Mental health of deaf people

Quality of Life of deaf adolescents in high school: A systematic literature review

There are few studies that have explored the Quality of Life (QoL) for deaf adolescents in high school (13-18 years). Following the PRISMA guidelines, this systematic literature review examined peer-reviewed research that has explored QoL for deaf adolescents in high school by using databases such as Science Citation Index, Scopus and Social Science Citation Index in addition to some related journals such as American Annals of the Deaf, the Journal of Deaf Studies and Deaf Education, Ear and Hearing, and Deafness and Education International spanning 14 years (2010-2024). By analysing the titles, abstracts, and keywords and reading full manuscripts, only seven were deemed appropriate for inclusion in this systematic review. All seven studies used quantitative research. This systematic review found that there is a discrepancy between the studies included in the use of measures. The results of the studies are different and some are contradictory. The QoL concept also differed amongst the studies. This study concluded that there is a great need to conduct more research into the QoL of deaf adolescents in high school with diverse research methods and the use of qualitative or mixed research, as well as expanding the scope of studies to include more dimensions in the concept of QoL.

Validation of a tablet-based application for hearing self-screening in an adult population

OBJECTIVE

This study evaluated the diagnostic performances of a tablet-based hearing screening test by assisted-test and self-test modes.

DESIGN/METHOD

Measurements were performed with the SoTone tests in normal hearing and hearing-impaired adult participants using an Android tablet and calibrated Bluetooth headphones. The duration of assisted- and self-test modes were compared. Receiver operating characteristic (ROC) curves were plotted after calculations of sensitivity and specificity at 20, 30, and 35 dB HL cut-off values.

STUDY SAMPLE

217 participants performed the tests. The effect of test mode (assisted versus self) was compared in a sample of 103 participants.

RESULTS

Self-test duration (89 s) was significantly longer than the assisted-test duration (75 s) (p = 0.003, Wilcoxon test). For the 20, 30, and 35 dB HL cut-off values, sensitivity was between 92% and 96%, and specificity was between 79 and 90%. Concordance of results between assisted-test and self-test modes was excellent (Cohen's kappa = 0.81, p < 0.001).

CONCLUSIONS

The SoTone hearing screening test is accurate for identifying the presence of a suspected hearing loss at 20 dB HL or more in adults. It can be used either in assisted-test or self-test modes.

A new mutation of Sgms1 causes gradual hearing loss associated with a reduced endocochlear potential

Sgms1 encodes sphingomyelin synthase 1, an enzyme in the sphingosine-1-phosphate signalling pathway, and was previously reported to underlie hearing impairment in the mouse. A new mouse allele, Sgms1tm1a, unexpectedly showed normal Auditory Brainstem Response thresholds. We found that the Sgms1tm1a mutation led to incomplete knockdown of transcript to 20 % of normal values, which was enough to support normal hearing. The Sgms1tm1b allele was generated by knocking out exon 7, leading to a complete lack of detectable transcript in the inner ear. Sgms1tm1b homozygotes showed largely normal auditory brainstem response thresholds at first, followed by progressive loss of sensitivity until they showed severe impairment at 6 months old. The endocochlear potential was consistently reduced in Sgms1tm1b mutants at 3, 4 and 8 weeks old, to around 80 mV compared with around 120 mV in control littermates. The stria vascularis showed a characteristic irregularity of marginal cell surfaces and patchy loss of Kcnq1 expression at their apical membrane, and expression analysis of the lateral wall suggested that marginal cells were the most likely initial site of dysfunction in the mutants. Finally, significant association of auditory thresholds with DNA markers within and close to the human SGMS1 gene were found in the 1958 Birth Cohort, suggesting that SGMS1 variants may play a role in the range of hearing abilities in the human population.

Antenatal Hospital Use among Deaf and Hard of Hearing Women

OBJECTIVE

Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women.

STUDY DESIGN

We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N = 925) and hearing (N = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for sociodemographic and clinical characteristics.

RESULTS

Among DHH women (N = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women (N = 28,95) during the antenatal period (all ps < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p < 0.001) and inpatient stays (RR = 1.89; p < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p-values < 0.001).

CONCLUSION

The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed.

KEY POINTS

· Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes..

Deaf perceptions about treatment for alcohol use and mental health

INTRODUCTION

Recent research suggests that alcohol use disorder may be more prevalent in the Deaf community, a diverse sociolinguistic minority group. However, rates of treatment-seeking among Deaf individuals are even lower than in the general society. This study used the Theory of Planned Behavior to identify Deaf adults' beliefs about treatment that may prevent their treatment-seeking behaviors.

METHODS

This study conducted elicitation interviews with 16 Deaf adults. The study team recruited participants from across the U.S. and conducted interviews on Zoom. Participant ages ranged from 27 to 67 years (M = 40, SD =10.8). Seventy-five percent of the sample was male, 75 % were White, and 12.5 % were Hispanic/Latine. The study conducted interviews in American Sign Language, subsequently interpreted into English by a nationally certified interpreter, and transcribed for data analyses. The study analyzed transcripts using the Framework Method. The study team coded the interviews in groups and assessed for saturation (≤ 5 % new themes) of themes throughout the analysis. This study reached saturation in the third group (six total groups).

RESULTS

Identified themes followed the Theory of Planned Behavior constructs. The study identified nine Behavioral Beliefs with four advantages and five disadvantages of seeking treatment, four Normative Beliefs with one support and three oppositions to seeking treatment, and thirteen Control Beliefs with five facilitators and eight barriers to seeking treatment. Overall, the Deaf participants reported several unique beliefs based on their cultural and linguistic perspectives, including a concern about unqualified providers, experiencing stress in treatment with hearing providers, stigma within the Deaf community, less access to cultural information about alcohol and mental health, less encouragement of traditional treatment in marginalized communities, and additional barriers (e.g., communication, limited Deaf treatment options, discrimination, etc.).

CONCLUSIONS

A thorough understanding of individual beliefs about treatment is necessary to develop interventions that may increase treatment-seeking behaviors. Previous research has demonstrated that individual beliefs may be modified using Cognitive Behavioral Therapy techniques to increase treatment-seeking behaviors among hearing individuals. Similar interventions may be useful with Deaf individuals; however, they must consider the unique cultural and linguistic perspectives of the community.

Severe maternal morbidity in deaf or hard of hearing women in the United States

OBJECTIVE

Prior studies on severe maternal morbidity (SMM) have often excluded women who are deaf or hard of hearing (DHH), even though they are at increased risk of pregnancy complications and adverse birth outcomes. This study compared rates of SMM during delivery and postpartum among DHH and non-DHH women.

METHODS

This nationally representative retrospective cohort study used hospital discharge data from the 2004-2020 Health Care and Cost Utilization Project Nationwide Inpatient Sample. The risk of SMM with and without blood transfusion during delivery and postpartum among DHH and non-DHH women were compared using modified Poisson regression analysis. The study was conducted in the United States in 2022-2023.

