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Acquired profound hearing loss: Mental health and other characteristics of a large sample

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Abstract and Figures

The study investigated the mental health and other characteristics of people with acquired profound hearing loss (APHL) and contrasted this group with acquired hearing loss (AHL) in general. A survey was completed over the internet by 95 adults and by 27 people who had attended a one-week course of rehabilitation. The latter group completed questionnaires of anxiety and depression, post-traumatic stress, and hearing handicap. The survey covered a wide range of factors associated with the history of hearing loss and evaluated previous contacts with professional services. The data from the two samples were very similar and were combined. The results indicated the existence of sudden and progressive onset groups, reliance on lip-reading, a severe effect of tinnitus, and some support for the conclusion that the psychosocial impact was greater in APHL than in AHL. A subgroup of APHL was severely distressed and handicapped. Respondents valued medical and audiological services but there was little evidence that previous counselling and support had been helpful. Recommendations for rehabilitation are briefly discussed.
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Richard Hallam*
,$
Paul Ashton*
,$
Katerina Sherbourne
$
Lorraine Gailey
$
*Department of Psychology,
University of Greenwich, London,
UK
$
Link Centre for Deafened People,
Eastbourne, UK
Key Words
Acquired profound hearing loss
Rehabilitation
Professional services
Mental health
Internet
Survey
Abbreviations
APHL: Acquired profound hearing
loss
AHL: Acquired hearing loss
HADS: Hospital anxiety and
depression scale
GHSI: Glasgow health status
inventory
LASC: Los Angeles symptom
checklist
PTSD: Post-traumatic stress
disorder
SI: Second informant
Original Article
International Journal of Audiology 2006; 45:715723
Acquired profound hearing loss: Mental health
and other characteristics of a large sample
Hipoacusia adquirida profunda: Salud mental y otras
caracterı
´sticas de una muestra grande
Abstract
The study investigated the mental health and other
characteristics of people with acquired profound hearing
loss (APHL) and contrasted this group with acquired
hearing loss (AHL) in general. A survey was completed
over the internet by 95 adults and by 27 people who had
attended a one-week course of rehabilitation. The latter
group completed questionnaires of anxiety and depres-
sion, post-traumatic stress, and hearing handicap. The
survey covered a wide range of factors associated with the
history of hearing loss and evaluated previous contacts
with professional services. The data from the two samples
were very similar and were combined. The results
indicated the existence of sudden and progressive onset
groups, reliance on lip-reading, a severe effect of tinnitus,
and some support for the conclusion that the psycho-
social impact was greater in APHL than in AHL. A
subgroup of APHL was severely distressed and handi-
capped. Respondents valued medical and audiological
services but there was little evidence that previous
counselling and support had been helpful. Recommen-
dations for rehabilitation are briefly discussed.
Sumario
El estudio investigo´ la salud mental y otras caracterı´sticas
de personas con hipoacusias profundas adquiridas
(APHL) y lo contrasto´ con hipoacusias adquiridas
(AHL) en general. Se completo´ una encuesta por internet
en 95 adultos y 27 personas que habı´an asistido a un
curso de rehabilitacio´n de una semana. Este u
´ltimo grupo
completo´ cuestionarios de ansiedad y depresio´n, de
tensio´n post-trauma´ tica y de impedimento auditivo. La
encuesta cubrio´ un amplio rango de factores asociados
con la historia de pe´rdida auditiva y evaluo´ contactos
previos con servicios profesionales. Los datos de las dos
muestras fueron similares y se combinaron. Los resulta-
dos indicaron la existencia de grupos de inicio su
´bito y
progresivo, dependencia de la labio-lectura, un efecto
severo del acu
´feno, y alguna evidencia para concluir que
el impacto psico-social era mayor en la APHL que en la
AHL. Un subgrupo de APHL se encontro´ severamente
perturbado y en desventaja. Los encuestados valoraron
los servicios me´dicos y audiolo´ gicos, pero existio´ poca
evidencia de que el apoyo y la asesorı´a previa hubieran
sido de valor. Se discuten brevemente recomendaciones
para rehabilitacio´n.
