Does Orthognathic Surgery Improve Mental Health Status: Depression, Anxiety, Distress, Perfectionism, and Quality of Life? A Prospective Cohort Study

Abstract

Background: The demand for cosmetic procedures, including orthognathic surgery, is increasing in Iran. Mental health and personality traits, such as perfectionism, influence quality of life and life satisfaction in individuals seeking such surgeries. Objectives: This prospective cohort study evaluated changes in mental health, perfectionism, and quality of life in patients before and six months after orthognathic surgery. Methods: This longitudinal cohort study was conducted at Saadi and Al-Zahra Hospitals between May 2O2O and September 2O2O. Thirty-five candidates for orthognathic surgery were recruited, based on available eligible patients and prior studies estimating the necessary sample size for detecting significant changes in quality of life outcomes. Inclusion criteria were age 18-50 years, at least basic literacy, and provision of informed consent. Exclusion criteria included cleft lip/palate, severe congenital abnormalities requiring surgery, major traumatic injuries, and significant psychiatric or neurological disorders. Participants were assessed preoperatively and at six months postoperatively, with data collected at both time points using validated questionnaires Orthognathic Quality of Life Questionnaire (OQLQ), Frost Multidimensional Perfectionism Scale (FMPS), Depression Anxiety Stress Scales-21 (DASS-21). Participant characteristics such as age and gender were reported, and potential confounders including age, gender, baseline quality of life, and baseline psychological status were controlled using multivariate linear regression. To minimize potential bias, strict inclusion and exclusion criteria were applied. Changes over time were analysed using analysis of variance (ANOVA), highlighting improvements in quality of life domains across the followup period. Results: Significant improvements were observed in oral health-related quality of life over six months, particularly in aesthetic (P = O.OO1, d =1.2), functional (P = O.OO8, d = 0.7), and awareness domains (P = 0.003, d = 0.9). No significant change was observed in interpersonal relationship scores (P = 0.89). Conclusions: Orthognathic surgery significantly enhances quality of life. However, the relatively small sample size, limited follow-up period, and specific study population may limit the generalisability of the results, and additional psychological interventions may be necessary to improve mental health outcomes.