RESULTS

The cohort included 9351 births to DHH women for the study period, and 13,574,382 age-matched and delivery year-matched births to non-DHH women in a 1:3 case-control ratio. The main outcomes were SMM and non-transfusion SMM during delivery and postpartum. Relative risks were sequentially adjusted for sociodemographic characteristics, hospital-level characteristics, and clinical characteristics. In unadjusted analyses, DHH women were at 80% higher risk for SMM (RR = 1.81, 95% CI 1.63-2.02, p < 0.001) during delivery and postpartum compared to non-DHH women. Adjustment for socio-demographic and hospital characteristics attenuated risk for SMM (RR = 1.54, 95% CI 1.38-1.72, p < 0.001). Adjustment for the Elixhauser comorbidity score further attenuated the risk of SMM among DHH women (RR = 1.13, 95% CI 1.01-1.26, p < 0.05).

CONCLUSION

The findings of this study demonstrate a critical need for inclusive preconception, prenatal, and postpartum care that address conditions that increase the risk for SMM among DHH people.

Child maltreatment among deaf and hard-of-hearing adolescent students: associations with depression and anxiety

Objective

Child abuse and neglect have several short- and long-term consequences for the victim. Though Deaf and Hard-of-Hearing children are at higher risk of being maltreated as compared to hearing children, little research in Saudi Arabia has focused on this population. To determine the prevalence of child maltreatment and to examine its association with depression and anxiety among a sample of Deaf and Hard-of-Hearing students in Saudi Arabia, recruited from secondary schools in southern Saudi Arabia.

Methods

The sample included 186 Deaf and Hard-of-Hearing students aged 14-17 years (M = 15.7 years; SD = 3.41 years). Data were collected using the Child Abuse Self-Report Scale, Center for Epidemiological Studies Depression Scale for Children, and Generalized Anxiety Disorder Questionnaire. Bivariate and Linear regression analyses were conducted using SPSS 20.

Results

About 47.3% of the students were exposed severe to very severe child maltreatment. The severity of maltreatment varied based on parents' educational and income level, number of children in the family, the Deaf and Hard-of-Hearing student's gender, and parents' hearing status. Linear regression analysis indicated that child maltreatment was a significant predictor of depression and anxiety in this sample.

Conclusion

Considering the socio-demographic factors influencing the prevalence of maltreatment in the present study, it seems important to work with parents of Deaf and Hard-of-Hearing children to improve their skills in rearing a child with special needs. Addressing the social stigma and social barriers experienced by DHH individuals through familial, institutional, and community interventions may be a first step toward long-term prevention of maltreatment among DHH children.

Deaf signers and hearing aids: motivations, access, competency and service effectiveness

OBJECTIVES

This study concerns culturally Deaf signers in the UK who use hearing aids and (i) explores motivations for hearing aid use (ii) identifies barriers and facilitators to accessing NHS hearing aid services, (iii) examines cultural competency of hearing aid clinics and (iv) identifies factors influencing effective adult hearing aid service provision.

DESIGN

Online survey in British Sign Language and English that was informed by Deaf service users.

STUDY SAMPLE

75 Deaf adult BSL users who wear hearing aids and use NHS hearing aid clinics.

RESULTS

No specific reason emerged as outstandingly important for hearing aid use; however, assisting with lipreading (57%) and listening to music (52%) were rated as very/extremely important. Access issues reported were contacting clinics, poor communication with staff and lack of Deaf awareness. To be an effective and culturally competent hearing aid clinic for Deaf signers, a good understanding of Deaf culture and language was most rated as important (87%).

CONCLUSION

The study is the first that explores hearing aid use and experiences of accessing hearing aid clinics from Deaf signers' perspectives. Enhancements to clinical practice are required to consider culturally Deaf people's motivations for hearing aid use and make services more BSL-friendly.

Cultural competence in NHS hearing aid clinics: a mixed-methods case study of services for Deaf British sign language users in the UK

BACKGROUND

This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers.

METHODS

This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels.

RESULTS

Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness.

CONCLUSION

This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.

Exploring spirituality and quality of life in individuals who are deaf and have intellectual disabilities

PURPOSE

While positive contributions of religion and spirituality (R/S) to quality of life (QOL) are confirmed by a growing body of evidence, only limited research has involved people with intellectual disabilities and so far, no studies included prelingually deaf individuals with intellectual disabilities. This study explores the role of R/S in people with intellectual disabilities and deafness living in three therapeutic living communities specifically adapted to their needs.

METHODS

Forty-one individuals (mean age: 46.93 years, 43.9% female) with prelingual deafness and mild to moderate intellectual disability participated in structured sign language interviews adapted to their cognitive-developmental level, regarding their QOL, individual spirituality and participation in spiritual practices in the community. Participants' QOL was assessed with an established short measure for QOL (EUROHIS-QOL) adapted to easy-to-understand sign language. With 21 participants, qualitative interviews were conducted. In addition, proxy ratings from caregivers were obtained.

RESULTS

The participants' ratings of their individual spirituality (r = 0.334; p = 0.03) and spiritual practices-in-community (r = 0.514; p = 0.00) correlated positively with their self-reported QOL. Qualitative findings illustrate the importance of R/S and give insights into R/S concepts and practices.

CONCLUSIONS

Personal spirituality and participating in spiritual practices are positively related to self-reported quality of life in deaf individuals with intellectual disability (ID). As a consequence, access to spiritual and religious services should be included in comprehensive programs and society at large.

Social perception in deaf individuals: A meta-analysis of neuroimaging studies

Deaf individuals may report difficulties in social interactions. However, whether these difficulties depend on deafness affecting social brain circuits is controversial. Here, we report the first meta-analysis comparing brain activations of hearing and (prelingually) deaf individuals during social perception. Our findings showed that deafness does not impact on the functional mechanisms supporting social perception. Indeed, both deaf and hearing control participants recruited regions of the action observation network during performance of different social tasks employing visual stimuli, and including biological motion perception, face identification, action observation, viewing, identification and memory for signs and lip reading. Moreover, we found increased recruitment of the superior-middle temporal cortex in deaf individuals compared with hearing participants, suggesting a preserved and augmented function during social communication based on signs and lip movements. Overall, our meta-analysis suggests that social difficulties experienced by deaf individuals are unlikely to be associated with brain alterations but may rather depend on non-supportive environments.

Development of mental health and psychosocial support (MHPSS) guidelines for deaf and hard of hearing children in the Gaza Strip

Deaf and hard of hearing children in the Gaza Strip may be at risk of mental health conditions and psychological distress, as a result of social exclusion and limited accessible communication. This article presents the process and research methods used to develop guidelines for schools in the Gaza Strip on mental health and psychosocial support for deaf and hard of hearing children. The process was guided by the GIN-McMaster guideline development checklist across four steps: (1) priority settings; (2) searching for evidence; (3) developing recommendations; (4) evaluation. Priority setting was spearheaded by local and international researchers, and a local steering committee comprised of deaf and hard of hearing representatives, school administration and staff, mental health specialists, family members and government officials. In searching for evidence, and in order to generate evidence-based recommendations for the guidelines, we utilised a scoping review of global mental health support for deaf and hard of hearing children and qualitative research with deaf and hard of hearing children and adults, families and teachers. Two pilot studies were conducted in mainstream and specialist educational settings as way of evaluation. The scoping review and qualitative research identified various content for the guidelines, including the importance of information on disability and deafness, promoting social inclusion and self-esteem, and accessible learning environments. The pilot studies demonstrated feasibility and acceptability among teachers and deaf and hard of hearing children, although teachers need sufficient support and resources to implement. Now finalised, the guidelines are being distributed to schools in the Gaza Strip to support the mental health and wellbeing of deaf and hard of hearing children.

