Trilogy of studies on the relationship between
Adverse Childhood Experiences and tinnitus / hyperacusis-related distress
childhood experiences are defined as exposures to different forms of abuse
(physical, emotional and sexual) and family dysfunction (substance abuse,
mental illness, mother treated violently, incarcerated household member and
parental separation) (Felitti et al. 1998). There are many
studies that suggest childhood
adversities might lead to development of negative core beliefs about self,
world, and the future (e.g., “I am unlovable”, “World is hostile”, “My future
is too awful”) (Noone et al. 2015; Stowkowy et al. 2016). In the context of cognitive therapy, such
perceptions are known as the cognitive triad and are believed to lead to
distress and psychological disorders (Beckham et al. 1986).
Based on the clinical observations in over 2000
patients who underwent specialised cognitive behavioural therapy (CBT) for tinnitus and/or
hyperacusis rehabilitation, Dr.
Aazh’s team and their international collaborators postulated that there may be a
relationship between adverse childhood experiences and being more vulnerable to
develop tinnitus/hyperacusis-related distress, disability and suicidal or
self-harm ideations across the life span. Consistent with this, there are several research studies suggesting
that childhood adversities can have neurobiological
and genetic influences on child development that may affect the way individuals
respond to stress later in life (De Bellis & Zisk 2014; Anda et al.
Parental separation and parental poor mental health
are important forms of adverse childhood experiences with prevalence of 23.3%
and 19.4%, respectively (Anda et al. 2006).
In a trilogy of papers on the relationship betweenchildhood
history of parental separation as well as parental mental illness and tinnitus/hyperacusis-related distress, disability and suicidal or
self-harm ideations in adulthood (Aazh et al. 2018b; Aazh et al. 2018c; Aazh et al.
2018a), Dr. Aazh’s team
There were no significant differences in
Tinnitus Handicap Inventory (THI) and Hyperacusis Questionnaire (HQ) between
patients with and without history of parental separation (Aazh et al. 2018c).
The scores on THI and HQ were worse in the
group that reported mental health disorders in their parents (p<0.01).
Parental mental health illness did not significantly relate to THI, however, it
was significantly related to the risk of hyperacusis (odds ratio, OR after
adjusting for age and gender: 2.05, p = 0.026). The adjusted OR for a subgroup
of patients with a diagnosis of hyperacusis was 6.7 (p = 0.011), indicating a
stronger relationship for this subgroup.
3- Parental mental
illness significantly increased the risk of depression, with unadjusted ORs of 2.7
(95% CI: 1.08 to 6.7, p = 0.033) for the Patient Health Questionnaire (PHQ-9). This
indicates that patients with tinnitus and/or hyperacusis are at higher risk of
developing depression if they have a childhood history of parental mental
illness than if they do not (Aazh et al. 2018a). Future studies
should explore whether psychotherapeutic treatments that specifically address
the impact of adverse childhood experiences, are useful for reducing the
distress caused by tinnitus and hyperacusis.
There is a significant relationship
between suicidal and self-harm ideations and the history of parental mental
illness after adjusting the model for (1) tinnitus disability as measured via THI,
(2) hyperacusis as measured via HQ, (3) anxiety as measured via Generalised
Anxiety Disorders (GAD-7), (4) depression as measured via PHQ-9, (5) age and
gender. Adjusted OR was 2.5 (95% CI: 1.14, 5.6, p=.022) (Aazh et al. 2018b). Therefore, clinicians
who offer tinnitus and hyperacusis rehabilitation should screen for suicidal
and self-harm ideations among patients with symptoms of depression and a
childhood history of parental mental illness. Patients with suicidal and
self-harm ideations should be referred to mental health services for further
diagnosis and treatment.
Aazh, H., Danesh,
A., & Moore, B. C. J. (2018a). Parental mental health in childhood as a
risk factor for anxiety and depression among people seeking help for tinnitus
and hyperacusis Journal of American
Academy of Audiology, [in press]
Aazh, H., Landgrebe, M., & Danesh, A. A. (2018b). Parental
mental illness in childhood as a risk factor for suicidal and self-harm
ideations in adults seeking help for tinnitus and/or hyperacusis. American Journal of Audiolgy, [in press]
Aazh, H., Langguth, B., & Danesh, A. A. (2018c). Parental separation
and parental mental health in childhood and tinnitus and hyperacusis handicap
in adulthood. International Journal of
Audiology [Epub ahead of print], 1-16.
Anda, R. F., Felitti, V. J., Bremner, J. D., et al. (2006). The
enduring effects of abuse and related adverse experiences in childhood. A
convergence of evidence from neurobiology and epidemiology. Eur Arch Psychiatry Clin Neurosci, 256, 174-86.
Beckham, E. E., Leber, W. R., Watkins, J. T., et al. (1986).
Development of an instrument to measure Beck's cognitive triad: the Cognitive
Triad Inventory. J Consult Clin Psychol,
De Bellis, M. D., & Zisk, A. (2014). The biological effects of
childhood trauma. Child Adolesc Psychiatr
Clin N Am, 23, 185-222, vii.
Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998).
Relationship of childhood abuse and household dysfunction to many of the
leading causes of death in adults. The Adverse Childhood Experiences (ACE)
Study. American College of Preventive
Medicine, 14, 245-58.
Noone, D., Ames, C., Hassanali, N., et al. (2015). A preliminary
investigation of schematic beliefs and unusual experiences in children. Eur Psychiatry, 30, 569-75.
Stowkowy, J., Liu, L., Cadenhead, K. S., et al. (2016). Core Schemas
in Youth at Clinical High Risk for Psychosis. Behav Cogn Psychother, 44,