in Nigeria [40,41]. The linear regression model, where oral hygiene status was a dependent variable, also adjusted for daily brushing and consumption of refined carbohydrates between meals. Interactions between sex and suicidal ideation/attempt in association with each of the three dependent variables were assessed. The p values for interaction were computed, and separate regression estimates were calculated for males and females. Odds rations/regression estimates and 95% confidence intervals (CI) were calculated. SPSS version 23.0 was used for statistical analysis. Significance was set at 5%.

Ethical considerations

Ethical approval was obtained from the Health Research Ethics Committee of the Institute of Public Health at Obafemi Awolowo University in Ile-Ife, Nigeria. Written parental consent was obtained for all adolescents less than 18 years old per national ethics guidelines [42]. Written assent was additionally obtained for those 12 to 17 years of age. Adolescents aged 18 to 19 years provided written individual consent. Only adolescents that assented to study participation in addition to parental consent were enrolled in the study. All study participants received a gift of valued at approximately $1.00.

Results

A total of 1,472 study participants were recruited (Table 1); age range of this cohort was 10 to 19 years. The mean age (standard deviation was 14.6 (2.6) years. There were 846 (57.5%) male participants, and 1,245 (84.6%) participants reported access to three meals a day in the preceding month. Most respondents (88.7%) reported brushing at least once daily, and 251 (17.1%) consumed refined carbohydrates between meals three or more time daily. The mean plaque index was 0.84 (0.56), and 202 (13.8%), 940 (64.0%), 310 (21.1%) and 17 (1.2%) participants had scores of 0, 1, 2, and 3 respectively. A total of 66 (4.5%) adolescents reported ever having suicidal ideation/attempts, 42 (2.8%) experienced suicidal ideation/attempts over the last 12 months, 20 (1.4%) reported they previously threatened to commit suicide, and 18 (1.2%) reported a likelihood of suicidal behavior in the future.

Table 1. Profiles, oral health practices and suicidal behaviors among Nigerian adolescents [N = 1,472].

Factors	Variables	Statistics
Sex	Male: n (%)	846 (57.5)
Sex	Female: n (%)	626 (42.5)
Age	Mean (SD)	14.6 (2.6)
Can afford three meals a day	Yes n (%)	1245 (84.6)
Can afford three meals a day	No n (%)	227 (15.4)
Brush at least once a daily	Yes: n (%)	1305 (88.7)
Brush at least once a daily	No: n (%)	167 (11.3)
Frequency of consumption of refined carbohydrates in-between-meals daily	three times a day or more n (%)	251 (17.1)
	Less than that three times a day n (%)	1221 (82.9)
Plaque index	Mean (SD)	0.84 (0.56)
Suicidal ideation or attempt	Had thought n (%)	66 (4.5)
Suicidal ideation or attempt	Never n (%)	1406 (95.5)
Frequency of suicidal ideation over past 12 months	Had thought n (%)	42 (2.8)
Frequency of suicidal ideation over past 12 months	Never n (%)	1430 (97.2)
Threat of suicide attempt	Had thought n (%)	20 (1.4)
Threat of suicide attempt	Never n (%)	1452 (98.6)
Self-reported likelihood of suicidal behavior in the future	Had thought n (%)	18 (1.2)
Self-reported likelihood of suicidal behavior in the future	Never n (%)	1454 (98.8)

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Table 2 lists the association between preventive oral health practices, oral hygiene status and suicidal ideation/attempt in the Nigerian adolescents. Being able to afford three meals a day was associated with significantly higher frequency of tooth brushing at least once a day (OR = 2.57, 95% CI: 1.74, 3.79), eating sugars (OR = 1.59, 95% CI: 1.02, 2.49), and better oral hygiene status (B = -0.10, 95%CI: -0.18, -0.01). Suicidal ideation/attempt was associated with significantly lower likelihood of tooth brushing (OR = 0.48, 95% CI: 0.26, 0.91) and significantly higher likelihood of consuming refined carbohydrates between meals daily (OR = 2.30, 95% CI: 1.29, 4.10) and poorer oral hygiene status (B = 0.18, 95% CI: 0.05, 0.32).

Table 2. Associations between brushing, sugar consumption, plaque accumulation, and suicidal ideation or attempt among Nigerian adolescents [N = 1472].

Variables		Brushing at least once daily OR (95% CI)	Eating sugars daily OR (95% CI)	Oral hygiene status B (95% CI)
Sex	Male vs female	0.87 (0.61, 1.22)	1.05 (0.79, 1.41)	0.04 (-0.02, 0.10)
Age		0.99 (0.93, 1.06)	0.96 (0.90, 1.01)	-0.01 (-0.02, 0.004)
Afford three meals a day		2.57 (1.74, 3.79)^*	1.59 (1.02, 2.49)^*	-0.10 (-0.18, -0.01)^*
Brushing at least once daily		-	-	-0.06 (-0.15, 0.03)
Eating refined carbohydrates in-between-meals daily		-	-	-0.06 (-0.13, 0.02)
Suicidal ideation or attempt		0.48 (0.26, 0.91)^*	2.30 (1.29, 4.10)^*	0.18 (0.05, 0.32)^*

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OR: Odds ratio; B: Regression coefficient; CI: Confidence interval;

*: Statistically significant at P< 0.05.

Table 3 illustrates the modifying effect of sex on the association between oral practices and suicidal ideation/attempt. Sex was significantly moderated the association between suicidal ideation/attempt and eating refined carbohydrates between meals daily (P = 0.01) but not the associations of suicidal ideation/attempt with tooth brushing (P = 0.72) or oral hygiene (P = 0.23). Among males, suicidal ideation/attempt was associated with a lower likelihood of eating refined carbohydrates between meals daily although this was not statistically significant (OR = 0.96, 95% CI: 0.35, 2.61); whereas, in females, suicidal ideation/attempt was associated with significantly higher likelihood of eating refined carbohydrates between meals daily (OR = 4.85, 95% CI: 2.23, 10.55).

Table 3. Modifying effect of sex on the association between tooth brushing, sugar consumption, plaque accumulation, and suicidal ideation/attempt [N = 1472].

Association between suicidal ideation/attempt and:	Male	Female	P for interaction
Brushing at least once daily ^a: OR (95% CI)	0.45 (0.19, 1.05)	0.56 (0.22, 1.47)	0.72
Eating refined carbohydrates in-between-meals daily ^a: OR (95% CI)	0.96 (0.35, 2.61)	4.85 (2.23, 10.55)	0.01
Plaque index ^b: B (95% CI)	-0.10 (-0.29, 0.09)	-0.24 (-0.44, -0.04)	0.23

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a: Controlling for age and affording three meals a day.

b: Controlling for age, affording three meals a day, brushing at least once daily, and eating refined carbohydrates between meals daily.

