Anxiety and depression associated with vertigo: a cross sectional study from India

C. S. Asha, C. T. Sudhir Kumar, Varghese P. Punnoose, Joe Jacob


Background: Vertigo is a common clinical symptom in the community as well as in specialist settings. Depression and anxiety are common among vertigo patients and have a significant impact on the course of illness.

Methods: This study was conducted at the outpatient clinics of Department of ENT, Government Medical College, Kottayam. Zung self-rating anxiety and Zung self-rating depression scales were used.  

Results: There were 158 patients in the study. The commonest diagnosis was benign paroxysmal positional vertigo (BPPV) (76; 48.1%) followed by migrainous vertigo (MV) (41; 25.9%), Meniere’s disease (MD) (31; 19.6%) and vestibular neuronitis (VN) (10; 6.3%). 74 (46.83%) patients had depression. Depression was most prevalent among MD (26; 83.87%) followed by MV (29; 70.73%). Mean depression score was highest with MD (58; SD=8.136) followed by MV (54.29; SD=10.441). 70 (44.03%) patients had anxiety. 50 being women and 20 men. A diagnosis of anxiety was most common in MD (25; 80.6%) followed by MV (33; 80.5%). Mean anxiety score was highest in MD (56.48; SD=11.003) followed by MV (54.15; SD=12.041), A diagnosis of anxiety was most common among patients with MD (25; 80.6%) followed by MV (33; 80.5%).

Conclusions: There is a high prevalence of depression and anxiety in Meniere’s disease and migrainous vertigo in India as evidenced by this study. Identification and appropriate management of coexisting mental health problems to address the disability, poor quality of life and protracted course is an integral part of managing vertigo.



Anxiety, Depression, Meniere’s disease, Migrainous vertigo

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Neuhauser HK. The epidemiology of dizziness and vertigo. Handbook Clin Neurol. 2016;137:67–82.

Neuhauser HK, Lempert T. Vertigo:epidemiological aspects. Seminars Neurology. 2009;29 (5):473-481.

Murdin L I, Schilder AG. Epidemiology of balance symptoms and disorders in the community:a systematic review. Otol Neurotol. 2015;36(3):387-92.

Bansal M. Common causes of vertigo and dizziness in Gujarat. Int J Clin Trials. 2016;3(4):250-3.

Piker EG, Jacobson GP, McCaslin DL, Grantham SL. Psychological comorbidities and their relationship to self-reported handicap in samples of dizzy patients. J Am Acad Audiol. 2008;19:337-47.

Hülse R, Biesdorf A, Hörmann K, Stuck B, Erhart M, Hülse M, et al. Peripheral Vestibular Disorders:An Epidemiologic Survey in 70 Million Individuals. Otol Neurotol. 2019;40(1):88-95.

KetolaS, Havia M, Appelberg B, Kentala E. Depressive symptoms underestimated in vertiginous patients. Otorhinolaryngol Head Neck Surg. 2007;137:312-5.

Eckhardt-Henn A, Dieterich M. Psychiatric disorders in otoneurology patients. Neurologic Clinics. 2005;23:731–49.

Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A. Dizziness:anxiety, health care utilization and health behaviour-results from a representative German community survey. J Psychosomatic Res. 2009;66:417-24.

Benecke H, Agus S, Kuessner D, Goodall G, Strupp M. The Burden and Impact of Vertigo:Findings from the REVERT Patient Registry. Frontiers Neurol. 2013;4:136.

Magliulo G, Bertin, S, Ruggieri M, Gagliardi M. Benign paroxysmal positional vertigo and post-treatment quality of life. Eur Arch Otorhinolaryngol. 2005;262:627-30.

Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere’ disease. Am Acad Otolaryngol. 1995;113:181-5.

Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004;24(1):9-160.

Neuhauser H K, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo, Neurology. 2001;56:436‐41.

Zung WW. A rating instrument for anxiety disorders. Psychosomatic Med. 1971;12(6):371–9.

Zung WW. A self-rating depression scale. Arch General Psychiatry. 1965;12:63–70.

