66 Chapter 3 diseases, regardless of the use of alcohol was combined with drugs or not. But the association between alcohol and OHRQoL is questionable since the association is more related to social circumstances and not directly by alcohol consumption [33,34]. In contrast, current study included patients diagnosed with a psychotic disorder (first-episode) and their peers and did not include the level of alcohol drinking and social circumstances. Furthermore, having no insurance oral health was an unexpected beneficial risk factor for improving OHRQoL. This is in contrast with the findings of Lam et al. [9] who state that underserved individuals receiving care for SMI in a public mental health service had low OHQoL, driven by unmet dental care needs and xerostomia. The unexpected outcomes of the multiple regression might be related to differences in the effects of risk factors on OHRQoL between patients diagnosed with a psychotic disorder (first-episode) and individuals from the general population. This study focussed on main effects. Future studies with an appropriate sample size should also take interactions between group and other risk factors into account. Study limitations This study aimed to compare the risk factors and OHRQoL in patients diagnosed with a psychotic disorder (first-episode) to individuals from the general population. In this study, 81 patients diagnosed with a psychotic disorder (first-episode) were successfully matched with 166 individuals from the general population without any history of psychotic disorder. Although this sample provides a realistic representation of people living in Friesland, a rural region in the north of the Netherlands, generalisability to a greater population or more urban settings remains to be investigated. Self-assessments were used to gain insight into risk factors and OHRQoL, and it could be possible that socially desirable answers were given in the areas of illicit drug or alcohol use. The influence of self-report in patients diagnosed with a psychotic disorder (first-episode) or the general population is not known.
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