Original articleThe association between tinnitus and mental health in a general population sample: Results from the HUNT Study☆,☆☆
Introduction
Tinnitus, or buzzing or ringing in the ears or head when no external sound stimuli are present, is a common health complaint in the general population. The prevalence of tinnitus in the adult population is estimated at 8–15%, depending on the definition [1], [2], and increases with age [1]. Tinnitus frequently occurs together with hearing loss but may also be experienced by individuals with normal hearing. In most cases, no specific organic cause is found and the symptoms can only be subjectively reported. Although many people learn to live with tinnitus, some find it severely debilitating [3]. In addition to general irritation and annoyance with the sound, tinnitus can cause sleeping difficulties, concentration difficulties, reduced speech intelligibility, and different kinds of psychosomatic, emotional, and interpersonal problems [4].
Given its relatively high prevalence and possible influence on several important aspects of life, tinnitus may well be a significant contributor to reduced mental health and well-being in the population. However, knowledge about this association in the general population is scanty [5]. An association between tinnitus and reduced quality of life was demonstrated in a cohort of older adults (n=2800) [6], whereas no association between tinnitus and depression was found in another survey of elderly people (n=583) [7]. A survey of members of tinnitus and hearing impairment associations found that nearly 50% of the respondents were sometimes depressed by tinnitus (n=338) [8]. However, these were surveys of segments and not of the whole general adult population.
The evidence on the association between tinnitus and mental health comes mostly from small clinical studies, which often found a strong association between tinnitus and psychiatric disorders. For instance, the prevalence of tinnitus patients who met the criteria for a lifetime psychiatric diagnosis has been reported to be as high as 45–78% [9], [10], [11]. Among tinnitus patients, various clinical studies found a prevalence of diagnosed current depressive disorders of 33–74% [9], [10], [12], [13], [14] and a prevalence of anxiety disorder of 29–49% [10], [13], [14]. Most of these studies reported a higher prevalence of anxiety and depression in tinnitus patients than in the general population [15]. However, other studies did not find a particularly high prevalence of psychiatric symptoms in tinnitus patient samples [16].
The strong association between mental health and tinnitus that is found in many clinical studies might apply to the group of persons who seek help at audiology clinics but cannot necessarily be generalized to the whole population of tinnitus cases, since many people with tinnitus never consult specialists [17]. This point is illustrated by studies that found systematic differences between help seekers and non–help seekers on psychological variables [18], [19]. In a review of research on diagnosed anxiety and depression in tinnitus patients, Robinson et al. [15] found that studies having specific severity criteria for inclusion of participants reported generally higher rates of depression than studies where no specific severity was required for participation.
The purpose of the present study was to examine the association between tinnitus and mental health and well-being in the general adult population. A further goal was to examine factors that might influence the variation in mental health and well-being among people with tinnitus.
Section snippets
Sample
In the years 1995 to 1997, all adult inhabitants of Nord-Trøndelag County, Norway, were invited to participate in the Nord-Trøndelag Health Study (HUNT-2). Two municipalities refused to participate. In some municipalities the data collection for the ordinary HUNT-2 was already finished before the integrated project, the Nord-Trøndelag Hearing Loss Study, started. Thus, the populations of 17 of the 24 municipalities were invited to participate in the Hearing Loss Study. One municipality,
Results
Table 1 shows the distribution of the tinnitus variable by sex and age. Overall, the proportion with tinnitus was higher among men than among women and varied from 12.3% among the youngest women to 28.5% among the oldest men.
Table 2 shows means and standard deviations (S.D.) on the mental health variables by tinnitus status, age, and sex. The means were generally low on symptoms of depression and anxiety and high on self-esteem and well-being both in the reference group and among the
Discussion
People with tinnitus overall scored somewhat higher on anxiety and depression, and a little lower on self-esteem and well-being than people without tinnitus. But the scores did not vary systematically with the symptom level. The associations with self-esteem and well-being were weaker than the associations with anxiety and depression and were not significant in all groups. Whereas clinical studies indicate a strong association between tinnitus and mental health, the associations found in this
Conclusion
The association between tinnitus and mental health found in this general population study was quite weak. The results support what is known from previous studies, that tinnitus symptom characteristics mean less than the subjective perception of them.
Acknowledgments
We want to thank the audiometry team for their diligence. Also, we thank Ellen Russon for editing the manuscript.
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The Nord-Trøndelag Hearing Loss Study, which is part of Nord-Trøndelag Health Study, (HUNT) was funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), research contract no. N01-DC-6-2104, and by the Norwegian Research Council. The present work was supported by The Norwegian Foundation for Health and Rehabilitation. HUNT was conducted in collaboration between the Norwegian Institute of Public Health, the National Health Screening Service, Nord-Trøndelag County Council, and the Norwegian University of Technology and Science. Drs. H.J. Hoffman (NIDCD), H.M. Borchgrevink, and J. Holmen participated in the planning and administration of the Nord-Trøndelag Hearing Loss Study. The Nord-Trøndelag County Health Officer and the Community Health Officer in Levanger and in other municipalities provided organizational and other practical support.
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Human participant protection: This study was approved by the Data Inspectorate of Norway and recommended by the Regional Committee for Medical Research Ethics.