Stress among Parents of Children with Hearing Loss and How They Deal with It: A Systematic Review

Navigating childhood hearing loss: the experiences of parents, grandparents and siblings

PURPOSE

This study aimed to explore the impact of childhood hearing loss on the family unit and their resulting intervention needs.

MATERIALS & METHODS

Qualitative descriptive methodology was used, with in-depth interviews analysed using reflexive thematic analysis. Four family units of children with hearing loss participated in the study, including parents (n = 5), grandparents (n = 7), and siblings (n = 5).

RESULTS

Five themes were developed from interview data: (1) the daily grind; (2) we're all in this together; (3) family dynamics; (4) the early intervention experience and (5) personal growth and adaptations. Family members were impacted in multi-faceted ways and identified informational and emotional intervention needs, with an integrative theme highlighting the emotional toll of childhood hearing loss on families.

CONCLUSIONS

Early intervention services have a crucial role in addressing third-party disability through a multi-disciplinary service delivery model that addresses the needs of all family members, beyond the child with hearing loss.

Psychological burden of hearing-impaired children and their parents through the COVID-19 pandemic

Objective

Childhood hearing impairment has potential repercussions on the mental well-being of both children and their parents. As a vulnerable population in accessing health care services, they may face specific challenges, especially during the COVID-19 pandemic. This cross-sectional study aims to investigate the association between childhood hearing impairment and the mental health of children and their parents, and to assess health care utilization of hearing-impaired children and its impact on mental outcomes for both during the COVID-19 pandemic.

Methods

Using the National Health Interview Survey (NHIS) database, we analyzed data for 15,989 children aged 5-17 and their corresponding parents. The correlations between childhood hearing impairment and mental outcomes were examined using logistic regression models. The 2020 (quarter 3 and quarter 4)-2021 NHIS data was singled out and re-analyzed, focusing on the utilization of medical care during the COVID-19 pandemic.

Results

After accounting for covariates, hearing-impaired children exhibited a higher frequency of anxiety (OR 2.33, 95% CI 1.79-3.02) or depression (OR 2.14, 95% CI 1.59-2.88). Parents of hearing-impaired children had significantly higher odds of a higher frequency of anxiety (OR 1.55, 95% CI 1.20-2.01) or depression (OR 1.73, 95% CI 1.30-2.29). Interaction effect of hearing impairment with survey year on parents' mental health outcomes was observed (p for interaction <0.1). Children with hearing loss had higher odds of reporting delayed medical care (OR 2.00, 95% CI 1.11-3.59) or canceled medical care (OR 1.96, 95% CI 0.98-3.96, p = 0.059) due to the pandemic. Delayed medical care (OR 12.41, 95% CI 2.78-55.46) or canceled medical care (OR 6.26, 95% CI 1.28-30.75) due to the COVID-19 pandemic significantly contributed to the increase of anxiety frequency in hearing-impaired children.

Conclusion

Childhood hearing impairment exhibits a substantial impact on children's and parental mental health, which is further exacerbated by the COVID-19 pandemic. Families of hearing-impaired children appear to be in a vulnerable position during public health emergencies such as the COVID-19 pandemic, which can further exacerbate their mental outcomes.

Cost-effectiveness of portable-automated ABR for universal neonatal hearing screening in India

The World Health Organization considers Universal Neonatal Hearing Screening (UNHS) essential to global public health. Rashtriya Bal Swasthya Karyakram has included newborn hearing screening in India since 2013. The program faces human, infrastructure, and equipment shortages. First-line hearing screening with improved diagnostic accuracy is needed. The Portable Automated Auditory Brainstem Responses (P-AABR) can be used in remote areas for UNHS due to its low infrastructure needs and diagnostic accuracy. This study evaluated the cost-effectiveness of P-AABR in UNHS. We employed an analytical model based on decision trees to assess the cost-effectiveness of Otoacoustic Emission (OAE) and P-AABR. The total cost to the health system for P-AABR, regardless of true positive cases, is INR 10,535,915, while OAE costs INR 7,256,198. P-AABR detects 262 cases, whereas OAE detects 26 cases. Portable Automated ABR costs INR 97 per case detection, while OAE costs INR 67. The final ICER was 97407.69. The P-AABR device is cost-effective, safe and feasible for UNHS Rashtriya Bal Swasthya Karyakram (RBSK) programs. Beyond reducing false referrals and parent indirect costs, it detects more hearing-impaired infants. Even in shortages of skilled workers, existing staff can be trained. Thus, this study suggests integrating this device into community and primary health centers to expand UNHS coverage.

