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. 2026 Jan 12;174(3):613–627. doi: 10.1002/ohn.70103

Suicidality in Individuals With Hearing Loss: A Systematic Review and Meta‐Analysis

Isabelle J Chau 1,2, Anuja H Shah 1,3, Shaun A Nguyen 1,✉, Habib G Rizk 1, Robert F Labadie 1, Ted A Meyer 1
PMCID: PMC12948401  PMID: 41521828

Abstract

Objective

To evaluate the prevalence of suicidality, including suicidal ideation and attempts, in individuals with any type of hearing loss compared to individuals without hearing loss, and to assess risk factors for suicidality in this population.

Data Sources

CINAHL, Cochrane Review, PubMed, Scopus, and PsycINFO through March 25, 2025.

Review Methods

Two investigators independently performed the search, screened abstracts, and selected publications for data extraction. Studies that assessed hearing loss and at least one suicidality measure in individuals aged 16 years or older were included for fixed and random‐effects meta‐analyses (proportions, continuous measures, relative risks [RR]). Depression and social isolation were also assessed.

Results

Of 5,015 abstracts identified, 14 studies (N = 221,681) were included. Individuals with hearing loss had higher prevalences of suicidal ideation (13.2% vs 9.3%) and suicide attempts (4.9% vs 2.4%) compared to controls (P < .0001). Hearing loss was associated with significantly increased risks of suicidal ideation (RR = 1.47, 95% CI [1.37‐1.57]) and suicide attempts (RR = 1.83, 95% CI [1.31‐2.55]). Subgroup analyses revealed that risk of depression was elevated only in individuals with subjective hearing loss, while risk of suicidal ideation was increased in individuals with either subjective or audiometrically measured hearing loss.

Conclusion

This meta‐analysis demonstrates a clear association between hearing loss and suicidality, although the strength of this relationship varies depending on how hearing loss is measured. Clinicians should consider both audiometric data and patient‐reported concerns when assessing psychiatric risk. These findings support early screening and timely interventions to mitigate mental health consequences.

Keywords: depression, hearing impairment, hearing loss, mental health, meta‐analysis, suicidality, systematic review

Hearing loss is one of the most common chronic health conditions globally. An estimated 430 million people worldwide require rehabilitation for disabling hearing loss, and by 2050, this number is projected to surpass 700 million. 1 Although the most common type of hearing loss is presbycusis, or age‐related hearing loss, the prevalence of hearing loss in younger adults is also increasing. 2 Given the rising rates of hearing loss, it is important to better understand the impact of hearing loss on communication and other aspects of life.

Hearing loss has been shown to negatively affect patients' quality of life and psychological wellbeing with multiple studies linking it to depression, loneliness, and cognitive decline. 3 , 4 , 5 , 6 The association between hearing loss and psychiatric conditions, such as depression and anxiety, in adults has been well described in the literature. Studies, including 2 recent meta‐analyses, have demonstrated that hearing loss increases the risk for depressive and anxiety symptoms. 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 In fact, a positive correlation between the severity of hearing loss and the odds of developing depressive symptoms has been described. 15

Hearing devices have been shown to improve patients' quality of life, depressive symptoms, and cognitive functioning as early as 6 to 12 months after treatment. 16 , 17 , 18 , 19 , 20 As hearing loss might be a modifiable risk factor for psychological distress, these studies highlight the importance of identifying hearing impairments early and offering appropriate auditory rehabilitation, psychiatric screening, and mental health resources to at‐risk patients.

While many studies have reported on the prevalence of depression and anxiety among patients with hearing loss, few have included data on suicidality measures. In 2022, the age‐adjusted rate of suicide in the United States was 14.2 deaths per 100,000 standard population and was highest among adults older than 75 years. 21 The association between hearing loss and suicidality has been assessed in cross‐sectional and cohort studies but has yet to be established in a meta‐analysis.

To address this gap, the current study reports the results of a meta‐analysis that evaluates the relation between hearing loss and suicidality, including suicidal ideation and suicide attempts. Specifically, this study aims to assess the prevalence of suicidality in individuals with any type of hearing loss compared to individuals without hearing loss. Additionally, this study aims to assess risk factors for suicidality in this population. We hypothesized that hearing loss is associated with an increased prevalence of suicidal ideation and suicide attempts. Gaining a better understanding of epidemiological information relating to suicidality in this population not only will contribute to existing literature on psychiatric comorbidities in patients with hearing loss but might also influence clinicians' approach to screening of hearing loss and psychiatric comorbidities in all patients.

