Tinnitus severity, depression, and the big five personality traits

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Abstract

A growing number of self-report measures for the evaluation of tinnitus severity has become available to research and clinical practice. This has led to an increased awareness of depression and personality as predictors of tinnitus severity in addition to loudness and other psychoacoustic measures. However, the net impact of personality dimensions on tinnitus ratings has not been investigated when the effect of depressed mood is controlled. In the present study, we demonstrate the role of the big five personality traits, ‘Neuroticism’, ‘Extraversion’, ‘Openness’, ‘Agreeableness’, and ‘Conscientiousness’, in affecting scores on two standard instruments for grading tinnitus-related complaints, the tinnitus handicap inventory (THI), and the tinnitus questionnaire (TQ). When 72 individuals with chronic tinnitus were examined, ‘Agreeableness’ negatively correlated with THI scores (p=.003), whereas the anxiety trait ‘Neuroticism’ correlated both with depressive symptomatology (p<.001) and TQ scores (p=.028), but not with THI ratings (n.s.). In addition to confirming the established roles of trait anxiety and depression, low ‘Agreeableness’ was thus identified as a novel predictor of tinnitus severity on the THI.

Introduction

The interplay of personality traits, depressed mood, and tinnitus severity is highly relevant to diagnosis and prognosis in tinnitus-related handicap (Russo et al., 1994). Depression often occurs together with tinnitus (Harrop-Griffiths et al., 1987) and frequently augments functional disability in individuals with tinnitus (Sullivan et al., 1993). In the light of strong placebo effects in tinnitus (Dobie et al., 1993), psychological factors play a further modulatory role in shaping the perception and report of distress associated with tinnitus. Close collaborations between audiologists and mental health professionals have been established in many specialized clinics to meet the specific challenges posed by these interactions (Reynolds et al., 2004).

Among the personality traits that have been identified in the past as predictors of subjective tinnitus severity counts self-reported anxiety (Halford and Anderson, 1991; Langenbach et al., 2005). Measures of anxiety sensitivity, or of excessive pre-occupation with somatic symptoms are often used in combination with tools addressing depression to adequately assess the severity of tinnitus at initial screenings, and to evaluate treatment outcome (Reynolds et al., 2004). Except for the contributory roles of depression and anxiety, however, little is known about personality-specific risk factors. Likewise, little is known about the relationship between temperament, self-reported depression and other forms of tinnitus-related handicap (Zachariae et al., 2000). There is preliminary evidence that the respective measures are not independent of each other and that symptom severity scales may give skewed results when personality traits and affective states are nor controlled for (Langenbach et al., 2005). In order to further improve our understanding of factors that may augment, or reduce, the morbidity associated with chronic tinnitus we therefore compared the outcome of two widely used tinnitus severity scales in relation to the severity of depression and individuals’ temperament. To this avail, we studied 72 individuals suffering from chronic tinnitus who were administered the tinnitus handicap inventory (THI; Newman et al., 1998; Kleinjung et al., 2007), the tinnitus questionnaire (TQ; Hallam et al., 1988; Goebel and Hiller, 1994), the Beck depression inventory (BDI; Beck et al., 1988), and the NEO-five factor inventory (NEO-FFI; Costa and McCrae, 1985). Partial correlations were computed of NEO-FFI subscales with the BDI, TQs, age, and gender.

Section snippets

Methods

One hundred patients who had presented consecutively to the university tinnitus clinic in the months preceding February 2005 were enrolled in the study. All had reported tinnitus as their primary complaint at the time of their audiologic examination, and had undergone a neurootological examination including otoscopy, recording of the acoustic middle ear reflexes, tympanometry (middle ear pressure measurements), pure tone audiometry, and tinnitus pitch and loudness matching. Questionnaires were

Results

Table 1 shows the total scores on the THI and TQ, together with results of distribution analyses. Both measures of severity followed a Gaussian distribution (p>.22). Using the consensus grading scheme of tinnitus severity from ‘slight’ to ‘catastrophic’ on the THI (McCombe et al., 2001), 13 participants (18.1%) reported grade I (slight) tinnitus, 1 individual only displayed symptoms on the TQ, 17 patients (23.0%) had grade II (mild), 22 participants (30.1%) scored as grade III (moderate)

Discussion

This is the first study to identify low ‘Agreeableness’ as a personality dimension highly correlated with tinnitus severity. Individuals who score low on ‘Agreeableness’ are thought to be highly competitive, self-centered, and more susceptible to anger (Meier and Robinson, 2004). It is conceivable that such individuals experience more discomfort from tinnitus compared to others, owing to a perceived inability to meet their own expectations and the levels of performance that they are used to

Conclusions

Significant correlations have emerged among the severity of tinnitus, depression, and two dimensions of personality. Tinnitus severity was predicted by low ‘Agreeableness’ and high ‘Neuroticism’, but the degree of correlation depended on which measure of severity was used. It remains to be seen whether the unhappy triad “depression, anxiety/‘Neuroticism’ and irritability/low ‘Agreeableness’” is an indicator of somatic comorbidity that may warrant adaptations of interventional techniques in

Abbreviations

    BDI

    Beck depression inventory

    NEO FFI

    NEO-five factor inventory

    THI

    tinnitus handicap inventory

    TQ

    tinnitus questionnaire

Acknowledgments

The authors wish to thank Sandra Pfluegl and Helene Niebling for assistance with data collection. The study was supported by a grant from the Tinnitus Research Initiative.

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