title: The impact of Type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression.
abstract: OBJECTIVE
  To evaluate the impact of Type D personality on health-related quality of life (HRQoL) and self-reported tinnitus-related distress in chronic tinnitus patients and whether this relationship is mediated by indicators of psychological distress (i.e., vital exhaustion, anxiety, and depression).
  
  
  METHODS
  Using a cross-sectional study design, 265 consecutive tinnitus patients were asked to complete the Hospital Anxiety and Depression Scale, the Maastricht Questionnaire, the Type D Scale (DS14), the Short-Form Health Survey 36, and the Tinnitus Reaction Questionnaire.
  
  
  RESULTS
  The prevalence of Type D was 35.5%. Type D patients were significantly more anxious, depressed, and vitally exhausted, and experienced more impaired HRQoL and increased tinnitus-related distress compared with non-Type D patients. Structural equation modeling showed that Type D personality directly increased symptoms of depression and anxiety, but not vital exhaustion. Type D was also a direct predictor of poor mental and physical HRQoL and increased tinnitus-related distress, although this influence was mainly mediated by symptoms of depression and anxiety. Anxiety, depression, and vital exhaustion had a direct influence on HRQoL and self-reported tinnitus-related distress, with a higher impact on mental HRQoL (R2 = 0.74) compared with physical HRQoL (R2 = 0.33). Vital exhaustion was a predictor of HRQoL and self-reported tinnitus-related distress; however, its influence was moderated by enhanced levels of anxiety and depression.
  
  
  CONCLUSIONS
  Tinnitus patients with a Type D personality were more likely to be anxious and depressed and to experience poor HRQoL and increased self-reported tinnitus-related distress, with the impact of Type D mainly being mediated by symptoms of anxiety and depression, although Type D also exerted a direct influence on these outcomes. These findings underline that to reduce the impact of tinnitus on HRQoL and self-reported tinnitus-related distress, treatment should be directed toward reducing anxiety and depression, especially in patients with a Type D personality.
authors.affiliation: Department of Otorhinolaryngology, University Medical Center, University of Groningen, Groningen, The Netherlands. h.bartels@kno.umcg.nl
authors.forename: Hilke
authors.initials: H
authors.lastname: Bartels
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Staal
authors.forename: Frans W J
authors.initials: FW
authors.lastname: Albers
authors.forename: Berrie
authors.initials: B
authors.lastname: Middel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005221:Fatigue / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010551:Personality; D010552:Personality Assessment; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000523:psychology*