Personality Traits and Tinnitus Distress: Results Based on Patients with Tinnitus in China

Background: Due to the socio-cultural differences between China and other countries, which may affect the development of an individual’s personality and behavior, it is necessary to explore the relationship between personality traits and tinnitus distress in the context of China’s socio-cultural background. Methods: The Tinnitus Handicap Inventory and the Eysenck Personality Questionnaire Short Scale Chinese version were used to explore the influence of personality traits on tinnitus distress in Chinese patients with tinnitus. Results: The results were not entirely consistent with previous studies from other countries. First, extroversion was significantly higher in patients with bothersome tinnitus, both in acute and chronic conditions. Second, the personality traits that affected the patients with bothersome tinnitus were different in different conditions. Finally, the tridimensional personality structure, high psychoticism / normal extroversion / normal neuroticism, was significantly higher in people with bothersome tinnitus. Furthermore, the difference became more obvious with a prolonged disease course. Conclusions: This study suggested that the relationship between personality traits and tinnitus distress in Chinese patients with tinnitus was not the same as in other countries. “High psychoticism / normal extroversion / normal neuroticism” may be a risk factor for chronic bothersome tinnitus in China.

Keywords: Acute tinnitus, chronic tinnitus, extraversion, neuroticism, psychoticism

How to cite this article:
Qi M, Zhang S, Li L, Li Z, Yin G, Yuan L, Fang B, Gu J, Wang X, Zeng X, Li Z. Personality Traits and Tinnitus Distress: Results Based on Patients with Tinnitus in China. Noise Health 2023;25:55-64
How to cite this URL:
Qi M, Zhang S, Li L, Li Z, Yin G, Yuan L, Fang B, Gu J, Wang X, Zeng X, Li Z. Personality Traits and Tinnitus Distress: Results Based on Patients with Tinnitus in China. Noise Health [serial online] 2023 [cited 2023 Apr 4];25:55-64. Available from: https://www.noiseandhealth.org/text.asp?2023/25/116/55/372596 Introduction

Tinnitus, the perception of sound in the absence of an exogenous sound stimulation, is a common clinical otologic symptom. Its general prevalence is 10% to 15%,[1],[2] and is more common among veterans.[3] Patients with severe tinnitus experience mental health problems, such as anxiety, depression, attention deficits, and sleep disorders, which can disrupt their lives.[4] Therefore, tinnitus has become a global public health problem, which has attracted the attention of experts from the fields of otology, audiology, and psychology.

Personality is a dispositional, essential, and relatively stable psychological characteristic of individuals, which influences an individual’s cognitive processing, behavioral motivation, emotional responses, interpersonal relationships, attitudes, and beliefs. Furthermore, its influence on perception and tinnitus distress has gradually received attention. For example, based on the vulnerability-stress model, vulnerability (a personality trait) was an important factor affecting tinnitus distress.[5] In addition, the studies of multidimensional personality traits also show that personality traits affect the perception and distress of tinnitus. The Multidimensional Personality Questionnaire (MPQ) revealed that the stress response and sense of alienation in patients with tinnitus were significantly higher than those with normal control. Moreover, social intimacy and self-control were significantly lower than those with normal control.[6] Studies based on the Big Five Personality Inventory (BFI)[7],[8],[9] and the Eysenck Personality Questionnaire (EPQ)[10],[11] found similar results as well, which demonstrated that patients with tinnitus had high neuroticism and low extroversion personality traits, which were strongly associated with tinnitus distress. A retrospective study[8] found that patients with tinnitus in the “clinically improved” and “clinically stable” groups were found to be less neurotic and more extroverted than those in the “clinically deteriorating” group. It was suggested that high neuroticism and low extroversion could be the main personality traits that affected tinnitus distress. However, a meta-study showed that the relationship between personality traits and tinnitus distress still needs to be further explored and clarified due to the heterogeneity of the study populations.[12]

As we know, current knowledge regarding the relationship between personality traits and tinnitus distress is predominantly based on studies from other countries, especially in Western countries, while studies based in China are relatively limited. However, there are significant socio-cultural differences between them. According to Markus and Kitayama,[13] the Western independent self is an independent and autonomous entity with significant internal attributes independent of context. While the Eastern interdependent self is seen as a member of a group, emphasizing personal belonging and dependence upon a context. The Chinese self, but not the Western self, may include significant others.

