The Impact of Hearing Loss on Social Engagement, Loneliness, and Depression
When Felicity, 70, of South Australia, was diagnosed with hearing loss in her 20s, it impacted much of her life. “I lived alone and couldn't use a phone or watch TV [it was before captions became law in Australia], and it wasn't unusual for me to go home from work on Friday and not even speak until I went to work on Monday,” she told HearingTracker. She remembers, “I always felt isolated and alone. In crowds, I felt invisible in full sight. I lost touch with my children, who lived overseas and interstate. Depression was my companion, and I contemplated suicide because of the loneliness.”
Loneliness is such a problem that former UK Prime Minister Teresa May appointed a Minister for Loneliness to address the issue and Mark Robinson, former chief officer of Age UK, said that loneliness has been proven to be worse for health than smoking 15 cigarettes a day.
Unfortunately, stories of hearing loss and social isolation, like Felicity’s, are all too common. Take Kirsty, 30, of Leicester in the UK, who has bilateral hearing loss and finds herself isolated in social situations: “I tend to sit by myself and not talk to others because I know I'm not going to hear them,” she explains.
HearingTracker spoke to Michael Harvey, PhD, a private practice psychologist in Massachusetts who specializes in hearing loss and tinnitus, to gain more insight into the psychological and social aspects of hearing loss.
The relationship between social isolation, loneliness, and depression
Though closely related, there is a difference between being “socially isolated” and “lonely.” Social isolation is a lack of social connections, whereas loneliness is defined as a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or the quality of one’s social relationships.
Michael Harvey, PhD, ABPP, is a clinical psychologist who specializes in tinnitus and hearing loss. He has authored many articles, keynote presentations, and papers on the subject, as well as three books: 'Listen with the Heart: Relationships and Hearing Loss', 'The Odyssey of Hearing Loss', and 'Psychotherapy with Deaf and Hard of Hearing Persons'.
If our capacity to socialize is impaired, we may become socially isolated, and our identity becomes impacted. “When someone is isolated for a long period of time, their sense of self disappears,” explains Harvey.
Of course, many of us value our isolation for a finite period. However, for the majority, after a prolonged period of not having any socialization, people may begin to experience feelings of loneliness which, in turn, can increase the risk of depression.
Some common symptoms of depression include trouble concentrating, remembering details and making decisions, as well as fatigue, sleep disturbances, irritability, pessimism, loss of interest in things once pleasurable, feelings of guilt, worthlessness, helplessness, and digestive problems. “Many people describe it as a feeling of deadness; a feeling of numbness,” Harvey adds.
Research about hearing loss and its affect on emotional health
A 2022 study found that untreated hearing loss significantly increases the odds of being emotionally lonely. Depression was a common factor that contributed to loneliness, social isolation, and poor social support.
Withdrawal from social interaction can often be a byproduct of hearing loss, as communication becomes difficult and misunderstandings and conversational faux pas more frequent. Helen Keller famously said "Blindness cuts us off from things, but deafness cuts us off from people."
A 2020 scientific literature review also found that hearing loss is associated with a higher risk of loneliness and social isolation. This finding has important implications for the cognitive and psychosocial health of older adults.
To estimate the prevalence of and risk factors for depression among adults (18 and older) with hearing loss, a 2005-2010 National Health and Nutrition Examination Survey (NHANES) found that 11.4% of US adults with self-reported hearing loss had moderate to severe depression, and an additional 19.1% had mild depressive symptoms, particularly among older women.
Furthermore, a Dutch study showed that every decibel drop in hearing for people under age 70 increases the odds of becoming severely lonely by 7%. The effect is similar in magnitude to that of obesity and smoking.
How can hearing loss lead to social isolation?
When asked about the connection between hearing loss and social isolation, Harvey recalls early sessions with a former patient: “I once treated a guy who had been hearing all his life, and lost his hearing at age 40, then became very depressed. And the only thing he wanted to talk to me about during the first few visits was how he felt being stuck in traffic.”
