Do patients with a unilateral peripheral vestibular disorder need psychological support?

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Laura Lijić, Tihana Mendeš, Andrijana Včeva, Željko Zubčić, Hrvoje Mihalj, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5738015/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Nowadays, vestibular diseases are quite common in the population and significantly impair quality of life. Additionally, a notable problem is that a certain number of patients experience psychological consequences. Therefore, it is important to investigate the connection between vestibular damage and the potential need for psychological intervention. This study aims to examine the correlation between anxiety in individuals with unilateral peripheral vestibular disorder in relation to gender, age, and the existence of acute and chronic, compensated and uncompensated, partial and complete unilateral peripheral vestibular disorder. Additionally, it was important to determine the degree of free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria in these patients using the Crown-Crisp Experience Index questionnaire. The study included 54 patients, 39 (72%) female and 15 (28%) male, with an average age of 61.5 ± 13.5 years. Results showed that the majority of participants had pronounced somatic anxiety (29.6%), followed by depression (14.8%), free-floating anxiety (9.4%), phobia-related anxiety (7.4%) and hysteria (7.4%) equally represented, and obsessiveness (1.8%) being the least pronounced. Nearly all participants (94%) were diagnosed with chronic hypofunction due to presenting for examination and diagnostic processing after the acute phase of the disease had ended. To conclude, no significant differences were observed in the common symptoms or personality traits within conventional categories of psychoneurotic and personality disorders concerning gender or the presence of vestibular hypofunction. Health sciences/Medical research/Outcomes research Health sciences/Medical research/Study design anxiety depression dizziness vestibular disease Figures Figure 1 1. Introduction The prevalence of dizziness is notably high, with an annual incidence of approximately 11%. Such patients have significantly higher mortality rates compared to patients without dizziness, considering age, gender, and comorbidities [ 1 – 3 ]. The prevalence of these disorders increases with age, affecting 30% of individuals over 60, and reaching 50% in those over 85 years old [ 4 ]. The incidence of dizziness is significantly higher in females [ 1 ]. According to data from the German Center for Vertigo and Balance Disorders, the most frequently diagnosed condition is benign paroxysmal positional vertigo (BPPV), accounting for 17.1% of all dizziness cases. Functional dizziness follows with 15%, and central dizziness accounts for 12.3%. Vestibular migraine, the most common cause of spontaneous and sudden episodes of dizziness, constitutes 11.4%. Meniere's disease accounts for10.1% and vestibular neuronitis for 8.3%. Together, these conditions represent 70% of all dizziness cases [ 7 ]. Risk factors include female gender, age over 40, low education level, cardiovascular diseases, and depression [ 8 ]. Additionally, around 30% of individuals will develop some form of dizziness during their lifetime. Patients with vestibular dysfunction are at risk of falling due to imbalance while walking, and falls are a major risk factor for mortality and morbidity in the elderly. A person with vestibular hypofunction, especially if compensation is poor, is significantly limited in performing everyday tasks such as driving a car or bicycle, walking, running, and exercising [ 9 ]. Such a person is forced to change lifestyle, becomes increasingly less functional, and becomes more dependent on others, leading to feelings of worthlessness and unproductiveness. They often feel misunderstood and unaccepted due to the atypical nature of the illness, which is not objectively visible but is based on the patient's subjective experience. This results in significant interpersonal stress, leading to emotional disturbances. It is known that there is a correlation between vestibular and psychological processes in the development of dizziness, so vestibular hypofunction can cause psychological problems just as psychological disturbances can trigger vestibular damage [ 9 ]. Two primary theories explain the connection between emotions and vertiginous disorders. The somatopsychological theory posits that psychological problems develop as a consequence of vestibular hypofunction, whereas the psychosomatic theory suggests that pre-existing emotional disturbances can trigger vestibular disorders [ 8 ]. A neurological hypothesis is also based on strong structural and biochemical connections between centers for emotional, postural, and somatosensory control. This strong connection is confirmed by numerous studies showing an increased incidence of psychiatric disorders in patients with vestibular hypofunction [ 10 ]. The development of symptoms such as anxiety, anxiousness, and depression is particularly noted in patients with chronic symptoms of vestibular hypofunction [ 11 ]. Symptoms commonly associated with vestibular disorders, such as dizziness, imbalance, nausea, and vomiting, often provoke significant discomfort, impacting patients' overall sense of well-being. It is not surprising that correlations between vestibular symptoms and complaints of anxiety have been observed, as the relationship between anxiety and dizziness is complex. For some, dizziness is a symptom of anxiety, while for others, anxiety arises as a consequence of dizziness. Additionally, dizziness itself can heighten the risk of developing anxiety. When someone experiences dizziness, concerns about their health may intensify which in turn can worsen their anxiety. According to many studies, chronic dizziness often shows a strong correlation with depression and anxiety. Numerous studies show a strong correlation between chronic dizziness and both depression and anxiety. For instance, a study by Egyptian researchers found that among patients experiencing dizziness, 29% reported anxiety, 7% had depression and 15% experienced both anxiety and depression [ 12 ]. Similar results were found in a study conducted in Korea, where high levels of depression and anxiety were observed in 11% and 18% patients with dizziness [ 13 ]. In a similar study, the percentages of patients with dizziness and psychological issues were relatively low. However, numerous studies with more significant findings, such as a study conducted among the Portuguese population, showed psychological manifestations in as many as 63.4% of patients with dizziness [ 14 ]. With regard to the mentioned studies, a disparity is observed in the incidence of psychological problems in patients with balance center impairments. Therefore, we aimed to investigate the prevalence of psychological complaints in our study. The aim of this study was to determine the levels of free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria in patients with acute and chronic unilateral peripheral vestibular disorder using the Crown-Crisp Experience Index questionnaire. Additionally, we sought to examine the prevalence of anxiety in patients with acute and chronic unilateral peripheral vestibular disorder. To the best of our knowledge, this is the first study to investigate the relationship between vestibular impairment and symptoms and personality traits within the conventional categories of psychoneurotic and personality disorders. 2. Materials and Methods A cross-sectional study was conducted. The study design was approved by the ethics committees of the Clinical Hospital Centre Osijek and the Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek (Approval number: 2158-61-46-23-94). The participants were adults over 18 who sought help at the Department of Audiology and Phoniatrics of the Clinic for Otorhinolaryngology and Head and Neck Surgery at KBC Osijek due to balance disturbances during 2021 and 2022 and all participants agreed and signed informed consent for participating in the study. The study was conducted according to the guidelines and instructions of the Declaration of Helsinki. All participants with suspected vestibular impairment underwent a clinical examination, including otoneurological, audiological, and vestibulological examinations. The diagnosis of unilateral peripheral vestibular disorder was based on the results of a bithermal caloric test performed as part of video nystagmography, and the results of cervical and ocular vestibular evoked myogenic potentials. Exclusion criteria included the presence of comorbidities along with unilateral peripheral vestibular damage, confirmed diagnosis of Meniere's disease, migraine-associated dizziness, or benign paroxysmal positional vertigo. Inclusion criteria required sufficient intellectual and literacy levels of the participants, an adequate understanding of the nature of the study, and independent completion of the provided questionnaire. Participants also needed to have