Acquired profound hearing loss (APHL) is the most severe form
of acquired hearing impairment and, by audiological criteria, it
affects approximately 150,000 people in the UK (Davis, 1994). In
this study, based at the LINK Centre for Deafened People, we
adopted a functional definition of APHL: the inability to use
sound alone (aided or unaided) to follow speech, even in optimal
environmental conditions. Unlike the group of people whose
deafness is congenital, people with APHL have usually grown up
with the identity of a hearing person. People with APHL may
gain some benefit from hearing aids and some obtain a cochlear
implant. However, they rely primarily on lip-reading or the
written word (Stewart-Kerr, 1992).
APHL can present unique challenges such as the loss of all
hearing in a very short period of time. The social response to
APHL is often unsympathetic and the failure to communicate
‘normally’ may be met with misunderstanding, sometimes
leading to stigmatization, embarrassment or ridicule (Orlans,
1985). Family members, too, may show a lack of understanding
(Aguayo & Coady, 2001; Schlau, 2004). APHL can have serious
implications for relationships and employment (David & Trehub,
1989). Consequently, people with APHL have been thought to
constitute a special group with distinct characteristics (Luey,
1980; Hogan, 2001). Although this claim has face validity, there
is little empirical evidence to show that APHL has a greater
psychosocial impact than AHL of lesser severity. The surveys
that have been reported in the literature have been conducted on
relatively small samples and have been sourced on the basis of
convenience, usually audiology/rehabilitation facilities or self-
help organizations. An advantage of the present study is its
larger sized sample, sourced either from persons using the LINK
charity or visitors to internet websites.
There is, of course, a large literature on acquired hearing loss
(AHL), which was identified in a UK Government survey as the
‘second most common disability’ after problems of locomotion
(Martin et al, 1988, p. 25). One of the problems in extracting
information about APHL in particular is that previous surveys
ISSN 1499-2027 print/ISSN 1708-8186 online
DOI: 10.1080/14992020600957335
#2006 British Society of Audiology, International
Society of Audiology, and Nordic Audiological Society
R. Hallam
56 Limes Grove, London, SE13 6DE, UK.
E-mail: post@rshallam.vispa.com
Accepted:
August 14, 2006
have included people with a wide range of hearing impairment.
However, certain studies have reported information on sub-
groups with severe hearing loss. In a survey by Jones et al (1987)
only five of 94 participants described themselves as ‘profoundly
deaf’ and 11% were said to have a serious loss (
/70 dB HL in
the better ear). Kerr & Cowie (1997) compared two groups: one
described as ‘profoundly deaf’, and another with ‘severe hearing
loss’, but they sometimes presented their data in combined
form.
If APHL is a distinct group within AHL, the nature and
severity of the psychosocial impact should be correlated with the
degree of hearing loss (usually estimated from pure tone
thresholds). Thomas (1984) presented evidence from two studies
in which ‘only a handful’ of people with APHL were included
(Thomas, 1984, p. 166). The first study comprised 211 employ-
ment-age adults who had been fitted with a hearing aid, at least
one year earlier, at a publicly funded (National Health Service)
clinic. The impact of hearing impairment on work, marriage,
family life and health were investigated and a rating scale for
anxiety and depression (the SAD inventory, Bedford & Foulds,
1978) was administered. The proportion of the total sample
scoring above cut-off for significant anxiety/depression was, at
19%, four times greater than the population average. There was a
strong association between distress scores and pure tone thres-
holds in the better ear. The proportion was 15.5% for mild to
moderate AHL (up to 69 dB HL) and 41% for 70 dB HL and
above. If speech discrimination was also poor, this latter figure
was raised to 57%. In the total sample, rates for unemployment
and divorce/separation were almost identical to those found in
the general population. However, there was evidence of a greater
psychosocial impact in the severe subgroup and high SAD scores
were associated with an adverse effect on marriage and family
life.
