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2019 HSR&D/QUERI National Conference Abstract

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1170 — Associations between tinnitus severity and mental health symptoms among Veterans with and without traumatic brain injury: A national survey

Lead/Presenter: Kathleen Carlson,  COIN - Portland
All Authors: Gilbert TA (Center to Improve Veteran Involvement in Care, VA Portland Healthcare System), Hooker, E (Center to Improve Veteran Involvement in Care, VA Portland Healthcare System), Carlson, KF (Center to Improve Veteran Involvement in Care, VA Portland Healthcare System; School of Public Health, Oregon Health and Science University)

Objectives:
Tinnitus, the sensation of ringing or buzzing in the ear, is the most prevalent disability among US Veterans. The impact of tinnitus on daily functioning can vary from mild to very severe. The interplay between tinnitus and mental health is poorly understood. The objective of this work was to examine associations between self-reported tinnitus severity and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) among Veteran VA users, with and without diagnosed traumatic brain injury (TBI), who used VA healthcare and were diagnosed with tinnitus between 2011 and 2016.

Methods:
A national, random sample of 1,800 Veterans, stratified by age and TBI diagnosis (yes/no), received a multimodal (mail/internet) survey. Tinnitus severity (none/mild, moderate, severe, very severe) was measured using the Tinnitus Functional Index, a validated measure. Mental health symptoms were assessed using validated screening instruments. We used inverse probability weights to account for sample stratification in analyses. Bivariable and multivariable logistic regression analyses were used to estimate associations between tinnitus severity and mental health.

Results:
A total of 893 surveys were completed. Almost 40% (95% CI: 32.8-43.9%) of respondents reported very severe tinnitus; 82.4% (95% CI: 78.0-86.7%) reported symptoms consistent with probable depression, 81.0% (95% CI: 76.4-85.5%) with anxiety, and 70.9% (95% CI: 65.7-76.2%) with PTSD. In bivariable logistic regression analyses, very severe tinnitus, compared to moderate tinnitus, was associated with greater odds of depression (OR = 8.4; 95% CI: 3.1-23.2) and anxiety (OR = 3.8; 95% CI: 1.6-9.1), but only marginally with PTSD. Results of bivariable analyses stratified by TBI diagnosis, and of multivariable analyses controlling for age, sex, time spent in the military, and TBI diagnosis, were similar.

Implications:
Many Veterans diagnosed with tinnitus reported a severe impact on their daily functioning. Those with the most severe tinnitus impact had higher odds of probable depression and anxiety. This pattern was similar among Veterans regardless of TBI diagnosis status.

Impacts:
These findings suggest that Veterans with severe tinnitus should also be assessed and potentially treated for mental health conditions. The coordination of audiology and mental health care in the VA healthcare system could help address these Veterans' needs.