Hearing Loss and Mental Health Conditions

BACKGROUND

Evidence demonstrates that there is a strong association between hearing difficulties and mental health conditions. In particular, common mental health disorders such as depression and anxiety show a strong link to hearing loss. Hearing loss is the chronic health condition that is the most often associated with depression in older adults.[1] Hearing difficulties could increase symptoms of anxiety and depression by 4 times.[2] According to the Health ABC study, subjects who reported worsened hearing had increased depressive and anxiety symptoms when they were followed for five years. Compared with individuals who reported no hearing loss, the odds of anxiety were higher among individuals with mild hearing loss (1.32) and the odds increased as the hearing loss worsened (1.59)[3]. A longitudinal population study of 10 566 adult Taiwanese found an increased risk of sudden hearing loss among those with an anxiety disorder.[4]

Possible explanations of the link between hearing loss include behavioural mechanisms. For instance, older adults with hearing difficulties may be more prone to withdrawing from social situations, which might contribute to increased feelings of loneliness and subsequent depression. A biological mechanism may also be at play. Emerging evidence shows that hearing loss can lead to a reduced activation in central auditory pathways. This in turn can lead to an increased activation of the cognitive control network, interruption of auditor limbic connectivity and atrophy in frontal regions of the brain. These effects can then increase the risk of depression as executive functions are compromised.[5]

Current evidence shows that interventions targeting hearing loss may be helpful for reducing symptoms of psychiatric disorders. For instance, a prospective study found that the use of a cochlear implant in older adults was associated with a significant decline in depressive symptoms at 6 and 12 months after treatment, controlling for baseline levels of depressive symptoms. The study also compared the use of cochlear implants to hearing aids, which exhibited an association with decreased depressive symptoms but failed to persist after 12 months post intervention. [6] A randomized controlled trial of the effect of hearing aids on quality of life in older adults demonstrated a significant effect of hearing aids on social and emotional functioning and symptoms of depression. [7]

In short, it is a spiral of declining quality of life and suffering that needs to be broken. Proper preventative measures, detection, treatment and monitoring are essential and can be effective. This requires that patients and practitioners have the proper attitudes and knowledge to identify hearing loss in patients with mental health conditions. National health services need to adapt to the fact that hearing loss and depression do not exist in isolation but are interrelated. Awareness needs to be raised about the specific symptoms of hearing loss to help patients recognise early signs. Lastly, cooperation between the different stakeholders involved in the interface between mental and hearing health is essential.

[1] Huang CQ, Dong BR, Lu  ZC, Yue  JR, Liu  QX.  Chronic diseases and risk for depression in old age: a meta-analysis of published literature.  Ageing Res Rev. 2010;9(2):131-141.

[2] Blazer DG, Tucci DL. Hearing loss and psychiatric disorders: a review. Psychol Med. 2019 Apr;49(6):891-897. doi: 10.1017/S0033291718003409. Epub 2018 Nov 20. PMID: 30457063.

[3] Brewster KK, Ciarleglio A, Brown PJ, Chen C, Kim HO, Roose SP, Golub JS, Rutherford BR. Age-Related Hearing Loss and Its Association with Depression in Later Life. Am J Geriatr Psychiatry. 2018 Jul;26(7):788-796. doi: 10.1016/j.jagp.2018.04.003. Epub 2018 Apr 13. PMID: 29752060; PMCID: PMC6008216.

[4] Contrera KJ, Betz J, Deal J, et al. Association of Hearing Impairment and Anxiety in Older Adults. J Aging Health. 2017;29(1):172-184. doi:10.1177/0898264316634571

[5] Rutherford BR, Brewster K, Golub JS, Kim AH, Roose SP. Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline. Am J Psychiatry. 2018;175(3):215-224. doi:10.1176/appi.ajp.2017.17040423

[6] Choi JS, Betz J, Li L, et al. Association of Using Hearing Aids or Cochlear Implants With Changes in Depressive Symptoms in Older Adults. JAMA Otolaryngol Head Neck Surg. 2016;142(7):652–657. doi:10.1001/jamaoto.2016.0700

[7] Mulrow CD, Aguilar  C, Endicott  JE,  et al.  Quality-of-life changes and hearing impairment: a randomized trial.  Ann Intern Med. 1990;113

OBJECTIVES

The main objectives of the project are the following:

• Raise awareness of the association between hearing loss and depression and anxiety and its possible explanations

• Raise awareness of the fact that interventions that target hearing loss can reduce the risk of developing a mental health condition or one’s mental health symptoms

• Encourage people with depression or anxiety to get screened for hearing loss and educate them about the fact that hearing loss could exacerbate the symptoms of their mental health condition and about the initial signs of hearing loss.

• Inform people with hearing loss that they may be at greater risk of developing depression or anxiety, particularly if they have a personal or family history of mental health conditions

• Encourage and educate clinicians and carers about this link and initial signs and symptoms.

• Introduce hearing health as part of a wider discussion on quality of life for people with mental health conditions

If you are interested in supporting this project, please contact us at executive.director@gamian.eu