In the second study, data were collected from a similar source
on 88 employment-age adults whose measured pure tone hearing
loss was at least 60 dB HL in the speech frequencies of the better
ear (mean level, 76 dB HL). Although the proportion scoring
above cut-off on the SAD was not as high as expected, it was still
nearly four times greater than the general population average
and SAD scores were, once again, associated with a measure
of speech discrimination. There was no evidence that gross
indicators of employment differed from the general population
but amongst the working participants, 62% reported having
suffered a loss of job status. The rate of separation or divorce, at
14.7%, was five times that in the first study. It is fair to conclude
from both studies that the psychosocial impact of hearing
impairment increases with its severity. The response rate was
reasonably high in both studies, at approximately 50%, and
Thomas (1984) reasoned that his estimate of the psychosocial
impact was actually a very conservative one. The correlation
between speech discrimination scores (but not sensory thres-
holds) and level of psychological distress has been confirmed by
Eriksson-Mangold & Carlsson (1991) using the Symptom Check
List (SCL-90-R, Derogatis, 1976).
There is at least one study of APHL that aimed to contact
all possible working age candidates in one city area in which
the authors obtained a sample of 38 described as having a
profound hearing loss and 49 as having a moderate loss (Kerr
& Cowie, 1997). Standardized questionnaires were not em-
ployed, but nearly 40% of all respondents said that their
hearing impairment had badly restricted their lives, and one in
ten felt that it had almost completely destroyed their lives. The
psychosocial impact, derived from several measures, was more
strongly related to employment status than to pure tone
thresholds. The specific ability to communicate could, how-
ever, be predicted from sensory thresholds and dependence on
lip-reading. Similar findings emerged from a study of 311
Swedish adults with severe to profound hearing impairment
(Ringdahl & Grimby, 2000). A measure of health-related
quality of life (HRQL) indicated lower energy levels and
greater distress and social isolation than in the general
population, but this was less true of persons working full-
time. The presence of additional handicaps was the major
predictor of HRQL. Pure-tone thresholds were not predictive
except in a subgroup with additional handicaps.
As can be seen, there is a lack of evidence that concerns
APHL alone. The evidence reviewed so far suggests that
additional factors can contribute to overall psychosocial
impact, e.g. employment status, marital problems, and addi-
tional handicaps. People with APHL are presented with
unique challenges that they may or may not be able to meet
successfully. In fact, there is some evidence of a bimodal
distribution with regard to the psychosocial impact within the
APHL group. Knutson & Lansing (1990) administered the
communication profile for the hearing impaired (CPHI,
Demorest & Erdman, 1987) and several standardized tests of
psychopathology to 27 consecutive referrals for cochlear
implantation. Each participant had a bilateral pure tone
average of at least 95 dB HL. They noted that although
group mean scores on the psychosocial tests were often in the
normal range, there was a wide distribution of scores ‘with
many subjects in the normal range and many evidencing
clinically significant elevations’ (Knutson & Lansing, 1990,
p. 659). It seems likely that as problems accumulate and
interact with increasing hearing impairment, the group of
people with APHL tend to separate out into those who are
able to adjust and those who cannot. Knutson & Lansing
(1990) found interesting patterns of correlation that point to
possible mechanisms. The attitudes and behaviours of others,
and a person’s style of adjusting to hearing loss, were
correlated with depressive symptoms. A different set of
correlations was obtained with a measure of ineffective
communication strategies.
The purpose of the present study was to document the main
characteristics of APHL and compare them, where possible,
with published data on AHL in order to test the claim that
APHL forms a distinct sub-group. We collected data from two
samples: a small sample (N
/27) that also participated in a
separate qualitative study, and a larger sample (N
/95) who
completed a survey via the internet. The interview sample
completed the same survey manually, as well as several
standardized questionnaires as indicators of psychosocial
impact. As we could not be sure that our small sample
of volunteers was representative of the wider population of
APHL, one of our aims was to check the external validity of our
survey findings with a larger and presumably more representa-
tive group obtained from a different source (the internet). Our
preliminary analyses revealed that the results from the two
groups were so similar that we decided to combine their survey
data in the present study.
716 International Journal of Audiology, Volume 45 Number 12
Method
Interview sample
As part of a qualitative study (Hallam et al, in press) of the
impact of APHL, 27 people were interviewed in depth at home;
quantitative data (see below) were also collected and these are
the subject of the present article. All participants had previously
expressed a willingness to volunteer for the study after having
been informed of its nature, been assured of confidentiality, and
having signed forms giving consent. Eighteen of them had
attended a one-week residential course at the LINK Centre, a
charity providing psychological rehabilitation for people with
APHL and their families (Sherbourne et al, 2002); the remainder
were recruited from other contacts with LINK. LINK receives
referrals from professionals, and attendees normally obtain
funding for the course. All participants had developed profound
hearing impairment as adults. The sample was selected for the
purposes of the qualitative study to provide a wide range of
experience and to be balanced for gender, urban and rural
location, and ethnicity. They were drawn from the full adult age
range so that we could investigate the impact on employment.
