Psychological Well-Being, Neuroticism, and the Risk of Benign Paroxysmal Positional Vertigo: A Triangulation Study

Benign paroxysmal positional vertigo (BPPV) is frequently accompanied by psychiatric and psychological comorbidities. However, the causal direction underlying the association between mental health traits and BPPV remains actively debated. We aimed to investigate the relationship between psychological well-being, neuroticism, and BPPV risk using a comprehensive triangulation framework.

We integrated three distinct methodological paradigms. First, we conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES, N = 3842). Second, we analyzed longitudinal cohort data from the UK Biobank (N = 401,265; median follow-up: 12.4 years). Finally, we applied bidirectional two-sample Mendelian randomization (MR) utilizing large-scale genome-wide association studies and FinnGen datasets to infer genetic causality.

Cross-sectional analysis revealed that higher life satisfaction was associated with significantly lower odds of BPPV symptoms. Longitudinally, survival analysis of the UK Biobank cohort demonstrated that higher neuroticism was inversely associated with the risk of incident BPPV, whereas high life satisfaction acted as a robust inverse correlate. Forward MR analysis corroborated a suggestive inverse genetic association of life satisfaction and positive affect against BPPV, alongside a risk-mitigating effect of emotional lability and neuroticism. Importantly, reverse MR analysis found no evidence of reverse causality from BPPV to mental health traits.

Consistent multi-method evidence is suggestive of a potential relationship where favorable psychological states demonstrate an inverse association with BPPV, while neuroticism is associated with decreased clinical incidence, challenging previous assumptions. These findings identify an intriguing association between psychological traits and vestibular health that warrants further investigation and independent replication before any clinical preventive implications can be proposed.