The effect of anxiety, depression, and structural social capital on life satisfaction among people with hearing disabilities: a cross-sectional study in Shanghai, China

Background

Life satisfaction (LS) serves as a crucial indicator of social wellbeing and plays a significant role in formulating strategies aimed at enhancing health outcomes among the hearing-disabled population. This study aimed to examine the effect of anxiety, depression, and structural social capital on life satisfaction among people with hearing disabilities in Shanghai, China.

Methods

A cross-sectional study was conducted in Shanghai, China. As of March 2022, 337 people with hearing disabilities were recruited from the Shanghai Disabled Persons' Federation. An online survey was conducted using a four-part questionnaire to collect data including demographic characteristics, the Hospital Anxiety and Depression Scale (HADS), the Social Capital Scale (SCS), and a single-item question to measure life satisfaction. One-sample t-tests, Pearson's correlation analysis, and hierarchical multiple regression analysis were performed.

Results

Anxiety (β = - 0.153) and depression (β = - 0.242) were significant factors influencing life satisfaction among people with hearing disabilities. Structural social capital also played an influential role in life satisfaction, and people with hearing disabilities who lack social networks (β = 0.125) and social support (β = 0.121) reported significantly lower levels of life satisfaction. However, no significant relationship was found in this study between LS and other components of structural social capital, such as social participation.

Conclusion

This study shows that paying attention to mental health is critical for people with hearing disabilities to achieve social wellbeing and promote LS improvement. At the same time, the government and society also need to focus on the structural social capital, provide various social service programs, enhance social support, and expand social networks, improving LS for people with hearing disabilities.

Barriers and facilitators to the inclusion of deaf people in clinical trials

BACKGROUND/AIMS

This article discusses the barriers that prevent deaf people from participating in clinical trials and offers recommendations to overcome these barriers and ensure equal access to study participation.

METHODS

Between April and May 2022, we conducted six focus groups with 20 deaf adults who use American Sign Language, all of whom had previous experience as research study participants. Focus group prompts queried community awareness of clinical trial opportunities, barriers and facilitators to deaf people's participation in clinical trials, and recommended resources to improve clinical trial access. This qualitative focus group data is supplemented by survey data gathered from 40 principal investigators and clinical research coordinators between November 2021 and December 2021. The survey queried researchers' prior experiences with enrolling deaf participants in clinical trials and strategies they endorse for enrollment of deaf participants in future clinical trials.

RESULTS

Focus group participants unanimously agreed that, compared to the general hearing population, deaf sign language users lack equivalent access to clinical trial participation. Reported barriers included lack of awareness of clinical trial opportunities, mistrust of hearing researchers, and refusal by clinical trial staff to provide accessible communication (e.g. denial of requests for sign language interpreters). Survey data from 40 principal investigators and clinical research coordinators corroborated these barriers. For example, only 2 out of 40 survey respondents had ever enrolled a deaf person in a clinical trial. Respondents indicated that the most helpful strategies for including deaf sign language users in future clinical trials would be assistance with making recruitment information accessible to deaf sign language users and assistance in identifying qualified interpreters to hire to help facilitate the informed consent process.

CONCLUSION

The lack of communication accessibility is the most common factor preventing deaf sign language users from participating in clinical trials. This article provides recommendations for hearing researchers to improve deaf people's access to clinical trials moving forward, drawing from mixed-methods data.

Effects of Cha-Cha Dance Training on Physical-Fitness-Related Indicators of Hearing-Impaired Students: A Randomized Controlled Trial

(1) Background: The physical fitness (PF) of hearing-impaired students has always been an international research hotspot since hearing-impaired students have difficulty in social interactions such as exercise or fitness programs. Sports interventions are proven to improve the fitness levels of hearing-impaired students; however, few studies evaluating the influence of Cha-cha (a type of Dance sport) training on the PF levels of hearing-impaired students have been conducted. (2) Purpose: This study aimed to intervene in hearing-impaired children through 12 weeks of Cha-cha dance training, evaluating its effects on their PF-related indicators, thus providing a scientific experimental basis for hearing-impaired children to participate in dance exercises effectively. (3) Methods: Thirty students with hearing impairment were randomly divided into two groups, and there was no difference in PF indicators between the two groups. The Cha-cha dance training group (CTG, n = 15) regularly participated in 90-min Cha-cha dance classes five times a week and the intervention lasted a total of 12 weeks, while the control group (CONG, n = 15) lived a normal life (including school physical education classes). Related indicators of PF were measured before and after the intervention, and a two-way repeated-measures analysis of variance was performed. (4) Results: After training, the standing long jump (CONG: 1.556 ± 0.256 vs. CTG: 1.784 ± 0.328, p = 0.0136, ES = 0.8081), sit-and-reach (CONG: 21.467 ± 4.539 vs. CTG: 25.416 ± 5.048, p = 0.0328, ES = 0.8528), sit-ups (CONG: 13.867 ± 4.912 vs. CTG: 27.867 ± 6.833, p < 0.0001, ES = 2.4677) and jump rope (CONG: 52.467 ± 29.691 vs. CTG: 68.600 ± 21.320, p = 0.0067, ES = 0.6547) scores showed significant differences. (5) Conclusions: After 12 weeks of Cha-cha dance training for hearing-impaired students, the PF level of hearing-impaired students in lower-body strength, flexibility, core strength, and cardiorespiratory endurance were effectively improved; however, there was no significant change in body shape, upper-body strength, vital capacity, and speed ability.

Satisfaction with life in a sample of prelingually deaf cochlear implant users with a good command of spoken Polish as the primary language

INTRODUCTION

This study investigated the level of satisfaction with life (SWL) in a group of cochlear implant (CI) users who had been prelingually deaf but were orally educated. They had received one or two CIs (as a child, adolescent, or adult) and were highly competent Polish speakers. This study looked at three factors that may affect SWL - psychosocial, deafness/hearing and communication related, and sociodemographic.

METHODS

The participants were prelingually deaf CI users who had learned highly competent spoken Polish as their primary language. They had been educated in mainstream or integrated schools (not schools for the deaf), and had no other disability or severe illness. Measurements were done with 5 questionnaires: the Satisfaction With Life Scale (SWLS), the I-Others Questionnaire, the Patient Health Questionnaire (PHQ-9), the Deaf Identity Development Scale (DIDS), and the Nijmegen Cochlear Implant Questionnaire (NCIQ).

