A Moderated Mediation Model Linking Speech-in-Noise Exposure, Speech Perception in Noise Ability, Loneliness, and Depression

PURPOSE: Hearing loss is associated with elevated levels of loneliness and depression, but the factors accounting for these associations remain unclear. This study examined whether real-world hearing behaviors-time spent in speech-in-noise (SiN) environments and speech perception in noise (SPIN) ability-are associated with loneliness and depression in young adults with normal hearing, using a moderated mediation model. METHOD: Fifty-four participants with audiometrically normal hearing completed standardized assessments of SPIN ability (Quick Speech-in-Noise test), loneliness (UCLA Loneliness Scale), and depression (Patient Health Questionnaire-9). Participants wore audio recorders for 1 week, and an open-source deep neural network (Yet Another Mobile Network) classified recordings to estimate SiN exposure time. Regression-based moderated mediation analyses tested whether the association between SiN exposure and depression was mediated by loneliness and moderated by SPIN ability. RESULTS: Greater time in SiN was associated with lower loneliness, particularly among individuals with average or better SPIN ability. In contrast, participants with poorer SPIN ability showed weaker associations, with high exposures sometimes associated with greater loneliness. Loneliness was positively associated with depression scores. A significant moderated mediation association emerged: The indirect association between SiN exposure and depression via loneliness was statistically significant only for individuals with approximately average or better SPIN ability. CONCLUSIONS: These findings are consistent with a person-environment fit perspective: Individuals whose hearing abilities align well with the demands of their environments tend to show better social-emotional health outcomes, whereas those with a mismatch between SPIN ability and SiN exposure show weaker or even reversed associations. This study illustrates how hearing-related behaviors and hearing abilities may be associated with social-emotional well-being and underscores the importance of considering both individual ability and everyday listening environments when designing and evaluating hearing health interventions.