They were not representative of all users of LINK’s services, a
sample that is weighted towards retired people, and they may not
be representative of APHL in general. It was partly for this
reason that we compared the interview sample with participants
recruited from a different source, the internet.
Questionnaires were sent out to the participant and a second
informant (usually the spouse) in advance of their interviews.
They were instructed to complete them separately, without
consulting. The quantitative measures were available on 23 people
with APHL (four missing). Of the 26 second informants inter-
viewed for the qualitative study, 20 completed the mental health
measure. Nineteen of the second informants were spouses/
partners, six were close family members, and one was a neighbour.
Internet sample
An invitation to take part in a survey about APHL was placed
on LINK’s website and on several internet newsgroups for deaf
and hard-of-hearing people. The survey is described below. It
was completed online by 123 respondents who came mostly from
the UK; 30% came from North America. Nine respondents were
excluded on the grounds of incomplete data and 19 were
excluded on the basis that their hearing impairment was not
profound. The statements we used to create an operational
definition of profound hearing impairment were taken from a
UK Government survey of disability (Martin et al, 1988). The
authors of this report carefully developed a set of questions
across eleven domains of disability, disability being defined as
the extent to which an individual’s performance is limited by
impairment. The highest severity of acquired deafness was
‘Cannot hear sounds at all’ and we included all respondents
who endorsed this statement. We also included participants who
endorsed three out of four of the statements representing the
most profound levels of difficulty with hearing (unaided). These
were: ‘Cannot follow a TV programme with the volume turned
up’, ‘Have difficulty hearing someone talking in a loud voice in a
quiet room’, ‘Cannot hear a doorbell, alarm clock or telephone
bell’ and ‘Cannot use a telephone without amplification’. We
could not independently assess the validity of these criteria, or
obtain audiograms, but the criteria excluded 15% of respondents
who regarded themselves as having a profound acquired hearing
impairment, and so they appear to be sufficiently stringent.
Measures
General survey
The survey asked about the severity and history of deafness,
perceived causes of deafness, associated medical symptoms,
general health, type of aids or devices used, contact with
professional services, evaluation of help received, and demo-
graphic characteristics. The wording of the questions was
taken where possible from previously published surveys, e.g.
Sherbourne & White (1999). Where this was not possible,
questions were discussed with LINK staff until a clear and
unambiguous wording was agreed. The survey was piloted with
several volunteers. The data that are presented below do not
represent the totality of our findings and some categories were
combined to simplify the presentation of results (combinations
are always indicated). A copy of the survey and the full results
can be obtained from the first author.
Standardized questionnaires
These were given to the interview sample only, and, in the case of
the hospital anxiety and depression scale, (HADS), to second
informants.
HADS
HADS (Zigmond & Snaith, 1983) is a 14-item scale, measuring
anxiety and depression, that has been standardized on the UK
population (Crawford et al, 2001). Internal consistencies have
been found to lie between .80 and .93 and test-retest reliability
(2 weeks) is around .85 (Herrman, 1997).
G
LASGOW
H
EALTH
S
TATUS
I
NVENTORY
(GHSI)
GHSI (Gatehouse, 1997) is an 18-item questionnaire (all-
purpose version), devised as a measure of outcome in interven-
tions for patients with hearing-related conditions, and in this
study was used as a general measure of handicap. It comprises a
heterogeneous collection of items referring to general optimism,
effects of hearing loss on social life, etc. Norms are provided for
hearing-related conditions and the general population.
L
OS
A
NGELES
S
YMPTOM
C
HECKLIST
(LASC)
LASC, (King et al, 1995) is a 17-item self-report measure of
symptoms of post-traumatic stress with an internal consistency
of approximately .89 and a test-retest reliability of .94. This
measure was selected on the grounds that sudden onset of APHL
could be regarded as a trauma. It was completed by participants
with respect to their experience of developing a profound
hearing impairment. Norms are available for clinical groups
but not for the general population.