RESULTS

The SWL level of the group was similar to that of the standard Polish population. SWL was positively related to positive self-perception, acceptance of oneself as a deaf person, and to perceiving the benefits of having a CI (as measured by three NCIQ domains: self-esteem, activity limitations, and social interactions). On the other hand, negative self-perception, marginal deaf identity, and depressive symptoms were negatively related to SWL. There was no relationship between SWL and knowledge of sign language. Lower depressive symptoms and greater hearing loss were both significant predictors of SWL, although those who used two CIs generally had a lower SWL.

CONCLUSIONS

Prelingually deaf CI users with low SWL require psychological support in many spheres, including working through problems of deaf identity, self-acceptance, and depression. Additional research should involve diverse DHH CI users, including those with limited spoken Polish competency or sign language skills, as well as members of the Polish Deaf community.

Socio-Emotional Experiences and Wellbeing of Deaf and Hard of Hearing Children and Their Parents before and during the COVID-19 Pandemic

Deaf and hard of hearing (DHH) children in Victoria, Australia, were exposed to strict public health restrictions, including sustained lockdowns, during the COVID-19 pandemic. DHH children have higher health and socio-emotional needs than their hearing peers. We aimed to (1) describe the socio-emotional experiences of DHH children and their parents and (2) compare child and parent socio-emotional wellbeing, before and during the COVID-19 pandemic. Between May and September 2020, 497 (62%) parents of DHH children from the Victorian Childhood Hearing Longitudinal Databank completed an online survey. Measures were drawn from the CoRonavIruS Health Impact Survey (CRISIS) v3.0. Data were summarized using descriptive statistics to compare outcomes before and during the pandemic. Parents reported their children to have more negative socio-emotional wellbeing (mean emotions/worries score, EWS, changed from 0.76 pre-pandemic to 1.10 during the pandemic, mean difference 0.34, 95% CI: 0.28 to 0.39), regardless of the type or severity of hearing loss. Parents also had more negative socio-emotional wellbeing (mean EWS changed from 1.05 pre-pandemic to 1.43 during the pandemic, mean difference 0.38, 95% CI: 0.31 to 0.44). Negative socio-emotional experiences co-occurred with large social changes during the pandemic. Additional services should support the socio-emotional wellbeing of DHH children during significant adverse childhood experiences.

Communication, inclusion and psychological wellbeing among deaf and hard of hearing children: A qualitative study in the Gaza Strip

Deaf and hard of hearing children are at risk of exclusion from community life and education, which may increase their risk of mental health conditions. This study explores the experience of deaf and hard of hearing children in the Gaza Strip, with particular focus on the factors that contribute to psychological wellbeing and distress. In-depth interviews were conducted with 17 deaf and hard of hearing children, 10 caregivers of deaf and hard of hearing children and eight teachers of deaf and hard of hearing children in mainstream and special schools, across the Gaza Strip. Further, three focus group discussions were held with deaf and hard of hearing adults and disability leaders, mental health specialists and other teachers of deaf and hard of hearing children. Data collection was completed in August 2020. Key themes identified in the analysis included lack of accessible communication, community exclusion, negative attitudes towards hearing impairment and deafness and the impact on deaf and hard of hearing children's sense of self, and limited family knowledge on hearing impairment and deafness. Further findings focused on strategies to improve the inclusion of deaf and hard of hearing children and how to promote wellbeing. In conclusion, participants in this study believed that deaf and hard of hearing children in the Gaza Strip are at increased risk of mental health conditions. Changes are needed across community and government structures, including education systems, to promote the inclusion of deaf and hard of hearing children and to support their psychological wellbeing. Recommendations from the findings include increasing efforts to improve awareness and reduce stigma, providing better access to sign language for deaf and hard of hearing children, and offering training for teachers of deaf and hard of hearing children, especially in mainstream environments.

Sensitivity to Deaf Culture Among Otolaryngology and Audiology Trainees

OBJECTIVE

The Deaf community is an ethnolinguistic minority group. Low sensitivity to Deaf culture contributes to health disparities among Deaf patients. This study determines the level of sensitivity to Deaf culture among otolaryngology-head and neck surgery (OHNS) and audiology trainees.

METHODS

Cross-sectional survey study of OHNS and audiology trainees from 10 large US institutions. Trainees were queried on their exposure to and comfort with Deaf patients and their education on, attitude toward, and awareness and knowledge of Deaf culture. Sensitivity to Deaf culture was operationalized as awareness and knowledge of Deaf culture. These were assessed using a 35-item instrument that was previously developed using a d/Deaf community-based participatory approach to research. We used T-tests to compare the sample to previous samples of medical students with training in Deaf culture (MS-TDCs) and general practitioners (GPs).

RESULTS

There were 91 completed surveys (response rate 44.5%). Almost all were aware of Deaf culture (97.8%). The mean knowledge score was 55.0% (standard deviation (SD) 13.4%), which was significantly higher than that for GPs at 43.0% (SD 15.0%) (95% confidence interval 8.1%, 15.8%, P < .0001) but significantly lower than that for MS-TDCs at 69.0% (SD 13.0%)(CI -20.3%, -7.6%, P < .0001). Knowledge scores were comparable for OHNS and audiology trainees (P = .09).

CONCLUSION

This sample of OHNS and audiology trainees was more sensitive to Deaf culture than GPs but less sensitive than MS-TDCs. Developing specialty-specific education may be warranted.

LEVEL OF EVIDENCE

4.

Hearing Impairment, Mental Health Services Use, and Perceived Unmet Needs Among Adults With Serious Mental Illness: A Cross-Sectional Study

PURPOSE

Individuals with hearing impairment have higher risks of mental illnesses. We sought to develop a richer understanding of how the presence of any hearing impairment affects three types (prescription medication, outpatient services, and inpatient services) of mental health services utilization (MHSU) and perceived unmet needs for mental health care; also, we aimed to identify sociodemographic factors associated with outpatient mental health services use among those with hearing impairment and discuss potential implications under the U.S. health care system.

METHOD

Using secondary data from the 2015-2019 National Survey on Drug Use and Health, our study included U.S. adults aged ≥ 18 years who reported serious mental illnesses (SMIs) in the past year. Multivariable logistic regression was used to examine associations of hearing impairment with MHSU and perceived unmet mental health care needs.

RESULTS

The study sample comprised 12,541 adults with SMIs. Prevalence of MHSU (medication: 55.5% vs. 57.5%; outpatient: 37.1% vs. 44.2%; inpatient: 6.6% vs.7.1%) and unmet needs for mental health care (47.5% vs. 43.3%) were estimated among survey respondents who reported hearing impairment and those who did not, respectively. Those with hearing impairment were significantly less likely to report outpatient MHSU (OR = 0.73, 95% CI [0.60, 0.90]).

CONCLUSIONS

MHSU was low while perceived unmet needs for mental health care were high among individuals with SMIs, regardless of hearing status. In addition, patients with hearing impairment were significantly less likely to report outpatient MHSU than their counterparts. Enhancing communication is essential to improve access to mental health care for those with hearing impairment.

