Hearing Healthcare: Seven Things You Should Know About Mental Health and Hearing Loss

Written by Dr. Peter Russell B.A., M.Sc., Au.D. Aud-Reg

Doctor of Audiology, Co-owner Hear Right Canada Nova Scotia Inc. 

Mental health affects us all. The Canadian Mental Health Association reported in 2021 that every year, 20% of Canadians experience a mental health problem or illness. They note that mental illness affects all Canadians, either directly or indirectly via a family member, friend, or colleague. In this article, I will review seven things you should know about mental health and hearing loss.

#1 Mental Health versus Mental Illness

The Canadian Mental Health Association states that mental health includes “our emotions, feeling of connection with others, our thoughts and feelings, and being able to manage life’s highs and lows”.

The American Psychiatric Association describes mental health as “the foundation for emotions, thinking, communication, learning, resilience and self esteem.’ They define mental illness as “health conditions involving changes in emotion, thinking and behavior… and are associated with distress and/or problems functioning in social, work or family activities”. Therefore, mental illness is viewed as a medical condition like any other health condition such as diabetes or heart disease.

#2: Two Most Common Types of Mental Illness

Depression and anxiety disorders are the two most common types of mental illness. In 2017, the World Health Organization (WHO) ranked depression as the largest contributor to global disability. Anxiety disorders ranked 6th.

Depressive disorders are characterized by at least two weeks of daily episodes of:

  • Sadness
  • Loss of interest or pleasure
  • Feelings of guilt or low self-worth
  • Disturbed sleep or appetite
  • Fatigue
  • Poor concentration.

Anxiety disorders are characterized by recurrent anxiety and fear. Some types of anxiety disorders include:

  • Phobias
  • Obsessive-compulsive disorder
  • Panic disorder
  • Generalized anxiety disorder
  • Port traumatic stress disorder (PTSD)

According to Statistics Canada (2020), major depression affects about 5.4% of Canadians. Anxiety disorders affect about 4.6%. Costs for mental illnesses to Canadian healthcare and social support was almost $80 billion in 2021.

#3 Most Common Type of Hearing Loss

According to Statistics Canada (2021), the percentage of adult hearing loss by age group is as follows:

  • Age 20-39: 9%
  • Age 40-49: 27%
  • Age 50-59: 51%
  • Age 60 to 69: 77%
  • Age 70-79: 94%

The most common type of permanent hearing loss that we develop as adults is called sensorineural. This type of hearing loss is most often the result of damage to tiny hair cells in the inner ear. Damage to hair cells can be due to aging, exposure to loud noise, and health conditions such as diabetes, cardiovascular disease, and thyroid disease. These hearing losses progress gradually, and usually affect the higher frequencies before the lower frequencies. Hair cell damage also can cause tinnitus (ringing or other sounds in the ears) and sensitivity to loud sounds.

#4 Symptoms of Hearing Loss

Early symptoms of hearing loss include:

  • Often asking people to repeat
  • Complaining that other people mumble
  • Difficulty understanding people in noise
  • Speaking loudly
  • Turning up the volume of the TV
  • Straining to understand conversations

#5 Psychosocial Impact of Hearing loss

It has been widely reported that most people with hearing loss wait 7 to 10 years after the beginning of symptoms before seeking help. During that time, the person gradually withdraws from social situations because of embarrassment and feeling unable to participate in group conversations. This social withdrawal gradually leads to social isolation. In 1999, a National Counsel on Aging (USA) study concluded that untreated hearing loss results in greater feelings of insecurity, depression, and anxiety. A 2014 study published by the Journal of the American Medical Association (JAMA) found that adults with hearing loss were more than 2 times likely to report depression, especially for females and those younger than 70.

#6 Hearing Loss May Be a Modifiable Risk Factor for Depression

Risk factors are conditions that increase your likelihood of developing a health problem. Modifiable risk factors are those that can reduce that likelihood if they are treated or prevented. Hearing loss is just one risk factor for depression and anxiety. So, a logical question is, can the treatment of hearing loss reduce risk of depression?  A 2020 study, also from JAMA investigated the relationship between hearing loss, psychological distress and the utilization of mental health services and treatments. Psychological distress was defined as depression and/or anxiety. They found that older adults with untreated hearing loss were 2 times more likely to use mental health medications and services compared to peers with normal hearing. They also found that those who use hearing aids reported significantly less psychological distress than those with untreated hearing loss. They concluded that hearing loss may be a significant risk factor for depression, and further study is needed on this subject. It is worthwhile to note that untreated hearing loss is a barrier to traditional therapies for depression and other psychiatric problem.

#7 Hearing Loss, Depression and Anxiety are Modifiable Risk Factors for Dementia

In 2020, The Lancet published a comprehensive article on the prevention, intervention and care for dementia. They identified 12 risk factors that may prevent or delay up to 40% of dementia cases. The greatest risk factor identified was midlife hearing loss at 8.2%. They cited several studies, one of which indicated that there is 2x the risk of dementia with mild hearing loss, 3x the risk with moderate hearing loss and 5x the risk with severe hearing loss. They also reported that hearing loss is associated with a decrease in brain volume. Hearing aid use was reported to be the largest factor to protect people with hearing loss from dementia. Several studies were cited that show increased dementia with untreated hearing loss but not for those who used hearing aids. After 65 years of age, depression and social isolation were identified at 3.9% and 3.5% respectively. It was reported that depression may be an early symptom of dementia before other clinical symptoms, such as memory loss, become apparent. Social contact was reported as a protective factor for dementia. They cited studies that indicate that frequent social contact in our later years is associated with better thinking abilities despite differences in culture.

Mental health and mental illness are complex issues. If hearing loss is a concern for anyone with mental health concerns, an audiologist can help. Audiologists can diagnose and treat hearing loss and collaborate with other health professionals to help you achieve a better quality of life.