Factors that influence stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants

OBJECTIVE

Stress levels among caregivers of children with hearing loss could influence caregiver-child interactions and ultimately, children's developmental outcomes. Given the limited understanding of stress levels among caregivers of Australian children with hearing loss, the present study aimed to examine stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants and to identify factors associated with greater stress levels.

METHODS

A total of 99 caregivers of 70 hearing aid users and 29 cochlear implant users participated in the study. Caregivers' stress was measured using the 68-item Pediatric Hearing Impairment Caregiver Experience (PHICE) questionnaire that examines caregivers' context-specific stress levels in relation to caring for a child with hearing loss. Factors contributing to stress were identified in relation to eight domains including communication, education, emotional well-being, equipment, financial, healthcare, social, and support.

RESULTS

Across domains, the three most common predictors of increased stress were the use of cochlear implants over hearing aids, use of sign and oral language (mixed) over oral language as the communication mode at home, and increased behavioural difficulties of the child.

CONCLUSION

Overall, reported stress levels among Australian caregivers were low. Identified factors influencing stress levels can inform service provision improvement.

The mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants: Cross-sectional study

PURPOSE

This study aimed to examine the relationship of stress, mental resilience, and coping style, and the mediation effect of mental resilience between stress and coping style among parents of children with cochlear implants.

DESIGN AND METHODS

A cross-sectional design was used. A total of 231 parents of children with cochlear implants were recruited from May 1, 2022, to February 28, 2023 at a comprehensive tertiary hospital and a cochlear implant rehabilitation center in China. Parenting Stress Index-Short Form (PSI-SF), the Connor-Davidson Resilience Scale (CD-RISC) and the Simplified Coping Style Questionnaire(SCSQ) were used to measure stress, mental resilience, and coping style respectively.

RESULTS

The mean score observed for PSI-SF, CD-RISC, active coping, and passive coping was 87.85 ± 24.59, 55.63 ± 16.11, 21.36 ± 6.73, and 9.05 ± 4.52, respectively. Mental resilience was a significant mediator explaining the effect of stress on active coping (β = -0.294; 95% bias-corrected bootstrap CI: -0.358 to -0.164).

CONCLUSIONS

Attention should be paid to the status of stress, mental resilience and coping style in parents of children with cochlear implants. Mental resilience mediated stress and coping style.

PRACTICE IMPLICATIONS

This study provides a theoretical basis for establishing an active coping care program for parents of children with cochlear implants. There is a need to identify strategies that can help increase the level of mental resilience of parents of children with cochlear implants and more subjective and objective social support should be provided to reduce their stress and to encourage active coping style.

Preschool Children with Hearing Loss: Social Communication and Parenting Stress

Studies on parenting stress (PS) in parents of children with hearing loss (HL) have found relationships between child behavior, language skills and parenting stress. The role of early social communication skills has not been researched before. The aim of this cross-sectional study was to investigate the relationship between child behavior, social communication and PS. The study was performed in a subgroup of a total population sample from the AChild (Austrian Children with Hearing Impairment-Longitudinal Databank) study. Preschool children (n = 81) with all degrees of HL and average cognitive functioning and their families were included, and the Parenting Stress Index (PSI) was used. Through factor component analysis, compound scores for externalizing/internalizing problem behavior and hyperactivity were analyzed. Although mean PS was not elevated, the proportion of those with elevated scores was higher compared with the norm population. There was a strong correlation between child behavior problems and PS (strongest correlation: externalizing problem behavior r = 0.643; p < 0.001). All three problem behaviors accounted for 49.7% of the variance in PS. An indirect effect of social communication on PS was almost completely mediated by problem behavior (especially hyperactivity). The importance of social communication development with respect to problem behavior and PS is highlighted.