confirmed vestibular impairment based on standard diagnostic tests and no prior diagnosed psychiatric or personality disorders. It is also important to note that an additional inclusion criterion was the absence of any previously known psychiatric diagnoses among study participants. Furthermore, participants did not meet criteria for any personality disorders or have any prior audio-vestibular diagnoses listed in the exclusion criteria. Participants who did not adhere to the prescribed diagnostic and therapeutic protocol were also excluded from the study. Figure 1 shows the proposed study design. From the figure, it can be observed that the study design can be divided into four stages. Stage 1 or the patients' collecting stage, Stage 2 or the patients' processing stage, Stage 3 or the patients' classification stage; and Stage 4 a recommendation stage. A total of 54 adults with suspected unilateral vestibular disorder at the Department of Audiology and Phoniatrics within the Clinic for Otorhinolaryngology and Head and Neck Surgery were selected (Stage 1). The diagnosis of vestibular impairment was confirmed in 54 patients (Stage 2). The Crown-Crisp Experience Index (CCEI) is a questionnaire designed to identify and measure common symptoms and personality traits within conventional categories of psychoneurotic disorders and personality disorders. It contains 48 items and six subscales, which are constructed to measure free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria. The total score of each subscale reflects the severity of each of these symptoms individually. Only participants with anxiety levels deviating by at least two standard deviations from the mean were considered, which influenced the results by excluding individuals with moderate anxiety levels. This selection criterion meant that only those with the highest anxiety levels were analyzed. The instrument has moderate validity and reliability, with reliability coefficients ranging between 0.68 and 0.77. All 54 patients underwent CCEI evaluation. Although the authors knew that a combination of at least two questionnaires could provide a more comprehensive understanding of personality disorders, the CCEI was used exclusively in this study. The Crown-Crisp Experimental Index questionnaire is considered a reliable instrument for measuring psychoneurotic illness and has particular application as a screening instrument in community surveys. (Stage 3). The results of CCEI were analyzed, and appropriate recommendations for further treatment were given (Stage 4). Categorical data were presented as absolute and relative frequencies. Differences between categorical variables were tested using the Chi-square test and, if necessary, Fisher's exact test. The normality of the distribution of numerical variables was assessed using the Shapiro-Wilk test. Numerical data were described by the mean and standard deviation for distributions that followed a normal distribution and by the median and interquartile range for other distributions. Differences in normally distributed numerical variables between two independent groups were tested using Student's t-test, while the Mann-Whitney U test was used for non-normally distributed variables. For three or more independent groups, analysis of variance (ANOVA) or the Kruskal-Wallis test was employed, depending on the normality of the distribution. All P-values were two-tailed. The significance level was set at α = 0.05. The analysis used MedCalc® Statistical Software version 20.218 (MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org ; 2023). 3. Results In this study of 54 patients, the average age was 61.5 ± 13.5 years, with a median age of 64 years. The study included 39 female participants (72%), who had an average age of 61.0 ± 13.1 years and a median age of 65 years. The remaining 15 participants (28%) were male, with an average age of 60.4 ± 14.7 years and a median age of 59 years. Table 1 shows the distribution of participants by compensation side and the extent. No of (%) participants Compensation Uncompensated 6 (11) Compensated 48 (89) Chronic / acute Chronic 51 (94) Acute 3 (6) Distribution Complete 3 (6) Partial 51 (94) Table 1 Distribution of participants by compensation side and extent Table 1 shows that asymmetry values (asymmetry greater than 25%) are recorded in 28 (52%) participants. Chronic hypofunction was observed in 51 participants (94%), and partial impairment was noted in the same number. Asymmetry was slightly more prevalent on the right side, occurring in 31 participants (57%), while possible central damage was identified in 7 participants (13%). Testing the differences in age among participants concerning the severity of common symptoms and personality traits within conventional categories of psychoneurotic disorders and personality disorders are shown in Table 2 . Table 2 Severity of common symptoms of anxiety, depression, and emotional lability concerning age of participants. Median (interquartile range) age of participants by severity of symptoms P* Severe Average (normal) Free-floating anxiety 70 (60–76) 64 (51–72) 0.28 Somatic anxiety 65 (58–74) 64 (49–73) 0.26 Anxiety in phobias 68 (60–70) 64 (52–74) 0.62 Obsessiveness 76 (n = 1) 64 (53–72) - Depression 63 (52–74) 64 (53–73) 0.97 Hysteria 69 (41–81) 64 (53–72) 0.51 *Mann Whitney U test Table 2 shows that the average age for individuals with severe symptoms of depression is 63 years (ranging from 52 to 74), while for those with normal symptoms of depression, it is 64 years (ranging from 53 to 73). It was found that there is no statistical significance between the two groups (P = 0.97). Table 3 shows the impact of various psychological states on tested participants. Table 3 Expression of common symptoms of anxiety, depression, and emotional lability concerning the gender of the participants No (%) of participants in relation to gender P* Men Women Total Free-floating anxiety Severe 3 (7.7) 2 (13.3) 5 (9) 0.61 Average (normal) 36 (92.3) 13 (86.7) 49 (91) Somatic anxiety Severe 12 (30.8) 4 (26.7) 16 (30) > 0.99 Average (normal) 27 (69.2) 11 (73.3) 38 (70) Anxiety in phobias Severe 2 (5.1) 2 (13.3) 4 (7) 0.31 Average (normal) 37 (94.9) 13 (86.7) 50 (93) Obsessiveness Severe 0 1 (6.7) 1 (2) 0.28 Average (normal) 39 (100) 14 (93.3) 53 (98) Depression Severe 8 (20.5) 0 8 (15) 0.09 Average (normal) 31 (79.5) 15 (100) 46 (85) Hysteria Severe 2 (5.1) 2 (13.3) 4 (7) 0.31 Average (normal) 37 (94.9) 13 (86.7) 50 (93) *Fisher's Exact Test The table shows that severe free-floating anxiety (a high level of diffuse, chronic discomfort and apprehension not directed towards any specific situation or object, with a high risk of developing generalized anxiety disorder) is present in 5 (9%) of the participants. Somatic anxiety (a level of somatic manifestations of anxiety so high that it likely creates significant discomfort and compromises daily functioning) is observed in 16 (30%) participants. Phobia-related anxiety (individuals with significant and pronounced fear and terror in specific situations such as confined spaces, heights, crowds, and illness) is recorded in 4 (7%) participants. Only one (2%) participant exhibits severe obsessiveness (individuals with excessive meticulousness, rigidity, a need for following routines, a pronounced aversion to change, a strong need for environmental control, and excessive checking). Depression is present in 8 participants (15%), indicating a high probability of meeting the criteria for certain depressive disorders. Hysteria is observed in 4 participants (7%) characterized by hypersensitivity, extroverted personalities with superficial and easily changeable emotions, a need for affection, emotional instability, and a tendency to develop functional physical complaints under stress. Notably, all 8 participants (100%) with severe depression were men, while none of the women (0%) reported severe depression. Furthermore, it can be seen that 46 participants (85%) did not have depression. Statistical analysis shows no significant difference between groups (P = 0.09). Table 4 shows an expression of common symptoms of anxiety, depression, and emotional lability concerning the presence of hypofunction. Table 4 Expression of common symptoms of anxiety, depression and emotional lability in relation to the presence of hypofunction No (%) of participants in relation to the presence of hypofunction P* No (disproportion ≤ 25%) Yes (hypofunction of labirint) Total Free-floating anxiety Severe 3 (12) 2 (7) 5 (9) 0.66 Average (normal) 23 (88) 26 (93) 49 (91) Somatic anxiety Severe 8 (31) 8 (29) 16 (30) 0.86 Average (normal) 18 (69) 20 (71) 38 (70) Anxiety in phobias Severe 3 (12) 1 (4) 4 (7) 0.34 Average (normal) 23 (88) 27 (96) 50 (93) Obsessiveness Severe 1 (4) 0 1 (2) 0.48 Average (normal) 25 (96) 28 (100) 53 (98) Depression Severe 4 (15) 4 (14) 8 (15) > 0.99 Average (normal) 22 (85) 24 (86) 46 (85) Hysteria Severe 4 (15) 0 4 (7) 0.05 Average (normal) 22 (85) 28 (100) 50 (93) *Chi-square test The table shows that 4 participants (15%) without vestibular hypofunction and 4 participants (14%) with vestibular