A comparative study of the attentional blink of facial expression in deaf and hearing children

The rapid serial visual presentation paradigm was used to investigate differences in the attentional blink between deaf children and hearing children in response to facial expressions of fear and disgust. The results showed that: (1) deaf and hearing children had a higher accuracy rate for T1 with disgustful facial expression than T1 with fear facial expression, (2) There was no significant difference in attentional blink between deaf and hearing children, (3) When T2 appeared at Lag6, the response accuracy of T2 in the disgust T1 condition was lower than that in fear T1 condition. However, no significant difference in T2 at Lag2 was found between the two conditions. The results showed that deaf children and those with hearing were more sensitive to facial expressions of disgust, which captured more attentional resources, and the ability of visual attention of deaf children was not weaker than hearing children.

Translation and Validation of the Hearing Environments and Reflection on Quality of Life (HEAR-QL) Questionnaire for Children and Adolescents in Arabic

Background There are numerous quality-of-life (QoL) assessment tools available; however, only a few are designed specifically for children with chronic conditions. Among these assessment tools are the Hearing Environments and Reflection on QoL questionnaires for children (HEAR-QL26, HEAR-Q28) developed by Washington University. Unfortunately, there are no other tools that assess hearing loss, and none of them are in Arabic. This paper aims to adapt the HEAR-QL to Arabic and provide an accessible method of measuring the QoL of children with hearing loss in our Arabic-speaking populations. Methodology An independent medical translator translated the HEAR-QL26 and HEAR-QL28 into Arabic. The translations were then examined by two bilingual, native Arabic-speaking otolaryngologists who modified the inadequate questions. Back-translation of the Arabic version into English was subsequently performed by an independent translator. Intra-rater reliability was tested for each of HEAR-QL26 and HEAR-QL28 using 10 participants for each survey, where the participants answered the surveys twice with a period of two weeks between them. A pilot study was conducted which had a total of 40 participants divided equally between the two surveys where each group had an equal number of hearing participants and participants with hearing loss. Results Both HEAR-QL26 and HEAR-QL28 were validated with an overall intra-rater reliability of 88.85% and 87.86% respectively. In the pilot study, the HEAR-QL26 participants with normal hearing scored a median of 2437.5, while the participants with hearing loss scored a median of 1837.5 (p = 0.001). Moreover, HEAR-QL28 participants had a median score of 2725 among participants with normal hearing and 1725 for participants with hearing loss (p = 0.001). Conclusion HEAR-QL is a well-established QoL in children with hearing loss. The validated Arabic adaptation can now be used to measure deafness in Arabic-speaking children.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Characterization of sleep among deaf individuals

OBJECTIVES

Numerous health disparities are documented in deaf population research, but few empirical sleep assessments exist for this under-served population, despite knowledge that sleep contributes to physical and mental health disparities. We sought to document subjective and objective sleep in deaf adults with cross-sectional and prospective measures.

METHODS

Twenty deaf participants completed validated sleep and mental health questionnaires, 2-weeks of nightly sleep diaries and continuous wrist-worn actigraphy monitoring, and 1-week of nightly, reduced-montage EEG recordings.

RESULTS

Questionnaire data suggest high prevalence of insomnia (70%), poor sleep (75%), daytime sleepiness (25%) and nightmares (20%) among participants. Strong correlations were found between depression and sleep quality, fear of sleep, and insomnia severity (p's < .005). Objective sleep assessments suggest elevated wake after sleep onset and low sleep efficiency and sleep duration.

CONCLUSIONS

The prevalence of sleep disturbance recorded from self-report and objective sleep measures provides preliminary evidence of sleep health disparity among deaf adults.

Introducing the READY Study: DHH Young people's Well-Being and Self-Determination

READY is a self-report prospective longitudinal study of deaf and hard of hearing (DHH) young people aged 16 to 19 years on entry. Its overarching aim is to explore the risk and protective factors for successful transition to adulthood. This article introduces the cohort of 163 DHH young people, background characteristics and study design. Focusing on self-determination and subjective well-being only, those who completed the assessments in written English (n = 133) score significantly lower than general population comparators. Sociodemographic variables explain very little of the variance in well-being scores; higher levels of self-determination are a predictor of higher levels of well-being, outweighing the influence of any background characteristics. Although women and those who are LGBTQ+ have statistically significantly lower well-being scores, these aspects of their identity are not predictive risk factors. These results add to the case for self-determination interventions to support better well-being amongst DHH young people.

Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model

OBJECTIVE

To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being.

DESIGN

A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change).

STUDY SAMPLE

Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3).

RESULTS

Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss.

CONCLUSION

Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Postpartum Hospital Readmissions Among Massachusetts Women Who are Deaf or Hard of Hearing

Objectives: Deaf or hard of hearing (DHH) women are at a higher risk of adverse pregnancy and birth outcomes compared with other women. However, little is known about postpartum outcomes among DHH women. The objective was to compare the risk of postpartum hospitalizations for DHH compared with non-DHH women and the leading indications for postpartum admissions. Materials and Methods: We analyzed data from the 1998-2017 Massachusetts Pregnancy to Early Life Longitudinal Data System and identified 3,546 singleton deliveries to DHH women and 1,381,439 singleton deliveries to non-DHH women. We used Cox proportional hazard models to compare the first hospital admission and ≥2 hospital admissions between DHH and non-DHH women within 1-42, 43-90, and 91-365 days after delivery. Results: DHH women had a higher risk for any hospital admissions across all periods (hazard ratios [HR] = 1.84; 95% confidence intervals [CI] 1.46-2.34 within 1-42 days; HR = 2.76; 95%CI 1.99-3.83 within 43-90 days; and HR = 3.10; 95%CI 2.66-3.60 91-365 days) after childbirth compared with non-DHH women. They had an almost seven times higher risk for repeated hospital admissions within 43-90 days (HR = 6.84; 95%CI 1.66-28.21) and nearly four times higher the risk within 91-365 days (HR = 3.63; 95%CI 2.00-6.59) after delivery compared with non-DHH women. The leading indications for readmission among DHH women included: conditions complicating the puerperium/hemorrhage and soft tissues disorders. Conclusion: Compared with other women, DHH women had significantly higher readmissions across all postpartum periods and for repeated admissions >42 days. Leading postpartum indications were distinct from those of non-DHH women.

Drinking to cope and coping strategies in Deaf/Hard of hearing college students

INTRODUCTION

Deaf and hard of hearing (DHH) students experience unique stressors as a minority linguistic and cultural group that may contribute to problematic substance and alcohol use behavior. Proper coping strategies may be one protective factor to avoid reliance on alcohol as a means to reduce stress.

METHODS

The current study compared the endorsement of coping strategies by DHH students and hearing individuals and their relationship to drinking to cope behavior. Data was collected among DHH (n = 126) and hearing students (n = 349) at a large university.

