New Perspective on Psychosocial Distress in Patients with Dysphonia: The Moderating Role of Perceived Control

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Objectives Although an association between psychosocial distress (depression, anxiety, somatization, and perceived stress) and voice disorders has been observed, little is known about the relationship between distress and patient-reported voice handicap. Furthermore, the psychological mechanisms underlying this relationship are poorly understood. Perceived control plays an important role in distress associated with other medical disorders. The objectives of this study were to (1) characterize the relationship between distress and patient-reported voice handicap and (2) examine the role of perceived control in this relationship. Study Design This is a cross-sectional study in a tertiary care academic voice clinic. Methods Distress, perceived stress, voice handicap, and perceived control were measured using established assessment scales. Association was measured with Pearson correlation coefficients; moderation was assessed using multiple hierarchical regression. Results A total of 533 patients enrolled. Thirty-four percent of the patients met criteria for clinically significant distress (ie, depression, anxiety, and/or somatization). A weak association (r = 0.13; P = 0.003) was observed between severity of psychosocial distress and vocal handicap. Present perceived control was inversely associated with distress (r = -0.41; P < 0.0001), stress (r = -0.30; P < 0.0001), and voice handicap (r = -0.30; P < 0.0001). The relationship between voice handicap and psychosocial distress was moderated by perceived control (b for interaction term, -0.15; P < 0.001); greater vocal handicap was associated with greater distress in patients with low perceived control. Conclusions Severity of distress and vocal handicap were positively related, and the relation between them was moderated by perceived control. Vocal handicap was more related to distress among those with low perceived control; targeting this potential mechanism may facilitate new approaches for improved care.

Original languageEnglish (US)
Pages (from-to)172-176
Number of pages5
JournalJournal of Voice
Issue number2
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
This study was funded through National Institutes of Health UL1TR000114. The authors are deeply grateful to Brenna Finley, MPH; Meg Her, MPH; Kathryn Banks, BA; and Patricia Fernandes Boettner, DDS, MS, for study coordination. The authors appreciate thoughtful input from Lions Voice Clinic members Deirdre D. Michael, PhD, CCC-SLP; Lisa Butcher, MS, CCC-SLP; Jesse Hoffmeister, MS, CCC-SLP; and George S. Goding Jr. MD, FACS, and from Bevan Yueh, MD, MPH.

Publisher Copyright:
© 2016 The Voice Foundation.


  • Anxiety
  • Depression
  • Moderation
  • Perceived control
  • Psychosocial distress
  • Somatization
  • Stress
  • Voice disorder
  • Voice handicap


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