Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2021 Aug 1;147(8):708-716. doi: 10.1001/jamaoto.2021.1049.
Tinnitus is a common disorder, but its impact on daily life varies widely in population-based samples. It is unclear whether this interference in daily life is associated with mental health problems that are commonly detected in clinical populations.
To investigate the association of tinnitus and its interference in daily life with symptoms of depression and anxiety and poor sleep quality in a population-based sample of middle-aged and elderly persons in a cross-sectional analysis and during a 4-year follow-up.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated data from the population-based Rotterdam Study of individuals 40 years or older living in Rotterdam, the Netherlands. Between 2011 and 2016, data on tinnitus were obtained during a home interview at least once for 6128 participants. Participants with information on depressive and anxiety symptoms and self-rated sleep quality, with Mini-Mental State Examination scores indicating unimpaired cognition, and with repeatedly obtained tinnitus and mental health outcome data were included. Data analyses were conducted between September 2019 and April 2020.
The presence of tinnitus and its interference with daily life were assessed during a home interview. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression, anxiety symptoms with the Hospital Anxiety and Depression Scale, and sleep quality with the Pittsburgh Sleep Quality Index. Linear regression analyses and linear mixed models adjusted for relevant confounders were used to assess the cross-sectional and longitudinal association of tinnitus with mental health.
Of 5418 complete-case participants (mean [SD] age, 69.0 [9.8] years; 3131 [57.8%] women), 975 (mean [SD] age, 71.7 [4.5] years; 519 [53.2%] women) had repeated measurements available for follow-up analyses. Compared with participants without tinnitus and participants with nonbothersome tinnitus, participants with tinnitus interfering with daily life reported more depressive (difference, 0.20; 95% CI, 0.11-0.28) and anxiety (difference, 0.15; 95% CI, 0.08-0.22) symptoms and poorer sleep quality (difference, 0.10; 95% CI, 0.03-0.16). Compared with participants without tinnitus, participants with nonbothersome tinnitus also reported more depressive (difference, 0.06; 95% CI, 0.03-0.09) and anxiety (difference, 0.05; 95% CI, 0.02-0.07) symptoms and poorer sleep quality (difference, 0.05; 95% CI, 0.03-0.08). Individuals indicating more interference with daily life reported having more mental health problems. During a mean follow-up of 4.4 years (range, 3.5-5.1 years), participants with tinnitus reported more anxiety symptoms and poorer sleep quality than those without tinnitus.
Findings of this population-based cohort study indicate that tinnitus was associated with more mental health problems in middle-aged and elderly persons in the general population, in particular when tinnitus interfered with daily life but not solely. Over time, more severe tinnitus was associated with an increase in anxiety symptoms and poor sleep quality. This outcome suggests that mental health problems may be part of the burden of tinnitus, even among individuals who do not report their tinnitus interfering with daily life.
耳鸣是一种常见疾病，但在基于人群的样本中，其对日常生活的影响差异很大。目前尚不清楚这种日常生活干扰是否与临床上常见的心理健康问题有关。
通过横断面分析和 4 年随访，研究耳鸣及其对日常生活的干扰与中年和老年人人群中抑郁和焦虑症状以及睡眠质量差的关系。
设计、地点和参与者：这项队列研究评估了荷兰鹿特丹市年龄在 40 岁及以上的人群中进行的基于人群的鹿特丹研究的数据。在 2011 年至 2016 年期间，通过家庭访谈至少一次获得了 6128 名参与者的耳鸣数据。纳入了具有抑郁和焦虑症状以及自我报告睡眠质量信息、迷你精神状态检查评分表明认知无障碍且具有重复获得的耳鸣和心理健康结果数据的参与者。数据分析于 2019 年 9 月至 2020 年 4 月之间进行。
通过家庭访谈评估了耳鸣的存在及其对日常生活的干扰。抑郁症状使用中心流行病学研究抑郁量表评估，焦虑症状使用医院焦虑和抑郁量表评估，睡眠质量使用匹兹堡睡眠质量指数评估。使用线性回归分析和线性混合模型调整相关混杂因素，以评估耳鸣与心理健康的横断面和纵向关联。
在 5418 名完整病例参与者（平均[标准差]年龄 69.0[9.8]岁；3131[57.8%]名女性）中，有 975 名（平均[标准差]年龄 71.7[4.5]岁；519[53.2%]名女性）有重复测量可供随访分析。与无耳鸣和无困扰性耳鸣的参与者相比，有耳鸣且对日常生活造成干扰的参与者报告有更多的抑郁（差异 0.20；95%置信区间 0.11-0.28）和焦虑（差异 0.15；95%置信区间 0.08-0.22）症状和更差的睡眠质量（差异 0.10；95%置信区间 0.03-0.16）。与无耳鸣的参与者相比，无困扰性耳鸣的参与者也报告有更多的抑郁（差异 0.06；95%置信区间 0.03-0.09）和焦虑（差异 0.05；95%置信区间 0.02-0.07）症状和更差的睡眠质量（差异 0.05；95%置信区间 0.03-0.08）。表示日常生活干扰更大的人报告有更多的心理健康问题。在平均 4.4 年（范围 3.5-5.1 年）的随访期间，有耳鸣的参与者报告的焦虑症状和睡眠质量比无耳鸣的参与者更差。
这项基于人群的队列研究的结果表明，耳鸣与中年和老年人的心理健康问题有关，尤其是当耳鸣对日常生活造成干扰时，但并非仅与耳鸣有关。随着时间的推移，更严重的耳鸣与焦虑症状和睡眠质量差的增加有关。这一结果表明，即使在那些不报告耳鸣对日常生活造成干扰的人群中，心理健康问题也可能是耳鸣负担的一部分。