Methods

Search Strategy

To address our PICO question of whether individuals with hearing loss have increased rates of suicidal ideation and suicide attempts compared to individuals without hearing loss, a systematic review with meta‐analysis was performed. A study protocol was registered on PROSPERO (ID CRD42024568264). Two investigators (IJC and AHS) independently performed a comprehensive search, and the results were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. 22 Five databases (PubMed, Scopus, CINAHL, Cochrane Review, and PsycINFO) were searched from inception to March 25, 2025, for studies assessing any type of hearing loss and at least one suicidality measure in individuals aged 16 years or older. Search strategies for each database are included in supplemental material (Supplement S1, available online). References were uploaded to Covidence (Veritas Health Innovation Ltd.).

Selection Criteria

Investigators (IJC and AHS) independently screened titles, abstracts, and full texts based on inclusion and exclusion criteria described below. Conflicting decisions were resolved through discussion. Articles that met inclusion criteria: (1) studied individuals aged 16 years or older, (2) assessed hearing loss by self‐report or by pure‐tone audiometry, (3) compared subjects based on hearing status, (4) assessed suicidality by self‐report or clinical evaluation, and (5) reported raw data (i.e., number of subjects rather than odds ratios). Exclusion criteria were: (1) non‐English studies, (2) non‐human research, (3) reviews, (4) commentaries, (5) case reports, and (6) studies including the pediatric population younger than 16 years of age. The age limit of 16 years was chosen because legal and ethical standards in certain countries often consider people aged 16 years or older to be capable of making health and research‐related decisions.

Data Extraction

Study characteristics as well as demographic data for individuals with hearing loss and individuals without hearing loss were extracted. Primary outcome measures were the prevalences of suicidal ideation and suicide attempts. Additional outcome measures were prevalence of depression and prevalence of social isolation. Marital status, reported in multiple studies, was used as an indicator of social isolation, as being unmarried, divorced, or widowed is often associated with reduced social engagement. 23 While this measure does not capture the full complexity of social isolation, which involves social support, participation in activities, and living arrangements, it provides a consistent indicator across studies. Given its association with suicidality and its potential to confound the relationship between hearing loss and psychiatric outcomes, tinnitus status was also extracted when reported. 24

Critical Appraisal of Selected Studies

Level of evidence of each study was assessed using the Oxford Centre for Evidence‐Based Medicine criteria. 25 Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross‐sectional studies and for cohort studies. 26 Two authors (IJC and AHS) independently reviewed the articles using the checklists and rated each item with a score of “1” for “yes” and “0” for “no,” “not applicable,” or “unclear.” 27 All disagreements were resolved by a third author (SAN). Cross‐sectional studies with 4 or more “yes” votes out of 8 questions and cohort studies with 6 or more “yes” votes out of 11 questions were considered to have low risk of bias and included for analysis.

Statistical Analysis

Meta‐analysis of continuous measures (age) was performed with Comprehensive Meta‐Analysis version 4 (Biostat Inc.). Meta‐analysis of risk ratio (hearing loss vs control group) for suicidality outcomes and depression and meta‐analysis of odds ratio for social isolation was performed with Cochrane Review Manager (RevMan) version 5.4 (The Cochrane Collaboration 2020). Meta‐analysis of proportions (patient characteristics, prevalence, etc.) was performed using MedCalc 22.017 (MedCalc Software). Each measure (mean, proportion [%], risk ratio [RR] or odds ratio [OR] and 95% confidence interval [CI]) was weighted according to the number of patients affected. Both the fixed effects model and the random effects model were used in this study. If there was high heterogeneity (I 2 > 50%), then a random effects model was used; if low heterogeneity (I 2 < 50%), then a fixed effects model is allowable. 28 , 29 In addition, a comparison of proportions, expressed as difference (Δ) and 95% CI was done to compare outcomes between 2 groups. Potential publication bias was evaluated by visual inspection of the funnel plot and Egger's regression test, which statistically examines the asymmetry of the funnel plot. 30 , 31 A P < 0.05 was considered a statistically significant difference for all statistical tests.

