Association of hearing impairment with social participation restriction and depression: comparison between midlife and older adults

Objectives: This study examined the association between hearing impairment and depression, focusing on the role of restricted social engagement as a mediator and whether the mediating relationship differed between midlife individuals (45–64) and older adults (65+). Methods: Individuals aged 45 and older from the cross-sectional National Health and Nutrition Examination Survey 2017–2018 were analyzed (N = 3,020). A multiple-group path analysis was conducted to compare midlife individuals (n = 1,774) and older adults (n = 1,246). Results: The results indicated that among U.S. adults aged 45 or older, 12.3% reported having serious difficulty hearing (21.2% among older adults vs. 7.4% among midlife adults). In both age groups, significant direct relationship between hearing impairment and depression, as well as indirect relationship via social participation restriction, were found. However, a significant difference was found in the relationship between restricted social participation and depression by age group (i.e. moderated mediation): The coefficient was greater among midlife adults than among older adults (Δb_{midlife-older}=1.109–0.383 = 0.726, p<.001). Conclusion: These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for midlife adults. As the importance of social engagement was greater among midlife adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.