According to the World Health Organization, 20 percent of children and adolescents have mental illness, and neuropsychiatric conditions are the most common disability among teens.1 Despite this, mental health remains relatively neglected in the child population. The U.S. Department of Health and Human Services has recognized depression as a public health problem and a leading cause of injury and illness.2 The prevalence of these mental health conditions increases in the presence of a chronic condition or disability, such as hearing loss.
Depression and anxiety are among the most common mental health conditions in adolescence and adulthood.3 Depression is characterized by persistent feelings of sadness, decreased interest in activities, fatigue, feelings of worthlessness, and changes in diet and sleep.4 Childhood depression is rare; however, its prevalence increases in adolescence and is usually more common in women.3 Anxiety is characterized as a persistent feeling of anxiety that is difficult to control and results in irritability, sleep disturbance, or difficulty concentrating.4 The most common and widespread diagnosis is generalized anxiety disorder, which is often identified in later adolescence.
Research in the field of mental health and hearing loss is largely unexplored or still quite limited. Existing published studies have shown variability within the hearing impaired population, with some studies reporting that nearly 25–38 percent of children have symptoms of sadness, worry, and social withdrawal, while other studies report no difference in the hearing impaired population.3.5
Identification and intervention of mental health conditions, such as depression and anxiety, are crucial because they are associated with long-term outcomes and compliance with treatment. For the hearing impaired population, mental health interventions may affect device use and inclusion in rehabilitation programs, which may affect or predict quality of life and / or speech and language outcomes.6 Mental health can also negatively affect school success and productivity.7
Our research implemented a universal protocol for the detection of depression and anxiety in adolescents served in otological / audiological practice as a standard of care. The aim of the study was to assess the prevalence of depression and anxiety in adolescents with hearing loss.
We recruited 104 adolescents aged 12 to 18 from the otology clinic. Because we wanted to focus on the association between hearing loss and mental health, patients with normal hearing were excluded from the study. The final sample was 92 adolescents with a mean age of 14 years (SD = 1.82), of whom 58.7 percent reported being Latin American and 62 percent had bilateral hearing loss. Patients completed a mental health examination once a year as part of their standard clinical care. Patients also completed demographic data, and a medical record was reviewed to collect data on their type and degree of hearing loss. Patients independently completed the examination on the iPad. If patients scored above the clinical limit, the family support team conducted a brief consultation with the adolescent and their parent and provided referrals.
The measures used in the review consisted of a patient health questionnaire (PHQ-85) and a generalized anxiety disorder questionnaire (GAD-78). These measures assess the symptoms of depression and anxiety. Both measures are widely used, are available in multiple languages and are considered reliable and valid. Next, patients were asked, “If you have any of the problems on this form (questions above), how much did these problems make it harder for you to do work / school, take care of things at home, or get along with other people? “Patients then indicated their impairment ranging from ‘not at all severe’ to ‘extremely severe.’
RESULTS AND HIGHLIGHTS
Twenty-five percent of adolescents scored above the clinical limit of at least one measure, and nine percent scored in the elevated range on both measures. More importantly, 30 percent of patients scored in the risk area for depression and 21 percent for anxiety. Our results illustrate the need for preventive work to reduce the symptoms of depression or anxiety before they develop into psychological disorders. Older adolescents reported more symptoms of depression compared with younger children (r = .232, p = .026). In addition, adolescents with bilateral sensorineural hearing loss were more likely to report elevated depressive symptoms (18%), followed by unilateral hearing loss (15%), bilateral conductive hearing loss (18%), and bilateral mixed hearing loss (33%). Similarly, adolescents with bilateral sensorineural hearing loss (18%) reported more anxiety symptoms, followed by unilateral hearing loss (25%). In general, adolescents who scored above the threshold on the measure of depression had severe to profound hearing loss, then moderate to severe, and mild to moderate (Figure 1). Similarly, on the measure of anxiety, we found that adolescents with severe to profound hearing had a higher rate of clinically elevated anxiety scores, followed by mild to moderate and moderate to severe (Figure 2). Finally, no significant association was found between mental health symptoms and the type of hearing aid. However, most adolescents who scored above the clinical cut-off value wore hearing aids accompanied by cochlear implants or no device.
CLINICAL APPLICATION AND RECOMMENDATIONS
Our research highlighted the need for mental health screening as part of otological and audiological practices. Moreover, it has shown that the use of the screen is feasible and justified given the heightened concerns reported by adolescents with hearing loss. Given these data, it is recommended that mental health examinations be an integral part of annual visits to patients with hearing impairment. The mental health check takes less than five minutes and can be easily managed by office staff, audiology assistants, students or nurses. Often patients and / or parents will have enough time to complete the examination while waiting to see an audiologist or otolaryngologist. A medical visit can begin with a quick review of the test results and a conversation with the patient and / or parents. If the results suggest that the patient is at risk of anxiety or depression, direct recommendations may be made to a psychologist or social worker to further discuss the results of the examination. In cases where these providers are not readily available, a doctor or audiologist can provide families with referrals from the local community for mental health services.
Although some audiology and otology clinics may be reluctant to manage a mental health examination for cost recovery and concerns about the effectiveness of the clinic, the benefits of resolving depression and anxiety in hearing-impaired adolescents outweigh these concerns about clinical cost-effectiveness. Children with depression and / or anxiety are seven times more likely to have been absent from school for more than two weeks7 and three times more likely not to follow treatment recommendations.2 As such, untreated mental health problems are likely to contribute to reduced wear time of hearing aids (hearing aids, cochlear implants, and acoustic implants) resulting in negative impacts on communication skills, quality of life, speech comprehension, and social interaction.
In conclusion, given the increasing rates of depression and anxiety in the world and the disproportionately risky population with hearing impairment, the integration of mental health examinations is urgently needed to identify those in need of psychological support and to link them to appropriate intervention. in order to reduce for a long time – a lasting impact on the quality of life and functioning of mental health. See the original article10 for further information.