Results

Search Results and Study Characteristics

The PRISMA flow diagram for this study is presented in Figure 1. The initial search of 5 databases yielded 5015 studies, from which 1688 duplicates were excluded. Of the remaining 3327 abstracts screened, 422 full‐text articles were assessed for eligibility. Exclusion criteria included incorrect outcomes, study design, patient population, or non‐English study. Ultimately, 15 studies met inclusion criteria: 3 used audiometric data to assess hearing loss, 11 relied on self‐report, and one utilized both. Ten studies evaluated suicidal ideation only, 2 evaluated suicide attempts only, 2 examined both suicidal ideation and suicide attempts, and one reported suicide mortality. As only Lee et al reported suicide mortality, it was not included in the meta‐analysis but is discussed separately. 32 As a result, 14 studies were included the final analysis, representing data from Korea (n = 5), the USA (n = 4), England (n = 1), Sweden (n = 1), France (n = 1), the Netherlands (n = 1), and Japan (n = 1). All studies except Khurana et al focused on individuals aged 18 and older; Khurana et al included individuals aged 16 and up, consistent with national definitions of adulthood. 33

Figure 1.

Figure 1

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Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram of the literature search.

Quality Assessment

The characteristics of these selected studies, published from 2011 to 2024, are provided in Table 1. Twelve studies were cross‐sectional with Oxford Level of Evidence (OLE) 4, and 2 cohort studies were OLE 3. JBI appraisal of the 12 cross‐sectional (5 to 8 scores) and 2 cohort studies (7 & 9 scores) found all to have good quality and low risk of bias (Figure 2). Egger's regression test showed no significant publication bias (−1.4; 95% CI [−3.2‐0.4]; P = .11) (Figure 3). Excluding 2 studies outside of the funnel in Figure 3 did not change this result (−1.3; 95% CI [−2.8‐0.2]; P = .08).

Table 1.

Descriptive features of studies included in the systematic review

Study Country Study design (Oxford level of evidence) Hearing loss assessment Suicidality assessment Suicidality timeline Hearing loss (n) No hearing loss (n)
Ahn et al. 2024 A Korea Cross‐sectional (4) PTA > 25 dB Suicidal ideation Past year 7275 15,940
Ahn et al. 2024 B Subjective 3563 19,652
Armstrong et al. 2016 USA Cross‐sectional (4) Subjective Suicidal ideation Past 2 weeks 314 3077
Barnett et al. 2011 USA Cross‐sectional (4) Subjective Suicide attempt Past year 339 2546
Cosh et al. 2019 France Cohort (3) Subjective Suicidal ideation NR 2373 2160
Fox et al. 2020 USA Cross‐sectional (4) Subjective Suicidal ideation, Suicide attempt Past year, past month, past 2 weeks 6028 6028
Joo et al. 2015 Korea Cross‐sectional (4) PTA ≥ 40 dB Suicidal ideation Past year 569 7917
Khurana et al. 2021 England Cross‐sectional (4) Subjective Suicidal ideation, Suicide attempt Past year 1323 5474
Kim et al. 2015 Korea Cross‐sectional (4) PTA ≥ 40 dB Suicidal ideation Past year 680 1822
Kim et al. 2020 Korea Cross‐sectional (4) PTA > 25 dB Suicidal ideation NR 2338 14,461
Lee & Chung et al. 2023 Korea Cross‐sectional (4) Subjective Suicidal ideation NR 2297 7623
Lugo et al. 2019 Sweden Cross‐sectional (4) Subjective Suicide attempt More than a year ago, past year, past month 12,272 59,007
Mori et al. 2017 Japan Cohort (3) Subjective Ikigai (sense of life worth living) Current 70 597
Park et al. 2022 USA Cross‐sectional (4) Subjective Suicidal ideation Past year 3378 30,764
Rurup et al. 2011 Netherlands Cross‐sectional (4) Subjective Suicidal ideation Ever, past week 587 1207
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Abbreviation: NR, not reported.

Figure 2.

Figure 2

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Risk of bias assessment based on the Joanna Briggs Institute checklists for cross‐sectional studies and for cohort studies.

Figure 3.

Figure 3

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Funnel plot. Eleven of thirteen studies assessing suicidal ideation were within the funnel, suggesting a low likelihood of publication bias.

Patient Characteristics

The selected studies included 221,681 individuals, with 43,406 (19.6%) in the hearing loss cohort and 178,275 (80.4%) in the control cohort. In the hearing loss group, 45.9% were male and the mean age was 60.0 years (95% CI [42.4‐77.6]). The control group included 43.7% males with a mean age of 56.7 years (95% CI [39.4‐74.1]). Additional characteristics are summarized in Supplement S2, available online.