For example, when the importance of the three types of self was compared among the Han ethnic group in China, it was discovered that relational self and individual self were ranked similarly and both were more important than collective self.[14],[15] Therefore, the relationship between personality traits and tinnitus distress may be different in the context of socio-cultural differences between Eastern and Western. Additionally, the relationship between personality traits and tinnitus distress at different conditions, such as acute (lasting less than 3 months) and chronic (lasting more than 6 months), is unclear as well.

To the best of our knowledge, previous studies investigating the relationship between personality traits and tinnitus distress have predominantly used Western samples; in contrast, Chinese samples are scarce in the literature. It has been widely acknowledged that there are significant socio-cultural differences between Western and Chinese cultures. According to Markus and Kitayama,[13] the Western independent self is an independent and autonomous entity with significant internal attributes independent of context; in contrast, the Eastern interdependent self is perceived as a member in a group, emphasizing personal belonging and dependence upon a context. The Chinese self, but not the Western self, may include significant others.[14],[15] For instance, neuroimaging studies have found that the medial prefrontal cortex (a key brain region for self processing) encodes both the self and the mother among Chinese individuals, but only encodes the self among Westerners.[16] In light of the above, we suggest that it is reasonable to predict that the relationship between personality traits and tinnitus distress would vary as a function of culture conditions (Western vs. Chinese).

To comprehensively understand the personality traits of patients with tinnitus in China and their relationship with tinnitus distress and to provide a data reference for the development of clinical treatment program elaboration for tinnitus, this study employed the Tinnitus Handicap Inventory (THI) to assess the distress of patients with acute and chronic tinnitus in China. Furthermore, the Eysenck Personality Questionnaire Short Scale Chinese version (EPQ-RSC)[17] was used to explore the influence of neuroticism (N), extroversion (E), and psychoticism (P) on tinnitus distress.

Materials and methods

This study was approved by the Ethics Committee ((2019)02-229-01). All the participants were notified about the study and provided informed consent.

Subjects

Volunteers were recruited from patients who complained of tinnitus in the otorhinolaryngology outpatient clinic from January to December 2020.

The inclusion criteria were as follows: (a) experiencing high frequency subjective tinnitus; (b) tinnitus as a major complaint; (c) without hyperacusis; (d) the pure-tone threshold, except 6000 and 8000 Hz, were ≤40 dB HL; and (e) never had a history of neurological or psychiatric disorders. Exclusion criteria were as follows: (a) exhibiting unreliable scale results, such as all questions had the same answer or got answers in regular, such as ABCABC... and (b) failing to complete all the questions.

After informed consent was obtained, the patients completed the scales and submitted them through the WeChat APP under the guidance of the research nurses. In this study, 198 participants were enrolled. Of these, 57 participants dropped out because it took longer than they expected to complete all the scales. Hence, 141 participants with valid data were included in the subsequent statistical analysis. The final data analyzed included 73 patients (40 men and 33 women) in the acute condition, whose tinnitus lasted no more than 3 months, and 68 patients (34 men and 34 women) in the chronic condition, whose tinnitus has persisted for 6 months or more. The participants ranged in age from 20 to 67 years.

Evaluation of the loudness of tinnitus

The loudness of tinnitus was evaluated by psychoacoustics, which was performed using the Tinnilogic audiological diagnostic and management system (BetterLife Medical, China) in a soundproof chamber as per national standards. The matching loudness of tinnitus and the hearing threshold of the corresponding frequency are obtained by psychoacoustic method, and the difference between them is the loudness of tinnitus, which is represented by dB SL.

Assessment of auditory ability

The pure tone audiometry was performed using the Astera pure tone audiometer (Otometrics, Denmark) in a soundproof chamber as per the national standards. Air conduction was performed at frequencies of 125, 250, 500, 1000, 2000, 4000, and 8000 Hz, but not 125 and 8000 Hz in the bone conduction. The minimum sound intensity at a reliable response of >50% could be obtained at each frequency, which was defined as the threshold of the frequency.

The auditory ability of the volunteers was assessed by the articulation index (AI) of the better ear, which was to measure the level of verbal information that could be heard by volunteers. AI was calculated based on the threshold of each test frequency.