hypofunction experienced severe depression. Additionally, 46 participants (85%) did not have depression. Statistical analysis indicated no significant difference (P > 0.99). Furthermore, based on Tables 3 and 4 , there were no significant differences in the typical symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning gender and the presence of hypofunction. Table 5 shows the degree of anxiety, depression, and emotional lability symptoms concerning acute or chronic hypofunction. Table 5 Expression of common symptoms of anxiety, depression, and emotional lability concerning acute or chronic hypofunction No (%) of participants P* Chronic Acute Total Free-floating anxiety Severe 4 (8) 1 / 3 5 (9) 0.26 Average (normal) 47 (92) 2 / 3 49 (91) Somatic anxiety Severe 15 (29) 1 / 3 16 (30) > 0.99 Average (normal) 36 (71) 2 / 3 38 (70) Anxiety in phobias Severe 3 (6) 1 / 3 4 (7) 0.21 Average (normal) 48 (94) 2 / 3 50 (93) Obsessiveness Severe 1 (2) 0 1 (2) 0.94 Average (normal) 50 (98) 3 / 3 53 (98) Depression Severe 7 (14) 1 / 3 8 (15) 0.39 Average (normal) 44 (86) 2 / 3 46 (85) Hysteria Severe 4 (8) 0 4 (7) > 0.99 Average (normal) 47 (92) 3 / 3 50 (93) * Fisher's Exact Test The table indicates that among the 44 participants (86%) with chronic hypofunction, 7 experienced severe depression, while 1 out of 3 participants with acute hypofunction reported severe depression. Overall, out of the 54 participants, 8 (15%) had severe depression. Statistical analysis revealed no significant difference (P = 0.39). Additionally, Table 6 presents the degree of anxiety, depression, and emotional lability symptoms concerning compensation. Table 6 Expression of common symptoms of anxiety, depression, and emotional lability concerning compensation No (%) of participants in relation to the compensation P* Uncompensated Compensated Total Free-floating anxiety Severe 1 / 6 4 (8) 5 (9) 0.46 Average (normal) 5 / 6 44 (92) 49 (91) Somatic anxiety Severe 2 / 6 14 (29) 16 (30) > 0.99 Average (normal) 4 / 6 34 (71) 38 (70) Anxiety in phobias Severe 1 / 6 3 (6) 4 (7) 0.39 Average (normal) 5 / 6 45 (94) 50 (93) Obsessiveness Severe 0 1 (2) 1 (2) > 0.99 Average (normal) 6 / 6 47 (98) 53 (98) Depression Severe 1 / 6 7 (15) 8 (15) > 0.99 Average (normal) 5 / 6 41 (85) 46 (85) Hysteria Severe 0 4 (8) 4 (7) > 0.99 Average (normal) 6 / 6 44 (92) 50 (93) *Fisher's Exact Test The table shows that among the participants with severe depression, 1 out of 6 had uncompensated hypofunction, while 7 out of 41 had compensated hypofunction. Overall, 4 participants (7%) out of 54 had severe depression. Statistical analysis indicated no significant difference (P > 0.99). 4. Discussion In this cross-sectional study with historical data, 54 participants with balance disorders and a diagnosis of unilateral labyrinthine hypofunction were involved. For diagnostic purposes, the bithermal caloric test and the results of cVEMP and oVEMP were used. The main aim of this study was to identify the association of anxiety, depression, hysteria, and obsessiveness with the type and nature of unilateral peripheral vestibular disorder. Consequently, participants completed the Crown-Crisp Experience Index questionnaire (CCEI) and were thus selected based on deviations from normal values of free-floating anxiety, somatic anxiety, phobia-related anxiety, depression, obsessiveness, and hysteria. The obtained results showed that patients with vertigo most frequently exhibited somatic anxiety and depression with no statistically significant differences in the presence of psychological issues concerning the types and nature of unilateral peripheral vestibular disorder. In the study, there were more female participants (72%) compared to male participants (28%), which aligns with findings in the literature. This finding can be attributed to hormonal changes that disrupt the homeostasis of labyrinthine fluid [ 13 ]. The patient population in this study was older, similar to the cohort examined in the study on unilateral vestibular hypofunction conducted by Lubetzky and colleagues [ 14 ]. An asymmetry greater than 25% was detected in just over half of the patients, which is higher than the findings of Felipe and colleagues, where asymmetry was present in less than half of the participants [ 11 ]. Nearly all patients had chronic vestibular hypofunction, whereas a 2019 retrospective study reported that 42.2% were in an acute state [ 15 ]. Central damage was identified in 7% of patients, compared to the 2019 study, which reported central damage in twice as many patients (15.6%) [ 16 ]. In terms of vestibular evoked myogenic potentials, cVEMP asymmetry was recorded less frequently than oVEMP asymmetry, aligning with the study by Magliula and colleagues, which found that 80% of patients had abnormal oVEMP results, while 47% had abnormal cVEMP results [ 16 – 19 ]. It is known that symptoms of vestibular hypofunction tend to improve over the weeks and months due to the process of vestibular compensation. This compensation results in significant functional recovery, facilitated by the nervous system's plasticity, which allows for adaptation to peripheral vestibular disorders [ 20 ]. In this study, most participants were compensated (89%), and there were no significant differences in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning acute or chronic hypofunction. When considering the results of the Crown-Crisp Experience Index and comparing them with the age of the patients, it is evident that anxiety is mainly present in older age, with the median age of 70 years. However, there is no statistically significant difference in the presence of psychological issues concerning the age of the participants. Similarly, in a Japanese study conducted by Miura and colleagues, the correlation between age and anxiety was also negative. In their study, a correlation was found between gender and anxiety indicating that anxiety is more common among females. The results of this study did not show a connection between gender and the occurrence of anxiety. Although Miura and colleagues hypothesize that patients in the earlier stages of the disease have more pronounced symptoms of anxiety, they did not account for the duration of symptoms [ 20 ]. This study did consider the duration of symptoms but found no significant statistical differences between acute and chronic hypofunction. The work of Hallam and Stephens, published in the United Kingdom, confirmed that complaints of vertigo are associated with higher scores on the anxiety scale of the CCEI. Participants who experienced vertigo also had significantly higher scores than those without vertigo on all CCEI scales except for depression and hysteria. In contrast, in this study, depression is the second most common condition among patients with vertigo. Therefore, participants who complained of vertigo predominantly exhibited phobic and somatic anxiety, which is similar to the results of this study, which show that most patients have pronounced somatic anxiety. Interestingly, in this study, phobia-related anxiety, which is predominantly represented in the work of Hallam and Stephens, is equal in frequency to hysteria, which is not represented at all in their study [ 21 , 22 ]. This study also had limitations. Only participants whose anxiety values deviated twice from the standard deviation were considered, which statistically influenced the results since individuals who were also anxious but not to the greatest extent were not analyzed as anxious. Furthermore, although the Crown-Crisp Experience Index is an excellent test for screening anxious individuals, it partially relies on the subjective experience of the person and depends on whether they want to share their condition with others or not. Another limitation of the study is that we used only one questionnaire (CCEI) for screening individuals with psychoneurotic pathology despite its reliability and validity as a measurement tool. It was noted that many individuals who completed the questionnaire responded negatively to clearly posed questions their anxiety, while significant anxiety was observed in responses to ambiguously posed questions, where the participants were uncertain what they were actually answering. Finally, we acknowledged that the small sample size was partly determined by the inclusion and exclusion criteria. However, as explained in the conclusion, a new study with a larger sample size would be recommended. 