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Original Investigation
June 10, 2021

Cross-sectional and Longitudinal Associations Between Tinnitus and Mental Health in a Population-Based Sample of Middle-aged and Elderly Persons

Author Affiliations
  • 1Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
  • 2Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
  • 3Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
  • 4Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
JAMA Otolaryngol Head Neck Surg. 2021;147(8):708-716. doi:10.1001/jamaoto.2021.1049
Key Points

Question  Does an association exist between tinnitus (and its interference with daily life) and mental health problems?

Findings  This cohort study involving 5418 participants found that bothersome tinnitus was associated with depressive symptoms, anxiety symptoms, and poorer sleep quality than nonbothersome tinnitus. At the end of a 4-year follow-up of 975 of these participants, baseline tinnitus appeared to be associated with mental health problems, but this association was not statistically significant.

Meaning  Tinnitus was associated with experiencing more mental health problems, even over time and among individuals who reported that their tinnitus was not interfering with daily life.


Importance  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.

Objective  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.

Main Outcomes and Measures  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.

Results  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.

Conclusions and Relevance  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.

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