<b>Exploring Psychological Distress: Examining the Dynamic Relationship Between Depression, Anxiety, and Stress in Tinnitus Patients</b>

Background: Tinnitus, the perception of sound without an external auditory stimulus, affects a substantial portion of the adult population and is frequently associated with psychological comorbidities. Even in individuals with normal hearing, tinnitus can lead to significant emotional distress, including depression, anxiety, and stress, thereby impairing quality of life. Understanding these associations is essential for developing comprehensive management strategies. Objective: To determine the prevalence and severity of depression, anxiety, and stress in tinnitus patients without hearing loss, and to examine their association with tinnitus severity and resilience. Methods: A cross-sectional observational study was conducted from October 2023 to March 2024 at two tertiary hospitals in Lahore, Pakistan. A total of 139 adults aged 19–67 years with subjective idiopathic tinnitus and normal hearing were recruited through purposive sampling. Tinnitus severity was assessed using the Tinnitus Handicap Inventory (THI), and psychological distress was measured with the Depression Anxiety Stress Scales (DASS-21). Correlations and chi-square tests were performed using SPSS v25, with p < 0.05 considered significant. Results: Moderate-to-severe depression affected 57.5% of participants, severe-to-extremely severe anxiety affected 47.5%, and moderate stress affected 23.7%. THI scores were significantly associated with all three psychological domains. Resilience was strongly negatively correlated with distress (r = -0.754, p < 0.001). Conclusion: Tinnitus without hearing loss is associated with substantial psychological burden and reduced resilience, underscoring the need for integrated psychosocial interventions.