RESULTS

While these two groups did not differ in their levels of problematic drinking behavior, there were differences observed in drinking to cope motives as well as in the levels of coping styles used. DHH students were found to endorse greater levels of emotion-oriented and task-oriented coping than hearing students. Drinking to cope motivations were also higher for DHH students, particularly those who endorsed greater emotion focused coping.

CONCLUSIONS

Interventions and educational efforts involving coping skills is a potentially important area of focus for the DHH student population. Further implications for understanding drinking behavior in this population are discussed.

Altering gene expression using antisense oligonucleotide therapy for hearing loss

Hearing loss affects more than 430 million people, worldwide, and is the third most common chronic physical condition in the United States and Europe (GBD Hearing Loss Collaborators, 2021; NIOSH, 2021; WHO, 2021). The loss of hearing significantly impacts motor and cognitive development, communication, education, employment, and overall quality of life. The inner ear houses the sensory organs for both hearing and balance and provides an accessible target for therapeutic delivery. Antisense oligonucleotides (ASOs) use various mechanisms to manipulate gene expression and can be tailor-made to treat disorders with defined genetic targets. In this review, we discuss the preclinical advancements within the field of the highly promising ASO-based therapies for hereditary hearing loss disorders. Particular focus is on ASO mechanisms of action, preclinical studies on ASO treatments of hearing loss, timing of therapeutic intervention, and delivery routes to the inner ear.

Deaf Children Need Rich Language Input from the Start: Support in Advising Parents

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.

Reproductive Justice for the Deaf Community

Almost half of all pregnancies each year in the United States are mistimed or unwanted and associated with adverse health outcomes. Deaf women are as likely to be pregnant as their hearing counterparts but are 67% more likely to experience unintended pregnancy. Although there are limited data on the sexual health behaviors of deaf individuals, research has shown that deaf people are more likely than the general population to rely on withdrawal and condoms to prevent pregnancy. Further, health resources and communication with physicians are often not fully accessible, with the former often in spoken or written English and the latter when sign language interpreters are not present. The combination of use of less--effective methods of contraception and inaccessible health resources puts deaf women at heightened risk for unintended pregnancy. Deaf women are denied reproductive justice when they are inadequately equipped to practice bodily autonomy and prevent unintended pregnancies. In this commentary, I present literature to illustrate the disparity deaf women face compared with hearing women and to make the case for the association among unintended pregnancy, its adverse effects, and reproductive injustice for deaf women. As a medically trained deaf woman conducting reproductive health research, I leverage my lived experience and accrued knowledge to elucidate the shortcomings and strategies to use. As public health researchers and health care professionals, we can alleviate this injustice with inclusive research methodology, representation on research and health care teams, and ensuring access to health information with time given and accommodations provided.

Behavioral compliance with preventive health measures for students with and without hearing disability during COVID-19 pandemic: A cross-sectional study

Background

Hearing loss affects over 1.5 billion individuals worldwide. Their disability and limited access to the coronavirus (COVID-19) pandemic information make them suffer a greater degree than ordinary people. However, the quantitative studies on the implementation of behavior compliance with preventive health measures for vulnerable groups such as people with hearing disability were limited. The purpose of this study was to explore the compliance with pandemic-related protective health measures among people with hearing disability.

Design

A cross-sectional survey, population-based cohort study of students aged 12-26 years with and without hearing disability was conducted. Behavioral compliance with preventive health measures was collected from the general education institutions and special education schools using an online questionnaire. Logistic regression and structural equation model were used to determine the associations among the demographic variables, different degrees of mental health status and psychological impacts, and preventive health behaviors.

Results

Among 1,589 participants, 485 (30.5%) students are with hearing disability (SHD), and 1,104 (69.5%) students with normal hearing (SNH). The SHD has a significantly lower degree of behavioral compliance with the preventive health measures than SNH has. Hearing disability and anxiety [odds ratio (OR) = 1.54-1.76, p < 0.05] are risk factors for avoiding sharing of utensils during mealtime. Hearing disability, male sex, father's education level, mother's profession, bedtime after 11:00 p.m., anxiety, and depression (OR = 1.45-2.95, p < 0.05) are risk factors for hand hygiene. Male sex (OR = 2.13, p < 0.001) is risk factor and being aged below 18 years old (OR = 0.62, p = 0.03) is protective factor for wearing masks. Exercise (OR = 0.32-0.70, p < 0.01) is the most protective factor for preventive health behaviors. Mediating effect of mental health status and psychological impacts between hearing level and the compliance with the preventive health measures was -0.044 (95% CI: -0.068 to -0.027).

Conclusions

To reduce the risk of contraction, update pandemic information, essential communication services, extra assistance, and support should be provided to these disabled persons who are more susceptible to a public health emergency.

Influence of Bone Conduction Hearing Implantation on Health-Related Quality of Life for Patients with Chronic Otitis Media

BACKGROUND

Chronic otitis media is a major public health burden that can result in a disabling hearing loss. Bone conduction hearing implants are an accepted form of hearing rehabilitation in these patients, but evidence supporting their usage typically comes from studies investigating mixed indications. The objective of our study was to examine how these devices impact health-related quality of life and hearing-disability in adult patients suffering from chronic otitis media.

METHODS

Health Utilities Index-mark III (n = 10) and Speech Spatial and Qualities of Hearing-49 data (n = 6) were extracted for adult patients with chronic otitis media from an international hearing implant registry. Data were compared at baseline and at 12-month post-implantation with a bone conduction hearing implant.

RESULTS

Patients demonstrated a clinically relevant mean utility gain of 0.145 following implantation and clinically relevant mean improvement in global speech spatial and qualities of hearing score following implantation.

CONCLUSIONS

Bone conduction implantation was found to improve hearing and health-related quality of life and reduce hearing disability in a small cohort of patients with chronic otitis media. These data highlight the importance of providing appropriate hearing rehabilitation for individuals with chronic otitis media.

Discrimination and Deaf Adolescents' Subjective Well-Being: The Role of Deaf Identity

This study tested the influence of Deaf identity (cognitive identification and affective identification) on the association between perceived deaf discrimination and subjective well-being among Chinese adolescents who are deaf and hard-of-hearing (DHH), based on the rejection-identification model. Questionnaires on perceived deaf discrimination, subjective well-being, Deaf identity, and demographic information were completed by 246 DHH students (15-23 years old) from special residential schools in China. The results indicated that: (1) higher level of perceived deaf discrimination was significantly associated with lower level of subjective well-being (direct effect = -0.24, 95% confidence interval [CI] = [-0.37, -0.12], p < .001); (2) there was a significant indirect effect of perceived deaf discrimination on subjective well-being via cognitive identification (indirect effect = -0.07, 95% CI = [-0.12, -0.01], p < .05); and (3) positive affective identification due to increased cognitive identification with Deaf community may help counteract the negative impact of perceived deaf discrimination on subjective well-being (indirect effect = 0.06, 95% CI = [0.03, 0.10], p < .001). These findings further support the notion that the different components of group identification should be examined separately.

