纵向队列研究中自感听觉障碍与心理社会健康之间的关联

文献信息

中文摘要

目的： 听力损失影响全球数百万人，并与孤独、抑郁和焦虑等心理社会后果相关。自我报告的听力问题可能提供听力测试之外关于情绪和社会功能的独特见解。关于成人自感听觉功能与心理社会健康之间关联的证据仍然稀少。本研究旨在探讨这一关系。
设计： 本研究使用荷兰听力纵向研究的基线和随访数据，这是一项前瞻性队列研究，入组时为18至70岁的成人。自感听觉障碍使用阿姆斯特丹听觉障碍与 handicap 量表（AIADH）评估，心理社会结局使用评估孤独、痛苦、抑郁、焦虑和躯体化的经验证问卷测量。自感听觉障碍与心理社会结局之间的关联使用线性混合效应模型和广义估计方程分析，并考虑重复测量、潜在效应修饰因素和混杂因素。
结果： 共2897名参与者（63%女性；基线平均年龄48.1岁）在最多四轮测量中提供数据。较高的自感听觉障碍（AIADH）在所有领域均一致地与较差的心理社会结局相关，呈分级关联。与报告很少或没有听觉障碍的参与者（AIADH 0至6）相比，最高AIADH四分位组（38至84）报告显著更高的孤独评分（量表0至11；B = 1.30；95%置信区间[CI]：0.98至1.61），包括社交孤独（量表0至5；B = 0.69；95% CI：0.52至0.87）和情感孤独（量表0至6；B = 0.61；95% CI：0.41至0.82）。心理痛苦（量表0至32）随AIADH评分升高而逐步增加，最高四分位组参与者报告的平均痛苦水平比最低四分位组高3.96分（95% CI：3.34至4.58）。较高的AIADH评分还与较高的抑郁症状平均水平（量表0至12；均值比[RoM]高达4.50；95% CI：3.02至6.67）、焦虑症状（量表0至24；RoM高达3.13；95% CI：2.36至4.15）和躯体化症状（量表0至32；RoM = 1.58；95% CI：1.46至1.71）相关。在按年龄、助听设备使用、耳鸣和听力损失发病年龄进行的特定分析中观察到效应修饰。在调整客观噪声中言语表现后，所有关联仍具有统计学显著性。
结论： 这些发现突显了自我报告听力困难的广泛心理社会影响，强调听力损失不仅影响沟通，还影响心理健康。将自我报告听力评估纳入听力学评估，并在有指征时于听力干预之外提供心理社会支持，可能改善整体健康。

英文摘要

OBJECTIVES: Hearing loss affects millions of people worldwide and is linked to psychosocial consequences such as loneliness, depression, and anxiety. Self-reported hearing problems may offer unique insights into emotional and social functioning beyond what audiometric tests reveal. Evidence on the association between self-perceived auditory functioning and psychosocial health in adults remains scarce. This study seeks to explore this relationship.
DESIGN: This study used baseline and follow-up data from the Netherlands Longitudinal Study on Hearing, a prospective cohort study with adults aged 18 to 70 years at enrollment. Self-perceived auditory disability was assessed using the Amsterdam Inventory for Auditory Disability and Handicap (AIADH), while psychosocial outcomes were measured using validated questionnaires assessing loneliness, distress, depression, anxiety, and somatization. The associations between self-perceived auditory disability and psychosocial outcomes were analyzed using linear mixed-effects models and generalized estimating equations, accounting for repeated measurements, potential effect modifiers, and confounders.
RESULTS: A total of 2897 participants (63% female; mean age at baseline 48.1 years) contributed data across up to four measurement rounds. Higher self-perceived auditory disability (AIADH) was consistently associated with worse psychosocial outcomes across all domains, showing graded associations. Compared with participants reporting little or no auditory disability (AIADH 0 to 6), those in the highest AIADH quartile (38 to 84) reported significantly higher loneliness scores (scale 0 to 11; B = 1.30; 95% confidence interval [CI]: 0.98 to 1.61), including both social loneliness (scale 0 to 5; B = 0.69; 95% CI: 0.52 to 0.87) and emotional loneliness (scale 0 to 6; B = 0.61; 95% CI: 0.41 to 0.82). Psychological distress (scale 0 to 32) increased progressively with higher AIADH scores, with participants in the highest quartile reporting on average 3.96 points higher distress levels than those in the lowest quartile (95% CI: 3.34 to 4.58). Higher AIADH scores were also associated with higher mean levels of depressive symptoms (scale 0 to 12; ratio of means [RoM] up to 4.50; 95% CI: 3.02 to 6.67), anxiety symptoms (scale 0 to 24; RoM up to 3.13; 95% CI: 2.36 to 4.15), and somatization symptoms (scale 0 to 32; RoM = 1.58; 95% CI: 1.46 to 1.71). Effect modification was observed in specific analyses by age, hearing device use, tinnitus, and age of onset of hearing loss. All associations remained statistically significant after adjustment for objective speech-in-noise performance.
CONCLUSIONS: These findings highlight the broad psychosocial impact of self-reported hearing difficulties, emphasizing that hearing loss affects not only communication but also mental well-being. Incorporating self-reported hearing assessments into audiological evaluations and providing psychosocial support when indicated alongside hearing interventions may improve overall well-being.