Discussion

The study findings indicate that suicidal behaviors were associated with poor oral health practices and oral hygiene status. Suicidal behaviors were also associated with less positive oral health practices such as insufficient tooth brushing, more negative practices such as daily between-meals consumption of refined carbohydrate, and with poor oral hygiene. In addition, there was sex difference in how suicidal ideation/attempt was associated with daily between-meal consumption of refined carbohydrates. A strong association was observed between suicidal ideation/attempt and daily consumption of refined carbohydrates between meals among female adolescents who had higher frequency of consumption of refined carbohydrate between meals and suicidal behaviors. Among males, in contrast, suicidal ideation/attempt was not significantly associated with any oral health behaviors. The study hypotheses were therefore validated.

This is the first study showing a relationship between oral health practices and suicidal ideation/attempt in a population of African adolescents. A strength of the study is the large sample size. Also, the household-based approach for sample recruitment renders the study findings generalizable to the study environment, and potentially possible to extrapolate the finding to other environments with similar population profiles. We however caution on extrapolation of findings to other cultures due to known influences of culture on mental health [43]. The study was conducted in a setting that was predominantly Yoruba, an ethnic group known to have very strong family orientation which is patho-protective [44]. The SBQ-R tool used to measure suicidal ideation/attempt had been validated among undergraduate students in the same study community. This strengthens the validity of study findings, as our study Cronbach’s alpha was similar to that reported in the prior studies. Similarly, the instrument used to measure the oral hygiene behavior had been used in prior studies involving undergraduates [45], and preschool children [46] in the same study community.

The study is, however, limited by its cross-sectional design; thus, it can only suggest an association and not a cause-effect relationship. Also, there might be social desirability and recall bias for the self-reported items, which may lead to under-estimation of variables such as number of missed meals per day and over-estimation of factors such as frequency of tooth brushing. In addition, other mental problems, substance use issues and use of medication may confound the association between the observed variables and should be addressed in future studies. Despite this limitation, the study highlights important findings that should be explored further.

First, the association between suicidal tendencies and poor tooth brushing habits may not be associated with the experience of low self-esteem, which acts as an early entry into the suicidal process [47–49]. A prior study in India found an association between suicidal ideation/attempt and poor oral hygiene status, but not with tooth brushing frequency or tooth brushing duration [50]. The authors however reported an association between suicidal ideation/attempt and frequency of change of toothbrush: fewer individuals with suicidal ideation/attempt changed their toothbrush at least once in six months [50]. We found an association between suicidal tendencies and poor tooth brushing habits measured by frequency of tooth brushing. Low self-esteem is a strong predictor of poor tooth brushing habits [51], and may therefore be the mediating factor between suicidal ideation/attempt and poor tooth brushing habits. This needs to be studied further.

Second, the association between suicidal tendencies and high daily between-meals consumption of refined carbohydrate may provide evidence to further substantiate prior findings on the association between sugar addiction and suicidal ideation/attempt [5], although there are multiple longitudinal studies showing an association of sugar consumption with an increased risk of depression [52–54]. Of concern is the risk for dental caries resulting from the high free-sugar consumption. Suicidal behavior is associated with poor treatment of dental caries [15], leading to pain, deteriorating quality of life, and risk for completed suicide [55,56].

Third, is the sex modifying role of the association between suicidal ideation/attempt and the daily consumption of refined carbohydrate between meals. This association, which was only found in females, is an important finding, as no prior study had highlighted the impact of sex on the sugar addiction and suicidal ideation/attempt relationship. The higher suicidal ideation/attempt for females has been associated with the higher risk of major depression in females, which is a predictive factor for more than half of all suicides [57]. The studies in Nigeria have consistently shown a female predilection for suicidal ideation/attempt [58,59]. Thus, considering the positive association between suicidal behaviors and depressive symptoms, which are higher among females, it is possible that the association between suicidality and high sugar consumption is mediated by depressive symptoms; however, future studies are needed to test this hypothesis. This finding may also point to the complexity of a sex relationship with suicidal ideation/attempt, as there are also suggestions of an underlying mechanism to sex difference in food choice and preferences including sweet tastes [58]. The possible role of culture in framing the relationship of sex and suicidal ideation/attempt [60] and moderating sex differences in taste preferences [61,62] needs to be explored further to explain the observed associations.

Conclusion

Our findings suggest that poor tooth brushing habits and poor oral hygiene are indicators for the risk of suicidal behaviors for adolescents, and high sugar consumption may be an additional risk factor for adolescent females. These findings highlight the importance of dental practitioners as members of healthcare teams responsible for screening, identifying and referring at-risk adolescents in timely fashion.

Supporting information

S1 File. Study household survey questionnaire.

(XLSX)

Click here for additional data file.^{(132.6KB, xlsx)}

S2 File

(DOCX)

Click here for additional data file.^{(107.9KB, docx)}

Acknowledgments

We acknowledge and thank the study participants for the contributions they made to generating new knowledge. Our appreciation also goes to field workers who collected study data.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

The author(s) received no specific funding for this work.