Development of a Health Behavior Screening Tool for Deaf College Students

Young adults who are Deaf or Hard-of-Hearing (D/HH) face behavioral health risks similar to hearing adults. Despite the emphasis on health behavior screening in health care settings, a brief screening tool in American Sign Language (ASL) does not exist. This manuscript describes the development and pilot testing of an online survey in ASL called the Deaf Health Behavior Report. The Deaf Health Behavior Report includes standardized questions for general health, health behaviors, and psychosocial topics. We invited all D/HH students at a university in Southern California to complete the Deaf Health Behavior Report. A total of 31 D/HH students completed the survey. The most prevalent health risks were related to nutrition, stress, and binge drinking. The Deaf Health Behavior Report is a useful tool for health promotion efforts on college campuses and in general health settings.

Implementing Ability-Based Design: A Systematic Approach to Conceptual User Modeling

The notion of Ability-Based Design , put forth by Wobbrock et al. [80, 82] as a solution to the challenge of creating accessible technology, has been discussed in human-computer interaction research now for over a decade. However, despite being cited as influential on various projects, the concept still lacks a general characterization of how to implement its required focus on abilities. In particular, it lacks a formulation of how to perceive and model users within an articulated design process. To address this shortcoming, we rely on conceptual user modeling to examine Ability-Based Design and propose a characterization of it that is not dependent upon a specific project or research effort, but that enables the ability-based design of new technologies in a systematic manner. Our findings show that Ability-Based Design’s focus on abilities requires important changes in typical user modeling approaches that cannot be met with current techniques. Based on the challenges identified through our analysis, we propose a first modification not only of current user modeling, but of current requirements analysis approaches to address abilities and their intertwined dependencies with tasks and contexts as core elements of conceptual models in Ability-Based Design. We thereby demonstrate not only the complexity of modeling users’ abilities, but also draw out promising ideas and perspectives for future research, emphasizing the need for future evaluative work on our approach.

School wellbeing and psychological characteristics of online learning in families of children with and without hearing loss during the Covid-19 pandemic

This study investigated the psychological characteristics of online learning on Italian students with and without hearing loss (HL) and on their parents, who were forced into isolation during the Covid-19 pandemic. An online survey collected information on socio-demographic data and opinions concerning online learning from 61 children (mean age 11; 25 males, 36 females), including 43 with HL and also from their parents; additionally, school wellbeing and anxiety were assessed. The results showed that, in both the student and parent groups, no significant effect of HL on school wellbeing and anxiety was found. Additionally, in parents, State Anxiety was significantly higher than Trait Anxiety, suggesting one possible impact of lockdown on psychological wellbeing. Differences due to HL were observed and discussed in correlation analyses. The Authors believe that this study is the first contribution to the psychological evaluation of the impact of online learning on families with hearing-impaired children, from the perspective of a successful, inclusive didactic.

What can a national patient registry tell us about psychiatric disorders and reasons for referral to outpatient services in youth with hearing loss?

BACKGROUND

Studies of reasons for referral to the Child and Adolescent Mental Health Services (CAMHS) and subsequent psychiatric disorders are missing in youth with Hearing loss (HL).

AIMS

To examine the referral reasons to CAMHS and the clinically diagnosed psychiatric disorders in youth with HL among the nationally representative population.

METHODS

The study population was a youth with HL referred to CAMHS and registered in the national Norwegian Patient Registry (NPR) during the years 2011-2016. The results were also compared with some data published from CAMHS for the General Youth Population (GenPop).

RESULTS

Among youth with HL, 18.1% had also been referred to CAMHS compared to about 5% in GenPop, at mean age 9.1 years, >70% before age 13 years vs. 46% in the GenPop. Boys with HL comprised 57% and were referred about two years earlier than girls with HL. Compared to the GenPop, youth with HL were referred more frequently for suspected neurodevelopmental- and disruptive disorders, and less frequently for suspected emotional disorders. Girls with HL were referred for suspected Attention-Deficit/Hyperactivity Disorder (ADHD) at about the same rate as boys with HL in the 7-12 year age group. The most frequently registered psychiatric disorders were ADHD: 29.8%, anxiety disorders: 20.4%, and autism spectrum disorders: 11.0%, while disruptive disorders constituted about 5.0%.

CONCLUSIONS

Youth with HL were referred to CAMHS more often, but earlier than the GenPop, mostly due to ADHD disorders. Although more rarely referred for suspected anxiety disorders, these were frequently diagnosed, suggesting that anxiety was not recognized at referral in youth with HL.

Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review

Background

d/Deaf people suffer from inequitable access to healthcare and health information. This results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people have been documented but not systematically analyzed. The purpose of this systematic review is to obtain a global overview of what we know about interventions aimed at improving health equity for d/Deaf people.

Methods

Medline Ovid SP, Embase, CINAHL EBSCO, PsycINFO Ovid SP, Central—Cochrane Library Wiley and Web of Science were searched for relevant studies on access to healthcare and health-related interventions for d/Deaf people following the PRISMA-equity guidelines. We focused on interventions aimed at achieving equitable care and equitable access to health information for d/Deaf people.

Results

Forty-six studies were identified and analyzed. Seven categories of interventions facing healthcare or health education inequities emerged: use of Sign Language (1), translation, validation and identification of clinical tools and scales (2), healthcare provider training program (3), development of adapted healthcare facilities (4), online interventions (5), education programs (6) and videos (7). Despite some methodological limitations or lack of data, these interventions seem relevant to improve equity of care and health education for d/Deaf people.

Conclusion

Interventions that promote healthcare equity, health education amongst d/Deaf patients and healthcare provider awareness of communication barriers and cultural sensitivity show promise in achieving more equitable care for d/Deaf patients. Meaningful engagement of d/Deaf individuals in the conceptualization, implementation and evaluation of health-related interventions is imperative.

Study Protocol: Type 1 Hybrid Effectiveness-Implementation Trial of a Behavioral Parent Training Intervention for Parents of Young Children Who Are Deaf or Hard of Hearing

PURPOSE

Children who are deaf or hard of hearing (DHH) and who use hearing aids or cochlear implants are more likely than their peers with typical hearing to exhibit behavior problems. Although multiple evidence-based interventions for child behavior problems exist, they are rarely delivered to children who are DHH, and no rigorous randomized controlled trials have been conducted to determine their effects with this population. This protocol describes a study aiming to test the effectiveness of an evidence-based behavioral parent training intervention adapted for parents of young children who are DHH and simultaneously to assess key implementation outcomes and multilevel contextual factors influencing implementation.

METHOD

The protocol for a Type 1 hybrid effectiveness-implementation trial of a behavioral parent training intervention for parents of young children who are DHH is presented, including details of the study design, participants, assessments, and analyses. Using a stakeholder-engaged, mixed-methods approach, we will test the effects of the intervention versus treatment as usual on parenting behaviors, child behaviors, and a range of secondary effectiveness outcomes, including adherence to using hearing aids and cochlear implants as well as measures of child speech and language. We will assess the acceptability, feasibility, fidelity, and costs of the intervention from the perspectives of peer coaches who deliver the intervention, hearing health care clinicians (including audiologists and speech-language pathologists), and administrators of programs serving young children who are DHH.

