Impact of Visual and Hearing impairment on Mental health and Cognitive function- A Cross sectional study
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Background: Sensory impairments are increasingly recognized as significant contributors to psychiatric morbidity, cognitive dysfunction and reduced quality of life (QOL). This study aimed to assess the impact of visual and hearing impairment on mental health and cognitive function while investigating the mediating roles of psychological distress in the relationship between sensory loss and QOL. Methods: This hospital-based cross-sectional study included 284 participants (142 with visual impairment and 142 with hearing impairment). Mental health was evaluated using the Depression Anxiety Stress Scale-21 (DASS-21), cognitive function through the Addenbrooke’s Cognitive Examination III (ACE-III), and QOL via the WHOQOL-BREF instrument. Results: Psychiatric morbidity was substantial, with depression, anxiety and stress observed in 22.2%, 38.7%, and 30.6% of participants, respectively. Visually impaired individuals experienced significantly higher rates of depression (31.0% vs. 13.4%, p < 0.001), anxiety (45.1% vs. 32.4%, p = 0.028), and stress (36.6% vs. 24.6%, p = 0.029) compared to those with hearing impairment. Cognitive impairment was also significantly more prevalent in the visually impaired group (72.5% vs. 56.3%, p = 0.004). Mediation analysis identified depression as the primary pathway through which sensory impairment adversely affects QOL. Conclusions: Sensory impairment, particularly visual loss, is associated with increased psychological distress, greater cognitive dysfunction and lower QOL. These findings emphasize the necessity of integrating routine psychiatric screening, cognitive assessments, and multidisciplinary rehabilitation into the comprehensive care of individuals with sensory disabilities. Keywords: Visual impairment; Hearing impairment; Mental health; Cognitive function; QOL HIGHLIGHTS: • Sensory impairment leads to high depression, anxiety and stress levels. • Visual loss has a greater impact on mental health than hearing impairment. • Cognitive impairment is significantly more prevalent in the visual group. • Depression is the primary mediator between sensory loss and quality of life. • Mental health and cognitive function represent independent clinical dimensions.
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Study Design and Ethics This research followed a hospital-based, analytical cross-sectional design conducted at **Sri Manakula Vinayagar Medical College and Hospital (SMVMCH)**, a tertiary care center in Puducherry, India. Ethical protocols included formal approval from the **Institutional Ethics Committee** (Approval No: SMVMCH-ECO/AL/197/2024) and obtaining written informed consent from all participants in their local language (Tamil) prior to enrollment. ### **Participant Recruitment and Sampling** We recruited **284 participants** (142 visually impaired and 142 hearing impaired) using a **convenience non-probability sampling** technique over an 18-month period from March 2024 to September 2025. The sample size was determined using **Open-Epi version 3.0** based on a 13.5% expected prevalence of mental illness in sensory-impaired populations, with 4% absolute precision and 80% power. Eligibility required participants to be **under 50 years of age** with **mild visual impairment** (Presenting Visual Acuity < 6/12) or **mild hearing impairment** (thresholds ≥20 dB). Individuals with moderate-to-profound loss, congenital anomalies, or a documented history of psychiatric or substance use disorders were excluded to minimize confounding variables. ### **Assessment Instruments** Data were gathered using a two-part structured proforma: * **Section I (Sociodemographics):** Collected details on age, sex, residence, and marital status. Socioeconomic status was categorized using the **Modified B.G. Prasad scale 2026**. * **Section II (Clinical Scales):** Employed three validated instruments: the **DASS-21** to measure depression, anxiety, and stress; the **ACE-III** (100-point tool) to evaluate attention, memory, fluency, language, and visuospatial abilities; and the **WHOQOL-BREF** to assess physical, psychological, social, and environmental quality of life (QOL). ### **Workflow and Statistical Analysis** The data gathering workflow involved **face-to-face interviews** conducted solely by the Principal Investigator to ensure uniformity and reduce measurement bias. Responses were recorded immediately, and questionnaires were checked daily for completeness. Data were entered into **Microsoft Excel 2016** using double-entry verification to maintain accuracy and subsequently analyzed using **IBM SPSS Statistics Version 24.0**. Descriptive statistics (means, SD, and percentages) summarized participant profiles. Inferential workflows included: * **Independent Student’s t-tests** to compare mean scores between impairment groups. * **Pearson Chi-square ($\chi^2$) tests** to examine associations between categorical variables. * **Pearson correlation analysis** to assess relationships between the assessment scales. * **Hayes PROCESS Model 4** for parallel multiple mediation analysis to investigate the pathways through which sensory loss impacted quality of life. Statistical significance was established at a two-tailed **p-value < 0.05**.
Institutions
- Sri Manakula Vinayagar Medical College and HospitalPuducherry, Puducherry