5. Conclusions Based on the conducted research and obtained results, no significant differences were observed in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning gender and age, although it can be noted that the patients are of older age. The majority of participants had pronounced somatic anxiety, followed by depression, then free-floating anxiety, with phobia-related anxiety and hysteria being equally represented, and obsessiveness being the least pronounced. Nearly all participants (94%) were diagnosed with chronic hypofunction due to presenting for examination and diagnostic processing after the acute phase of the disease had ended. No significant differences were observed in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning acute or chronic hypofunction. A total of 89% of the participants were compensated, and 94% had partial vestibular disorder, with no significant differences observed in the usual symptoms and personality traits concerning compensation. Because of all stated above, we believe a personalized approach is necessary for every patient with damage to the vestibular system. Although damage to the vestibular system is compensated over time, the psychological aspect is negligible, as shown in our study. Therefore, it is essential to include a psychologist in the standard management of vertigo, given the complexity of functional vertigo and the need to address comorbid anxiety. Regarding the question in the title, psychological assessment should be an integral part of the standard procedure for diagnosing and treating patients with vestibular disorders, particularly for those who score above two standard deviations on the CCEI questionnaire. Incorporating a holistic assessment of well-being into the standard protocol for diagnosing and managing patients with vestibular disorders could be highly beneficial. Beyond medical treatment, informing patients about the relationship between vestibular disorders and aspects of emotional well-being, such as anxiety and general mental resilience, can provide a supportive foundation for symptom management. Educational sessions aimed at explaining these links can help patients better understand their symptoms and reduce feelings of discomfort and fear. In this way, a combination of medical and psychological support can significantly improve treatment outcomes and reduce comorbidities associated with psychological issues. This study opens up the possibility of conducting a larger and more detailed study that will consider smaller deviations from the standard and include participants who showed abnormalities in the CCEI questionnaire. This approach highlights the importance of screening for and treating comorbid mental health disorders, which is essential for the effective management of vertigo disorders. Ultimately, addressing these issues can lead to improved quality of life and fewer complications for patients. Declarations Author Contribution Author Contributions: Conceptualization, L.L., and T.M.; methodology, A.V., and H. M.; software, K.K.; validation, A.V., H.V. and Z.Z.; formal analysis, M.R.; investigation, L.L.; data curation, J.S., and H.M.; writing—original draft preparation, Z.K.; writing—review and editing, A.R.; visualization, T.K., J.S. and A.G. supervision, A.V. All authors have read and agreed to the published version of the manuscript Acknowledgments: All individuals who contributed to this work have been acknowledged in the authorship list. Data Availability The data supporting this study's findings are available from the corresponding author upon reasonable request. References Strupp, M. et al. Vestibular Disorders. Dtsch. Arzteblatt Int. 24 April . 117 (17), 300–310 (2020). Dommaraju, S. & Perera, E. An approach to vertigo in general practice. Aust Fam Physician travanj . 45 (4), 190–194 (2016). Nguyen, C. T., Basso, M. & Epley Maneuver, U. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citirano 26. svibanj 2023.]. 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Waissbluth, S., Sepúlveda, V., Leung, J. S. & Oyarzún, J. Caloric and video head impulse test dissociated results in dizzy patients. Front. Neurol. 13 , 1000318 (2022). Rosengren, S. M., Colebatch, J. G., Young, A. S., Govender, S. & Welgampola, M. S. Vestibular evoked myogenic potentials in practice: Methods, pitfalls and clinical applications. Clin. Neurophysiol. Pract. 4 , 47–68 (2019). Lacour, M., Helmchen, C. & Vidal, P. P. Vestibular compensation: the neuro-otologist’s best friend. J. Neurol. 263 , 54–64 (2016). Hallam, R. S. & Stephens, S. D. G. Vestibular disorder and emotional distress. J. Psychosom. Res. 1 January . 29 (4), 407–413 (1985). Wassermann, A., Finn, S. & Axer, H. Age-Associated Characteristics of Patients With Chronic Dizziness and Vertigo. J. Geriatr. Psychiatry Neurol. 2022 ; 35 (4):580–585 . Additional Declarations No competing interests reported. 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Osijek","correspondingAuthor":false,"prefix":"","firstName":"Hrvoje","middleName":"","lastName":"Vidić","suffix":""},{"id":399968521,"identity":"304c982c-e034-49f5-95ec-2d391de38171","order_by":8,"name":"Tamara Kopf","email":"","orcid":"","institution":"University of Osijek","correspondingAuthor":false,"prefix":"","firstName":"Tamara","middleName":"","lastName":"Kopf","suffix":""},{"id":399968523,"identity":"1db912d5-2429-44f3-b16b-64129dfca1c6","order_by":9,"name":"Antoneta Gudelj","email":"","orcid":"","institution":"University of Osijek","correspondingAuthor":false,"prefix":"","firstName":"Antoneta","middleName":"","lastName":"Gudelj","suffix":""},{"id":399968526,"identity":"1b360e36-13f9-43d7-8109-36aecca0b6d2","order_by":10,"name":"Andrea Russo","email":"","orcid":"","institution":"University of Split","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Russo","suffix":""},{"id":399968527,"identity":"0532eaf1-faf1-425a-8a74-f77709d0378e","order_by":11,"name":"Joško Šoda","email":"","orcid":"","institution":"University of Split","correspondingAuthor":false,"prefix":"","firstName":"Joško","middleName":"","lastName":"Šoda","suffix":""},{"id":399968529,"identity":"2d572a36-3480-4355-a2b6-3abcf67b7e80","order_by":12,"name":"Zlatko Kljajic","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIie3PsWrDMBAG4DMCeRH1eqXQZ1ApiAzGfpAuMgfuVMgDZHDp0KUPkJfomlkgSJdSr4EsNX4BjR069Jx0yGJlLVT/5DP3cfoBUlL+YDAHC6gBLgAEgC75X/bookT8EgmCybKdSHeOHHMkwR+GKLl8giEsllUt897roPvq9dnzlVV5N0euBBCiJiEViWat97R5b5hs24duhlxzFyZOSiDhFRPjmGSdjxH6YqJkMU7kg0w/xAk/rJ2uoEQSpLSrzO7MFa7fLriLljje3qw1WbPjKzbSBd9eaI/fVV0UzYiBP0x/P3yGVTlLAJQVeDI2h007uz4ld1k4GevockpKSsq/zA8VIlZzDMSGoQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Split","correspondingAuthor":true,"prefix":"","firstName":"Zlatko","middleName":"","lastName":"Kljajic","suffix":""}],"badges":[],"createdAt":"2024-12-30 22:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5738015/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5738015/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-12930-7","type":"published","date":"2025-07-26T15:58:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73673083,"identity":"56df2d6f-97c0-4c01-9910-acf147982b08","added_by":"auto","created_at":"2025-01-13 12:53:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118301,"visible":true,"origin":"","legend":"\u003cp\u003eThe proposed study design\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5738015/v1/55ab4a8119b3436110c304d9.png"},{"id":87756783,"identity":"6a5122a6-2ef7-4db2-a517-9a359dbfe5e9","added_by":"auto","created_at":"2025-07-28 16:09:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942389,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5738015/v1/bc4c2f90-4323-4a41-acff-962e815a0964.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Do patients with a unilateral peripheral vestibular disorder need psychological support?","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe prevalence of dizziness is notably high, with an annual incidence of approximately 11%. Such patients have significantly higher mortality rates compared to patients without dizziness, considering age, gender, and comorbidities [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The prevalence of these disorders increases with age, affecting 30% of individuals over 60, and reaching 50% in those over 85 years old [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The incidence of dizziness is significantly higher in females [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to data from the German Center for Vertigo and Balance Disorders, the most frequently diagnosed condition is benign paroxysmal positional vertigo (BPPV), accounting for 17.1% of all dizziness cases. Functional dizziness follows with 15%, and central dizziness accounts for 12.3%. Vestibular migraine, the most common cause of spontaneous and sudden episodes of dizziness, constitutes 11.4%. Meniere's disease accounts for10.1% and vestibular neuronitis for 8.3%. Together, these conditions represent 70% of all dizziness cases [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Risk factors include female gender, age over 40, low education level, cardiovascular diseases, and depression [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, around 30% of individuals will develop some form of dizziness during their lifetime. Patients with vestibular dysfunction are at risk of falling due to imbalance while walking, and falls are a major risk factor for mortality and morbidity in the elderly. A person with vestibular hypofunction, especially if compensation is poor, is significantly limited in performing everyday tasks such as driving a car or bicycle, walking, running, and exercising [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such a person is forced to change lifestyle, becomes increasingly