Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

Objectives: The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service–connected disability among U.S. Veterans (Veterans Benefits Administration, 2016) and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (Hoffmire et al., 2015), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus. Design: Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death. Results: Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide. Conclusions: The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual's subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal's Web site (www.ear-hearing.com). ACKNOWLEDGEMENTS: This material is the result of work supported with resources and the use of facilities at the VA Portland Healthcare System and the support of the VHA Office of Patient Care Services, Post Deployment Health Services. The authors acknowledge the help that Dr. Robert Bossarte provided to the first two authors as they were starting this research study. Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. All authors contributed equally to this work. E.M. and C.J. conducted the literature review, and E.M. wrote most of the introduction and discussion sections. D.D. and C.W. ran the data analyses and wrote most of the Methods section, including the results, and created the tables. A.S. reviewed and discussed the data analyses with D.D. and C.W. All authors not only discussed the results and their implications but also edited the article throughout its evolution. There are no conflicts of interest to report. Received June 27, 2017; accepted January 23, 2018. Address for correspondence: Erin Martz, VA Portland Healthcare System, Bldg. 6, Room 114A, 3710 SW U.S. Veterans Hospital Rd, Portland, OR 97239. E-mail: rehabilityoregon@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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