References

1.World Health Organization. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. 2018 [Available from: https://www.who.int/healthinfo/global_burden_disease/estimates/en/index.html. Accessed: 2021 January 15.
2.Barnes JN, Joyner MJ. Sugar highs and lows: the impact of diet on cognitive function. J Physiol. 2012;590(12):2831. 10.1113/jphysiol.2012.234328 [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry. 2000;34(3):420–36. 10.1080/j.1440-1614.2000.00691.x [DOI] [PubMed] [Google Scholar]
4.Ruchkin V, Koposov RA, Koyanagi A, Stickley A. Suicidal Behavior in Juvenile Delinquents: The Role of ADHD and Other Comorbid Psychiatric Disorders. Child Psychiatry Hum Dev. 2017;48(5):691–8. 10.1007/s10578-016-0693-9 [DOI] [PubMed] [Google Scholar]
5.Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep. 2017;7(1):6287. 10.1038/s41598-017-05649-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Chong CP, Shahar S, Haron H, Din NC. Habitual sugar intake and cognitive impairment among multi-ethnic Malaysian older adults. Clin Interv Aging. 2019;14:1331–42. 10.2147/CIA.S211534 [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Naneix F, Darlot F, De Smedt-Peyrusse V, Pape JR, Coutureau E, Cador M. Protracted motivational dopamine-related deficits following adolescence sugar overconsumption. Neuropharmacology. 2018;129:16–25. 10.1016/j.neuropharm.2017.11.021 [DOI] [PubMed] [Google Scholar]
8.Jacques A, Chaaya N, Beecher K, Ali SA, Belmer A, Bartlett S. The impact of sugar consumption on stress driven, emotional and addictive behaviors. Neurosci Biobehav Rev. 2019;103:178–99. 10.1016/j.neubiorev.2019.05.021 [DOI] [PubMed] [Google Scholar]
9.Westover AN, Marangell LB. A cross-national relationship between sugar consumption and major depression? Depress Anxiety. 2002;16(3):118–20. 10.1002/da.10054 [DOI] [PubMed] [Google Scholar]
10.Hsu TM, Konanur VR, Taing L, Usui R, Kayser BD, Goran MI, et al. Effects of sucrose and high fructose corn syrup consumption on spatial memory function and hippocampal neuroinflammation in adolescent rats. Hippocampus. 2015;25(2):227–39. 10.1002/hipo.22368 [DOI] [PubMed] [Google Scholar]
11.Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Int J Environ Res Public Health. 2018;15(7). 10.3390/ijerph15071425 [DOI] [PMC free article] [PubMed] [Google Scholar]
12.Kane SF. The effects of oral health on systemic health. Gen Dent. 2017;65(6):30–4. [PubMed] [Google Scholar]
13.Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006;114(2):109–14. 10.1111/j.1600-0722.2006.00334.x [DOI] [PubMed] [Google Scholar]
14.Skośkiewicz-Malinowska K, Malicka B, Ziętek M, Kaczmarek U. Oral health condition and occurrence of depression in the elderly. Medicine (Baltimore). 2018;97(41):e12490. 10.1097/MD.0000000000012490 [DOI] [PMC free article] [PubMed] [Google Scholar]
15.Jamieson LM, Paradies YC, Gunthorpe W, Cairney SJ, Sayers SM. Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults. BMC Public Health. 2011;11:656. 10.1186/1471-2458-11-656 [DOI] [PMC free article] [PubMed] [Google Scholar]
16.Kisely S. No Mental Health without Oral Health. Can J Psychiatry. 2016;61(5):277–82. 10.1177/0706743716632523 [DOI] [PMC free article] [PubMed] [Google Scholar]
17.Hopes LM, Williams A. Depression, self-defeating, and self-destructive behaviors as predictors of suicide ideation in males and females. Psychol Rep. 1999;84(1):63–6. 10.2466/pr0.1999.84.1.63 [DOI] [PubMed] [Google Scholar]
18.Kim YS, Kim HN, Lee JH, Kim SY, Jun EJ, Kim JB. Association of stress, depression, and suicidal ideation with subjective oral health status and oral functions in Korean adults aged 35 years or more. BMC Oral Health. 2017;17(1):101. 10.1186/s12903-017-0391-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
19.Kabiru CW, Izugbara CO, Beguy D. The health and wellbeing of young people in sub-Saharan Africa: an under-researched area? BMC Int Health Hum Rights. 2013;13:11. 10.1186/1472-698X-13-11 [DOI] [PMC free article] [PubMed] [Google Scholar]
20.Nalugya-Sserunjogi J, Rukundo GZ, Ovuga E, Kiwuwa SM, Musisi S, Nakimuli-Mpungu E. Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health. 2016;10:39. 10.1186/s13034-016-0133-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
21.Cortina MA, Sodha A, Fazel M, Ramchandani PG. Prevalence of child mental health problems in sub-Saharan Africa: a systematic review. Arch Pediatr Adolesc Med. 2012;166(3):276–81. 10.1001/archpediatrics.2011.592 [DOI] [PubMed] [Google Scholar]
22.Mapayi B, Olakunle O, Osilaja R, Oyebode B, Ogunyemi M, Adewole O, et al. Gender differences in suicidal ideations and attempts among secondary school students in Ile-Ife, Nigeria. African Journal of Gender and Development. 2016;3(1):40–56. [Google Scholar]
23.Gureje O, Kola L, Uwakwe R, Udofia O, Wakil A, Afolabi E. The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being. Psychol Med. 2007;37(6):821–30. 10.1017/S0033291707000311 [DOI] [PubMed] [Google Scholar]
24.Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, et al. Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10–19 years: cross-sectional study. Trop Med Int Health. 2020;25(1):54–69. 10.1111/tmi.13336 [DOI] [PubMed] [Google Scholar]
25.Kleemola-Kujala E, Räsänen L. Relationship of oral hygiene and sugar consumption to risk of caries in children. Community Dent Oral Epidemiol. 1982;10(5):224–33. 10.1111/j.1600-0528.1982.tb00384.x [DOI] [PubMed] [Google Scholar]
26.Josefczyk ME. The State of Oral Health on the African Continent: Liberty University; 2015. [Google Scholar]
27.Olabisi AA, Udo UA, Ehimen UG, Bashiru BO, Gbenga OO, Adeniyi AO. Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria. J Int Soc Prev Community Dent. 2015;5(1):59–63. 10.4103/2231-0762.151979 [DOI] [PMC free article] [PubMed] [Google Scholar]
28.Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, et al. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991;60(4):570–85. 10.1037//0022-3514.60.4.570 [DOI] [PubMed] [Google Scholar]
29.Beck AT, Steer RA, Beck JS, Newman CF. Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide Life Threat Behav. 1993;23(2):139–45. [PubMed] [Google Scholar]
30.Kashani JH, Reid JC, Rosenberg TK. Levels of hopelessness in children and adolescents: a developmental perspective. J Consult Clin Psychol. 1989;57(4):496–9. 10.1037//0022-006x.57.4.496 [DOI] [PubMed] [Google Scholar]
31.Kuo WH, Gallo JJ, Eaton WW. Hopelessness, depression, substance disorder, and suicidality—a 13-year community-based study. Soc Psychiatry Psychiatr Epidemiol. 2004;39(6):497–501. 10.1007/s00127-004-0775-z [DOI] [PubMed] [Google Scholar]
32.Araoye M. Research methodology with statistics for health and social sciences. 2nd ed. Ilorin Nigeria: Nathadex Publications; 2008. [Google Scholar]