Instruments

The EPQ-RSC comprised 48 questions divided into four subscales, neuroticism (N), extroversion (E), psychoticism (P), and Lie (L), with 12 questions per subscale. Patients were asked to choose the most appropriate option for each question based on their actual experience in the past month. The Cronbach α for the four subscales were 0.77, 0.75, 0.57, and 0.74, respectively, when tested with a larger domestic sample.[17] In the neuroticism scale, high scores indicate more emotional reactions, such as anxiety and worry, and even irrational behavior, while low scores indicate weaker emotional reactions. A high score for extroversion means extroversion, and low scores indicate introversion. High scores in psychoticism indicate loneliness, indifference, and difficulty adapting to the external environment, while low scores are normal. According to the EPQ-RSC manual,[17] the analysis of the test results is based on the standard score (T = 50 + (Raw Score – Norm Average Score/Standard Deviation of Norm)). The standard score between 40 and 60 includes about 68.46% of the norm population, and the standard score between 30 and 70 includes about 95.45% of it. It is generally believed that a score of 39 or below, 40 to 60, and 61 or above indicates a low, normal, or high level of personality traits, respectively.

The THI, which is widely used in clinical practice and research, measured the severity of tinnitus. Patients were asked to select the most appropriate option for each question based on their experience over the past month.[18] The higher the score, the greater the severity of tinnitus. The Chinese version of the THI (THI-C) was tested in Mandarin and Cantonese-speaking populations, and the Cronbach’s coefficient of skewness ranged from 0.90 to 0.94.[19],[20],[21] The distress of tinnitus was classified into five levels based on the THI score[22]: normal (0–16), mild (18–36), moderate (38–56), severe (58–76), and profound (78–100). Among them, normal and mild scores were classified as “unbothersome tinnitus,” while moderate, severe, and profound scores were classified as “bothersome tinnitus.”

Statistical analysis

The data obtained from each scale were organized and analyzed using SPSS version 25.0. The THI scores were analyzed according to the total score of the subscales, whereas raw scores obtained for the EPQ-RSC required t-score conversion before the subsequent statistical analysis. The mean standard deviation was used to describe continuous variables with a normal distribution, whereas the median and quartile were used to describe others. Categorical variables were statistically described by frequency. An independent sample t-test, rank-sum test, and chi-square test were used for inter-group comparison of the continuous variables, ordered categorical variables, and other categorical variables, respectively. All comparisons were two-sided, and P < 0.05 was considered a statistical significance.

Results

Basic information

According to the duration and distress of tinnitus, the enrolled patients were divided into four groups: “acute unbothersome,” “acute bothersome,” “chronic unbothersome,” and “chronic bothersome,” and there was no significant difference in sex ratio between the groups (χ2 = 0.57, P = 0.90) [Table 1]. Meanwhile, there was also no significant age differences between the groups (44.55 ± 13.22, 44.00 ± 13.90, 43.50 ± 14.24, 46.63 ± 13.51, respectively) [Figure 1].

Tinnitus distress

The Cronbach’s coefficient of THI was 0.96 in this study.

The mean THI scores in the acute and chronic conditions were 38.33 ± 27.98 and 40.88 ± 27.56, respectively, and there were no statistically significant differences between the THI scores of the acute and chronic groups (P = 0.59) [Figure 2]. The chi-square analysis showed that there was no significant statistical difference in the distribution of the distress of patients with tinnitus in the acute or chronic conditions (c2 = 0.21, P = 0.65) [Table 2].

Figure 2 Comparison of THI assessment in patients with tinnitus at different conditions.

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Table 2 Distribution of tinnitus distress in patients with different conditions

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Loudness of tinnitus

The loudness of tinnitus in acute unbothersome, acute bothersome, chronic unbothersome, and chronic bothersome conditions were 4.61 ± 2.38, 5.03 ± 2.65, 4.42 ± 1.83, and 4.60 ± 1.71 dB SL, respectively, and there was no significant difference between any two groups [Figure 3].

Auditory ability

The articulation index (AI) in acute unbothersome, acute bothersome, chronic unbothersome, and chronic bothersome conditions were 87.42 ± 22.21%, 93.09 ± 5.56%, 93.60 ± 11.01%, and 85.00 ± 23.67%, respectively, and there was no significant difference between any two groups [Figure 4].

Distribution of personality traits in patients in acute and chronic conditions

Credibility analysis of EPQ-RSC

The Cronbach α for N, E, P, L were 0.82, 0.76, 0.60, and 0.78, respectively, in this study. Meanwhile, the standard score of L in acute unbothersome, acute bothersome, chronic unbothersome, and chronic bothersome conditions were 51.63 ± 8.89, 52.20 ± 8.34, 50.39 ± 8.98, 51.80 ± 9.85, respectively, which were within the normal range, and there was no significant statistical difference between the groups [Figure 5].