Measures of Hearing Loss, Depression, and Suicidality

Studies assessed hearing loss using either subjective self‐reported questionnaires or pure‐tone average (PTA) measurements (Table 1). Of the 4 studies measuring PTA, 2 considered hearing loss as a PTA threshold >25 dB in the better‐hearing ear, 34 , 35 one defined it as a PTA threshold ≥40 dB in the worse‐hearing ear, 36 and another considered it as a PTA >40 in the better‐hearing ear. 37 The remaining studies used self‐report information by asking about hearing loss status, 38 , 39 , 40 difficulty understanding a conversation, 41 any difficulty hearing or use of a hearing aid, 33 trouble hearing with one or both ears even when wearing a hearing aid, 42 level of discomfort when hearing without a hearing aid, 34 level of discomfort when hearing, 43 problems hearing without a hearing aid, 44 deafness or serious difficulty hearing, 45 whether they could hear well enough without normal aids. 46 Research has shown that self‐reported hearing loss can provide reasonably accurate estimates of hearing loss prevalence. 47 , 48 Moreover, self‐reported hearing measures are favorable for epidemiological studies due to their accessibility, efficiency, and lower costs. 49

Tinnitus status was reported in 3 of the 14 included studies. Joo et al. stratified participants into 4 groups—normal hearing without tinnitus, normal hearing with tinnitus, hearing loss without tinnitus, and hearing loss with tinnitus—and reported suicidal ideation rates of 12.9%, 19.6%, 20.3%, and 23.0%, respectively. 36 Lugo et al. and Kim et al. provided tinnitus data but did not report sufficient information to stratify participants by both tinnitus and hearing status, limiting the ability to analyze suicidality or perform sensitivity analyses to account for tinnitus as a confounder. 35 , 44

Suicidality was assessed through a variety of validated surveys (Table 1). Eight studies used a binary past‐year suicidality question to assess suicidal ideation or suicide attempts. 33 , 34 , 36 , 37 , 38 , 39 , 44 , 45 Of the remaining 6 studies, 3 did not report any timeline for suicidal ideation, 35 , 41 , 43 one reported 2‐week suicidal ideation, 42 one reported past‐week and any history of suicidal ideation, 46 and one reported current suicidal ideation. 40 Additionally, although all studies evaluated either suicidal ideation or suicide attempts, they used various instruments and phrasing. For example, Armstrong et al. assessed suicidal ideation in the past 2 weeks, using the last item of the Patient Health Questionnaire‐9 (PHQ‐9). Mori et al assessed whether participants currently had ikigai, a Japanese term for a sense of life worth living. Cosh et al. adopted the suicidality item (Did you repeatedly consider hurting yourself, feel suicidal, or wish that you were dead?) from the Major Depressive Disorder module of the Mini‐International Neuropsychiatric Interview (MINI). This study did not specify the timeline used for the suicidality evaluation. While studies used slightly different wording to evaluate suicidality outcomes, each question represented a point along the suicidality continuum. 50 Given the significant variability in outcome measures, random effects were used in analysis of suicidality and depression to account for study heterogeneity (I 2 values in 4, 5, 6, 7).

Figure 4.

Figure 4

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Risk ratios of suicidal ideation in individuals with and without hearing loss. Subgroup analyses were conducted for studies measuring hearing loss by audiometric data and studies assessing self‐reported hearing loss.

Figure 5.

Figure 5

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Risk ratios of suicide attempts in individuals with and without hearing loss.

Figure 6.

Figure 6

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Risk ratios of depression in individuals with and without hearing loss. Subgroup analyses were conducted for studies measuring hearing loss by audiometric data and studies assessing self‐reported hearing loss.

Figure 7.

Figure 7

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Odds ratios of not being married in individuals with and without hearing loss. Subgroup analyses were conducted for studies measuring hearing loss by audiometric data and studies assessing self‐reported hearing loss.

Prevalence and Risk of Suicidal Ideation in Individuals with Hearing Loss

The prevalences for suicidal ideation, suicide attempts, and depression among individuals with and without hearing loss are summarized in Table 2. Suicidal ideation prevalence was reported in 12 studies. 33 , 34 , 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 Among individuals with hearing loss (n = 30,795), the pooled prevalence of suicidal ideation was 13.2% (95% CI [7.8%‐19.7%]), significantly higher than the 9.3% (95% CI [7.9%‐8.3%]) prevalence observed in those without hearing loss (n = 116,722) by a difference of 3.9% (95% CI [3.5%‐4.3%], P < .0001).

