Individuals with disabilities are at an increased risk for recent and lifetime substance use compared to individuals without disabilities.1,2 Some estimates suggest that individuals with disabilities are 2–4 times more likely to use substances than individuals without disabilities.3 Data from the National Health and Nutrition Examination Survey (NHANES) 2013–2018 reported that individuals with vision loss only and hearing loss only had 36 % and 37 % greater odds, respectively, of drug use than those without a disability.1 In other work, persons with hearing loss were significantly more likely to have higher rates of illicit drug use and dependence, substance use disorders, or prescription opioid use disorders in comparison with persons without hearing loss, including those with other forms of disability.4,5 Prior research indicates that between 20 and 50 % of individuals with vision loss used substances.6 As a consequence of increased substance use, persons with sensory impairments may experience an increased risk for excess healthcare utilization and poor outcomes. For instance, one study reported that individuals who are deaf and hard of hearing had an 80 % higher risk of emergency department visits related to opioid overdose.7 There is a critical need for recent research that assesses the underlying mechanisms influencing the relationship between vision and/or hearing loss and substance use among persons with vision and/or hearing loss.

The connection between substance use and mental health conditions has been well established by previous research.8 Additionally, individuals with disabilities have higher rates of mental health conditions than persons without disabilities.9 A higher proportion of individuals with vision loss only or hearing loss only report having a diagnosis of a depressive disorder than those without vision or hearing loss.9 Individuals with hearing loss have higher rates of psychological distress, depression, anxiety, suicide attempts, and suicidal ideation than those without hearing loss.10,11 Additionally, one out of four individuals with vision loss report having depression or anxiety.12 Furthermore, findings indicate that individuals with disabilities who also report having psychiatric conditions such as depression and anxiety experience significantly higher rates of opioid misuse and overdose deaths than those without a disability.13 Both qualitative and quantitative studies have identified mental health conditions as being important factors in the etiology of substance use among individuals with disabilities.2,14 Hence, prior research suggests that mental health issues and conditions may be mediators of the association between hearing and/or vision impairment and substance use.

Mediation analysis is a critical approach to understanding the components that underly the relationship between vision and/or hearing loss and substance use. Mediators account for the association between an independent and dependent variable, helping to identify “how or why” an effect occurs.15 While previous studies have focused on assessing whether vision and/or hearing loss are associated with substance use, minimal research has sought examine whether mental health may mediate this relationship. Depression has been examined as a mediator of the pathway between some types of disability or indicators of well-being and substance use related outcomes. For instance, a study found a mediating effect of depression on the relationship between neurocognitive impairment and health-related quality of life among opioid dependent men.16 Another study found that depressive symptoms may play a mediating role in the effect of perceived stress on substance use outcomes, particularly illicit opioid use.17 In addition, disability-focused research has evaluated whether the effect of disability indicators on substance use was mediated by chronic pain.2 No known research has investigated whether the relationship between vision and/or hearing loss and substance use is mediated by depression.

The objective of this analysis was to assess, using a nationally representative sample, whether recent depression mediates the relationship between vision and/or hearing loss and recent substance use (RSU). We hypothesized that increased risk of recent substance use among those with vision and/or hearing loss is due in part to recent depression. Findings can inform the development of program, interventions, and policies that incorporate a focus on depression to address substance use most effectively among persons with vision and/or hearing loss.