But what does being stuck in traffic have to do with hearing loss and isolation? “The answer is, no matter how hard he tried to get out of the traffic jam, he couldn't. No matter how hard he tried to understand people when in a group, he couldn't. He was stuck, helpless.” Such communication difficulties can lead to social isolation for a variety of reasons, including the following:
Difficulty conversing in groups and background noise
Hearing loss makes it more difficult to engage with loved ones and colleagues, and socialize, particularly in noisy environments. This is the case for Donald. 81, from the UK, who has bilateral moderate hearing loss, “I'm fine at home but if out and about in a noisy restaurant or party, I can really struggle,” he said.
A recent article by researchers at the National Acoustics Laboratory (NAL) in Australia shows that people with one-sided (unilateral) hearing loss have the same problems. One person in the study said “Scenarios where I need to hear someone on my deaf side are extremely frustrating and sometimes totally impossible,” and another participant said “By the end of the meal, my brain is usually exhausted from trying to hear everyone.”
Some people with hearing loss start to withdraw from social situations, particularly those involving noisy venues like bars and restaurants.
Paul, 50, a healthcare scientist in the UK who has low-frequency hearing loss in his right ear and intermittent high-frequency hearing loss in his left ear, finds noisy environments challenging. “If I cannot hear in social situations like clubs or pubs. It can be isolating. I tend to withdraw socially in noisy environments,” he explains.
Kathy, 70, of Denver experienced a profound sudden sensorineural hearing loss in her right ear, in February 2021. “Because this was during COVID, I was already isolated, and this didn't help. I am a very social person and didn't let it stop me. But, being in loud restaurants, concerts, etc., gave me a feeling of isolation even in a group,” she recalls.
Frustration in having to remind people
Dr. Harvey notes that, particularly in social situations, the more people drink, eat, and become tired, the less clearly they communicate. People may forget the communication needs of the hard-of-hearing members of the party, meaning those affected must either keep reminding the hearing members or take a backseat in the conversation.
Not being able to participate fully in once enjoyable activities
When we can’t participate in recreational activities we previously enjoyed (social gatherings, concerts, sports, etc.), there is the danger of losing our sense of identity.
Kirsty enjoys salsa dancing, though struggles with the social aspect. “I started dancing around 8 years ago. Since my hearing loss has deteriorated, I have found it difficult to do the socializing part of 'social dancing.' It makes me feel isolated in that other ladies have bonded and can chat away over the loud music. When I get asked questions or people try to talk to me, I just nod along and guess what they are saying,” she told HearingTracker.
Group social events, sports, and other activities can become more problematic when you can't understand what is being said over distances and/or noise.
Struggles forming and maintaining relationships
Communication difficulties can be frustrating for both the person with hearing loss and their communication partners (e.g., family, friends, and colleagues) which can lead to lead to decreased social engagement.
The hearing partner may not always remember their partner's communication needs, and it can be tiring to keep repeating or rephrasing for their partner. When individuals with hearing loss ask for repetition and their communication partner dismisses parts of the conversation by responding with a comment such as, “Oh, it doesn't matter,” this can be hurtful and leave them feeling like a burden to loved ones.
Nuances in intimate conversations with loved ones are often lost, which can also impact relationships.
Felicity recollects how her hearing loss reduced her ability to communicate and impacted relationships. “I was a single mum, so dating was fraught with difficulties,” she said.
Difficulty communicating at work
Paul has experienced workplace issues due to poor hearing and localization, and colleagues lacking patience when he asks for repetition. He explains, “This can impact socially in the workplace and make some interactions awkward.”
Hearing loss at work can lead to misunderstandings and strained relationships.
The mental effort needed to listen and communicate may also lead to depleted energy resources for social activity and interactions. People with hearing loss may find it easier and less stressful to stay at home rather than socialize.
The long-term effects of social isolation
Untreated hearing loss, social isolation, loneliness, and depression can impact on health and contribute to a poorer quality of life in the following ways:
Depression and hearing loss has been associated with a large number of chronic illnesses. Further, the Centers for Disease Control and Prevention (CDC) highlights the health consequences of social isolation and loneliness as follows:
- Social isolation significantly increases a person’s risk of premature death from all causes.
- Poor social relationships (characterized by social isolation or loneliness) are associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.