Table 2.

Number of individuals with suicidal ideation, suicide attempts, and depression within groups with and without hearing loss for each selected study

Hearing loss No hearing loss
Study Suicidal ideation (n) Suicide attempts (n) Depression (n) Suicidal ideation (n) Suicide attempts (n) Depression (n)
Ahn et al. 2024A 1271 ‐ ‐ 1943 ‐ ‐
Ahn et al. 2024B 736 ‐ ‐ 2478 ‐ ‐
Armstrong et al. 2016 13 ‐ 46 109 ‐ 277
Barnett et al. 2011 ‐ 7 ‐ ‐ 10 ‐
Cosh et al. 2019 237 ‐ 51 164 ‐ 29
Fox et al. 2020 2118 1037 ‐ 1313 502 ‐
Joo et al. 2015 116 ‐ 75 1021 ‐ 1005
Khurana et al. 2021 74 13 ‐ 317 39 ‐
Kim et al. 2015 165 ‐ ‐ 344 ‐ ‐
Kim et al. 2020 468 ‐ 397 1938 ‐ 1837
Lee & Chung et al. 2023 58 ‐ 367 129 ‐ 1045
Lugo et al. 2019 ‐ 543 ‐ ‐ 1852 ‐
Mori et al. 2017 2 ‐ ‐ 25 ‐ ‐
Park et al. 2022 141 ‐ 236 692 ‐ 1424
Rurup et al. 2011 134 ‐ ‐ 201 ‐ ‐
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To account for potential differences in measurement methods, we conducted subgroup analyses separating studies using audiometric data from those relying on subjective hearing assessments. 51 , 52 In the 4 studies using audiometric data, the prevalence of suicidal ideation was 20.3% (95% CI [17.8%‐23.0%]) among individuals with hearing loss (n = 10,862), compared to 14.1% (95% CI [12.5%‐15.7%]) among those without hearing loss (n = 40,140), yielding a significant difference of 6.2% (95% CI [5.4%‐7.0%]; P < .0001). In 9 studies using self‐reported hearing loss, the prevalence was 10.3% (95% CI [3.7%‐19.8%]) among those with hearing loss (n = 19,933) and 7.4% (95% CI [3.4%‐12.6%]) among controls (n = 76,582), corresponding to a significant difference of 2.9% (95% CI [2.5%‐3.4%]; P < .0001).

Overall, hearing loss was associated with a significantly elevated risk of suicidal ideation (RR = 1.47; 95% CI [1.37‐1.57]; P < .0001) (Figure 4). This association remained robust in sensitivity analysis excluding the 2 studies that fell outside the funnel plot (RR = 1.49; 95% CI [1.41‐1.58]; P < .001) (Figure 3). Elevated risk of suicidal ideation was consistent across measurement methods: RR = 1.45 (95% CI [1.37‐1.53]; P < .0001) for audiometric studies and RR = 1.46 (95% CI [1.32‐1.63]; P < .0001) for subjective assessments.

Prevalence and Risk of Suicide Attempts in Individuals with Hearing Loss

Four studies reported the prevalence of suicide attempts, all of which assessed hearing loss through self‐report. 33 , 38 , 39 , 44 Among individuals with hearing loss (n = 19,962), the prevalence of suicide attempts was 4.9% (95% CI [0.5%‐13.1%]), significantly higher than the 2.4% (95% CI [0.6%‐5.4%]) prevalence observed in individuals without hearing loss (n = 73,055), reflecting a difference of 2.5% (95% CI [2.2%‐2.8%], P < .0001).

Because all studies relied on subjective hearing assessments, subgroup analyses were not conducted. Nonetheless, subjective hearing loss was significantly associated with increased risk of suicide attempts (RR = 1.83; 95% CI [1.31‐2.55]; P = .0004) (Figure 5).