Distribution of personality traits in patients with acute tinnitus

In the acute condition, the independent sample rank-sum test showed no statistically significant differences between unbothersome and bothersome tinnitus (P = 0.62) in most patients with high psychoticism. Conversely, most patients with bothersome tinnitus displayed normal extroversion and those with unbothersome tinnitus displayed normal or low extroversion to a similar extent; the independent sample rank-sum test revealed that there was a significant difference between unbothersome and bothersome tinnitus (P = 0.004). Furthermore, patients with bothersome tinnitus displaying high or normal neuroticism were almost similar, while most patients with unbothersome tinnitus displayed normal neuroticism; the independent sample rank-sum test revealed that there was a significant difference between unbothersome and bothersome tinnitus (P = 0.03) [Figure 6]a.

Figure 6 Distribution of personality characteristics of patients with tinnitus in different conditions. The personality distribution of patients with unbothersome tinnitus or with bothersome tinnitus were shown on the left and right sides respectively. In the acute condition (a), the personality differences between unbothersome tinnitus and bothersome tinnitus mainly focus on extroversion and neuroticism. In the chronic condition (b), the personality differences between unbothersome tinnitus and bothersome tinnitus mainly focus on psychoticism and extroversion.

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Distribution of personality traits in patients with chronic tinnitus

In the chronic condition, most patients with bothersome tinnitus displayed high psychoticism, while unbothersome patients with tinnitus displayed high or normal psychoticism to a similar extent, and the independent sample rank-sum test showed a significant difference between unbothersome and bothersome tinnitus (P < 0.001). Conversely, the independent sample rank-sum test showed a significant difference between unbothersome and bothersome tinnitus (P = 0.03) in most patients with normal extraversion. Furthermore, the independent sample rank-sum test showed no significant difference between unbothersome and bothersome tinnitus (P = 0.46) in most patients with normal neuroticism [Figure 6]b.

Tridimensional personality structure in patients with different tinnitus severity

Psychoticism, extroversion, and neuroticism constituted the tridimensional personality structure. The three personality traits have high, normal, and low levels, which can constitute 27 tridimensional personality structures. For example, “high psychoticism / normal extroversion / normal neuroticism,” “high psychoticism / normal extroversion / high neuroticism,” and so on. Ten of which were observed in patients with tinnitus investigated in this study.

Tridimensional personality structure in patients with acute tinnitus

The chi-square test revealed that the distribution of tridimensional personality structure was significantly different between the groups (P = 0.01). Furthermore, patients with bothersome tinnitus had fewer types of tridimensional personality structure than patients with unbothersome tinnitus. In patients with unbothersome tinnitus, “high psychoticism / low extroversion / normal neuroticism” was the most common (31.58%), followed by “high psychoticism / normal extroversion / normal neuroticism” (23.68%). In patients with bothersome tinnitus, “high psychoticism / normal extroversion / normal neuroticism” was the most common (34.29%), followed by “high psychoticism / normal extroversion / high neuroticism” and “normal psychoticism / normal extroversion / high neuroticism” (22.86%) [Figure 7]a.

Figure 7 The tridimensional personality structure of patients with tinnitus in different conditions. The tridimensional personality structure of patients with unbothersome tinnitus or with bothersome tinnitus was shown on the left and right sides respectively. The distribution of tri-dimensional personality structure was significantly different between unbothersome tinnitus and bothersome tinnitus both in the acute condition (a) and in the chronic condition (b). The tri-dimensional personality structure, high psychoticism / normal extroversion / normal neuroticism, was significantly higher in bothersome tinnitus.

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Tridimensional personality structure in patients with chronic tinnitus

The chi-square test showed that the distribution of tridimensional personality structure was significantly different between the groups (P < 0.01) and that patients with bothersome tinnitus had fewer types of tridimensional personality structure than patients with unbothersome tinnitus. Among patients with unbothersome tinnitus, “high psychoticism / normal extroversion / normal neuroticism” was the most common (21.05%), followed by “normal psychoticism / normal extroversion / high neuroticism” and “normal psychoticism / normal extroversion / normal neuroticism” (both 15.79%). In patients with bothersome tinnitus, “high psychoticism / normal extroversion / normal neuroticism” was the most common (53.33%), followed by “high psychoticism / normal extroversion / high neuroticism” (20.00%) [Figure 7]b.

