An ICF-based content analysis of the overlap between questionnaires assessing tinnitus distress and depressive symptoms
- 1Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 2University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- 3Cochlear Technology Centre, Mechelen, Belgium
Abstract
Introduction: The experience of tinnitus varies considerably among individuals, particularly in terms of perceived distress. Psychological factors play a major role in this variability, and numerous studies have demonstrated a correlation between symptoms of depression and tinnitus distress. Both constructs are commonly assessed through self-report questionnaires. However, content overlap between these questionnaires can make it challenging to differentiate the constructs and interpret their relationship. Given the variation in content among questionnaires assessing tinnitus distress and depressive symptoms, a comprehensive examination of their similarities and differences is needed. This study therefore aims to systematically assess the content overlap of tinnitus distress and depressive symptom questionnaires using the International Classification of Functioning, Disability and Health (ICF) framework. Methods and analysis: Six validated, multi-item, self-report questionnaires measuring tinnitus distress (THI, TQ, mTQ, THQ, TRQ, TFI) and seven validated, multi-item, self-report depressive symptom questionnaires (BDI-II, HADS-D, SDS, PHQ-9, CES-D, SCL-90-R depression subscale, DASS-42 depression subscale) were included in the content analysis. The underlying concepts of all items of these questionnaires were linked to the most specific ICF categories based on established linking rules. The overlap between the tinnitus distress and depressive symptom questionnaires was analyzed based on the assigned second-level ICF categories. Results: The depressive symptom questionnaires demonstrated less diversity in ICF category coverage compared to the tinnitus distress questionnaires, with 14 versus 23 second-level ICF categories. Seven second-level categories were shared between tinnitus distress and depressive symptom questionnaires; energy and drive functions, sleep functions, attention functions, emotional functions, thought functions, interpersonal interactions and relationships, and recreation and leisure. The content analysis showed that, at the second-level ICF category, the TQ had the lowest degree of overlap with the depressive symptom questionnaires (11.54–26.92%), while the TRQ exhibited the highest (61.54–73.08%). Among the depressive symptom questionnaires, the SDS showed the least overlap with the tinnitus distress questionnaires (40–60%), whereas the DASS-42 depression subscale demonstrated the most overlap (85.71–100%). Conclusion: The overlap between tinnitus distress and depressive symptom questionnaires emphasizes the importance of carefully selecting assessment tools and interpreting their results, based on specific clinical or research goals. This content analysis can guide making decisions about this selection.
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BibTeX
@article{fuchten2026icfbased,
title = {{An ICF-based content analysis of the overlap between questionnaires assessing tinnitus distress and depressive symptoms}},
author = {Denise Fuchten and Kelly K. S. Assouly and Inge Stegeman and Adriana L. Smit},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358644},
url = {https://doi.org/10.1371/journal.pone.0358644},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - An ICF-based content analysis of the overlap between questionnaires assessing tinnitus distress and depressive symptoms
AU - Denise Fuchten
AU - Kelly K. S. Assouly
AU - Inge Stegeman
AU - Adriana L. Smit
PY - 2026
DA - 2026/09/21
JO - PLOS One
DO - 10.1371/journal.pone.0358644
UR - https://doi.org/10.1371/journal.pone.0358644
AB - Introduction: The experience of tinnitus varies considerably among individuals, particularly in terms of perceived distress. Psychological factors play a major role in this variability, and numerous studies have demonstrated a correlation between symptoms of depression and tinnitus distress. Both constructs are commonly assessed through self-report questionnaires. However, content overlap between these questionnaires can make it challenging to differentiate the constructs and interpret their relationship. Given the variation in content among questionnaires assessing tinnitus distress and depressive symptoms, a comprehensive examination of their similarities and differences is needed. This study therefore aims to systematically assess the content overlap of tinnitus distress and depressive symptom questionnaires using the International Classification of Functioning, Disability and Health (ICF) framework. Methods and analysis: Six validated, multi-item, self-report questionnaires measuring tinnitus distress (THI, TQ, mTQ, THQ, TRQ, TFI) and seven validated, multi-item, self-report depressive symptom questionnaires (BDI-II, HADS-D, SDS, PHQ-9, CES-D, SCL-90-R depression subscale, DASS-42 depression subscale) were included in the content analysis. The underlying concepts of all items of these questionnaires were linked to the most specific ICF categories based on established linking rules. The overlap between the tinnitus distress and depressive symptom questionnaires was analyzed based on the assigned second-level ICF categories. Results: The depressive symptom questionnaires demonstrated less diversity in ICF category coverage compared to the tinnitus distress questionnaires, with 14 versus 23 second-level ICF categories. Seven second-level categories were shared between tinnitus distress and depressive symptom questionnaires; energy and drive functions, sleep functions, attention functions, emotional functions, thought functions, interpersonal interactions and relationships, and recreation and leisure. The content analysis showed that, at the second-level ICF category, the TQ had the lowest degree of overlap with the depressive symptom questionnaires (11.54–26.92%), while the TRQ exhibited the highest (61.54–73.08%). Among the depressive symptom questionnaires, the SDS showed the least overlap with the tinnitus distress questionnaires (40–60%), whereas the DASS-42 depression subscale demonstrated the most overlap (85.71–100%). Conclusion: The overlap between tinnitus distress and depressive symptom questionnaires emphasizes the importance of carefully selecting assessment tools and interpreting their results, based on specific clinical or research goals. This content analysis can guide making decisions about this selection.
SN - 1932-6203
ER -