Results
General survey
D
EMOGRAPHIC DETAILS OF THE INTERVIEW AND INTERNET
SAMPLES
(T
ABLE
1)
The samples covered the entire adult age range and between one
third and one half were in employment. The majority were
Acquired profound hearing loss: Mental
health and other characteristics of a large
sample
Hallam/Ashton/Sherbourne/Gailey 717
married. The internet sample contained somewhat fewer married
individuals and more of them were in employment but these
differences were not statistically significant at the 5% level,
applying the Chi Square test.
S
EVERITY OF HEARING
(T
ABLE
2)
The severity of impairment is indicated by the fact that nearly
60% could not hear sounds at all and almost all could not hear a
doorbell, alarm clock, or telephone bell. Around two thirds had
Table 1. Demographic characteristics (figures in parentheses are percentages)
Interview sample
(N
/27)
Internet sample
(N/95)
(5 missing)
Sex (male:female) 13:14 31:59
Mean Age (years) 54.36 51.37
Age Range 2578 21 80
Marital status: (Missing
/2) (Missing/7)
Married or living as married 20 (74.0) 53 (55.7)
Widowed 01 (03.7) 09 (09.4)
Single 03 (11.1) 18 (18.9)
Divorced or separated 01 (03.7) 08 (08.4)
Living alone (with or without children): (Missing
/4) (Missing/8)
Yes 02 (07.4) 28 (29.4)
Employment: (Missing
/2) (Missing/10)
Employed full or part-time 09 (33.3) 45 (47.3)
Retired 10 (37.0) 34 (25.2)
Unemployed 06 (22.2) 16 (16.8)
Nationality: (Missing
/6)
British 27 (100.0) 55 (57.8)
USA/Canada 28 (29.4)
Other 06 (06.3)
Table 2. Total sample - Self-report of present level of hearing
Without any form of aid:
Cannot hear sounds at all 71 (58.2)
Cannot follow a TV programme with the volume turned up 119 (97.5)
Have difficulty hearing someone talking in a loud voice in a quiet room 109 (89.3)
Cannot hear a doorbell, alarm clock or telephone bell 117 (95.9)
Cannot use the telephone without amplification (or at all) 113 (92.6)
Cannot follow a TV programme at a volume others find acceptable 119 (97.5)
Difficulty hearing someone talking in a normal voice in a quiet room 116 (95.1)
Difficulty following a conversation against background noise 121 (99.1)
Wearing an aid or implant (if relevant):
How difficult is it for you to understand people who know you well? (4 missing)
Not difficult at all 39 (32.0)
Quite difficult 51 (41.8)
Very difficult 21 (17.2)
Impossible 7 (5.7)
How difficult is it for you to understand strangers? (6 missing)
Not difficult at all 19 (15.6)
Quite difficult 32 (26.2)
Very difficult 48 (39.3)
Impossible 17 (13.9)
718 International Journal of Audiology, Volume 45 Number 12
difficulty understanding someone they knew well, even when
aided.
H
ISTORY OF HEARING LOSS
(T
ABLE
3)
The onset of hearing loss occurred throughout the lifespan; in a
minority (17%) hearing dropped to a profound level very
suddenly over one week. For half the sample, loss of hearing
took place over a number of years. Thirty-nine per cent of the
sample had experienced a profound loss for more than five years.
As noted, the sample was fairly evenly spread as to when a
difficulty with hearing was first noticed, and a specialist
consulted, but there were more in the internet sample with an
earlier age of noticing it (up to age 20 versus over 20, Chi
Square
/4.42, pB/.05). Around two thirds of the total sample
believed they knew the cause of their hearing loss and indicated
a wide range of causes, the most common of which was ‘heredity’
(34%).
H
EARING AIDS AND COCHLEAR IMPLANTS
(T
ABLE
4)
Just over half of respondents possessed hearing aids, of either
analogue or digital types, usually worn in both ears. Aids were
helpful ‘moderately’ or ‘a lot’ when communicating with others
(65%). Approximately one third were in possession of a cochlear
implant (or in the process of getting one) and one third did not
want one; 10% were undecided. Twelve per cent were told they
were not suitable to have one. Three quarters of implant users
found that it helped them ‘moderately’ or ‘a lot’ to communicate
with others.
