Beyond the auditory: anxiety bridges sleep disturbances and depressive symptoms to tinnitus handicap.

BACKGROUND

Tinnitus is closely associated with psychological factors including anxiety, depression, and sleep disturbances. However, how these variables interact to influence tinnitus severity remains poorly understood, warranting further exploration.

METHODS

This retrospective study analyzed data from 285 patients with tinnitus, utilizing the Tinnitus Handicap Inventory (THI), Self-Rating Depression Scale (SDS), Self-Rating Scale of Sleep (SRSS), and Self-Rating Anxiety Scale (SAS) as assessment instruments. Univariate and multivariate regression analyses were performed to identify psychosocial factors associated with THI scores. Structural equation modeling (SEM) was employed to examine the mediating role of anxiety-specifically, whether sleep disturbances and depression exacerbate tinnitus handicap indirectly through heightened anxiety. Subgroup analyses were further conducted to evaluate the stability of this psychological mediation pathway across different demographic and clinical subgroups (e.g., age, gender, disease duration).

RESULTS

Tinnitus severity was significantly positively correlated with scores on the SRSS, SDS, and SAS (all P < 0.05). Multivariate regression analysis identified age, sleep quality (SRSS), and anxiety (SAS) as independent predictors of increased Tinnitus Handicap Inventory (THI) scores. Structural equation modeling further confirmed that SAS partially mediated the relationship between SRSS and THI (mediation effect: 31.7%) and fully mediated the relationship between SDS and THI. Subgroup analyses revealed that the mediating effect of anxiety was more pronounced in middle-aged and elderly individuals, females, and patients with left-sided tinnitus.

CONCLUSION

Anxiety serves as a central mediating mechanism linking sleep disturbances and depressive symptoms to tinnitus severity. The present findings demonstrate that anxiety not only directly exacerbates tinnitus-related handicap but also mediates the influence of sleep and mood disturbances on tinnitus distress. These findings underscore the critical role of anxiety in personalized tinnitus treatment.