less functional, and becomes more dependent on others, leading to feelings of worthlessness and unproductiveness. They often feel misunderstood and unaccepted due to the atypical nature of the illness, which is not objectively visible but is based on the patient's subjective experience. This results in significant interpersonal stress, leading to emotional disturbances. It is known that there is a correlation between vestibular and psychological processes in the development of dizziness, so vestibular hypofunction can cause psychological problems just as psychological disturbances can trigger vestibular damage [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Two primary theories explain the connection between emotions and vertiginous disorders. The somatopsychological theory posits that psychological problems develop as a consequence of vestibular hypofunction, whereas the psychosomatic theory suggests that pre-existing emotional disturbances can trigger vestibular disorders [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. A neurological hypothesis is also based on strong structural and biochemical connections between centers for emotional, postural, and somatosensory control. This strong connection is confirmed by numerous studies showing an increased incidence of psychiatric disorders in patients with vestibular hypofunction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The development of symptoms such as anxiety, anxiousness, and depression is particularly noted in patients with chronic symptoms of vestibular hypofunction [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Symptoms commonly associated with vestibular disorders, such as dizziness, imbalance, nausea, and vomiting, often provoke significant discomfort, impacting patients' overall sense of well-being. It is not surprising that correlations between vestibular symptoms and complaints of anxiety have been observed, as the relationship between anxiety and dizziness is complex. For some, dizziness is a symptom of anxiety, while for others, anxiety arises as a consequence of dizziness. Additionally, dizziness itself can heighten the risk of developing anxiety. When someone experiences dizziness, concerns about their health may intensify which in turn can worsen their anxiety. According to many studies, chronic dizziness often shows a strong correlation with depression and anxiety. Numerous studies show a strong correlation between chronic dizziness and both depression and anxiety. For instance, a study by Egyptian researchers found that among patients experiencing dizziness, 29% reported anxiety, 7% had depression and 15% experienced both anxiety and depression [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similar results were found in a study conducted in Korea, where high levels of depression and anxiety were observed in 11% and 18% patients with dizziness [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In a similar study, the percentages of patients with dizziness and psychological issues were relatively low. However, numerous studies with more significant findings, such as a study conducted among the Portuguese population, showed psychological manifestations in as many as 63.4% of patients with dizziness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. With regard to the mentioned studies, a disparity is observed in the incidence of psychological problems in patients with balance center impairments. Therefore, we aimed to investigate the prevalence of psychological complaints in our study. The aim of this study was to determine the levels of free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria in patients with acute and chronic unilateral peripheral vestibular disorder using the Crown-Crisp Experience Index questionnaire. Additionally, we sought to examine the prevalence of anxiety in patients with acute and chronic unilateral peripheral vestibular disorder. To the best of our knowledge, this is the first study to investigate the relationship between vestibular impairment and symptoms and personality traits within the conventional categories of psychoneurotic and personality disorders.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eA cross-sectional study was conducted. The study design was approved by the ethics committees of the Clinical Hospital Centre Osijek and the Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek (Approval number: 2158-61-46-23-94). The participants were adults over 18 who sought help at the Department of Audiology and Phoniatrics of the Clinic for Otorhinolaryngology and Head and Neck Surgery at KBC Osijek due to balance disturbances during 2021 and 2022 and all participants agreed and signed informed consent for participating in the study. The study was conducted according to the guidelines and instructions of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eAll participants with suspected vestibular impairment underwent a clinical examination, including otoneurological, audiological, and vestibulological examinations. The diagnosis of unilateral peripheral vestibular disorder was based on the results of a bithermal caloric test performed as part of video nystagmography, and the results of cervical and ocular vestibular evoked myogenic potentials.\u003c/p\u003e \u003cp\u003eExclusion criteria included the presence of comorbidities along with unilateral peripheral vestibular damage, confirmed diagnosis of Meniere's disease, migraine-associated dizziness, or benign paroxysmal positional vertigo. Inclusion criteria required sufficient intellectual and literacy levels of the participants, an adequate understanding of the nature of the study, and independent completion of the provided questionnaire. Participants also needed to have confirmed vestibular impairment based on standard diagnostic tests and no prior diagnosed psychiatric or personality disorders. It is also important to note that an additional inclusion criterion was the absence of any previously known psychiatric diagnoses among study participants. Furthermore, participants did not meet criteria for any personality disorders or have any prior audio-vestibular diagnoses listed in the exclusion criteria. Participants who did not adhere to the prescribed diagnostic and therapeutic protocol were also excluded from the study.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the proposed study design.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom the figure, it can be observed that the study design can be divided into four stages. Stage 1 or the patients' collecting stage, Stage 2 or the patients' processing stage, Stage 3 or the patients' classification stage; and Stage 4 a recommendation stage.\u003c/p\u003e \u003cp\u003eA total of 54 adults with suspected unilateral vestibular disorder at the Department of Audiology and Phoniatrics within the Clinic for Otorhinolaryngology and Head and Neck Surgery were selected (Stage 1). The diagnosis of vestibular impairment was confirmed in 54 patients (Stage 2).\u003c/p\u003e \u003cp\u003eThe Crown-Crisp Experience Index (CCEI) is a questionnaire designed to identify and measure common symptoms and personality traits within conventional categories of psychoneurotic disorders and personality disorders. It contains 48 items and six subscales, which are constructed to measure free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria. The total score of each subscale reflects the severity of each of these symptoms individually. Only participants with anxiety levels deviating by at least two standard deviations from the mean were considered, which influenced the results by excluding individuals with moderate anxiety levels. This selection criterion meant that only those with the highest anxiety levels were analyzed.\u003c/p\u003e \u003cp\u003eThe instrument has moderate validity and reliability, with reliability coefficients ranging between 0.68 and 0.77. All 54 patients underwent CCEI evaluation. Although the authors knew that a combination of at least two questionnaires could provide a more comprehensive understanding of personality disorders, the CCEI was used exclusively in this study. The Crown-Crisp Experimental Index questionnaire is considered a reliable instrument for measuring psychoneurotic illness and has particular application as a screening instrument in community surveys. (Stage 3).\u003c/p\u003e \u003cp\u003eThe results of CCEI were analyzed, and appropriate recommendations for further treatment were given (Stage 4).\u003c/p\u003e \u003cp\u003eCategorical data were presented as absolute and relative frequencies. Differences between categorical variables were tested using the Chi-square test and, if necessary, Fisher's exact test. The normality of the distribution of numerical variables was assessed using the Shapiro-Wilk test. Numerical data were described by the mean and standard deviation for distributions that followed a normal distribution and by the median and interquartile range for other distributions. Differences in normally distributed numerical variables between two independent groups were tested using Student's t-test, while the Mann-Whitney U test was used for non-normally distributed variables. For three or more independent groups, analysis of variance (ANOVA) or the Kruskal-Wallis test was employed, depending on the normality of the distribution. All P-values were two-tailed. