Investigation of the Role of Anxiety and Depression on the Formation of Phantom Vibration and Ringing Syndrome Caused by Working Stress during Medical Internship

Abstract

Phantom vibration syndrome (PVS) and phantom ringing syndrome (PRS) are prevalent hallucinations during medical internship. Depression and anxiety are probably understudied risk factors of PVS and PRS. The aim was to evaluate the role of anxiety and depression on the relationship between working stress during medical internship and PVS and PRS. A prospective longitudinal study, consisted of 74 medical interns, was carried out. The severity of phantom vibrations and ringing, as well as anxiety and depression as measured before, at the third, sixth, and 12th month during internship, and two weeks after internship. We conducted a causal mediation analysis to quantify the role of depression and in the mechanism of working stress during medical internship inducing PVS and PRS. The results showed that depression explained 21.9% and 8.4% for stress-induced PRS and PVS, respectively. In addition, anxiety explained 15.0% and 7.8% for stress-induced PRS and PVS, respectively. Our findings showed both depression and anxiety can explain a portion of stress-induced PVS and PRS during medical internship and might be more important in clinical practice and benefit to prevention of work-related burnout.

Causal Mediation Analysis with Multiple Time-varying Mediators

“…Moreover, the causal relationship between subjective perception and anxiety or depression can be bidirectional. 30,31 Therefore, it is necessary to assume that the previous variables affect the latter; for example, poor health feelings at baseline affect the anxiety and/or depression at the 2-year follow-up visit, and anxiety and/or depression at baseline affects the poor health feelings at the 4-year follow-up visit. The causal diagram considered in this application is illustrated in Figure 5.…”