Rehability Oregon, and the National Center of Rehabilitative Auditory Research, Veterans Affairs Portland Healthcare System, Portland, Oregon.
Portland State University, Portland, Oregon.
Ear Hear. 2018 Nov/Dec;39(6):1046-1056. doi: 10.1097/AUD.0000000000000573.
The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service-connected disability among U.S. Veterans () and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus.
Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death.
Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide.
The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus.
本研究旨在探讨耳鸣诊断与自杀之间是否存在关联，以及抑郁和焦虑是否会增强这种关联。鉴于耳鸣是美国退伍军人中排名最高的服务相关残疾（），且退伍军人自杀率高于社区自杀率（），因此将探讨耳鸣与自杀之间可能存在的关联。同时，还将检查同时存在的身体状况，以确定它们是否会增加耳鸣背景下的自杀风险。
本研究使用与持久自由/伊拉克自由/新黎明行动（OEF/OIF/OND）相关的行政医疗保健数据，确定了 2002 年 1 月 1 日至 2011 年 12 月 31 日期间使用退伍军人事务部（VA）医疗保健系统的退伍军人。截至 2011 年 12 月，使用国家死亡指数（NDI）文件确定已死亡的退伍军人。耳鸣病例一直随访至死亡或研究结束。使用国际疾病分类第 9 版临床修订版（ICD-9-CM）代码来识别所有病症和疾病。根据死亡率研究标准，使用国际疾病分类第 10 版（ICD-10）代码来识别死亡原因。
在 2002 年 1 月至 2011 年 12 月期间接受 VA 护理的 769934 名 OEF/OIF/OND 退伍军人中，有 15%（n=116358）被诊断为耳鸣。在这些被诊断为耳鸣的退伍军人中，21%还被诊断患有抑郁症，另有 8%患有焦虑症，另有 17%同时患有抑郁症和焦虑症。54%的人被诊断为无抑郁或焦虑的耳鸣。在患有耳鸣的人群中，有 41.9%同时患有听力损失。患有耳鸣的退伍军人的自杀率低于没有耳鸣的退伍军人。同时患有精神疾病的诊断并不会显著增加自杀的风险。
研究结果并未证实临床和传闻报告中关于耳鸣可能与退伍军人自杀有关的说法。然而，康复心理学的原理表明，慢性损伤或残疾的发作并不能预测个体随后的心理状态；其他个人属性可能更为重要。听力学家和心理学家等医疗保健专业人员应意识到耳鸣与心理健康问题之间的关联，并准备好满足患有耳鸣的个体的心理需求。