Discussion

Previous studies have shown that high neuroticism and low extroversion are essential personality traits that influence tinnitus distress.[10],[11] However, personality, based on innate biological differences, is gradually formed through continuous social internalization under the influence of a socio-cultural environment.[13] Thus, a personality analysis of patients with tinnitus from different socio-cultural environments will enrich our understanding of the relationship between personality traits and tinnitus distress. The stability of the P scale of EPQ has always been unsatisfactory. This study also found that the α coefficient of the P scale was only 0.60. However, considering that the performance of patients with bothersome tinnitus was similar to the psychiatric description, such as egocentric, stubborn, impulsive, and suspicious, the data of the P scale were still included in the analysis in this study.

Extraversion, an individual’s tendency to engage in social activities, is an essential factor in tinnitus distress. Previous studies have shown a significant negative correlation between extroversion and tinnitus distress, that is, the higher the level of extroversion, the lower the tinnitus distress.[8],[10] This may be because a higher level of extroversion meant that individuals were more confident, had better emotional regulation and social skills, could build better social networks and actively use them, and got additional social support resources to help them cope with the difficulties they faced.[23] However, this study found a different result among Chinese patients with tinnitus: extroversion was significantly positively correlated with tinnitus distress, both in acute and chronic conditions. We speculated that this may be due to the different socio-cultural environment between China and other countries (individualism vs. collectivism), in which a collectivist with a higher level of extroversion may be more concerned about integrating successfully into group living, thus leading to increased tinnitus distress. First, the hearing impairment that accompanies tinnitus may affect the verbal communication of patients with tinnitus with others, thus interfering with normal social activities. In this study, no significant difference in AI was found between patients with unbothersome tinnitus and patients with bothersome tinnitus in either an acute or chronic tinnitus condition. This suggests that auditory impairment may only be a necessary but insufficient condition for tinnitus distress, with the level of extraversion being the key factor. Second, the abnormal auditory experience and lack of understanding by bystanders of the subjective experience of patients with tinnitus may cause patients to develop anxiety about disassociation from the group. The tendency to fit in with a group may make it easier for patients with tinnitus to accept the group’s misconceptions regarding tinnitus, reinforcing the patient’s adverse psychological, and behavioral responses to it. Notably, only a small number of the tinnitus patients studied in this study belonged to the high extroversion level, and they all had chronic, unbothersome tinnitus. Hence, it is questionable whether patients with high extroversion are less likely to develop severe tinnitus distress. In other words, the level of extroversion may have an inverted u-shaped relationship with tinnitus distress. We need a perfect further approach by increasing the sample size to gain more insight.

Neuroticism is another critical factor in tinnitus distress. Research shows that individuals with high neuroticism are more inclined to focus on negative information regarding an event when faced with a stressful one.[24] Furthermore, it is more challenging to dissociate attention from a threatening stimulus.[25] Hence, individuals with high neuroticism may focus more on the negative aspects of tinnitus when they experience it as a sudden and abnormal auditory experience. Furthermore, they may have excessive anxiety and worry regarding their own health and may find it difficult to get rid of their negative beliefs, which can thus affect their routine work and life. Previous studies provide data to support the relationship between neuroticism and tinnitus distress, explaining that the higher the level of neuroticism, the higher the tinnitus distress.[8],[10] Similar results were found in acute tinnitus in this study, whereas they were not found in the chronic condition. These results may be due to the fact that neuroticism primarily influences the patient’s stress response to tinnitus. Patients with acute tinnitus lack a proper understanding of the condition, and highly neurotic individuals are more likely to form a negative evaluation of ambiguous scenarios. Hence, they are more likely to form a stronger physiological and psychological stress response to it. As the disease progresses, patients with tinnitus have a more profound understanding of the disease and exclude the serious diseases associated with tinnitus, such as acoustic neuroma, nasopharyngeal cancer, etc. Resultingly, their stress response gradually decreases, and the relationship between neuroticism and tinnitus distress weakens.