33.Adekoya-Sofowora CA, Nasir WO, Oginni AO, Taiwo M. Dental caries in 12-year-old suburban Nigerian school children. Afr Health Sci. 2006;6(3):145–50. 10.5555/afhs.2006.6.3.145 [DOI] [PMC free article] [PubMed] [Google Scholar]
34.Folayan MO, Odetoyinbo M, Harrison A. Differences in use of contraception by age, sex and HIV status of 10-19-year-old adolescents in Nigeria. Int J Adolesc Med Health. 2015;29(4). 10.1515/ijamh-2015-0059 [DOI] [PubMed] [Google Scholar]
35.Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8(4):443–54. 10.1177/107319110100800409 [DOI] [PubMed] [Google Scholar]
36.Brown GK. A review of suicide assessment measures for intervention research with adults and older adults. 2001. [Google Scholar]
37.Cotton CR, Peters DK, Range LM. Psychometric properties of the Suicidal Behaviors Questionnaire. Death Stud. 1995;19(4):391–7. 10.1080/07481189508252740 [DOI] [PubMed] [Google Scholar]
38.Aloba O, Ojeleye O, Aloba T. The psychometric characteristics of the 4-item Suicidal Behaviors Questionnaire-Revised (SBQ-R) as a screening tool in a non-clinical sample of Nigerian university students. Asian J Psychiatr. 2017;26:46–51. 10.1016/j.ajp.2017.01.017 [DOI] [PubMed] [Google Scholar]
39.Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol. 1967;38(6):Suppl:610–6. 10.1902/jop.1967.38.6.610 [DOI] [PubMed] [Google Scholar]
40.Adewuya AO, Ola BA, Coker OA, Atilola O, Zachariah MP, Olugbile O, et al. Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey, Nigeria. BJPsych Open. 2016;2(6):385–9. 10.1192/bjpo.bp.116.004333 [DOI] [PMC free article] [PubMed] [Google Scholar]
41.Oyedele TA, Folayan MO, Chukwumah NM, Onyejaka NK. Social predictors of oral hygiene status in school children from suburban Nigeria. Braz Oral Res. 2019;33:e022. 10.1590/1807-3107bor-2019.vol33.0022 [DOI] [PubMed] [Google Scholar]
42.Federal Ministry of Health Nigeria-National Health Research Ethics Committee. Policy Statement Regarding Enrollment of Children in Research in Nigeria 2016 [Available from: http://nhrec.net/nhrec/Final%20NHREC%20Policy%20Statement%20on%20Enrollment%20of%20Children%20in%20Research.pdf. Accessed: 2021 January 15.
43.Mikolajczyk RT, Maxwell AE, El Ansari W, Naydenova V, Stock C, Ilieva S, et al. Prevalence of depressive symptoms in university students from Germany, Denmark, Poland and Bulgaria. Soc Psychiatry Psychiatr Epidemiol. 2008;43(2):105–12. 10.1007/s00127-007-0282-0 [DOI] [PubMed] [Google Scholar]
44.Akinsulore A, Esimai O, Afolabi O, Aloba O, Mapayi B. Prevalence and factors associated with depressive symptoms among Yoruba adults in a semi-urban community in South-Western Nigeria. Journal of Behavioral Health. 2015;4(3):81–6. [Google Scholar]
45.Folayan MO, Khami MR, Folaranmi N, Popoola BO, Sofola OO, Ligali TO, et al. Determinants of preventive oral health behaviour among senior dental students in Nigeria. BMC Oral Health. 2013;13:28. 10.1186/1472-6831-13-28 [DOI] [PMC free article] [PubMed] [Google Scholar]
46.Folayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, et al. Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health. 2015;15:72. 10.1186/s12903-015-0058-y [DOI] [PMC free article] [PubMed] [Google Scholar]
47.Overholser JC, Adams DM, Lehnert KL, Brinkman DC. Self-esteem deficits and suicidal tendencies among adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(7):919–28. 10.1097/00004583-199507000-00016 [DOI] [PubMed] [Google Scholar]
48.De Man AF, Gutiérrez BIB. The relationship between level of self-esteem and suicidal ideation with stability of self-esteem as moderator. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement. 2002;34(4):235–8. [Google Scholar]
49.Thompson AH. The suicidal process and self-esteem. Crisis. 2010;31(6):311–6. 10.1027/0227-5910/a000045 [DOI] [PubMed] [Google Scholar]
50.Raja M, Jayakumar P, Govindaraj K, Mithradas N, Saket P, Thilagar S. Appraisal of Oral Hygiene Status amongst Subjects with Suicidal Leanings-A Pilot Study. Journal of Clinical and Diagnostic Research. 2018;12(11):1–4. [Google Scholar]
51.Huff M, Kinion E, Kendra MA, Klecan T. Self-esteem: a hidden concern in oral health. J Community Health Nurs. 2006;23(4):245–55. 10.1207/s15327655jchn2304_5 [DOI] [PubMed] [Google Scholar]
52.Guo X, Park Y, Freedman ND, Sinha R, Hollenbeck AR, Blair A, et al. Sweetened beverages, coffee, and tea and depression risk among older US adults. PLoS One. 2014;9(4):e94715. 10.1371/journal.pone.0094715 [DOI] [PMC free article] [PubMed] [Google Scholar]
53.Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, Pla-Vidal J, Martínez-González MA. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr. 2012;15(3):424–32. 10.1017/S1368980011001856 [DOI] [PubMed] [Google Scholar]
54.Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408–13. 10.1192/bjp.bp.108.058925 [DOI] [PMC free article] [PubMed] [Google Scholar]
55.Chukwumah NM, Folayan MO, Oziegbe EO, Umweni AA. Impact of dental caries and its treatment on the quality of life of 12- to 15-year-old adolescents in Benin, Nigeria. Int J Paediatr Dent. 2016;26(1):66–76. 10.1111/ipd.12162 [DOI] [PubMed] [Google Scholar]
56.Balazs J, Miklosi M, Halasz J, Horváth LO, Szentiványi D, Vida P. Suicidal Risk, Psychopathology, and Quality of Life in a Clinical Population of Adolescents. Front Psychiatry. 2018;9:17. 10.3389/fpsyt.2018.00017 [DOI] [PMC free article] [PubMed] [Google Scholar]
57.Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000;177:546–50. 10.1192/bjp.177.6.546 [DOI] [PubMed] [Google Scholar]
58.Manippa V, Padulo C, van der Laan LN, Brancucci A. Gender Differences in Food Choice: Effects of Superior Temporal Sulcus Stimulation. Front Hum Neurosci. 2017;11:597. 10.3389/fnhum.2017.00597 [DOI] [PMC free article] [PubMed] [Google Scholar]
59.Adewuya AO, Oladipo EO. Prevalence and associated factors for suicidal behaviours (ideation, planning, and attempt) among high school adolescents in Lagos, Nigeria. Eur Child Adolesc Psychiatry. 2020;29(11):1503–12. 10.1007/s00787-019-01462-x [DOI] [PubMed] [Google Scholar]
60.Stewart SM, Kennard BD, Lee PW, Mayes T, Hughes C, Emslie G. Hopelessness and suicidal ideation among adolescents in two cultures. J Child Psychol Psychiatry. 2005;46(4):364–72. 10.1111/j.1469-7610.2004.00364.x [DOI] [PubMed] [Google Scholar]
61.Mennella JA. Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr. 2014;99(3):704s–11s. 10.3945/ajcn.113.067694 [DOI] [PMC free article] [PubMed] [Google Scholar]
62.Lombardo M, Aulisa G, Padua E, Annino G, Iellamo F, Pratesi A, et al. Gender differences in taste and foods habits. Nutrition & Food Science. 2019;50(1):229–39. [Google Scholar]

