several reports suggesting a high prevalence of psychological disturbances in
patients suffering from tinnitus and hyperacusis (Pinto et al.
2014; Juris et al. 2013; Schecklmann et al. 2014; Andersson et al. 2004; Pattyn
et al. 2016; Paulin et al. 2016; Aazh & Allott 2016; Aazh & Moore
2017b; Aazh & Moore 2017a). Patients suffering from psychological
disturbances are more likely to develop suicidal or self-harm ideations. It is
important to investigate suicidal ideations, as they are associated with
suicidal behaviour, even though only a small proportion of those with suicidal
ideations actually attempt suicide (Kessler et al. 1999; Suominen et al.
is the prevalence of suicidal and self-harm ideations?
A recent analysis by Dr. Aazh’s tinnitus team
including the data for over 650 patients who sought help for tinnitus and/or
hyperacusis showed that suicidal and self-harm ideations are present in 15% of the
Should I ask about suicidal thoughts?
It is important for
the non-psychologists to know that there is no convincing evidence that asking
patients about suicidal ideations increase the risk of patients committing
suicide (Cowen et al.
2012). In the Oxford
handbook of Psychiatry, Cowen et al (2012) highlighted that someone who has
already thought of suicide is likely to feel relieved when the clinician raises
the issue. Enquiring about suicidal inclinations can help the patient to talk
about their intentions and feel that they are better understood by their
clinician which in turn may reduce the risk of suicidal behavior (Cowen,
Harrison, & Burns, 2012). Audiology
departments play a major role in offering therapy and support for patients
experiencing tinnitus and hyperacusis (Thompson et
al. 2017; Thompson et al. 2018; Aazh et al. 2018a; Aazh & Moore 2018b; Aazh
& Moore 2018a). Audiologists who are
involved in tinnitus and hyperacusis rehabilitation should be alert to factors
that predict suicidal and self-harm ideations in this population.
What are the factors that predict suicidal and
self-harm ideations in patients seeking help for tinnitus and/or hyperacusis?
Based on the results
of the pioneering studies by Dr.Aazh’s tinnitus team, the two variables that
are associated with the risk of suicidal and self-harm ideations are patients’ childhood history of parental mental illness
and their current depression level (Aazh et al.
2018b; Aazh & Moore 2018c).
As shown in the table
below, the relationship between childhood history of parental mental illness
and the suicidal and self-harm ideations remained significant in the adjusted
model. This suggests that even taking into account the impact of depression,
which is known to be associated with suicidal risk, the childhood history of
parental mental illness has a screening value in identifying patients who may
be at risk for developing suicidal and self-harm ideations.
Table. Logistic regression model showing the odds ratio (OR) for suicidal and
self-harm ideations (dependent
variable). Unadjusted OR values and adjusted OR values and their 95% confidence
intervals (CI) are presented (n = 279). The adjusted OR takes
into account the effects of age and gender in addition to the effects of other
variables in the model. Variables included in the model were presence or
absence of parental mental illness and categories based on scores for the THI
(Tinnitus Handicap Inventory), HQ (Hyperacusis Questionnaire), GAD-7
(Generalised Anxiety Disorder), and PHQ-9 (Patient Health Questionnaire).
| || |
Adjusted OR (95%
3.3 (1.7 to 6.3)
2.5 (1.14 to 5.6)
Tinnitus handicap category
No handicap (THI
Mild (THI score
Severe (THI score
0.88 (0.087 to 8.9)
2.7 (0.31 to 22.5)
8.5 (1.1 to 65.9)
1.17 (0.09 to 14.7)
2.15 (0.2 to 22.4)
2.3 (23 to 22.1)
No (HQ < 22)
Yes (HQ ≥ 22)
2.57 (1.35 to 4.9)
0.8 (0.36 to 1.77)
Abnormal (GAD-7 ≥
8.96 (3.8 to 20.9)
2.03 (0.62 to 6.6)
Abnormal (PHQ-9 ≥
14.3 (5.8 to 35.8)
7.7 (2.6 to 26.3)
Note: Significant pvalues are indicated in bold font.
What to do?
Based on the Dr.
Aazh’s tinnitus protocol, if patients expressed thoughts of
harming themselves or others they should immediately put in touch with their GP
or with the on-call psychiatrist in the hospital in order to receive
appropriate care and support.
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