Introduction
Methods
PRISMA flowchart: see Fig. 1
Study quality
Results
Anxiety measures
Community studies (Table 1)
Studies reporting diagnoses
Studies reporting symptoms
Summary
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In people with hearing impairment recruited from community samples, one large study reported an 11.1% lifetime prevalence of ‘unspecified anxiety disorder’.
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A global study with a very large sample reported a prevalence of self-reported anxiety over the past month of 19.1% in the hearing impaired sample.
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Significant anxiety symptom prevalences of 15.4–31.3% were reported in five studies in people with predominantly acquired hearing impairment.
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One study reported a 41% prevalence of significant anxiety symptoms in people with dual sensory loss.
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Every study that compared hearing impaired and non-hearing impaired people found a higher prevalence of anxiety disorder or symptoms in the hearing impaired group.
Studies in ENT settings (Table 2)
First author, year | Adapted Newcastle Ottawa Scale Score | Setting | Sample | Comparator sample | Anxiety measure | Prevalence of clinically significant anxiety (95% confidence intervals) | |||
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S | C | O | Total/higher quality? | ||||||
Studies using symptom measures as outcome | |||||||||
Jones, 1984 [33] | 3 | 2 | 3 | 8 Yes | General Practice Age-sex Register, South Wales | 201 people with self-reported hearing impairment | 426 without hearing impairment | DSSI Cut-off ≥ 6 | Hearing impaired: 15.4% (11.1–21.1) Comparator group: 8% |
Palmer, 2013 [35] | 2 | 2 | 3 | 7 No | Deaf Genetics Project, USA | 245 individuals with unexplained sensorineural deafness since an early age, confirmed by audiology | None | STAI-S Cut-off ≥ 40 | Hearing impaired: 15.1% (11.2–20.1) (pre-genetic test to look for genetic cause of hearing impairment) |
Carlsson, 2014 [25] | 3 | 2 | 3 | 8 Yes | Swedish Quality Register of Otorhinolaryngology Sweden | 1274 people registered as having objectively measured hearing impairment | None | HADS Cut-off ≥ 8 | 31.3% (28.8–33.9) |
Turunen-Taheri, 2016 [26] | 3 | 2 | 3 | 8 Yes | Register for deaf adults, Sweden | 924 people with severe to profound hearing impairment | 244 with hearing and visual impairment | HADS Cut-off ≥ 8 | Hearing impaired: 29% (26.2–32) Dual sensory loss: 41% (35-47.2) |
Contrera, 2017 [36] | 3 | 2 | 2 | 7 Yes | USA community-dwelling adults aged 70–79 | 1083 with hearing impairment | 731 without hearing impairment | HSC 2 symptoms “a little” or 1 symptom “quite a bit” | Hearing impaired: 23.2% (20.7–25.9) Comparator group: 19.4% |
Vancamfort, 2017 [38] | 3 | 2 | 2 | 7 Yes | Utilised data from the World Health Survey (WHS), a cross-sectional study undertaken in 2002–2004 in 70 countries worldwide | 6159 with hearing problems | 165,869 without hearing problems | Participants were asked: Overall in the past 30 days, how much of a problem did you have with worry or anxiety? Those that answered severe or extreme were classified as having anxiety | Hearing impaired: 19.1% (18.1–20.1) Comparator group: 8.7% |
Jayakody, 2018 [31] | 2 | 2 | 3 | 7 No | Ear Science Institute, Australia | 98 people aged between 40 and 88 years with objectively measured hearing impairment | 53 people without hearing impairment | DASS-21 Cut-off ≥ 8 | Hearing loss for speech: 32.7% (24.2–42.4) Comparator group: 20% |
Studies using diagnosis as outcome | |||||||||
Schild, 2012 [8] | 0 | 0 | 3 | 3 No | Deaf community, USA | 77 people recruited from the deaf community | None | CAPS | 19.5% had PTSD (12.2–29.7) |
Hsu, 2016 [24] | 2 | 2 | 1 | 5 Yes | Taiwan Longitudinal Health Insurance Database covering 99% population | 5043 people with acquired hearing loss | 20,172 randomly selected matched controls | ICD-9 code of ‘unspecified anxiety disorder’ recorded | Hearing impaired: 11.1% (10.3–12) Comparator group: 5.4% |
First author, year | Adapted Newcastle–Ottawa Scale Score | Setting | Sample | Comparator sample | Anxiety measure | Prevalence of clinically significant anxiety (95% confidence intervals) | |||
---|---|---|---|---|---|---|---|---|---|
S | C | O | Total/higher quality? | ||||||
Studies using symptom measures as outcome | |||||||||
Andersson, 2009 [27] | 3 | 0 | 2 | 5 Yes | Outpatient Sweden | 111 patients who had had cochlear implants between 1999 and 2005. All had tinnitus | None | HADS-A Cut-off > 10 | 13.5% (8.4–21.1) |
Helvik, 2009 [37] | 3 | 2 | 2 | 7 Yes | Outpatient Norway | 170 patients who were referred for consideration of further audiological rehabilitation | None | PHQ: question on self-report anxiety | 25.9% (19.9–33) |