Zung WW. From Art to Science: The Diagnosis and Treatment of Depression. Arch General Psychiatry. 1973;29(3):328–37.

Yuan Q, Yu L, Shi D, Ke X, Zhang H. Anxiety and depression among patients with different types of vestibular peripheral vertigo. Medicine (Baltimore). 2015;94(5):453.

Bruderer SG, Bodmer D, Stohler NA, Jick SS, Meier CR. Population-Based Study on the Epidemiology of Ménière's Disease. Audiol Neurotol. 2017;22(2):74-82.

Eckhardt-Henn A, Best C, Bense S, Breuer P, Diener G, Tschan R, et al. Psychiatric comorbidity in different organic vertigo syndromes. J Neurol. 2008;255:420–8.

Tyrrell J, White M P, Barrett G, Ronan N, Phoenix C, Whinney D J et al. Mental Health and Subjective Well-being of Individuals With Ménière's: Cross-sectional Analysis in the UK Biobank. Otol Neurotol. 2015;36 (5):854-61.

Coker N J, Coker R R, Jenkins H A, Vincent K R. Psychological Profile of Patients with Meniere's Disease. Arch Otolaryngol Head Neck Surg. 1989;115(11):1355-7.

Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience. 2009;164(4):1579-87.

Best C, Eckhardt-Henn A, Tschan R, Dieterich M. Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes: results of a prospective longitudinal study over one year. J Neurol. 2009;256:58–65.

Eagger S, Luxon L M, Davies RA, Coelho A, Ron MA. Psychiatric morbidity in patients with peripheral vestibular disorder:a clinical and neuro-otological study. J Neurol Neurosurg Psychiatry. 1992;55(5):383-7.

Lahmann C, Henningsen P, Brandt T, Strupp M, Jahn K, Dieterich M, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry. 2015 ;86(3):302-8.

Yokota Y, Kitahara T, Sakagami M, Ito T, Kimura T, Okayasu T, et al. Surgical results and psychological status in patients with intractable Ménière's disease. Auris Nasus Larynx. 2016;43(3):287-91.

Furukawa M, Kitahara T, Horii A, Uno A, Imai T, Ohta Y et al. Psychological condition in patients with intractable Meniere's disease. Acta Oto-Laryngologica. 2013;133(6):584-9.

Wexler M, Crary WG. Meniere's disease: The psychosomatic hypothesis. Am J Otolaryngol. 1986;7:93–6.

Takahashi M, Ishida K, Iida M, Yamashita H, Sugawara K. Analysis of lifestyle and behavioural characteristics in Meniere's disease patients and a control population. Acta Oto-Laryngologica. 2001;121:254–6.

Takeda T, Kakigi A, Saito H. Antidiuretic hormone (ADH) and endolymphatic hydrops. Acta Otolaryngologica Suppl. 1995;519:219–22.

Juhn SK, Li W, Kim JY, Javel E, Levine S, Odland RM. Effect of stress-related hormones on inner ear fluid homeostasis and function. Am J Otolaryngol. 1999;20:800–6.

Sawada S, Takeda T, Saito H. Antidiuretic hormone and psychosomatic aspects in Menière's disease. Acta Otolaryngologica Suppl. 1997;528:109–12.

Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Comorbidity of migraine and depression:investigating potential etiology and prognosis. Neurology. 2003;60(8):1308-12.

Krog NH, Engdahl B, Tambs K. The association between tinnitus and mental health in a general population sample: results from the HUNT Study. J Psychosomatic Res. 2010;69(3):289-98.

Cullen KE. The vestibular system:multimodal integrationand encoding of self-motion formotor control. Trends Neurosci. 2012;35:185–96.

Borel L, Lopez C, Péruch P, Lacour M. Vestibular syndrome:a change in internal spatial representation. Clin Neurophysiol. 2008;38:375–89.

Van Cruijsen N, Wit H, Albers F. Psychological aspects of Ménière's disease. Acta Otolaryngologica. 2003;123:340–7.

Van Cruijsen N, Jaspers JP, van de Wiel HB, Wit H P, Albers FW. Psychological assessment of patients with Menière's disease. Int J Audiol. 2006;45(9):496-502.