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Adolescent development of psychosis as an outcome of hearing impairment: a 10-year longitudinal study

  • M. van der Werf (a1), V. Thewissen (a1) (a2), M. D. Dominguez (a1), R. Lieb (a3) (a4), H. Wittchen (a3) (a5) and J. van Os (a1) (a6)...



It has long been acknowledged that hearing impairment may increase the risk for psychotic experiences. Recent work suggests that young people in particular may be at risk, indicating a possible developmental mechanism.


The hypothesis that individuals exposed to hearing impairment in early adolescence would display the highest risk for psychotic symptoms was examined in a prospective cohort study of a population sample of originally 3021 adolescents and young adults aged 14–24 years at baseline, in Munich, Germany (Early Developmental Stages of Psychopathology Study). The expression of psychosis was assessed at multiple time points over a period of up to 10 years, using a diagnostic interview (Munich Composite International Diagnostic Interview; CIDI) administered by clinical psychologists.


Hearing impairment was associated with CIDI psychotic symptoms [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.10–3.81], particularly more severe psychotic symptoms (OR 5.66, 95% CI 1.64–19.49). The association between hearing impairment and CIDI psychotic symptoms was much stronger in the youngest group aged 14–17 years at baseline (OR 3.28, 95% CI 1.54–7.01) than in the older group aged 18–24 years at baseline (OR 0.82, 95% CI 0.24–2.84).


The finding of an age-specific association between hearing impairment and psychotic experiences suggests that disruption of development at a critical adolescent phase, in interaction with other personal and social vulnerabilities, may increase the risk for psychotic symptoms.


Corresponding author

*Address for correspondence: M. van der Werf, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, PO Box 616 (VIJV), 6200 MD Maastricht, The Netherlands. (Email:


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Arrindell, WA, Ettema, JHM (eds) (2003). SCL-90. Handleiding bij een Multidimensionale Psychopathologie Indicator [SCL-90. Manual of a Multidimensional Indicator of Psychopathology]. Swets Test Publisher: Lisse.
Bentall, RP (1990). The illusion of reality: a review and integration of psychological research on hallucinations. Psychological Bulletin 107, 8295.
Bess, FH, Dodd-Murphy, J, Parker, RA (1998). Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear and Hearing 19, 339354.
Bonicatto, S, Dew, MA, Soria, JJ, Seghezzo, ME (1997). Validity and reliability of Symptom Checklist ‘90 (SCL90) in an Argentine population sample. Social Psychiatry and Psychiatric Epidemiology 32, 332338.
Boydell, J, van Os, J, McKenzie, K, Murray, RM (2004). The association of inequality with the incidence of schizophrenia – an ecological study. Social Psychiatry and Psychiatric Epidemiology 39, 597599.
Brown, AS, Cohen, P, Greenwald, S, Susser, E (2000). Nonaffective psychosis after prenatal exposure to rubella. American Journal of Psychiatry 157, 438443.
Cannon, M, Caspi, A, Moffitt, TE, Harrington, H, Taylor, A, Murray, RM, Poulton, R (2002). Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Archives of General Psychiatry 59, 449456.
Chapman, LJ, Chapman, JP, Kwapil, TR, Eckblad, M, Zinser, MC (1994). Putatively psychosis-prone subjects 10 years later. Journal of Abnormal Psychology 103, 171183.
Cooper, AF, Curry, AR (1976). The pathology of deafness in the paranoid and affective psychoses of later life. Journal of Psychosomatic Research 20, 97–105.
Cougnard, A, Marcelis, M, Myin-Germeys, I, De Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, C, Spauwen, J, Van Os, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model. Psychological Medicine 37, 513527.
Dalman, C, Allebeck, P, Gunnell, D, Harrison, G, Kristensson, K, Lewis, G, Lofving, S, Rasmussen, F, Wicks, S, Karlsson, H (2008). Infections in the CNS during childhood and the risk of subsequent psychotic illness: a cohort study of more than one million Swedish subjects. American Journal of Psychiatry 165, 5965.
David, A, Malmberg, A, Lewis, G, Brandt, L, Allebeck, P (1995). Are there neurological and sensory risk factors for schizophrenia? Schizophrenia Research 14, 247251.
Derogatis, LR (1983). SCL-90-R Administration, Scoring and Procedures Manual-II. Clinical Psychometric Research: Towson, MD.
Dominguez, MD, Wichers, M, Lieb, R, Wittchen, HU, van Os, J (2009). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin. Published online: 21 May 2009. doi: 10.1093/schbul/sbp022.
Fortnum, H, Davis, A (1993). Hearing impairment in children after bacterial meningitis: incidence and resource implications. British Journal of Audiology 27, 4352.
Frith, CD (1992). The Cognitive Neuropsychology of Schizophrenia. Lawrence Erlbaum Associates: Hove, UK.
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Henquet, C, Krabbendam, L, Spauwen, J, Kaplan, C, Lieb, R, Wittchen, HU, van Os, J (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal (Clinical Research Edition) 330, 11.
Herrgard, E, Karjalainen, S, Martikainen, A, Heinonen, K (1995). Hearing loss at the age of 5 years of children born preterm – a matter of definition. Acta Paediatrica 84, 11601164.
Janssen, I, Krabbendam, L, Jolles, J, van Os, J (2003). Alterations in theory of mind in patients with schizophrenia and non-psychotic relatives. Acta Psychiatrica Scandinavica 108, 110117.
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis – linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 5968.
Kaymaz, N, van Os, J (2010). Extended psychosis phenotype – yes: single continuum – unlikely. Psychological Medicine. Published online: 20 March 2010. doi: 10.1017/S0033291710000358.
Kramer, SE, Kapteyn, TS, Kuik, DJ, Deeg, DJ (2002). The association of hearing impairment and chronic diseases with psychosocial health status in older age. Journal of Aging and Health 14, 122137.
Lataster, T, Myin-Germeys, I, Derom, C, Thiery, E, van Os, J (2009). Evidence that self-reported psychotic experiences represent the transitory developmental expression of genetic liability to psychosis in the general population. American Journal of Medical Genetics Part B 150B, 10781084.
Leask, SJ, Done, DJ, Crow, TJ (2002). Adult psychosis, common childhood infections and neurological soft signs in a national birth cohort. British Journal of Psychiatry 181, 387392.
Leff, JP (1968). Perceptual phenomena and personality in sensory deprivation. British Journal of Psychiatry 114, 14991508.
Lieb, R, Isensee, B, von Sydow, K, Wittchen, HU (2000). The Early Developmental Stages of Psychopathology Study (EDSP): a methodological update. European Addiction Research 6, 170182.
Linscott, RJ, van Os, J (2010). Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology 6, 391419.
Marschark, M (1993). Psychological Development of Deaf Children. Oxford University Press: New York.
Mason, OJ, Brady, F (2009). The psychotomimetic effects of short-term sensory deprivation. Journal of Nervous and Mental Disease 197, 783785.
Olusanya, BO, Newton, VE (2007). Global burden of childhood hearing impairment and disease control priorities for developing countries. Lancet 369, 13141317.
Paykel, ES, Abbott, R, Jenkins, R, Brugha, TS, Meltzer, H (2000). Urban–rural mental health differences in Great Britain: findings from the National Morbidity Survey. Psychological Medicine 30, 269280.
Peters, ER, Joseph, SA, Garety, PA (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin 25, 553576.
Peterson, CC, Siegal, M (1995). Deafness, conversation and theory of mind. Journal of Child Psychology and Psychiatry 36, 459474.