Guitar, 2013 [32] | 3 | 2 | 3 | 8 Yes | Outpatient New Zealand | 44 severely or profoundly deaf people on the waiting list for cochlear implantation | 119 post-cochlear implantation patients | DASS-21 Cut-off not stated | Hearing impaired: 38.6% (25.7–53.4) Comparator: 18% (20.6% absolute difference) |
Gomaa, 2014 [30] | 2 | 0 | 2 | 4 No | Outpatient Egypt | 46 patients with hearing impairment | 1: 100 patients with hearing impairment and tinnitus 2: 50 with neither complaint | DASS Cut-off: ≥ 8 | Hearing impaired: 8.7% (3.4–20.3) Hearing impaired with tinnitus: 86% (77.9–91.5) Comparator: not stated |
Kloostra, 2014 [28] | 3 | 0 | 3 | 6 Yes | Outpatient The Netherlands | 117 patients from the cochlear implant database | Same group after intervention | HADS-A Cut-off > 10 | Hearing impaired: 29.1% (21.6–37.9) Comparator: 17.1% (11.9% absolute difference) |
Studies using diagnosis as outcome | |||||||||
Mahapatra, 1974 [19] | 3 | 0 | 1 | 4 Yes | Inpatient UK | 49 post-lingually bilaterally deaf patients | 40 patients with unilateral hearing loss | Psychiatric interview based on ICD8 | Hearing impaired: 4.6% (0.4–10.7) Comparator: not stated |
Kalayam, 1991 [17] | 3 | 0 | 2 | 5 Yes | Outpatient USA | 46 hearing impaired patients aged 55 and over | None | DSM-III-R diagnoses from psychiatric interview | 2.2% (0.4–11.3) |
Olze, 2011 [34] | 2 | 0 | 3 | 5 No | Outpatient Germany | 58 post-lingually deafened patients awaiting cochlear implantation | Same group after intervention | GAD-7 Cut-off ≥ 10 | Hearing impaired: 25.6% (14.9–40.2) Comparator: 3.4% (22.2% absolute difference) |
Bruggemann, 2017 [15] | 3 | 0 | 3 | 6 Yes | Outpatient Germany | 47 post-lingually bilaterally deafened candidates for cochlear implantation | Same group after intervention | CIDI diagnosis of anxiety disorder | 31.9% (20.4–46.2) Comparator: 30% (1.9% absolute difference) |
Studies using both diagnosis and symptoms as outcome | |||||||||
Clark, 1994 [16] | 3 | 0 | 3 | 6 Yes | Outpatient USA | 50 consecutive patients presenting with hearing impairment | 50 consecutive patients presenting with dizziness | Stanford panic inventory for panic disorder | Hearing impaired: 0 had panic disorder (0–7.1) (8% had panic attacks) Comparator: 20% panic disorder |
Leposavic, 2006 [18] | 2 | 0 | 3 | 5 No | Outpatient Serbia | 60 stapedectomy patients | Same group after intervention | Standardised psychiatric interview: ICD-10 diagnoses of ‘neurotic disorders’ MMPI | Hearing impaired: 60% (47.4–71.4) Comparator: 30% (30% absolute difference) |
Studies reporting diagnoses
Studies reporting symptoms
Pre- and post-intervention ENT studies
Summary
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Across studies of higher quality, the reported anxiety prevalence in hearing impaired populations ranged from 2.2 to 31.9% for any anxiety disorder, and 13.5–38.6% for presence of clinically significant anxiety symptoms.
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Anxiety symptoms were lower (by between 1.9 and 30%) after surgical intervention to improve hearing in all five studies assessing this.
Studies in mental health settings (Table 3)
Author, year | Adapted Newcastle–Ottawa Scale Score | Setting and country | Sample | Comparator sample | Anxiety disorder measure | Prevalence of anxiety disorder (95% confidence intervals) | |||
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S | C | O | Total/higher quality? | ||||||
Appleford, 2003 [23] | 2 | 0 | 2 | 4 Yes | Inpatient and Outpatient Deaf Mental Health Service UK | 305 hearing impaired patients | 621 hearing patients from same hospital or clinic | ICD-10 diagnosesa | 17% (13.3–21.7) 8%** |
De Bruin, 2004 [22] | 2 | 0 | 2 | 4 Yes | Outpatient Deaf Mental Health Service The Netherlands | 214 outpatients | None | DSM IV diagnosesa | 7.5% (4.7–11.8) |
Black, 2006 [9] | 2 | 0 | 2 | 4 Yes | Inpatient Deaf Mental Health Service USA | 64 hearing impaired patients | 180 hearing patients from same hospital | DSM IV diagnosesa | 39.1% (28.1–51.3) 8.8%** |
Landsberger, 2010 [21] | 2 | 0 | 2 | 4 Yes | Inpatient Mental Health Service USA | 30 deaf patients | 60 hearing patients from same hospital | DSM IV-TR diagnosesa | |
Diaz, 2013 [20] | 2 | 1 | 2 | 5 Yes | Outpatient Deaf Mental Health Service USA | 241 deaf patients | 345 hearing patients from same clinic | DSM IV diagnosesa | 18.7% (14.3–24.1) 30.1%** |
Summary
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The reported prevalence of anxiety disorder in hearing impaired mental health patients ranged from 7.5 to 39.1%.
Correlates of anxiety symptoms
Tinnitus
Other factors linked to sensory impairment
Psychosocial factors
Other factors
Summary
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Tinnitus was consistently associated with presence of anxiety in hearing impaired people in 6/6 studies examining this.
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Severity of hearing impairment was also identified as a correlate of anxiety in 3/3 studies examining this.