Psychoticism is a reflection of the individual’s negative personality traits. Individuals with a higher level of psychoticism are more likely to be egocentric, apathetic, stubborn, impulsive, hostile, aggressive, suspicious, psychopathic, and antisocial. Currently, there have been few studies on the relationship between psychoticism and tinnitus distress, but several studies[26],[27] from China suggested that psychoticism may be linked to chronic tinnitus distress. The results of the present study showed that in the chronic condition of tinnitus, the proportion of patients with high psychoticism in those with bothersome tinnitus was significantly higher than that in those with unbothersome tinnitus, which suggested that psychoticism could be an important factor that affected the distress of chronic tinnitus. This may be because individuals with high psychoticism find it more difficult to accept others’ opinions to correct their own misconceptions, which leads to the persistence of a stress response. Simultaneously, repeated and unsuccessful medical interventions further strengthen patients’ misconceptions, thus aggravating their stress response to tinnitus.

To gain a more comprehensive understanding of the influence of each personality trait on tinnitus distress, this study further analyzed the tridimensional personality structure of patients with tinnitus. The results showed that patients with bothersome tinnitus had fewer types of tridimensional personality structures in acute and chronic conditions than patients with unbothersome tinnitus, which suggested that tinnitus distress may be associated with a few tridimensional personality structures. Additionally, the results revealed that “high psychoticism / normal extroversion / normal neuroticism” had the highest proportion of patients with bothersome tinnitus and that the difference between the unbothersome and bothersome groups increased with the development of tinnitus chronicity. This suggests that those with a “high psychoticism / normal extroversion / normal neuroticism” personality structure may be more likely to develop bothersome tinnitus and experience tinnitus chronicity among Chinese patients with tinnitus.

Conclusion

In the present study, we analyzed the personality traits of Chinese patients with tinnitus using the EPQ-RSC and found that the personality traits that affected tinnitus distress differed from those of patients with tinnitus from other countries. Furthermore, personality traits that influenced tinnitus distress differed between acute and chronic conditions. More importantly, the present study initially suggested that the tridimensional personality structure, high psychoticism / normal extroversion / normal neuroticism, was a key risk factor for bothersome tinnitus. However, the sample size of this study was relatively small, and it was not possible to conduct a comprehensive analysis and discussion on the changing trend of personality traits in terms of “slight,” “mild,” “moderate,” “severe,” and “extreme serious” tinnitus distress. In addition, the pseudo-time series analysis of personality traits from acute to chronic condition in this study was based on the premise of stable personality traits. But some research has shown that personality is not as stable as it might be, and that at least some personality differences can be conceptualized as alternative strategies for solving recurrent adaptive problems.[28] In other words, personality may just change in response to the perception and distress of tinnitus. Finally, the investigation based on clinical samples is susceptible to the risk of sample deviation. Therefore, subsequent studies should be combined with community epidemiological investigation, expand the sample size, and be closely followed-up, aiming to comprehensively investigate the personality characteristics of tinnitus patients in China.

Acknowledgments

Li Zhicheng and Zeng Xiangli constructed the theoretical framework of the research, developed the research program, and perfected the manuscript; Qi min, Zhangshuqi, Li Lingwei, and Li Zhenzhi performed the research program, collated data, and wrote the manuscript; Yuan Lianxiong was responsible for the statistical analysis of the data; Yin gendi, Fang Bixing, Gu Jing, and Wang Xinyi conducted the hearing assessment; and Qi Min, Li Lingwei, Li Zhenzhi, Zhang shuqi, Yuan Lianxiong, Zeng Xiangli, and Li Zhicheng discussed the results and implications and commented on the manuscript at all stages.

Contribution to the field statement

Current knowledge regarding the relationship between personality traits and tinnitus distress is predominantly based on studies from other countries, while studies based in China are relatively limited. Due to the socio-cultural differences between China and the other countries, which may affect the development of an individual’s personality and behavior. This study provides preliminary evidence that socio-cultural differences may affect the development of an individual’s personality and behavior, which in turn can affect tinnitus distress, and high psychoticism / normal extroversion / normal neuroticism, maybe a key risk factor for chronic bothersome tinnitus in China. The results of this study provide a new perspective for understanding the mental health of Chinese tinnitus patients, and also lay a theoretical basis for the subsequent psychological intervention of Chinese tinnitus patients.

Financial support and sponsorship

This work was supported by the Science and Technology Program of Guangzhou, China (grant number: 201704030081), the Nursing Research Fund of the Third Affiliated Hospital of Sun Yat-sen University (grant number: 2019HL07), and the National Natural Science Foundation of China (grant number: 82171151).

Conflicts of interest

There are no conflicts of interest.

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