- Loneliness is associated with higher rates of depression, anxiety, and suicide.
- Loneliness among heart failure patients is associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.
- Social isolation is associated with about a 50% percent increased risk of dementia.
Further complications arise when people with hearing loss avoid medical appointments due to worries of misunderstanding medical history questions, diagnoses, or treatment and intervention explanations.
Addiction as a coping mechanism
According to Recovery Centers of America, loneliness or depression can result in using alcohol or drugs to deal with these feelings. Turning to the “comfort” of alcohol or drugs becomes a way of coping with feeling alone, unloved, rejected, and confused – it’s a way to numb that pain. But it’s a vicious cycle because, without the drugs or alcohol, the feelings of loneliness come back, and if you don’t find a way of coping emotionally, these feelings keep building.
As the addiction worsens, relationships become damaged, causing more powerful feelings of loneliness and isolation. Therefore, as loneliness fuels addiction, addiction, in turn, causes loneliness.
Harvey points out another type of addiction, namely the internet. “Many people cope with loneliness and depression by being online for long periods of time. Now, that's good in some respects—there are a lot of incredible benefits to that. But it also can be quite addictive and can deprive people of the opportunity to socialize with real people in real time,” he said. “The good news is, texting and captioning is a godsend for people with hearing loss because it solves the communication misunderstandings, but it's a double-edged sword…it's a balancing act.”
For people with hearing loss, online captioning and social media channels can be a godsend but can also have its downside, with the potential to detract from the importance of in-person interaction, says Dr. Harvey.
Poorer economic status
Hearing loss and social isolation can also impact employment status. A UK study on the experience of people with hearing loss and employment found that 68% of people with hearing loss felt isolated at work because of their hearing loss, and 41% had retired early due to the impact of their hearing loss and struggles with communication at work.
What can we do about this?
So, how can we stop this domino effect of the consequences of social isolation due to hearing loss? The answer: technology and supportive services.
Hearing aids and implants
Hearing aids, implants, and hearing technology amplify sounds so that the wearer can listen and communicate better. Modern hearing aids even have features such as background noise reduction and directional microphones, so you can focus on the direction of the conversation. Wearers can communicate more effectively and participate more fully in social activities they used to enjoy.
A 2020 study found that the use of hearing aids reduced the risk of psychological distress among all adults, resulting from hearing loss. In fact, some studies have shown reductions in depressive symptoms within just 3 months of hearing aid use.
Donald has experienced, first-hand, the impact of hearing aids on his well-being. He explains, “I am less socially isolated now I use my hearing aids.”
Similarly, cochlear implants have given Felicity a whole new lease of life. She told HearingTracker, “Cochlear implants have returned me to a normal life. After receiving implants, I have since passed grade 8 and Certificate of Performance on piano. In 2020, I commenced a master’s degree over Zoom. I have just completed that degree with High Distinction and am now commencing a PhD. While deaf I was a hearing person who could not hear...now I am a hearing person who can hear.”
In the NAL article about the impact of unilateral hearing loss, some comments from hearing aid users included “It’s amazing and worth it. It just takes time,”“I use it whenever I am out of the house, especially for loud and crowded places; it’s incredibly helpful in normal situations,” and “It makes hearing easier and conversations much easier to pick out of background noise. A standard hearing aid helps considerably. Outside of the house I use it about 80% of the time.”
To find out if hearing aids or implants could help you, schedule a consultation with an audiologist who can carry out a hearing evaluation and advise you on your options.
Getting your hearing tested and understanding your options is the first step in overcoming a hearing loss.
Those experiencing isolation or the emotional impact of hearing loss may benefit from counseling or psychotherapy. “Often there's a grieving process that happens when people become hearing impaired,” explains Harvey. A therapist can help you address the psychological effects associated with hearing loss.
Connecting with others
Many people find comfort and support in connecting with others going through similar experiences. Whether in person or virtual, support groups for people with hearing loss provide a place where you can, share stories, seek, and share advice, and enjoy a sense of community.
There are a variety of online support groups you can find by searching on social media platforms. You can also search on the Hearing Loss Association of America website to see if there is a support group in your area.