PLoS One. doi: 10.1371/journal.pone.0247073.r001

Decision Letter 0

Frédéric Denis

7 Jan 2021

PONE-D-20-34066

Oral health practices and oral hygiene status as indicators of suicidal ideation among Nigerian adolescents

PLOS ONE

Dear Dr. Folayan,

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Reviewer #1: Yes

Reviewer #2: Yes

**********

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Reviewer #1: I Don't Know

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This is an extremely relevant subject with an impressive sample; it deserves publication and requires only minor adjustments. Below are suggestions to improve the article. Congratulations on your beautiful study!

Introduction

1. I suggest removing the excerpt about 2014 from the first paragraph, leaving only the information about 2017. It is a bit repetitive.

2. Rephrase the following excerpt in a more clear and objective way - “Suicidal ideation/attempt may also increase the risk for poor toothbrushing and plaque accumulation through a common link - depression. Depression leads to reduction in energy, self-worth, and esteem, which may lead to poor toothbrushing, plaque accumulation, and poor oral hygiene. Poor oral health is also a risk factor for depression.”

3. The introduction section is too long, it requires more objectivity. In addition, the results fill a gap not only in the study’s region but a worldwide gap. We know that studies like these, with a large sample size, are scarce.

Methods and Results

1. Could the studied community have influenced the results?

2. Were mental health, medication and substance (drugs) use also investigated? Could these factors influence the results?

3. Why were the results not compared with a control group? Adolescents with no intention to commit or no attempted suicide? We know that adolescence is a period when oral hygiene decreases and sugar consumption increases.

4. The article mentions caries evaluation in the methods section. How was it accomplished? Where is the result? Was periodontal disease evaluated? Oral injuries?

5. The numerical values can be better described, at least by presenting minimum, maximum and median values as well.

6. The use of graphs showing associations and trends can further enhance the article.

Discussion

1. The discussion section could extrapolate a little more by using data from the literature, as well as touch a little more on the visible plaque index and on the questionnaire used to assess suicide.

Conclusion – this section is objective and impactful!

Reviewer #2: The reviewer would like to thank the authors for their interesting study. However some minor comments should be considered to improve the manuscript.

1- The abstract is very long and does not summarize the study. Please provide a short abstract that presents only the most important information of the investigation.

2- The authors discussed the limitations of the study in the first part of the discussion. It would be much better if the authors created a paragraph at the end of the discussion about the limitations. This makes it easier for the reader to understand all aspects and limitations discussed.

3- The authors provided a clear discussion of the relationship between high sugar consumption, depression and the suicidal rate. Nevertheless, some points need to be further discussed, as the role of the socioeconomical status. Is the number of meals per day also an effective instrument to conclude the socioeconomical status of the participants? This also needs to be discussed further.

4- Are there similar studies in other countries, maybe outside Africa? Please discuss and compare if available.

5- Formatting mistakes should be corrected

**********

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Reviewer #1: Yes: bruna lavinas sayed picciani

Reviewer #2: No

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PLoS One. 2021 Feb 25;16(2):e0247073. doi: 10.1371/journal.pone.0247073.r002

Author response to Decision Letter 0

28 Jan 2021

Response to Reviewers

PLOS One Article PONE-D-20-34066

Oral health practices and oral hygiene status as indicators of suicidal ideation among Nigerian adolescents

15 January, 2021

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

Response: We have thoroughly re-examined and revised our formatting in line with PLOS One’s style requirements. Heading font styles and sizes, reference citations and styles and supplementary file naming have all been checked and corrected. Thank you for bringing this to our attention.

In your revised cover letter, please address the following prompts:

We will update your Data Availability statement on your behalf to reflect the information you provide.

Response: Thanks. We have uploaded the anonymised data set used for this study along with the revised manuscript.

Response: In text citation (S1 File) and a Supporting Information file section for our supplemental file have been added accordingly.

Review Comments to the Author

Reviewer #1:

This is an extremely relevant subject with an impressive sample; it deserves publication and requires only minor adjustments. Below are suggestions to improve the article. Congratulations on your beautiful study!

Response: Thank you for the kind words!

Introduction

1. I suggest removing the excerpt about 2014 from the first paragraph, leaving only the information about 2017. It is a bit repetitive.

Response: Thank you for bringing this to our attention; the excerpt has been removed.

Response. Sentence revised to read: Depression leads to reductions in energy and self-esteem, which may lead to poor oral hygiene behaviors and health status [13, 14]. Poor oral health is also a risk factor for depression [15]. Depression may therefore be a mediating factor between suicidal ideation/attempt and poor oral hygiene.

Response: Thank you for the helpful critique. We have reduced the length of the Introduction section; it is now less than 600 words (574 words to be exact). We have also made edits to portray more objectivity and to highlight that our findings are potentially bridging national, regional and global gaps in oral/mental health research.

Methods and Results

1. Could the studied community have influenced the results?

Response: This is a possibility. We have addressed this in the manuscript and cautioned on the generalisability of the study finding because of cultural differences in communities. Please see the second paragraph in the Discussion section of the manuscript.

2. Were mental health, medication and substance (drugs) use also investigated? Could these factors influence the results?

Response: We do agree that mental health, medication and substance use may influence the results. They were not, however, included in this study. We added a narrative in Discussion/ Limitations about this and called for future studies to address this gap in knowledge.

Response: The objective for this study was to identify oral health practices and behaviours associated with suicidal ideation/attempt. We do acknowledge that a study identifying differences in oral health practices and behaviours in adolescents with and without suicidal ideation is a good mini study. We will conduct this analysis and publish as a separate manuscript

4. The article mentions caries evaluation in the methods section. How was it accomplished? Where is the result? Was periodontal disease evaluated? Oral injuries?

Response: Thanks for picking up this gap in the methodology. This study only determined the association between suicidal ideation/attempt and oral hygiene status. The oral hygiene status is a risk factor for caries, periodontal disease and other general health problems. We have adjusted the methods to remove ambiguity regarding caries evaluation. Unfortunately, we did not have data for periodontal disease and oral injuries.

