The Mental Health Impact of Hearing Impairment Among Older Adults: The Mediating Role of Social Participation and Loneliness

Background: One of the critical yet understudied factors affecting older adults’ daily functioning and quality of life is hearing impairment. Although often considered a normal part of aging, hearing impairment is associated with adverse psychological and cognitive outcomes. This study examines the mechanisms through which hearing impairment influences depressive symptoms, focusing on pathways involving reduced social participation (behavioral withdrawal) and increased loneliness (subjective perceptions of social alienation). Guided by the Biopsychosocial Theory, we hypothesized that the impact of hearing impairment on depressive symptoms would be mediated by social participation and loneliness.

Methods: From the 2022 Health and Retirement Study (HRS), 3,265 participants (Mean age = 69.1, SD = 10.1) who completed hearing tests and psychosocial questionnaires were included in the analyses. Hearing impairment was assessed using a hearing screening device (Siemens HearCheck). Depressive symptoms were measured using the CES-D, excluding the loneliness item, loneliness was assessed using the HRS-adapted UCLA Loneliness Scale, and social participation was measured with the number of social activities in which participants engaged. We examined multivariate regression and mediation models testing the direct effect of hearing impairment on depressive symptoms, as well as the mediating roles of social participation and loneliness.

Results: The direct effect of hearing impairment on depressive symptoms was significant (B [SE] = 0.038 [0.011], p=0.001 ). Hearing impairment had significant indirect effects on depressive symptoms through both social participation (B [SE] = 0.014 [0.002], bias-corrected 95% CI = [0.010, 0.019]) and loneliness (B [SE] = 0.013 [0.004], bias-corrected 95% CI = [0.005, 0.022]). The indirect effects accounted for 38.2% of the total effect in the model with social participation and 35.0% in the model with loneliness.

Conclusion: Our findings suggest that hearing impairment may lead older adults to withdraw from social participation or experience loneliness, which in turn contributes to depressive symptoms. These results highlight the importance of incorporating strategies to enhance social participation and reduce loneliness in mental health interventions targeting older adults affected by hearing impairment.