Prevalence of Suicidality Stratified by Hearing Loss Severity

Four studies stratified suicidality outcomes based on hearing loss severity. 34 , 41 , 44 , 46 Lugo et al examined suicide attempts across 3 levels of self‐reported hearing difficulty: “no problems without a hearing aid,” “no problems with a hearing aid,” and “major difficulties.” The prevalence of suicide attempts was 3.1% in individuals with no hearing problems without a hearing aid, 3.2% in those with no problems using a hearing aid, and 4.8% among individuals reporting major hearing difficulties. 44

The remaining 3 studies assessed suicidal ideation across varying degrees of hearing loss. Rurup et al categorized participants by hearing ability and found suicidal ideation rates of 16.7% of patients with no hearing loss, 22.3% of patients with mild hearing loss, and 25.6% of patients with severe hearing loss. 46 Similarly, Cosh et al reported suicidal ideation rates of 7.6% for those with no hearing loss, 9.5% for mild hearing loss, and 11.3% for severe hearing loss. 41 Ahn et al analyzed both subjective and objective hearing loss. Based on subjective self‐report, suicidal ideation was present in 12.6% of those with no hearing discomfort, 19.2% with mild discomfort, and 26.8% with considerable discomfort. Using audiometric criteria, the prevalence of suicidal ideation was 12.2% for normal hearing (PTA <25 dB), 14.8% for mild hearing loss (PTA 26‐40 dB), and 20.8% for moderate‐to‐severe hearing loss (PTA >40 dB). 33

Prevalence and Risk of Depression in Individuals with Hearing Loss

Six studies reported the prevalence of depression. 35 , 36 , 41 , 42 , 43 , 45 Among individuals with hearing loss (n = 11,269), the prevalence of depression was 10.9% (95% CI [5.6%‐17.6%]), compared to 8.3% (95% CI [4.6%‐12.9%]) among those without hearing loss (n = 66,002), representing a significant difference of 2.6% (95% CI [2.0%‐3.2%], P < .0001).

In the 2 studies that used audiometric hearing assessments, the prevalence of depression was 15.3% (95% CI [11.8%‐19.1%]) in individuals with hearing loss (n = 2907) vs 12.7% (95% CI [12.3%‐13.1%]) in those without hearing loss (n = 22,378), a significant difference of 2.6% (95% CI [1.3%‐4.0%]; P = .0001). In 4 studies using subjective hearing loss measures, depression prevalence was 8.9% (95% CI [3.3%‐17.0%]) in individuals with hearing loss (n = 8362) compared to 6.3% (95% CI [2.4%‐12.0%]) in those without hearing loss (n = 43,624), yielding a similar significant difference of 2.6% (95% CI [2.0%‐3.3%]; P < .0001).

Across all 6 studies, hearing loss was significantly associated with increased risk of depression (RR = 1.32, 95% CI [1.17‐1.50]; P < .0001) (Figure 6). However, this association varied by hearing loss measurement. Among individuals with audiometrically confirmed hearing loss, the increased risk was not statistically significant (RR = 1.20; 95% CI [0.94‐1.53]; P = .14). In contrast, subjective hearing loss was significantly associated with depression (RR = 1.41; 95% CI [1.17‐1.71]; P = .0004).

Of the 4 studies that evaluated suicidality by hearing loss severity, Cosh et al also reported depression stratified by hearing level. 41 In this study, the prevalence of major depressive disorder (MDD) was 1.3% (29/2160) in participants without hearing loss, 2.3% (40/1756) in those with mild hearing loss, and 1.8% (11/617) in those with severe hearing loss.

Prevalence and Odds of Social Isolation in Individuals with Hearing Loss

Seven studies provided data on marital status, distinguishing between individuals who were married and those who were not (ie, single, divorced, separated, widowed). In 2 studies using audiometric assessments, the prevalence of being married was 73.2% (95% CI [66.3%‐79.6%]) among individuals with hearing loss (n = 2907) and 83.3% (95% CI [76.6%‐89.1%]) among those without hearing loss (n = 22,378), representing a significant difference of 10.1% (95% CI [8.4%‐11.8%]; P < .0001).

Among the 5 studies using subjective hearing loss assessments, 55.2% (95% CI [48.9%‐61.5%]) of individuals with hearing loss (n = 7727) were married, compared to 58.6% (95% CI [50.4%‐66.5%]) of individuals without hearing loss (n = 44,021), a significant difference of 3.3% (95% CI [2.1%‐4.5%]; P < .0001).

When pooling data across all 7 studies, the overall prevalence of being married was 60.5% (95% CI [52.1%‐68.6%]) in individuals with hearing loss (n = 10,634) and 66.3% (95% CI [55.1%‐76.6%]) in those without hearing loss (n = 66,399), a significant difference of 5.8% (95% CI [4.8%‐6.8%]; P < .0001).

Combined analysis across all studies demonstrated that hearing loss was associated with significantly higher odds of not being married (OR = 1.31, 95% CI [1.06‐1.62]; P = .01) (Figure 7). However, in subgroup analyses based on the method of hearing assessment (audiometric vs. subjective), the association between hearing loss and marital status was not statistically significant.

