Psychological Medicine

Original Articles

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

M. van der Werfa1 c1, V. Thewissena1a2, M. D. Domingueza1, R. Lieba3a4, H. Wittchena3a5 and J. van Osa1a6

a1 Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON Graduate School of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands

a2 Open University of the Netherlands, Faculty of Psychology, Heerlen, The Netherlands

a3 Max Planck Institute of Psychiatry, Clinical Psychology and Epidemiology Unit, Munich, Germany

a4 Epidemiology and Health Psychology, Institute of Psychology, University of Basel, Basel, Switzerland

a5 Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany

a6 King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK


Background 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.

Method 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.

Results 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).

Conclusions 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.

(Received October 02 2009)

(Revised March 10 2010)

(Accepted April 06 2010)

(Online publication May 19 2010)


c1 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: