Highlights
– Longitudinal data from the Netherlands Longitudinal Study on Hearing (WHAM) indicate hearing‑aid (HA) uptake is associated with lower depression scores among people without tinnitus and with lower total loneliness among adults >65 years.
– Self‑reported improvement in hearing disability did not mediate the relationship between HA uptake and socio‑emotional outcomes.
– Duration of HA use (5–15 years) and greater daily wearing time had limited associations with socio‑emotional outcomes; only 1–4 hours/day use linked to lower somatization.
Background
Hearing loss is highly prevalent and increases with age. Beyond difficulties in auditory perception, untreated hearing impairment is associated with social isolation, reduced quality of life, increased risk of depressive symptoms, and cognitive decline. Hearing aids are the primary intervention to improve audibility and communication, but evidence on the extent to which improved hearing translates into sustained socio‑emotional benefits remains mixed. Randomized trials are limited, and longitudinal cohort studies provide an important complementary perspective on real‑world effects of hearing‑aid adoption, adherence, and long‑term use.
Study Design (WHAM Study: Jansen et al., 2025)
The WHAM Study used data from the Netherlands Longitudinal Study on Hearing collected between October 2006 and January 2024. Participants completed an online digits‑in‑noise hearing test and repeated surveys every five years that captured hearing‑aid use (uptake, duration, daily hours), self‑perceived hearing disability, and a range of psychosocial outcomes: depression, anxiety, distress, somatization, social and emotional loneliness, and total loneliness. Three research questions (RQs) were addressed:
- RQ1: Association between HA uptake (adoption between follow‑ups) and socio‑emotional outcomes, and mediation by self‑perceived hearing disability.
- RQ2: Association between daily HA use (hours/day) and socio‑emotional outcomes at follow‑up.
- RQ3: Association between duration of HA use (5, 10, or 15 years) and socio‑emotional outcomes.
Eligible participants were those who met criteria for HA candidacy at interval start and were not using a HA at that time. Uptake versus non‑uptake groups were compared while controlling for baseline (pre‑uptake) socio‑emotional measures. The final analytic samples comprised 281 participants for RQ1, 280 for RQ2, and 180 for RQ3. Analyses used gamma regression models with generalized estimating equations to account for repeated measures.
Key findings
The WHAM Study reports nuanced, domain‑specific associations between hearing‑aid use and psychosocial outcomes rather than broad robust effects across all measures.
Main results
- HA uptake and depression: Among participants without tinnitus, HA uptake was significantly associated with lower depression scores (p < 0.05). This suggests hearing‑aid adoption can reduce depressive symptoms in people whose distress is not confounded by tinnitus.
- HA uptake and loneliness: In the subgroup aged >65 years, HA uptake was associated with lower total loneliness scores. The benefit appears age‑dependent and aligns with the centrality of social participation in older adults.
- No significant associations were observed between HA uptake and anxiety, somatization (overall), distress, or emotional loneliness.
- Mediation: Self‑perceived hearing disability did not mediate the relationship between HA uptake and socio‑emotional outcomes. In other words, reductions in depressive symptoms and loneliness associated with HA uptake were not accounted for by a simple pathway of improved self‑perceived hearing ability in this sample.
- Duration of use: No consistent associations were found between years of HA use (5, 10, or 15 years) and socio‑emotional outcomes.
- Daily wearing time: Daily frequency of HA use was largely unassociated with psychosocial outcomes; the sole exception was that wearing a HA for 1–4 hours per day was linked to lower somatization scores.
Effect sizes and statistical considerations
The published summary reports statistical significance for subgroup associations (depression in non‑tinnitus participants; loneliness in >65 years) but does not provide broad, consistent effect sizes across domains in this summary. The use of gamma regression is appropriate for skewed psychosocial outcome distributions; generalized estimating equations account for intra‑subject correlation across intervals. Sample sizes in subgroup analyses are modest and may limit power to detect small effects.
Expert commentary and interpretation
The WHAM Study provides important longitudinal, real‑world data on psychosocial outcomes following HA adoption. Several points warrant emphasis for clinicians and researchers.