Discussion

Findings from this meta‐analysis demonstrate that the nonpediatric population with hearing loss has greater prevalences of suicidal ideation (13.2% vs 9.3%), suicide attempts (4.9% vs 2.4%), and depression (10.9% vs 8.3%) compared to individuals without hearing loss. Individuals with hearing loss also had a lower prevalence of being married (60.5% vs 66.3%), which served as a proxy for social connection. Subgroup analyses comparing subjective hearing loss to hearing loss measured by audiometry revealed that these higher prevalences in individuals with hearing loss remained significant, although important differences emerged.

For suicidal ideation, studies using audiometric data showed a higher prevalence of suicidal ideation in individuals with hearing loss (20.3%) compared to those without hearing loss (14.1%). These absolute prevalences were higher than those found in subjective hearing loss studies (10.3% vs. 7.4%), yet the relative risks in both subgroup analyses were nearly identical (RR = 1.45 vs 1.46). This similar relative risk, despite differing baseline rates, may reflect the influence of underlying psychological factors, such as distress, contributing both to perceived hearing loss and to suicidal ideation in individuals with subjective hearing loss.

For suicide attempts, the data were limited to studies using subjective hearing loss, which showed a significantly increased prevalence and risk (RR = 1.83) of suicide attempts in the hearing loss group. Given this limitation, further research using objective audiometric measures is needed to determine whether this association holds true in individuals with audiometrically defined hearing loss.

Notably, the increased risk of depression only remained significant in studies that assessed subjective hearing loss (RR = 1.41). Studies using audiometric data did not reach statistical significance (RR = 1.20, P = .14). Prior research has demonstrated the strong association between depression and hearing loss measured by PTA, demonstrating that depression worsens with more severe hearing loss. 53 , 54 The low number of studies in our subgroup analysis may account for the lack of a significantly higher risk. A potential causal relation between hearing loss and depression has been investigated but remains inconclusive. One study found that subjects who experienced more psychopathology experienced more hearing difficulties. 55 Another study suggested that sudden sensorineural hearing loss induces or further exacerbates depression. 56

Existing literature shows that, among US adults in the 2015 to 2019 National Survey on Drug Use and Health, the past‐year prevalence of suicidal thoughts was 4.3% and of suicide attempts was 0.6%. 57 Another study using data from the same survey found that, of patients with any hearing limitation, 5.0% reported suicidal ideation, 1.6% reported suicide planning without attempt, and 1.8% reported suicide attempts. 58 Compared to national survey data, our findings show higher prevalences of suicidal ideation and suicide attempts in adults with hearing loss. However, direct comparisons to national survey data should be interpreted with caution as variability in study designs, populations, or covariate adjustments may explain observed differences.

Lee et al. was the only included study to report suicide mortality. In this cohort, 155 of 23,786 individuals with hearing impairment died by suicide, compared to 10,994 of 3,734,890 individuals without disability. 32 The study found that hearing disability was associated with an increased risk of suicide mortality (HR: 1.35 [1.15, 1.58]). As no other included studies reported suicide mortality, this outcome could not be incorporated into the meta‐analysis. Additional studies that reported only odds ratios for the association between hearing loss and suicidality also could not be included in our analysis. However, their findings were consistent with ours, showing increased rates of suicidal ideation among individuals with hearing loss compared to those without hearing loss. 59 , 60 , 61 , 62 , 63

Several factors may contribute to the elevated risk and prevalence of suicidality among individuals with hearing loss, including older age, cognitive impairment, and social isolation. 5 , 6 , 64 Communication barriers associated with hearing loss may exacerbate loneliness and isolation, which in turn may heighten emotional and psychological distress. 65 One study found that loneliness accounted for 42% of the association between hearing loss and depressive symptoms. 66 To investigate the role of social isolation in our study, we analyzed marital status, a commonly reported outcome across included studies and a proxy for social connectivity used in prior research. 65 , 67 Our results indicated that being unmarried was more prevalent in those with hearing loss in subgroup analyses. However, while hearing loss was associated with higher odds of being unmarried overall (RR = 1.31), the odds of being unmarried was not significantly different between individuals with and without hearing loss in subgroup analyses. These results highlight the need to differentiate between subjective and objectively measured hearing loss in psychiatric risk assessments.