Peterson, CC, Siegal, M (1998). Changing focus on the representational mind: deaf, autistic and normal children's concept of false photos, false drawings and false beliefs. British Journal of Developmental Psychology 16, 301320.
Peterson, CC, Wellman, HM, Liu, D (2005). Steps in theory-of-mind development for children with deafness or autism. Child Development 76, 502517.
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Reed, V, Gander, F, Pfister, H, Steiger, A, Sontagg, H, Trenkwalder, C, Hundt, W, Wittchen, H (1998). To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 7, 619627.
Romans-Clarkson, SE, Walton, VA, Herbison, GP, Mullen, PE (1990). Psychiatric morbidity among women in urban and rural New Zealand: psycho-social correlates. British Journal of Psychiatry 156, 8491.
Rossler, W, Riecher-Rossler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J, Gross, VA (2007). Psychotic experiences in the general population: a twenty-year prospective community study. Schizophrenia Research 92, 114.
Russell, PA, Hosie, JA, Gray, CD, Scott, C, Hunter, N, Banks, JS, Macaulay, MC (1998). The development of theory of mind in deaf children. Journal of Child Psychology and Psychiatry 39, 903910.
Schultz, G, Melzack, R (1991). The Charles Bonnet syndrome: ‘phantom visual images’. Perception 20, 809825.
Selten, JP, Cantor-Graae, E (2007). Hypothesis: social defeat is a risk factor for schizophrenia? British Journal of Psychiatry 51 (Suppl.), s9–s12.
Sindhusake, D, Mitchell, P, Smith, W, Golding, M, Newall, P, Hartley, D, Rubin, G (2001). Validation of self-reported hearing loss. The Blue Mountains Hearing Study. International Journal of Epidemiology 30, 13711378.
Spauwen, J, Krabbendam, L, Lieb, R, Wittchen, HU, van Os, J (2006). Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment. Psychological Medicine 36, 407415.
Stefanis, N, Thewissen, V, Bakoula, C, van Os, J, Myin-Germeys, I (2006). Hearing impairment and psychosis: a replication in a cohort of young adults. Schizophrenia Research 85, 266272.
Stein, LM, Thienhaus, OJ (1993). Hearing impairment and psychosis. International Psychogeriatrics 5, 4956.
Tharpe, AM, Sladen, DP (2008). Causation of permanent unilateral and mild bilateral hearing loss in children. Trends in Amplification 12, 1725.
Thewissen, V, Myin-Germeys, I, Bentall, R, de Graaf, R, Vollebergh, W, van Os, J (2005). Hearing impairment and psychosis revisited. Schizophrenia Research 76, 99–103.
van der Werf, M, van Boxtel, M, Verhey, F, Jolles, J, Thewissen, V, van Os, J (2007). Mild hearing impairment and psychotic experiences in a normal aging population. Schizophrenia Research 94, 180186.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine 39, 179195.
van Os, J, Rutten, BP, Poulton, R (2008). Gene–environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 10661082.
van Winkel, R, Stefanis, NC, Myin-Germeys, I (2008). Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene–stress interaction. Schizophrenia Bulletin 34, 10951105.
Veling, W, Selten, JP, Susser, E, Laan, W, Mackenbach, JP, Hoek, HW (2007). Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. International Journal of Epidemiology 36, 761768.
Verdoux, H, Maurice-Tison, S, Gay, B, Van Os, J, Salamon, R, Bourgeois, ML (1998). A survey of delusional ideation in primary-care patients. Psychological Medicine 28, 127134.
Weiser, M, Werbeloff, N, Drukker, M, Van Os, J, Dohrenwend, BP, Yoffe, R, Levav, I, Davidson, M (2009). Self-reported psychotic symptoms in the community, and risk of later hospitalization for non-affective psychotic disorders. Schizophrenia Bulletin 35, 74.
Welham, J, Scott, J, Williams, G, Najman, J, Bor, W, O'Callaghan, M, McGrath, J (2009). Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychological Medicine 39, 625634.
WHO (1990). Composite International Diagnostic Interview (CIDI), Version 1.0. World Health Organisation: Geneva, Switzerland.
Wittchen, H, Pfister, H (eds) (1997). DIA-X-Interviews: Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Engänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittsuntersuchung (DIA-X-Monatsversion); Ergänzungsheft (DIA-X-12 Monatsversion); PC-programm zur Durchfuhrung der Interviews (Längs und Querschnittsuntersuchung); Ausertungsprogramm [DIA-X-Interviews: Manual for Screening and Interview, Interview Issue Longitudinal Study (DIA-X-Lifetime), Supplement Issue (DIA-X-Lifetime); Interview Issue Cross-section Analysis (DIA-X-month version), Supplement Issue (DIA-X-12-month version), PC Program for Carrying out the Interviews (Longitudinal and Cross-examination); Analysis programme]. Swets & Zeiltinger: Frankfurt, Germany.
Wittchen, HU (1994). Reliability and validity studies of the WHO – Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.
Wittchen, HU, Lachner, G, Wunderlich, U, Pfister, H (1998 a). Test–retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.
Wittchen, H-U, Lieb, R, Schuster, P, Oldehinkel, T (1999). When is onset? Investigations into early developmental stages of anxiety and depressive disorders. In Childhood Onset of ‘Adult’ Psychopathology, Clinical and Research Advances (ed. Rapoport, J. L.), pp. 259302. American Psychiatric Press: Washington.
Wittchen, HU, Perkonigg, A, Lachner, G, Nelson, CB (1998 b). Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. European Addiction Research 4, 1827.
Zammit, S, Odd, D, Horwood, J, Thompson, A, Thomas, K, Menezes, P, Gunnell, D, Hollis, C, Wolke, D, Lewis, G, Harrison, G (2009). Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort. Psychological Medicine 39, 14571467.


Adolescent development of psychosis as an outcome of hearing impairment: a 10-year longitudinal study

  • M. van der Werf (a1), V. Thewissen (a1) (a2), M. D. Dominguez (a1), R. Lieb (a3) (a4), H. Wittchen (a3) (a5) and J. van Os (a1) (a6)...


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