CONCLUSIONS

Results of this trial will inform future efforts to close the gap between prevalence of behavioral problems in young children who are DHH and access to and use of evidence-based interventions to prevent and treat them. If effective, this intervention could be widely implemented using strategies informed by the findings of this study to benefit young children who are DHH and followed in hearing health care and their families.

Exploring accommodations along the education to employment pathway for deaf and hard of hearing healthcare professionals

BACKGROUND

Deaf and hard of hearing (DHH) people are an underserved population and underrepresented among healthcare professionals. A major barrier to success for DHH healthcare professionals is obtaining effective accommodations during education and employment. Our objective: describe DHH individuals' experiences with accommodations in healthcare education.

METHODS

We used an online survey and multipronged snowball sampling to recruit participants who identify as DHH and who had applied to a U.S. health professional school (regardless of acceptance status). One hundred forty-eight individuals representing multiple professions responded; 51 had completed their training. Over 80% had been accepted to, were currently enrolled, or had completed health professions schools or residency programs, and/or were employed. The survey included questions addressing experiences applying to health professions programs and employment; satisfaction with accommodations in school and training; having worked with a disability resource professional (DRP); and depression screening.

RESULTS

Use and type of accommodation varied widely. While in school, respondents reported spending a mean of 2.1 h weekly managing their accommodations. Only 50% were highly satisfied with the accommodations provided by their programs. Use of disability resource providers (DRPs) for accommodations was highest during school (56%) and less frequent during post-graduate training (20%) and employment (14%). Respondents who transitioned directly from school to employment (versus via additional training) were more satisfied with their accommodations during school and were more likely to find employment (p = 0.02). Seventeen respondents screened positive for risk of depression; a positive screen was statistically associated with lower school accommodation satisfaction.

CONCLUSIONS

DHH people study and practice across many health professions. While respondents were mostly successful in entering health professions programs, accommodation experiences and satisfaction varied. Satisfaction with accommodations was related to successful employment and wellness. Low satisfaction was associated with higher likelihood of depression symptoms. To increase representation in the workforce, healthcare professional schools, training programs, and employers should enhance support for the learning and working climates for people with disabilities.

COVID-19 and Deafness: Impact of Face Masks on Speech Perception

BACKGROUND

 The COVID-19 pandemic has made wearing face masks a common habit in public places. Several reports have underlined the increased difficulties encountered by deaf people in speech comprehension, resulting in a higher risk of social isolation and psychological distress.

PURPOSE

 To address the detrimental effect of different types of face masks on speech perception, according to the listener hearing level and background noise.

RESEARCH DESIGN

 Quasi-experimental cross-sectional study.

STUDY SAMPLE

 Thirty patients were assessed: 16 with normal hearing [NH], and 14 hearing-impaired [HI] with moderate hearing loss.

DATA COLLECTION AND ANALYSIS

 A speech perception test (TAUV) was administered by an operator trained to speak at 65 dB, without a face mask, with a surgical mask, and with a KN95/FFP2 face mask, in a quiet and in a noisy environment (cocktail party noise, 55 dB). The Hearing Handicap Index for Adults (HHI-A) was administered twice, asking subjects to complete it for the period before and after the pandemic outburst. A 2-way repeated-measure analysis of variance was performed.

RESULTS

 The NH group showed a significant difference between the no-mask and the KN95/FFP2-mask condition in noise (p = 0.01). The HI group showed significant differences for surgical or KN95/FFP2 mask compared with no-mask, and for KN95/FFP2 compared with surgical mask, in quiet and in noise (p < 0.001). An increase in HHI-A scores was recorded for the HI patients (p < 0.001).

CONCLUSION

 Face masks have a detrimental effect on speech perception especially for HI patients, potentially worsening their hearing-related quality of life.

Encapsulation of Alpha-Lipoic Acid in Functional Hybrid Liposomes: Promising Tool for the Reduction of Cisplatin-Induced Ototoxicity

In this study, in order to address the drawback of cisplatin (CDDP)-induced ototoxicity, we propose a straightforward strategy based on the delivery of a sulfur-based antioxidant, such as lipoic acid (LA), to HEI-OC1 cells. To this aim, hybrid liposomes (LA@PCGC) with a spherical shape and a mean diameter of 25 nm were obtained by direct sonication of LA, phosphatidylcholine and a gelatin-curcumin conjugate in a physiological buffer. LA@PCGC were found to be stable over time, were quickly (i.e., by 1 h) taken up by HEI-OC1 cells, and guaranteed strong retention of the bioactive molecule, since LA release was less than 20%, even after 100 h. Cell viability studies showed the efficiency of LA@PCGC for stabilizing the protective activity of LA. Curcumin residues within the functional liposomes were indeed able to maintain the biological activity of LA, significantly improving (up to 2.19-fold) the viability of HEI-OC1 cells treated with 5 μM CDDP. Finally, LA@PCGC was incorporated within an alginate-based injectable hydrogel carrier to create a formulation with physical chemical features suitable for potential ear applications.

Characteristics of Psychologists Assessing Deaf and Hard of Hearing Clients

Psychological assessment plays a large part in the practice of psychology. Over the years, steps have been taken towards ensuring ethical and culturally sensitive psychological assessment for underserved populations, but little is known about the current state of the field of assessment of deaf and hard-of-hearing (DHH) individuals. An exploratory survey of school and clinical psychologists who work with DHH clients (n = 30) was conducted to obtain a snapshot of the state of the field. The current article focuses on sociodemographic characteristics, clinical training, clinical experiences, and language abilities of clinical psychologists who work with DHH clients. Participants averaged 15 years of assessment experience and almost all participants had some type of specialized training in assessing DHH clients. More than half of participants reported their ability to use multiple languages and communication approaches as either excellent or good. Current findings were compared with a similar survey from nearly 50 years ago (Levine, E. S. (1974). Psychological tests and practices with the deaf: A survey of the state of the art. Volta Review, 76, 298-319), and significant differences were found in participants' self-reported experience with DHH clients, training, and methods of communication.

Theory of Mind and Alexithymia in Deaf and Hard-of-Hearing Young Adults

The aim of the current study was to examine theory of mind (ToM), the ability to infer the mental states of others, in young adults who are deaf and hard-of-hearing (DHH), and to explore the influence of alexithymia, an inability to understand emotions of the self and others, on ToM performance in this group. Compared to participants with typical hearing, DHH participants displayed significantly lower affective ToM skills and greater alexithymia. After accounting for verbal intelligence quotient, hearing status and alexithymia significantly contributed to poorer ToM performance, accounting for over 14% of the variance. Having a parent who is deaf and being part of the Deaf community were associated with better emotion processing and appear to be important protective factors. Findings provide support that ToM difficulties may linger into young adulthood among DHH individuals and that alexithymia may be a contributing factor. Early intervention programs emphasizing emotional understanding, perspective-taking, and communication skills are warranted for DHH children as well as their caregivers.