Editorial: Mental health and suicide prevention in sensory impairment populations

understanding of the impact of SI on mental health.Two studies explored the link between depressive symptoms and HI, using longitudinal survey evidence. Sun Q et al drew on the 8 th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) which was run from 2017-2018 and involved more than 5000 adults aged ≥ 65; where researchers sought to explore the relationship between depressive symptoms, psychological wellbeing, and HI. Findings not only reveal the direct negative effect of auditory loss on both depressive symptoms and psychological well-being, but also an indirect effect on depressive symptoms which is mediated through diminished psychological adaptability. The authors underline the significant protective role that psychological well-being can play in alleviating the impact of HI on depressive symptoms and call for a deeper understanding of the underlying mechanisms and pathways to develop more targeted interventions for this population.Using data from close to 3000 individuals aged ≥45 who were involved in the China Health and Retirement Longitudinal Study (CHARLS), Liu Q et al developed and validated a nomogram to predict the risk between HI and depressive symptoms in middle-and older-aged adults. This tool would assist in risk stratification and early identification of individuals at higher risk for depression.The study revealed that more than 40% of this population experienced depressive symptoms, which markedly exceeded global prevalence estimates of 10-20%. This aligns with the evidence from a nationwide cohort study by Wang J et al which also drew evidence from the CHARLS database, and involved more than 3000 middle-and older-aged adults. Analysis demonstrated that increases in depressive symptom scores resulted in an increased risk of new-onset dual SI, with authors highlighting the importance of close monitoring of depressive symptoms to detect at-risk individuals. These observations also raise the question of the possible bidirectional relationship between depression and SI, suggesting possible shared biological and psychosocial pathways, and thus the need for further longitudinal investigations to determine causal mechanisms.Two other studies looked at the link between affective disorders and VI. A cross-sectional study by Niu T et al involving patients aged ≥65 with cataracts -a major cause for VI -found that those with economic hardship, comorbid hearing disorders, and poor self-reported health status, were more likely to develop depressive symptoms. These findings underscore the need for more targeted public health interventions to raise awareness about the importance of early risk assessment and health screening, as well as the need for changes to government policies to help alleviate the financial burden faced by this population.While other studies focused on depressive symptoms, Yao W et al focused on symptoms of anxiety in adults aged ≥65, also drawing data from close to 12000 participants from the CLHLS database. Individuals with VI were found to have significantly higher levels of anxiety, with binary logistic regression modelling indicating that it was a significant predictor for anxiety symptoms in older adults. The model also found that poorer sleep quality, a prominent experience of older adults with VI, could also exacerbate these symptoms.All five studies were rooted in Chinese populations, particularly in older adults, highlighting the need for more globally representative research, especially in lower socioeconomic countries where the impact on mental health is even more pronounced (9). While most countries have or are approaching an ageing population (10) -who have an increased risk of Sis (11,12) -evidence points to high prevalence rates even in middle-aged adults, warranting more attention to this age group as well.It was observed that suicide was not assessed in any of these papers and is rarely done so in other studies. Culture has a significant impact on help-seeking behaviour, with many traditional or collectivist cultures often focusing on physical rather than mental health (9,13). Stigma related to mental health especially suicide, is also frequently seen as a barrier to seeking care (14,15), thus hindering early detection, diagnosis, and more importantly, management. Indeed, a common underlying thread in the included studies is the importance of early identification and risk stratification. As such, the importance of culture cannot be overlooked.Similarly, the impact of mental health on SI should be examined as studies show it can exacerbate these conditions, rather than just being a result of them (16)(17)(18). However, future studies should move beyond examining prevalence rates and risk factors. The study by Sun et al revealed the impact of SI on psychological well-being as well (19), and as such more qualitative work to explore the lived experiences of patients should be undertaken to ascertain the real impact on psychological well-being, life satisfaction, and quality of life, as all have a significant bearing on mental health. This also highlights the importance of adopting a multifaceted approach when treating people with SI, integrating care for sensory issues with larger health and wellness programs focusing on risk factors that impact mental health such as diet, sleep, social support etc. Indeed, further studies should explore the role of diet and certain food types in mitigating mental health risks in this population (20,21).Healthcare professionals must also be cognizant of the fact that there is no 'one-size fits all' when it comes to interventions/programmes. Indeed, research has shown different risk factors and barriers to seeking help based on socioeconomic backgrounds (22). Thus, for any intervention to be truly meaningful and effective, a community-based participatory approach must be adopted, where those affected by the outcomes of these interventions/programmes are included as active partners through co-design (23). This will enable more tailored interventions, enhance patient engagement, and foster a sense of ownership over the programmes developed