5. The numerical values can be better described, at least by presenting minimum, maximum and median values as well.

Response: The study cohort’s age range (10 to 19 years) as well as the range for plaque scores have now been included in first paragraph of the Results section’s narrative. We have provided range for the data it is feasible to provide these values for

6. The use of graphs showing associations and trends can further enhance the article.

Response: We used logistic regression for two dependent variables (brushing at least once daily and consumption of refined carbohydrates in between meals) and this displays no plots for associations, trends or interactions. Also, in the linear regression, the independent variable of interest was suicidal ideation or attempt which is a binary variable for which no interaction plot can be produced. The only alternative left was to use clustered bar charts for the association between suicidal ideation or attempt and the two categorical dependent variables (brushing and consumption of refined carbohydrates) after splitting the sample by sex. If these were used, they would show bivariate associations without the adjustment of regression analyses. This would distort the results and mislead readers. Because of this, we chose not to use graphs.

Discussion

Response: We discussed the use of merits and demerits of use of the questionnaire used to assess suicide as oral hygiene behavior in the second paragraph of the discussion section. We have also included some references and Discussion narrative comparing the study findings with other findings. Please see references 43-46.

2. Conclusion – this section is objective and impactful!

Response: Thank you for the kind assessment.

Reviewer #2:

The reviewer would like to thank the authors for their interesting study. However some minor comments should be considered to improve the manuscript.

1. The abstract is very long and does not summarize the study. Please provide a short abstract that presents only the most important information of the investigation.

Response: This has been revised and word number reduced accordingly; it is now 348 words long, and we only include salient results.

2. The authors discussed the limitations of the study in the first part of the discussion. It would be much better if the authors created a paragraph at the end of the discussion about the limitations. This makes it easier for the reader to understand all aspects and limitations discussed.

Response: We followed the STROBE guidelines for cross sectional studies; it requires the strength and limitations of the study be written up immediately after the first paragraph that gives a summary of the results.

3. The authors provided a clear discussion of the relationship between high sugar consumption, depression and the suicidal rate. Nevertheless, some points need to be further discussed, as the role of the socioeconomical status. Is the number of meals per day also an effective instrument to conclude the socioeconomical status of the participants? This also needs to be discussed further.

Response: Thank you for this query. There are previous studies to demonstrate that the number of meals accessed per day is an indication of the socioeconomic status for children in Nigeria. Please see Sodipo MA et al. Influence of socio-economic status on intake of lunch by school age children. FUTA J. Res. Sci. 2017; 13 (1): 129-136

4. Are there similar studies in other countries, maybe outside Africa? Please discuss and compare if available.

Response: We have improved the Discussion by making references to other studies. There are precious few studies to compare with though. Please see references 50, 52-54.

5. Formatting mistakes should be corrected.

Response: Thanks for highlighting this. We have effected extensive formatting edits: throughout the manuscript (particularly Title Page, heading fonts) and in the References and Supporting Information sections. We trust that all formatting mistakes have been taken care of.

Attachment

Submitted filename: Response to Reviewers_PLOS One MH, Suicide.doc

Click here for additional data file.^{(55.5KB, doc)}

PLoS One. doi: 10.1371/journal.pone.0247073.r003

Decision Letter 1

Frédéric Denis

1 Feb 2021

Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

PONE-D-20-34066R1

Dear Dr. Folayan,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Frédéric Denis, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

PLoS One. doi: 10.1371/journal.pone.0247073.r004

Acceptance letter

Frédéric Denis

16 Feb 2021

PONE-D-20-34066R1

Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

Dear Dr. Folayan:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Frédéric Denis

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 File. Study household survey questionnaire.

(XLSX)

Click here for additional data file.^{(132.6KB, xlsx)}

S2 File

(DOCX)

Click here for additional data file.^{(107.9KB, docx)}

Attachment

Submitted filename: Response to Reviewers_PLOS One MH, Suicide.doc

Click here for additional data file.^{(55.5KB, doc)}

Data Availability Statement

All relevant data are within the paper and its Supporting Information files.

[pone.0247073.ref001] 1.World Health Organization. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. 2018 [Available from: https://www.who.int/healthinfo/global_burden_disease/estimates/en/index.html. Accessed: 2021 January 15.

[pone.0247073.ref002] 2.Barnes JN, Joyner MJ. Sugar highs and lows: the impact of diet on cognitive function. J Physiol. 2012;590(12):2831. 10.1113/jphysiol.2012.234328 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref003] 3.Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry. 2000;34(3):420–36. 10.1080/j.1440-1614.2000.00691.x [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref004] 4.Ruchkin V, Koposov RA, Koyanagi A, Stickley A. Suicidal Behavior in Juvenile Delinquents: The Role of ADHD and Other Comorbid Psychiatric Disorders. Child Psychiatry Hum Dev. 2017;48(5):691–8. 10.1007/s10578-016-0693-9 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref005] 5.Knüppel A, Shipley MJ, Llewellyn CH, Brunner EJ. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep. 2017;7(1):6287. 10.1038/s41598-017-05649-7 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref006] 6.Chong CP, Shahar S, Haron H, Din NC. Habitual sugar intake and cognitive impairment among multi-ethnic Malaysian older adults. Clin Interv Aging. 2019;14:1331–42. 10.2147/CIA.S211534 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref007] 7.Naneix F, Darlot F, De Smedt-Peyrusse V, Pape JR, Coutureau E, Cador M. Protracted motivational dopamine-related deficits following adolescence sugar overconsumption. Neuropharmacology. 2018;129:16–25. 10.1016/j.neuropharm.2017.11.021 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref008] 8.Jacques A, Chaaya N, Beecher K, Ali SA, Belmer A, Bartlett S. The impact of sugar consumption on stress driven, emotional and addictive behaviors. Neurosci Biobehav Rev. 2019;103:178–99. 10.1016/j.neubiorev.2019.05.021 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref009] 9.Westover AN, Marangell LB. A cross-national relationship between sugar consumption and major depression? Depress Anxiety. 2002;16(3):118–20. 10.1002/da.10054 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref010] 10.Hsu TM, Konanur VR, Taing L, Usui R, Kayser BD, Goran MI, et al. Effects of sucrose and high fructose corn syrup consumption on spatial memory function and hippocampal neuroinflammation in adolescent rats. Hippocampus. 2015;25(2):227–39. 10.1002/hipo.22368 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref011] 11.Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Int J Environ Res Public Health. 2018;15(7). 10.3390/ijerph15071425 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref012] 12.Kane SF. The effects of oral health on systemic health. Gen Dent. 2017;65(6):30–4. [PubMed] [Google Scholar]