P
ROFESSIONAL HELP RECEIVED
(T
ABLE
5)
Participants were asked what specialist they had seen and when
(i.e. now, in the past when first lost hearing, or never) and
whether the professional help had been of use to them. Because
of a potential ambiguity as to whether respondents continued to
be seen over time, only the category of ‘help never received’ is
shown in Table 5. Very few people had never received help from
an audiologist or medical consultant. Least utilized by both
samples was counselling/psychotherapy. Nearly half had never
received help of this kind. A follow-up question asked whether
the help they had received from professionals had been of use to
them (Yes or No). As an approximation to the relative usefulness
of the different kinds of help received, the ratio of ‘yes’ (of use)
to ‘no’ (not useful) was calculated for help received now and in
the past, so that a ratio of less than one indicates that more
people failed to find it useful than those who did. For some
categories (e.g. counsellor/psychotherapist) the numbers were
very small and so the findings must be interpreted cautiously;
nevertheless, the results were consistent across the two samples.
As might be expected, audiologists were most consistently
regarded as useful, followed by medical consultants. Help
received when first deafened was usually regarded as more useful
than help currently received. The lowest ratios were obtained for
counselling/psychotherapy.
The comments produced when participants were asked what
kind of help they would have liked to have received but did not,
can be briefly summarized as follows; the interview sample
wanted a better informed, more responsive and deaf-aware
service from medical professionals. Next most frequently wanted
was counselling/psychological therapy. In the internet sample, a
frequent request was for some form of counselling or support for
themselves (and family) in helping them to cope. Next most
commonly mentioned were (in order) advice/information, more
responsive medical help, lip-reading/signing, and environmental
aids/aids to communication. Although there appears to be a
contradiction between participants not finding counselling
useful and yet wanting it, it must be borne in mind that few
people had received this kind of help. Social workers were rarely
mentioned as offering this kind of support as their main
function was viewed as providing environmental aids.
Around 6570% of participants were in regular contact with
other people with hearing impairments. In around 40%, this was
through a self-help organization.
M
ODES OF COMMUNICATION
(T
ABLES
6
AND
7)
Approximately 60% of respondents said they were able to lip-
read well and over 80% used lip-reading ‘very often’ to ‘always’
in conversation. Signing was rarely used as the main mode of
communication in conversation (just 9%, very often or always).
Finger spelling and paper and pencil were used more frequently
(by around 20% of the sample). A large number of respondents
had attended lip-reading classes and obtained benefit from doing
so.
Table 3. History of hearing loss
At what age did you ....?
Begin to notice any difficulty with your hearing (12 missing)
010 years 20 (16.4)
1120 22 (18.0)
2130 20 (16.4)
3140 20 (16.4)
4150 17 (13.9)
/50 11 (09.0)
When did your hearing drop to the level is it now? (5 missing)
One year ago or less 18 (14.7)
15 years ago 52 (42.6)
More than 5 years 47 (38.5)
How suddenly did you lose your hearing? (6 missing)
Over one week 21 (17.2)
Between one week and a month 20 (16.4)
Over about six months 4 (03.2)
Over about one year 7 (05.7)
Over a number of years 64 (52.4)
Table 4. Aids and implants
Do you wear hearing aids? (5 missing)
Yes 72 (59.0)
Have you ever wanted a cochlear implant(s)? (2 missing)
Yes (Have one, or in process of getting one) 39 (32.0)
Yes (but never offered one) 14 (11.5)
Yes (but told not suitable) 15 (12.3)
Undecided 12 (09.8)
No 40 (32.8)
Acquired profound hearing loss: Mental
health and other characteristics of a large
sample
Hallam/Ashton/Sherbourne/Gailey 719
O
THER
ENT
AND HEALTH PROBLEMS
(T
ABLE
8)
Tinnitus was commonly reported and lasted longer than five
minutes in 73% of respondents. In this sub-group, three quarters
were moderately to severely annoyed by tinnitus. Tinnitus
interfered with sleep patterns moderately or severely in 22% of
all participants. Other ENT and health problems were common.