1. Benefits are domain‑specific and subgroup‑dependent
The differential effects—reduced depressive symptoms in people without tinnitus and reduced total loneliness in older adults—highlight that hearing aids are not a universal remedy for all psychosocial sequelae of hearing loss. Older adults may derive the greatest social participation gains, potentially because communication opportunities and social networks are closely tied to perceived hearing ability in later life. Tinnitus is a known independent driver of distress; the lack of benefit among those with tinnitus underscores the need for targeted tinnitus management alongside amplification.
2. Lack of mediation by self‑perceived hearing disability
That self‑perceived improvement in hearing disability did not mediate psychosocial gains is notable. It suggests multiple pathways by which HAs may influence well‑being: direct improvements in specific communicative situations, increased confidence in social engagement, or broader behavioral changes (e.g., re‑engagement in activities). Alternatively, measurement issues (ceiling/floor effects, timing of assessments) could have obscured mediation effects.
3. Duration and intensity of use show limited predictive value
Absence of a clear dose–response relationship between years of use or daily wearing hours and psychosocial outcomes may reflect several realities: (a) users who persist long‑term may already have achieved their maximum psychosocial benefit early; (b) fitting quality, personalization, and rehabilitation support likely matter more than raw wearing time; (c) residual communication challenges, environmental barriers, and comorbidities (cognitive impairment, chronic illness, tinnitus) modulate outcomes.
4. Clinical implications
For audiologists and primary care clinicians, these results reinforce that recommending HA adoption is important but not sufficient to guarantee broad psychosocial recovery. Integrating psychosocial assessment and interventions (counseling, communication training, peer support, tinnitus management when present) should be standard in comprehensive care pathways. Screening for depression and loneliness before and after HA fitting can help identify patients who need adjunctive support.
5. Methodological strengths and limitations
Strengths: long duration of follow‑up (up to 15 years), repeated objectively anchored hearing testing (digits‑in‑noise), and control of baseline psychosocial status. Limitations: observational design—risk of residual confounding and selection bias (those who choose HAs may differ systematically); modest sample sizes for subgroup analyses; potential misclassification of daily wearing hours by self‑report; five‑year intervals could miss short‑term trajectories after uptake; limited granularity on HA technology, fitting quality, and rehabilitation intensity.
Practical recommendations
- Do not view hearing aids as a standalone psychosocial intervention. Combine amplification with counseling and communication strategies, especially for individuals with tinnitus or complex social needs.
- Screen older adults with hearing loss for loneliness and depression; consider expedited referral to multidisciplinary supports when indicated.
- Measure outcomes beyond audibility—use validated psychosocial tools pre‑ and post‑fitting to identify unmet needs.
- Recognize that maximal psychosocial benefit may not scale with wearing hours alone; focus instead on individualized fittings and rehabilitation that enhance real‑world communicative success.
Conclusion
The WHAM longitudinal study adds nuanced, clinically useful evidence: hearing‑aid uptake can reduce depression (in those without tinnitus) and loneliness in older adults, but effects are not uniform across socio‑emotional domains, and are not explained solely by improved self‑perceived hearing. These findings argue for a holistic model of hearing care that pairs amplification with psychosocial support and tailored rehabilitation to optimize well‑being. Future research should prioritize randomized or hybrid implementation designs that test integrated care packages, quantify short‑term trajectories after HA fitting, and examine mechanisms linking amplification to psychosocial outcomes.
Funding and trial registration
The WHAM Study report lists funding and authorship details in the original publication (Jansen LA et al., Ear Hear. 2025). No ClinicalTrials.gov registration is provided in the referenced citation.
Selected references
1. Jansen LA, van Wier MF, Lissenberg‑Witte BI, Smits C, Kramer SE. The WHAM Study: Socio‑Emotional Well‑being Effects of Hearing Aid Use and Mediation Through Improved Hearing Ability. Ear Hear. 2025 Nov‑Dec;46(6):1641‑1651. doi: 10.1097/AUD.0000000000001700. PMID: 40708091; PMCID: PMC12533782.
2. World Health Organization. World Report on Hearing. Geneva: WHO; 2021. (Provides context on population burden and consequences of hearing loss.)
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