Differential associations of objective hearing loss and subjective hearing difficulty with depressive symptom...

To examine whether objective audiometric hearing loss and subjective hearing difficulty show differential associations with depressive symptoms in a nationally representative Korean population.

Data were obtained from 6589 participants aged ≥40 years in the Korea National Health and Nutrition Examination Survey (2020 and 2022). Hearing status was classified into four groups based on pure-tone audiometry (≥26 dB HL at 0.5-4 kHz in the better ear) and self-reported hearing difficulty. Depressive symptoms were defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥ 10, with symptom-level analyses conducted for each PHQ-9 item. Survey-weighted logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs).

Overall, 4.3% of participants had depressive symptoms. Compared with normal hearing, participants with subjective hearing difficulty but no audiometric hearing loss had higher odds of depressive symptoms (OR = 1.74, 95% CI = 1.01, 3.00). Symptom-level analyses showed significant associations between subjective hearing difficulty without audiometric loss and psychomotor changes, suicidal ideation, concentration difficulties, low self-esteem, and appetite changes.

Subjective hearing difficulty, even without audiometric loss, was associated with depressive symptoms. As an easily ascertainable measure, it may represent a marker of vulnerability to depressive symptoms and may warrant consideration in mental health screening.