Mental Well-Being Tightly Linked to Hearing Health

1 Mar , 2016

Audiologists have a significant part to play in identifying anxiety, depression, and other mental health problems in hearing health care patients and in ensuring that these patients receive the proper psychological care.

To achieve this, they need to have a network of mental health professionals to which to refer patients, or suggest that patients see their primary care physicians for further assessment and referral, according to Barbara E. Weinstein, PhD, professor of audiology and founding executive officer of Health Sciences Doctoral Programs at the Graduate Center, City University of New York, coauthor of the Hearing Handicap Inventory for the Elderly/Adults and columnist for The Hearing Journal.

Stacy Weisend, AuD, a clinical audiologist and vestibular lab coordinator at the University of Akron in Akron, OH, said it is not the role of the hearing health care professional to diagnose or treat mental health problems, but it is their duty to counsel and treat within the realm of audiology.

“We need be able to recognize signs and symptoms of depression, anxiety, and other disorders so we can properly refer patients,” she said.

DEPRESSION AND ANXIETY’S PREVALENCE

Of 18,318 individuals who participated in the National Health and Nutrition Examination Survey (NHANES), the prevalence of moderate-to-severe depression is dose dependent, with 4.9 percent of moderately to severely depressed individuals reporting excellent hearing, 7.1 percent reporting good hearing, and 11.4 percent experiencing a little trouble or greater hearing impairment, according to a recent National Institute on Deafness and Other Communication Disorders report (JAMA Otolaryngol Head Neck Surg 2014;140[4]:293-302).

Overall, the prevalence of mental health problems in the hearing health population is largely unknown, said Dr. Weisend.“We typically see people after they have an audiological issue, such as tinnitus, hearing loss, hyperacusis, or dizziness, and it is difficult to determine whether they have mental health problems, as many are undiagnosed or unreported,” she said. “If there is a diagnosis of anxiety or depression, knowing whether it stems from a hearing problem or a preexisting condition is challenging”, she added.

Most audiologists do not measure presenting mental health conditions, nor do they typically measure outcomes in these domains, according to Dr. Weinstein.“But one would speculate that among people with moderate-to-severe hearing loss there would be a considerable depression factor, given the studies demonstrating a link between depression, hearing loss, and self-rated psychosocial hearing difficulties,” she said.

Depression and anxiety seem to have a high prevalence in Dr. Weisend’s patients, she added. Even though patients may not have an official diagnosis, they seem to experience—per self-report—an alteration in their mental health that has psychosocial manifestations that affect their individual thoughts and behaviors. Audiological issues, for example, can limit or sever social connections, and human beings are social by nature, she said.When patients lose their social connections, “they lose the mirror [or] feedback, that helps them calibrate and stay in line with the world.” Social pain and rejection can trigger the same neural pathways as physical pain, said Dr. Weisend, but social pain is much more easily triggered and can be relived more vividly than physical pain.

MENTAL HEALTH KNOWLEDGE NECESSARY FOR PATIENTS

The literature demonstrates a relationship between hearing loss and depression, said Dr. Weinstein. For example, the incidence of depressive symptoms is higher among persons self-reporting a hearing handicap as compared with those not reporting one, and self-reported hearing handicap is an independent predictor of depressive symptoms. Some studies,for example, show that hearing aids reduce depression (Geriatr Gerontol Int. 2012 Jul;12(3):440-445 http://onlinelibrary.wiley.com/doi/10.1111/j.1447-0594.2011.00789.x/abstract;jsessionid=0A07FBB35A8D13D8FDF65DB01DA3EE69.f02t02).

A recent study reported that hearing health care patients with moderate-to-severe hearing loss may experience anxiety associated with the inability to manage their condition, as well as physiologic symptoms such as elevated blood glucose levels, said Dr. Weinstein (Disabi Rehabil 2015;37:22:2070-2075  www.tandfonline.com/doi/full/10.3109/09638288.2014.996675).

Persons with self-reported psychosocial hearing difficulties also experience fatigue, a symptom associated with reduced quality of life, depression, and compromised decision-making ability, she said, citing recent studies (Ear Hear. 2016;37(1):e1-e10 http://journals.lww.com/ear-hearing/pages/articleviewer.aspx?year=2016&issue=01000&article=00014&type=abstract

Audiologists also need to understand the grieving reactions of people who are experiencing hearing loss, said Michael A. Harvey, PhD, ABPP, a private-practice clinical psychologist with specialization in hearing loss in Framingham, MA, and a former consulting faculty member at Salus University in Elkins Park, PA. Notably, people born with moderate-to-profound hearing loss don’t have the same grieving reactions as individuals who transition from normal hearing to hearing loss. “You see a lot more acute depression and anxiety as people experience a real loss, going from one state to a lesser state,” he said.

Audiologists should be aware that patients with a moderate hearing loss often experience a phenomenon called “between two worlds,” which is characterized by identifying with both the hearing and deaf communities, said Dr. Harvey.

People may identify with the hearing world through their love of music, for example. When they start experiencing problems hearing in crowds or environments with background noise, however, they may begin to feel isolated and gravitate toward the deaf community, but without knowing how to sign.

Patients with hearing loss may experience a range of emotional and psychological symptoms, said Robert Sweetow, PhD, emeritus professor in the Department of Otolaryngology–Head and Neck Surgery at the University of California, San Francisco. These can include anger, denial, guilt, paranoia, embarrassment, frustration and impatience, isolation and withdrawal, sadness, depression, anxiety, loss of confidence, self-pity, and fatigue. People with hearing loss may also recognize a fundamental difference in the way others perceive them and the way in which they communicate. As a result, they often don’t want to be told by an audiologist what to do or how to view their hearing loss, he said.

More research is needed to show how audiological interventions can positively affect patients’ health outcomes and quality of life, said Dr. Weinstein. Notably, a soon-to-be-published manuscript demonstrates that hearing aids used to improve speech understanding in noise also reduce social and emotional loneliness, which, in turn, may affect cognition, she said.

Source: Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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