One limitation of this study is that the included studies stratified demographic characteristics by either hearing status or suicidality but not both, thereby limiting the ability to analyze how demographic factors may influence suicidality specifically among individuals with hearing loss. In other words, the available data did not permit comparisons across 4 clinically relevant subgroups: individuals with both hearing loss and suicidal ideation, those with hearing loss but no suicidal ideation, those with suicidal ideation but no hearing loss, and those with neither condition. A longitudinal, prospective study design that concurrently stratifies participants by both hearing status and suicidality would help elucidate the directionality and causality of this relationship. Another limitation is the heterogeneity in study methodologies, particularly in the assessment of hearing loss and suicidality. Most studies in this meta‐analysis relied on self‐reported measures of hearing loss, which, while subjective, may better capture perceived functional limitations and participation restrictions. 68 Including both objective (PTA) and subjective assessments in future studies could improve the accuracy and comprehensive of hearing loss classification. 52 For example, Ahn et al, found that subjective hearing loss was more strongly associated with suicidal ideation than audiometrically measured hearing loss. 34 Similarly, individuals who reported hearing difficulties in the absence of audiometrically confirmed loss have been shown to have a higher prevalence of depression. 69 These findings underscore the importance of incorporating both objective and subjective hearing assessments when examining associations with psychiatric outcomes. Additionally, as tinnitus is associated with suicidality, it is an important confounder to consider. 24 Patients with tinnitus without hearing loss may have suicidal thoughts or behaviors due to tinnitus alone. In our study, however, it was not possible to control for the presence of tinnitus as most studies did not report tinnitus status in hearing loss and control groups. Despite this limitation, the consistent association between hearing loss and suicidality observed across multiple studies, along with findings from Joo et al, suggests that hearing loss may exert an independent effect. Nonetheless, future research that accounts for tinnitus will be important to differentiate its contribution and clarify the specific role of hearing loss. In addition to the limited reporting of tinnitus, another limitation was the insufficient evidence to assess whether amplification devices reverse or reduce suicidality in individuals with hearing loss. Future studies evaluating mental health outcomes before and after amplification are needed to explore this relationship.

Hearing devices, including hearing aids and cochlear implants, are effective interventions that have been shown to improve the quality of life, alleviate depressive symptoms, and reduce psychological distress among individuals with hearing loss. 14 , 19 These benefits highlight the importance of routine hearing loss screening and the need to recognize that individuals who self‐report hearing difficulties may be particularly susceptible to mental health challenges. Notably, the psychological impact of hearing loss extends beyond depression and can have more severe consequences, including suicidality. Emerging initiatives aim to integrate mental health support into routine audiologic care, offering a promising approach to holistic patient management. 70 Given the substantial burden of chronic conditions such as hearing loss and the associated costs of healthcare visits, assisted devices, and interventions, it is essential to prioritize the wellbeing of patients with hearing impairment through comprehensive and coordinated care.

Conclusion

Individuals with hearing loss, whether measured by audiometric data or self‐report, demonstrate an increased prevalence and risk of suicidal ideation compared to individuals without hearing loss. Subgroup analyses revealed that an increased risk of depression was only significant in studies using subjective hearing loss measures. Similarly, although subjective hearing loss carried an increased risk of suicide attempts, further research using objectively measured hearing loss is warranted. This meta‐analysis underscores the importance of recognizing both self‐reported and audiometrically measured hearing loss when assessing psychiatric risk. Early identification of hearing impairment and appropriate interventions have the potential to prevent mental health deterioration and improve quality of life in this population.

Author Contributions

Isabelle J. Chau, design, conduct, analysis, writing, figure generation, and editing; Anuja H. Shah, design, conduct, analysis, writing, figure generation, and editing; Shaun A. Nguyen, design, conduct, analysis, interpretation, writing, and editing; Habib G. Rizk, design, interpretation, and editing; Robert F. Labadie, design, interpretation, and editing; Ted A. Meyer, design, interpretation, and editing.

Disclosures

Competing interests

None.

Funding source

None.

This work was presented as a poster at The Triological Society 2025 Combined Sections Meeting; January 23‐25, 2025; Orlando, Florida, USA.

Supporting information

HLS_Supplement.

OHN-174-613-s001.docx (21.7KB, docx)

HLS_PRISMA_2020_checklist.

OHN-174-613-s002.docx (31.8KB, docx)

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Supplementary Materials

HLS_Supplement.

OHN-174-613-s001.docx (21.7KB, docx)

HLS_PRISMA_2020_checklist.

OHN-174-613-s002.docx (31.8KB, docx)

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