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05. The analysis used MedCalc\u0026reg; Statistical Software version 20.218 (MedCalc Software Ltd, Ostend, Belgium; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.medcalc.org\u003c/span\u003e\u003cspan address=\"https://www.medcalc.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e; 2023).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eIn this study of 54 patients, the average age was 61.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 years, with a median age of 64 years. The study included 39 female participants (72%), who had an average age of 61.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 years and a median age of 65 years. The remaining 15 participants (28%) were male, with an average age of 60.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.7 years and a median age of 59 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshows the distribution of participants by compensation side and the extent.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo of (%) participants\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompensation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUncompensated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompensated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChronic / acute\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistribution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (94)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Distribution of participants by compensation side and extent\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that asymmetry values (asymmetry greater than 25%) are recorded in 28 (52%) participants. Chronic hypofunction was observed in 51 participants (94%), and partial impairment was noted in the same number. Asymmetry was slightly more prevalent on the right side, occurring in 31 participants (57%), while possible central damage was identified in 7 participants (13%).\u003c/p\u003e \u003cp\u003eTesting the differences in age among participants concerning the severity of common symptoms and personality traits within conventional categories of psychoneurotic disorders and personality disorders are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSeverity of common symptoms of anxiety, depression, and emotional lability concerning age of participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMedian (interquartile range) age of participants by severity of symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003cp\u003e(normal)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFree-floating anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (60\u0026ndash;76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (51\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomatic anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (58\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (49\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety in phobias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (60\u0026ndash;70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (52\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObsessiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (n\u0026thinsp;=\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (53\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (52\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (53\u0026ndash;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHysteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (41\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (53\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Mann Whitney U test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that the average age for individuals with severe symptoms of depression is 63 years (ranging from 52 to 74), while for those with normal symptoms of depression, it is 64 years (ranging from 53 to 73). It was found that there is no statistical significance between the two groups (P\u0026thinsp;=\u0026thinsp;0.97). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the impact of various psychological states on tested participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpression of common symptoms of anxiety, depression, and emotional lability concerning the gender of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo (%) of participants in relation to gender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFree-floating anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSomatic anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026nbsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (73.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnxiety in phobias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObsessiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHysteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37 (94.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Fisher's Exact Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe table shows that severe free-floating anxiety (a high level of diffuse, chronic discomfort and apprehension not directed towards any specific situation or object, with a high risk of developing generalized anxiety disorder) is present in 5 (9%) of the participants. Somatic anxiety (a level of somatic manifestations of anxiety so high that it likely creates significant discomfort and compromises daily functioning) is observed in 16 (30%) participants. Phobia-related anxiety (individuals with significant and pronounced fear and terror in specific situations such as confined spaces, heights, crowds, and illness) is recorded in 4 (7%) participants. Only one (2%) participant exhibits severe obsessiveness (individuals with excessive meticulousness, rigidity, a need for following routines, a pronounced aversion to change, a strong need for environmental control, and excessive checking). Depression is present in 8 participants (15%), indicating a high probability of meeting the criteria for certain depressive disorders. Hysteria is observed in 4 participants (7%) characterized by hypersensitivity, extroverted personalities with superficial and easily changeable emotions, a need for affection, emotional instability, and a tendency to develop functional physical complaints under stress. Notably, all 8 participants (100%) with severe depression were men, while none of the women (0%) reported severe depression. Furthermore, it can be seen that 46 participants (85%) did not have depression. Statistical analysis shows no significant difference between groups (P\u0026thinsp;=\u0026thinsp;0.09). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows an expression of common symptoms of anxiety, depression, and emotional lability concerning the presence of hypofunction.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpression of common symptoms of anxiety, depression and emotional lability in relation to the presence of hypofunction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo (%) of participants in relation to the presence of hypofunction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (disproportion\u0026thinsp;\u0026le;\u0026thinsp;25%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (hypofunction of labirint)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFree-floating anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSomatic anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnxiety in phobias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObsessiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHysteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe table shows that 4 participants (15%) without vestibular hypofunction and 4 participants (14%) with vestibular hypofunction experienced severe depression. Additionally, 46 participants (85%) did not have depression. Statistical analysis indicated no significant difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.99). Furthermore, based on Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there were no significant differences in the typical symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning gender and the presence of hypofunction. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the degree of anxiety, depression, and emotional lability symptoms concerning acute or chronic hypofunction.