[pone.0247073.ref013] 13.Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006;114(2):109–14. 10.1111/j.1600-0722.2006.00334.x [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref014] 14.Skośkiewicz-Malinowska K, Malicka B, Ziętek M, Kaczmarek U. Oral health condition and occurrence of depression in the elderly. Medicine (Baltimore). 2018;97(41):e12490. 10.1097/MD.0000000000012490 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref015] 15.Jamieson LM, Paradies YC, Gunthorpe W, Cairney SJ, Sayers SM. Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults. BMC Public Health. 2011;11:656. 10.1186/1471-2458-11-656 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref016] 16.Kisely S. No Mental Health without Oral Health. Can J Psychiatry. 2016;61(5):277–82. 10.1177/0706743716632523 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref017] 17.Hopes LM, Williams A. Depression, self-defeating, and self-destructive behaviors as predictors of suicide ideation in males and females. Psychol Rep. 1999;84(1):63–6. 10.2466/pr0.1999.84.1.63 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref018] 18.Kim YS, Kim HN, Lee JH, Kim SY, Jun EJ, Kim JB. Association of stress, depression, and suicidal ideation with subjective oral health status and oral functions in Korean adults aged 35 years or more. BMC Oral Health. 2017;17(1):101. 10.1186/s12903-017-0391-4 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref019] 19.Kabiru CW, Izugbara CO, Beguy D. The health and wellbeing of young people in sub-Saharan Africa: an under-researched area? BMC Int Health Hum Rights. 2013;13:11. 10.1186/1472-698X-13-11 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref020] 20.Nalugya-Sserunjogi J, Rukundo GZ, Ovuga E, Kiwuwa SM, Musisi S, Nakimuli-Mpungu E. Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health. 2016;10:39. 10.1186/s13034-016-0133-4 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref021] 21.Cortina MA, Sodha A, Fazel M, Ramchandani PG. Prevalence of child mental health problems in sub-Saharan Africa: a systematic review. Arch Pediatr Adolesc Med. 2012;166(3):276–81. 10.1001/archpediatrics.2011.592 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref022] 22.Mapayi B, Olakunle O, Osilaja R, Oyebode B, Ogunyemi M, Adewole O, et al. Gender differences in suicidal ideations and attempts among secondary school students in Ile-Ife, Nigeria. African Journal of Gender and Development. 2016;3(1):40–56. [Google Scholar]

[pone.0247073.ref023] 23.Gureje O, Kola L, Uwakwe R, Udofia O, Wakil A, Afolabi E. The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being. Psychol Med. 2007;37(6):821–30. 10.1017/S0033291707000311 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref024] 24.Nyundo A, Manu A, Regan M, Ismail A, Chukwu A, Dessie Y, et al. Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10–19 years: cross-sectional study. Trop Med Int Health. 2020;25(1):54–69. 10.1111/tmi.13336 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref025] 25.Kleemola-Kujala E, Räsänen L. Relationship of oral hygiene and sugar consumption to risk of caries in children. Community Dent Oral Epidemiol. 1982;10(5):224–33. 10.1111/j.1600-0528.1982.tb00384.x [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref026] 26.Josefczyk ME. The State of Oral Health on the African Continent: Liberty University; 2015. [Google Scholar]

[pone.0247073.ref027] 27.Olabisi AA, Udo UA, Ehimen UG, Bashiru BO, Gbenga OO, Adeniyi AO. Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria. J Int Soc Prev Community Dent. 2015;5(1):59–63. 10.4103/2231-0762.151979 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref028] 28.Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST, et al. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991;60(4):570–85. 10.1037//0022-3514.60.4.570 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref029] 29.Beck AT, Steer RA, Beck JS, Newman CF. Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide Life Threat Behav. 1993;23(2):139–45. [PubMed] [Google Scholar]

[pone.0247073.ref030] 30.Kashani JH, Reid JC, Rosenberg TK. Levels of hopelessness in children and adolescents: a developmental perspective. J Consult Clin Psychol. 1989;57(4):496–9. 10.1037//0022-006x.57.4.496 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref031] 31.Kuo WH, Gallo JJ, Eaton WW. Hopelessness, depression, substance disorder, and suicidality—a 13-year community-based study. Soc Psychiatry Psychiatr Epidemiol. 2004;39(6):497–501. 10.1007/s00127-004-0775-z [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref032] 32.Araoye M. Research methodology with statistics for health and social sciences. 2nd ed. Ilorin Nigeria: Nathadex Publications; 2008. [Google Scholar]

[pone.0247073.ref033] 33.Adekoya-Sofowora CA, Nasir WO, Oginni AO, Taiwo M. Dental caries in 12-year-old suburban Nigerian school children. Afr Health Sci. 2006;6(3):145–50. 10.5555/afhs.2006.6.3.145 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref034] 34.Folayan MO, Odetoyinbo M, Harrison A. Differences in use of contraception by age, sex and HIV status of 10-19-year-old adolescents in Nigeria. Int J Adolesc Med Health. 2015;29(4). 10.1515/ijamh-2015-0059 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref035] 35.Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8(4):443–54. 10.1177/107319110100800409 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref036] 36.Brown GK. A review of suicide assessment measures for intervention research with adults and older adults. 2001. [Google Scholar]

[pone.0247073.ref037] 37.Cotton CR, Peters DK, Range LM. Psychometric properties of the Suicidal Behaviors Questionnaire. Death Stud. 1995;19(4):391–7. 10.1080/07481189508252740 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref038] 38.Aloba O, Ojeleye O, Aloba T. The psychometric characteristics of the 4-item Suicidal Behaviors Questionnaire-Revised (SBQ-R) as a screening tool in a non-clinical sample of Nigerian university students. Asian J Psychiatr. 2017;26:46–51. 10.1016/j.ajp.2017.01.017 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref039] 39.Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol. 1967;38(6):Suppl:610–6. 10.1902/jop.1967.38.6.610 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref040] 40.Adewuya AO, Ola BA, Coker OA, Atilola O, Zachariah MP, Olugbile O, et al. Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey, Nigeria. BJPsych Open. 2016;2(6):385–9. 10.1192/bjpo.bp.116.004333 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref041] 41.Oyedele TA, Folayan MO, Chukwumah NM, Onyejaka NK. Social predictors of oral hygiene status in school children from suburban Nigeria. Braz Oral Res. 2019;33:e022. 10.1590/1807-3107bor-2019.vol33.0022 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref042] 42.Federal Ministry of Health Nigeria-National Health Research Ethics Committee. Policy Statement Regarding Enrollment of Children in Research in Nigeria 2016 [Available from: http://nhrec.net/nhrec/Final%20NHREC%20Policy%20Statement%20on%20Enrollment%20of%20Children%20in%20Research.pdf. Accessed: 2021 January 15.

