Purpose Anxiety disorders are common. Prevalence is likely to be raised in people with hearing impairment, who experience higher rates of associated risk factors. We conducted, to our knowledge, the first systematic review of the prevalence and correlates of anxiety in people with hearing impairment. Methods We searched electronic databases and references of included studies, using predetermined criteria to retrieve original research reporting prevalence of anxiety disorders or symptoms in adult, hearing impaired populations. We assessed risk of bias using the adapted Newcastle Ottawa Scale. Results We included 25 studies evaluating 17,135 people with hearing impairment. Community studies of higher quality reported a lifetime prevalence of anxiety disorder of 11.1% (one study) and point prevalences of 15.4-31.3% for clinically significant anxiety symptoms (five studies) in people who predominantly had acquired hearing impairment. Anxiety prevalence was higher in hearing impaired people in 8/10 studies with a comparator non-hearing impaired group. Anxiety symptoms decreased after surgical intervention for hearing in all studies investigating this. Correlates consistently associated with anxiety were tinnitus and hearing impairment severity. Conclusions Prevalence of anxiety is higher among people with hearing impairment than the general population; our findings indicate that this excess morbidity may be related to the hearing impairment itself, as it was associated with the severity of impairment, and reduced after surgical treatment. Clinicians should be aware of the potential impact of hearing on mental health, and that where hearing ability can be improved, this may reduce anxiety. Prospero registration number CRD42018088463.
Psychosis is reportedly associated with hearing and visual impairment. The mechanisms for this are poorly understood. Using data from the 2014 English Adult Psychiatric Morbidity Survey, we hypothesised: that hearing and visual impairments would be associated with psychotic symptoms; that the probability of psychotic symptoms would be related to the severity of impairment; and that these associations would be partly explained by reduced social fulfilment. Methods We analysed cross-sectional data using logistic regression. Visual and auditory impairment comprised the exposures, while screening positive on the Psychosis Screening Questionnaire (PSQ) was the outcome. We used structural equation modelling to assess mediation by social fulfilment, measured by the Social Functioning Questionnaire. Results Screening positive on the PSQ was strongly associated with visual impairment overall (Adjusted Odds Ratio (AOR) 1.81, 95% Confidence Intervals (CI) 1.33 to 2.44), but especially with moderate visual impairment (AOR 2.75, 95% CI 1.78 to 4.24, p<0.001). Psychotic symptoms were associated with a severe degree of hearing impairment (AOR 4.94, 95% CI 1.66 to 14.67, p=0.004), but less so with hearing impairment overall (AOR 1.50, 95% CI 1.10 to 2.04, p=0.010). Social functioning accounted for approximately 50% of associations with both types of sensory impairment, though confidence intervals were broad. Conclusions Our findings support a relationship between psychotic symptoms and visual impairment (particularly moderate impairment), and a linear association between psychosis and hearing impairment. Social functioning may mediate these relationships and so form an adjunctive target for intervention, alongside sensory correction. These associations should be investigated longitudinally.
ObjectivesSensory impairments are associated with worse mental health and poorer quality of life, but few studies have investigated whether sensory impairment is associated with suicidal behaviour in a population sample. We investigated whether visual and hearing impairments were associated with suicidal ideation and attempt.DesignNational cross-sectional study.SettingHouseholds in England.ParticipantsWe analysed data for 7546 household residents in England, aged 16 and over from the 2014 Adult Psychiatric Morbidity Survey.ExposuresSensory impairment (either visual or hearing), Dual sensory impairment (visual and hearing), visual impairment, hearing impairment.Primary outcomeSuicidal ideation and suicide attempt in the past year.ResultsPeople with visual or hearing sensory impairments had twice the odds of past-year suicidal ideation (OR 2.06; 95% CI 1.17 to 2.73; p<0.001), and over three times the odds of reporting past-year suicide attempt (OR 3.12; 95% CI 1.57 to 6.20; p=0.001) compared with people without these impairments. Similar results were found for hearing and visual impairments separately and co-occurring.ConclusionsWe found evidence that individuals with sensory impairments are more likely to have thought about or attempted suicide in the past year than individuals without.
Background People with sensory impairments may be at increased risk of depression and anxiety but experience barriers to accessing treatment. Aims To investigate whether people with sensory impairment have more depressive and anxiety symptoms than people without, whether this is mediated by social functioning and whether they report greater non-treatment. Method We analysed data from the English 2014 Adult Psychiatric Morbidity Survey using regression models, with the Clinical Interview Schedule-Revised (CIS-R) score as the primary outcome and self-reported hearing and vision impairment as exposures. A secondary outcome was self-reported receipt of mental health diagnosis and treatment. We used structural equation modelling to assess for mediation by social functioning. Results A total of 19.0% of people with hearing impairment, and 30.9% and 24.5% with distance and near visual impairments, respectively, had clinically significant psychological morbidity. Adjusted mean CIS-R score was 1.86 points higher in people with hearing impairment compared with those without (95% CI 1.30–2.42, P<0.001). People with distance and near vision impairment had mean CIS-R scores 3.61 (95% CI 2.58–4.63, P<0.001) and 2.74 (95% CI 2.12–3.37, P<0.001) points higher, respectively, than those without. Social functioning accounted for approximately 50% of these relationships between sensory impairment and psychological morbidity. We found no evidence of an increased treatment gap for people with sensory impairment. Conclusions Social functioning, a potentially modifiable target, may mediate an association between sensory impairment and depressive and anxiety symptoms.
SUMMARY Peer review is widely accepted as essential to ensuring scientific quality in academic journals, yet little training is provided in the specifics of how to conduct peer review. In this article we describe the different forms of peer review, with a particular focus on the differences between single-blind, double-blind and open peer review, and the advantages and disadvantages of each. These illustrate some of the challenges facing the community of authors, editors, reviewers and readers in relation to the process of peer review. We also describe other forms of peer review, such as post-publication review, transferable review and collaborative review, and encourage clinicians and academics at all training stages to engage in the practice of peer review as part of continuing professional development.
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