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpression of common symptoms of anxiety, depression, and emotional lability concerning acute or chronic hypofunction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo (%) of participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAcute\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFree-floating anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSomatic anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnxiety in phobias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObsessiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHysteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 / 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Fisher's Exact Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe table indicates that among the 44 participants (86%) with chronic hypofunction, 7 experienced severe depression, while 1 out of 3 participants with acute hypofunction reported severe depression. Overall, out of the 54 participants, 8 (15%) had severe depression. Statistical analysis revealed no significant difference (P\u0026thinsp;=\u0026thinsp;0.39). Additionally, Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e presents the degree of anxiety, depression, and emotional lability symptoms concerning compensation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpression of common symptoms of anxiety, depression, and emotional lability concerning compensation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNo (%) of participants in relation to the compensation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP*\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUncompensated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCompensated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFree-floating anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSomatic anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAnxiety in phobias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObsessiveness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHysteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage (normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 / 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Fisher's Exact Test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe table shows that among the participants with severe depression, 1 out of 6 had uncompensated hypofunction, while 7 out of 41 had compensated hypofunction. Overall, 4 participants (7%) out of 54 had severe depression. Statistical analysis indicated no significant difference (P\u0026thinsp;\u0026gt;\u0026thinsp;0.99).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this cross-sectional study with historical data, 54 participants with balance disorders and a diagnosis of unilateral labyrinthine hypofunction were involved. For diagnostic purposes, the bithermal caloric test and the results of cVEMP and oVEMP were used. The main aim of this study was to identify the association of anxiety, depression, hysteria, and obsessiveness with the type and nature of unilateral peripheral vestibular disorder. Consequently, participants completed the Crown-Crisp Experience Index questionnaire (CCEI) and were thus selected based on deviations from normal values of free-floating anxiety, somatic anxiety, phobia-related anxiety, depression, obsessiveness, and hysteria. The obtained results showed that patients with vertigo most frequently exhibited somatic anxiety and depression with no statistically significant differences in the presence of psychological issues concerning the types and nature of unilateral peripheral vestibular disorder.\u003c/p\u003e \u003cp\u003eIn the study, there were more female participants (72%) compared to male participants (28%), which aligns with findings in the literature. This finding can be attributed to hormonal changes that disrupt the homeostasis of labyrinthine fluid [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The patient population in this study was older, similar to the cohort examined in the study on unilateral vestibular hypofunction conducted by Lubetzky and colleagues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. An asymmetry greater than 25% was detected in just over half of the patients, which is higher than the findings of Felipe and colleagues, where asymmetry was present in less than half of the participants [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nearly all patients had chronic vestibular hypofunction, whereas a 2019 retrospective study reported that 42.2% were in an acute state [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Central damage was identified in 7% of patients, compared to the 2019 study, which reported central damage in twice as many patients (15.6%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In terms of vestibular evoked myogenic potentials, cVEMP asymmetry was recorded less frequently than oVEMP asymmetry, aligning with the study by Magliula and colleagues, which found that 80% of patients had abnormal oVEMP results, while 47% had abnormal cVEMP results [\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It is known that symptoms of vestibular hypofunction tend to improve over the weeks and months due to the process of vestibular compensation. This compensation results in significant functional recovery, facilitated by the nervous system's plasticity, which allows for adaptation to peripheral vestibular disorders [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, most participants were compensated (89%), and there were no significant differences in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning acute or chronic hypofunction. When considering the results of the Crown-Crisp Experience Index and comparing them with the age of the patients, it is evident that anxiety is mainly present in older age, with the median age of 70 years. However, there is no statistically significant difference in the presence of psychological issues concerning the age of the participants. Similarly, in a Japanese study conducted by Miura and colleagues, the correlation between age and anxiety was also negative. In their study, a correlation was found between gender and anxiety indicating that anxiety is more common among females. The results of this study did not show a connection between gender and the occurrence of anxiety. Although Miura and colleagues hypothesize that patients in the earlier stages of the disease have more pronounced symptoms of anxiety, they did not account for the duration of symptoms [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This study did consider the duration of symptoms but found no significant statistical differences between acute and chronic hypofunction.\u003c/p\u003e \u003cp\u003eThe work of Hallam and Stephens, published in the United Kingdom, confirmed that complaints of vertigo are associated with higher scores on the anxiety scale of the CCEI. Participants who experienced vertigo also had significantly higher scores than those without vertigo on all CCEI scales except for depression and hysteria. In contrast, in this study, depression is the second most common condition among patients with vertigo. Therefore, participants who complained of vertigo predominantly exhibited phobic and somatic anxiety, which is similar to the results of this study, which show that most patients have pronounced somatic anxiety. Interestingly, in this study, phobia-related anxiety, which is predominantly represented in the work of Hallam and Stephens, is equal in frequency to hysteria, which is not represented at all in their study [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also had limitations. Only participants whose anxiety values deviated twice from the standard deviation were considered, which statistically influenced the results since individuals who were also anxious but not to the greatest extent were not analyzed as anxious. Furthermore, although the Crown-Crisp Experience Index is an excellent test for screening anxious individuals, it partially relies on the subjective experience of the person and depends on whether they want to share their condition with others or not. Another limitation of the study is that we used only one questionnaire (CCEI) for screening individuals with psychoneurotic pathology despite its reliability and validity as a measurement tool.\u003c/p\u003e \u003cp\u003eIt was noted that many individuals who completed the questionnaire responded negatively to clearly posed questions their anxiety, while significant anxiety was observed in responses to ambiguously posed questions, where the participants were uncertain what they were actually answering.\u003c/p\u003e \u003cp\u003eFinally, we acknowledged that the small sample size was partly determined by the inclusion and exclusion criteria. However, as explained in the conclusion, a new study with a larger sample size would be recommended.