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Original Investigation |

Hearing Impairment Associated With Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010

Chuan-Ming Li, MD, PhD1; Xinzhi Zhang, MD, PhD2; Howard J. Hoffman, MA1; Mary Frances Cotch, PhD3; Christa L. Themann, MA, CCC-A4; M. Roy Wilson, MD2,5
[+] Author Affiliations
1Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
2National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
3Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
4Hearing Loss Prevention Team, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
5Office of the President, Wayne State University, Detroit, Michigan
JAMA Otolaryngol Head Neck Surg. 2014;140(4):293-302. doi:10.1001/jamaoto.2014.42.
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Importance  Depression among hearing impaired US adults has not been studied previously.

Objective  To estimate the prevalence of and risk factors for depression among adults with hearing loss.

Design, Setting, and Participants  Adults aged 18 years or older (N = 18 318) who participated in the National Health and Nutrition Examination Survey (NHANES), 2005-2010, a nationally representative sample.

Interventions  Multistage probability sampling of US population.

Main Outcomes and Measures  Depression, assessed by the 9-item Patient Health Questionnaire (PHQ-9) scale, and hearing impairment (HI), assessed by self-report and audiometric examination for adults aged 70 years or older.

Results  The prevalence of moderate to severe depression (PHQ-9 score, ≥10) was 4.9% for individuals reporting excellent hearing, 7.1% for those with good hearing, and 11.4% for participants who reported a little trouble or greater HI. Using excellent hearing as the reference, after adjusting for all covariates, multivariate odds ratios (ORs) for depression were 1.4 (95% CI, 1.1-1.8) for good hearing, 1.7 (1.3-2.2) for a little trouble, 2.4 (1.7-3.2) for moderate trouble, 1.5 (0.9-2.6) for a lot of trouble, and 0.6 (0.1-2.6) for deaf. Moderate HI (defined by better ear pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz within the range 35- to 49-dB hearing level) was significantly associated with depression among older women (OR, 3.9; 95% CI, 1.3-11.3), after adjusting for age, sex, race/ethnicity, lifestyle characteristics, and selected health conditions.

Conclusions and Relevance  After accounting for health conditions and other factors, including trouble seeing, self-reported HI and audiometrically determined HI were significantly associated with depression, particularly in women. Health care professionals should be aware of an increased risk for depression among adults with hearing loss.

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Figure 1.
Prevalence of Depression Among US Adults by Sex and Reported Hearing Status, National Health and Nutrition Examination Survey 2005-2010

Limit lines indicate 95% CI.

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Figure 2.
Better Ear Pure-Tone Average (BE PTA) and 9-Item Patient Health Questionnaire (PHQ-9) Mean Score by Reported Hearing Status, National Health and Nutrition Examination Survey 2005-2006 and 2009-2010

Air conduction, BE PTA of thresholds at 0.5, 1, 2, and 4 kHz, measured in decibels hearing level (HL) scale, for men (A) and women (B) for US adults aged 70 years or older. Limit lines indicate 95% CI.

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Figure 3.
Prevalence of Moderate to Severe Depression Among US Adults by Race/Ethnicity and Reported Hearing Status Based on the National Health and Nutrition Examination Survey 2005-2006 and 2009-2010

Limit lines indicate 95% CI.

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