Differential associations of objective hearing loss and subjective hearing difficulty with depressive symptom profiles: A nationwide population-based study in Korea

OBJECTIVE: To examine whether objective audiometric hearing loss and subjective hearing difficulty show differential associations with depressive symptoms in a nationally representative Korean population. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.