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eBased on the conducted research and obtained results, no significant differences were observed in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning gender and age, although it can be noted that the patients are of older age. The majority of participants had pronounced somatic anxiety, followed by depression, then free-floating anxiety, with phobia-related anxiety and hysteria being equally represented, and obsessiveness being the least pronounced. Nearly all participants (94%) were diagnosed with chronic hypofunction due to presenting for examination and diagnostic processing after the acute phase of the disease had ended. No significant differences were observed in the usual symptoms and personality traits within the conventional categories of psychoneurotic disorders and personality disorders concerning acute or chronic hypofunction. A total of 89% of the participants were compensated, and 94% had partial vestibular disorder, with no significant differences observed in the usual symptoms and personality traits concerning compensation. Because of all stated above, we believe a personalized approach is necessary for every patient with damage to the vestibular system. Although damage to the vestibular system is compensated over time, the psychological aspect is negligible, as shown in our study. Therefore, it is essential to include a psychologist in the standard management of vertigo, given the complexity of functional vertigo and the need to address comorbid anxiety.\u003c/p\u003e \u003cp\u003eRegarding the question in the title, psychological assessment should be an integral part of the standard procedure for diagnosing and treating patients with vestibular disorders, particularly for those who score above two standard deviations on the CCEI questionnaire. Incorporating a holistic assessment of well-being into the standard protocol for diagnosing and managing patients with vestibular disorders could be highly beneficial. Beyond medical treatment, informing patients about the relationship between vestibular disorders and aspects of emotional well-being, such as anxiety and general mental resilience, can provide a supportive foundation for symptom management.\u003c/p\u003e \u003cp\u003eEducational sessions aimed at explaining these links can help patients better understand their symptoms and reduce feelings of discomfort and fear. In this way, a combination of medical and psychological support can significantly improve treatment outcomes and reduce comorbidities associated with psychological issues.\u003c/p\u003e \u003cp\u003eThis study opens up the possibility of conducting a larger and more detailed study that will consider smaller deviations from the standard and include participants who showed abnormalities in the CCEI questionnaire. This approach highlights the importance of screening for and treating comorbid mental health disorders, which is essential for the effective management of vertigo disorders. Ultimately, addressing these issues can lead to improved quality of life and fewer complications for patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor Contributions: Conceptualization, L.L., and T.M.; methodology, A.V., and H. M.; software, K.K.; validation, A.V., H.V. and Z.Z.; formal analysis, M.R.; investigation, L.L.; data curation, J.S., and H.M.; writing\u0026mdash;original draft preparation, Z.K.; writing\u0026mdash;review and editing, A.R.; visualization, T.K., J.S. and A.G. supervision, A.V. All authors have read and agreed to the published version of the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e \u003cp\u003eAll individuals who contributed to this work have been acknowledged in the authorship list.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting this study's findings are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStrupp, M. et al. Vestibular Disorders. \u003cem\u003eDtsch. Arzteblatt Int. 24 April\u003c/em\u003e. \u003cb\u003e117\u003c/b\u003e (17), 300\u0026ndash;310 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDommaraju, S. \u0026amp; Perera, E. An approach to vertigo in general practice. \u003cem\u003eAust Fam Physician travanj\u003c/em\u003e. \u003cb\u003e45\u003c/b\u003e (4), 190\u0026ndash;194 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen, C. T., Basso, M. \u0026amp; Epley Maneuver, U. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citirano 26. svibanj 2023.]. Dostupno na: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK563287/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK563287/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBalatsouras, D. G., Koukoutsis, G., Fassolis, A., Moukos, A. \u0026amp; Apris, A. Benign paroxysmal positional vertigo in the elderly: current insights. \u003cem\u003eClin. Interv Aging\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e, 2251\u0026ndash;2266 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrupp, M., Dieterich, M. \u0026amp; Brandt, T. The Treatment and Natural Course of Peripheral and Central Vertigo. \u003cem\u003eDtsch. \u0026Auml;rztebl Int. July\u003c/em\u003e. \u003cb\u003e110\u003c/b\u003e (29\u0026ndash;30), 505\u0026ndash;516 (2013).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDougherty, J. M., Carney, M., Hohman, M. H. \u0026amp; Emmady, P. D. Vestibular Dysfunction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited on 27 May 2023]. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK558926/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK558926/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall, C. D., Herdman, S. J., Whitney, S. L., Anson, E. R. \u0026amp; Carender, W. J. Hoppes CW. i ostali. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. \u003cem\u003eJ. Neurol. Phys. Ther. 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Psychiatry Neurol. 2022\u003c/em\u003e ;\u003cb\u003e35\u003c/b\u003e(4):580\u0026ndash;585 .\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anxiety, depression, dizziness, vestibular disease","lastPublishedDoi":"10.21203/rs.3.rs-5738015/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5738015/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNowadays, vestibular diseases are quite common in the population and significantly impair quality of life. Additionally, a notable problem is that a certain number of patients experience psychological consequences. Therefore, it is important to investigate the connection between vestibular damage and the potential need for psychological intervention. This study aims to examine the correlation between anxiety in individuals with unilateral peripheral vestibular disorder in relation to gender, age, and the existence of acute and chronic, compensated and uncompensated, partial and complete unilateral peripheral vestibular disorder. Additionally, it was important to determine the degree of free-floating anxiety, phobia-related anxiety, obsessiveness, somatic manifestations, depression, and hysteria in these patients using the Crown-Crisp Experience Index questionnaire. The study included 54 patients, 39 (72%) female and 15 (28%) male, with an average age of 61.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 years. Results showed that the majority of participants had pronounced somatic anxiety (29.6%), followed by depression (14.8%), free-floating anxiety (9.4%), phobia-related anxiety (7.4%) and hysteria (7.4%) equally represented, and obsessiveness (1.8%) being the least pronounced. Nearly all participants (94%) were diagnosed with chronic hypofunction due to presenting for examination and diagnostic processing after the acute phase of the disease had ended. To conclude, no significant differences were observed in the common symptoms or personality traits within conventional categories of psychoneurotic and personality disorders concerning gender or the presence of vestibular hypofunction.\u003c/p\u003e","manuscriptTitle":"Do patients with a unilateral peripheral vestibular disorder need psychological support?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-13 12:52:56","doi":"10.21203/rs.3.rs-5738015/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-10T11:38:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-05T09:36:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-20T23:54:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265925983266744660549371597407899004225","date":"2025-01-12T21:47:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109970676005937205131430523392533831475","date":"2025-01-11T15:27:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-09T12:06:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-09T12:01:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-01-09T11:54:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-08T12:14:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-12-30T22:17:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8723d0e7-ca17-42ed-94cf-3db308757358","owner":[],"postedDate":"January 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":42624496,"name":"Health sciences/Medical research/Outcomes research"},{"id":42624497,"name":"Health sciences/Medical research/Study design"}],"tags":[],"updatedAt":"2025-07-28T16:05:01+00:00","versionOfRecord":{"articleIdentity":"rs-5738015","link":"https://doi.org/10.1038/s41598-025-12930-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-26 15:58:28","publishedOnDateReadable":"July 26th, 2025"},"versionCreatedAt":"2025-01-13 12:52:56","video":"","vorDoi":"10.1038/s41598-025-12930-7","vorDoiUrl":"https://doi.org/10.1038/s41598-025-12930-7","workflowStages":[]},"version":"v1","identity":"rs-5738015","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5738015","identity":"rs-5738015","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}