A new study finds that hearing loss can have devastating impacts on the daily lives of millions of people, even leading to crippling depression — and many people may not realize they have worsening hearing.

The study, presented at the American Psychological Association Convention in Toronto, Canada, finds that many people who are hard of hearing battle in silence with their hearing problems, and are often reluctant to seek any sort of help, according to a Medical News Today report.

The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that about 15 percent of American adults, which amounts of a whopping 37.5 million people, have at least some problems with their hearing.

Hearing aids can help by amplifying sounds, and they have a good track record in terms of helping those with hearing loss, but many don’t use them because of the stigma. In fact, only about 30 percent of those who are over 70 years old and would benefit from a hearing aid use them, and just 16 percent of adults younger than 70 have tried one even though it would benefit them greatly.

And the mental problems can be significant for those who decline to address their hearing loss problem. A study conducted by the National Council of Aging found that people who didn’t use hearing aids who could have benefited from them were 50 percent more likely to get depression than those who used such devices. This was based on a study of 2,304 people who had hearing loss.

Part of that may be the social aspect. Hearing aid users were more likely to get involved in social activities, reducing the isolation that many people with hearing loss often feel, and isolation can lead to dementia as well.