[pone.0247073.ref043] 43.Mikolajczyk RT, Maxwell AE, El Ansari W, Naydenova V, Stock C, Ilieva S, et al. Prevalence of depressive symptoms in university students from Germany, Denmark, Poland and Bulgaria. Soc Psychiatry Psychiatr Epidemiol. 2008;43(2):105–12. 10.1007/s00127-007-0282-0 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref044] 44.Akinsulore A, Esimai O, Afolabi O, Aloba O, Mapayi B. Prevalence and factors associated with depressive symptoms among Yoruba adults in a semi-urban community in South-Western Nigeria. Journal of Behavioral Health. 2015;4(3):81–6. [Google Scholar]

[pone.0247073.ref045] 45.Folayan MO, Khami MR, Folaranmi N, Popoola BO, Sofola OO, Ligali TO, et al. Determinants of preventive oral health behaviour among senior dental students in Nigeria. BMC Oral Health. 2013;13:28. 10.1186/1472-6831-13-28 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref046] 46.Folayan MO, Kolawole KA, Oziegbe EO, Oyedele T, Oshomoji OV, Chukwumah NM, et al. Prevalence, and early childhood caries risk indicators in preschool children in suburban Nigeria. BMC Oral Health. 2015;15:72. 10.1186/s12903-015-0058-y [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref047] 47.Overholser JC, Adams DM, Lehnert KL, Brinkman DC. Self-esteem deficits and suicidal tendencies among adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(7):919–28. 10.1097/00004583-199507000-00016 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref048] 48.De Man AF, Gutiérrez BIB. The relationship between level of self-esteem and suicidal ideation with stability of self-esteem as moderator. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement. 2002;34(4):235–8. [Google Scholar]

[pone.0247073.ref049] 49.Thompson AH. The suicidal process and self-esteem. Crisis. 2010;31(6):311–6. 10.1027/0227-5910/a000045 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref050] 50.Raja M, Jayakumar P, Govindaraj K, Mithradas N, Saket P, Thilagar S. Appraisal of Oral Hygiene Status amongst Subjects with Suicidal Leanings-A Pilot Study. Journal of Clinical and Diagnostic Research. 2018;12(11):1–4. [Google Scholar]

[pone.0247073.ref051] 51.Huff M, Kinion E, Kendra MA, Klecan T. Self-esteem: a hidden concern in oral health. J Community Health Nurs. 2006;23(4):245–55. 10.1207/s15327655jchn2304_5 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref052] 52.Guo X, Park Y, Freedman ND, Sinha R, Hollenbeck AR, Blair A, et al. Sweetened beverages, coffee, and tea and depression risk among older US adults. PLoS One. 2014;9(4):e94715. 10.1371/journal.pone.0094715 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref053] 53.Sánchez-Villegas A, Toledo E, de Irala J, Ruiz-Canela M, Pla-Vidal J, Martínez-González MA. Fast-food and commercial baked goods consumption and the risk of depression. Public Health Nutr. 2012;15(3):424–32. 10.1017/S1368980011001856 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref054] 54.Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408–13. 10.1192/bjp.bp.108.058925 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref055] 55.Chukwumah NM, Folayan MO, Oziegbe EO, Umweni AA. Impact of dental caries and its treatment on the quality of life of 12- to 15-year-old adolescents in Benin, Nigeria. Int J Paediatr Dent. 2016;26(1):66–76. 10.1111/ipd.12162 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref056] 56.Balazs J, Miklosi M, Halasz J, Horváth LO, Szentiványi D, Vida P. Suicidal Risk, Psychopathology, and Quality of Life in a Clinical Population of Adolescents. Front Psychiatry. 2018;9:17. 10.3389/fpsyt.2018.00017 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref057] 57.Qin P, Agerbo E, Westergård-Nielsen N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry. 2000;177:546–50. 10.1192/bjp.177.6.546 [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref058] 58.Manippa V, Padulo C, van der Laan LN, Brancucci A. Gender Differences in Food Choice: Effects of Superior Temporal Sulcus Stimulation. Front Hum Neurosci. 2017;11:597. 10.3389/fnhum.2017.00597 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref059] 59.Adewuya AO, Oladipo EO. Prevalence and associated factors for suicidal behaviours (ideation, planning, and attempt) among high school adolescents in Lagos, Nigeria. Eur Child Adolesc Psychiatry. 2020;29(11):1503–12. 10.1007/s00787-019-01462-x [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref060] 60.Stewart SM, Kennard BD, Lee PW, Mayes T, Hughes C, Emslie G. Hopelessness and suicidal ideation among adolescents in two cultures. J Child Psychol Psychiatry. 2005;46(4):364–72. 10.1111/j.1469-7610.2004.00364.x [DOI] [PubMed] [Google Scholar]

[pone.0247073.ref061] 61.Mennella JA. Ontogeny of taste preferences: basic biology and implications for health. Am J Clin Nutr. 2014;99(3):704s–11s. 10.3945/ajcn.113.067694 [DOI] [PMC free article] [PubMed] [Google Scholar]

[pone.0247073.ref062] 62.Lombardo M, Aulisa G, Padua E, Annino G, Iellamo F, Pratesi A, et al. Gender differences in taste and foods habits. Nutrition & Food Science. 2019;50(1):229–39. [Google Scholar]

PERMALINK

Oral health practices and oral hygiene status as indicators of suicidal ideation among adolescents in Southwest Nigeria

Morenike Oluwatoyin Folayan

Maha El Tantawi

Olakunle Oginni

Elizabeth Oziegbe

Boladale Mapayi

Olaniyi Arowolo

Abiola Adetokunbo Adeniyi

Nadia A Sam-Agudu

Roles

Abstract

Background

Methods

Results

Conclusion

Introduction

Materials and methods

Study design and study population

Sample size and sampling technique

Data collection

Oral health practices

Suicidal behavior assessment

Intra-oral examination

Standardization of examiners

Data analysis

Ethical considerations

Results

Table 1. Profiles, oral health practices and suicidal behaviors among Nigerian adolescents [N = 1,472].

Table 2. Associations between brushing, sugar consumption, plaque accumulation, and suicidal ideation or attempt among Nigerian adolescents [N = 1472].

Table 3. Modifying effect of sex on the association between tooth brushing, sugar consumption, plaque accumulation, and suicidal ideation/attempt [N = 1472].

Discussion

Conclusion

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Frédéric Denis

Roles

Author response to Decision Letter 0

Decision Letter 1

Frédéric Denis

Roles

Acceptance letter

Frédéric Denis

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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