Table 8 summarizes and extracts from more detailed information
in the survey. Despite the number of symptoms reported, only
8% described themselves as in poor health.
Standardized questionnaires (interview sample only)
HADS
The means for people with APHL and their second informants
are shown in Table 9. The proportion scoring above a cut-off (10/
11), indicating a significant level of depressed or anxious mood,
is also given.
The means for the APHL group and for second informants
(SI) did not differ significantly (depression, t, two-tailed,
/.87,
df 41, NS; anxiety, t
/.35, df 41, NS). Depression mean scores,
but not anxiety means, differed significantly from UK norms (t,
two-tailed, APHL depression
/4.42, df 1813, pB/.001; SI
depression
/2.41, df 1810, pB/.02). The proportions scoring
above the recommended cut-off for depression were 17%
(APHL) and 15% (SI). The corresponding figures for significant
anxiety were approximately 30% and 20%. In the general UK
population (N
/1792), the proportions above threshold are
3.6% for depression and 12.4% for anxiety (Crawford et al,
2001). Taken together, the results for our sample represent an
elevation in the rate of significant depressed mood by a ratio of
4.8 for APHL (Chi Square, df 1
/31.60, pB/.001) and by a ratio
of 4.2 for SI (Chi Square
/24.79, pB/.001). The corresponding
figures for significant anxiety were 2.4 (Chi Square
/10.29, pB/
.001) and 1.6 (Chi Square/9.15, p B/.001).
Anxiety and depression scores were positively correlated
within participants, (Pearson r
//0.73, p B/.0001). However,
the anxiety and depression scores of paired APHL and SI
participants (n
/20) were not significantly correlated (depres-
sion, r
//.34, anxiety, r//.07).
GHSI (T
ABLE
10)
The APHL group was significantly handicapped when compared
with a sample of people seeking hearing aid provision; over half
(57%) fell below the lowest score of the general population (low
scores indicate lower health status). The mean score was very
much lower than that obtained from an ENT outpatient group
(Rejali et al, 2004) complaining primarily of tinnitus (t
/23.0,
df
/50, PB/.0001). In a slightly modified, but similarly, scored
version of the GHSI given to adults who had been deafened,
Hawthorne & Hogan (2002) obtained mean scores of 60 for
implanted participants and 44 for non-implantees, emphasizing
the low scores obtained by our own sample.
LASC (T
ABLE
11)
The standard deviation of the scores was considerably greater
than that observed in other clinical groups and the scores were
not normally distributed. The modal value was five, while three
(14%) scored above 40 which is in the range of Vietnam veterans
known to be demonstrating symptoms of post-traumatic stress
disorder (PTSD); four (18%) scored between 20 and 40. The
mean lies somewhere between the results obtained for women
seeking help in the community and a sample of psychiatric
outpatients. The data can be interpreted to mean that a minority
of participants with APHL were experiencing symptoms of post-
traumatic stress to a degree found in known sufferers of PTSD.
Discussion
There seems little question that we have collected data from a
profoundly hearing impaired group of participants of whom
nearly 60% cannot hear sounds at all, and only 16% say they
have no difficulty understanding strangers. In terms of the rate
of onset of APHL, the sample fell into approximately equal-
sized groups, a rapid onset group with loss of hearing within one
year, and a group with a slower rate of onset over several years.
In a Canadian sample of 25, David & Trehub (1989) similarly
found two groups: 15 had a progressive loss, and 10 a sudden
loss. The primary mode of communication in APHL was
Table 5. Professional help received
Ratio of service ‘useful’ to ‘not useful’
None received Now In the past
General practitioner (GP) 27 (22.1) .96 1.75
Medical consultant 18 (14.7) 1.41 2.86
Audiologist 8 (06.5) 4.46 5.28
Hearing therapist 36 (29.5) 1.08 1.40
Counselling/psychotherapist 57 (46.7) .27 .38
Social worker 37 (30.3) .81 1.04
Lip-reading tutor 35 (28.7) 1.06 1.03
Implant team 38 (31.1) .54 .71
Intensive rehabilitation 48 (39.3) .95 1.19
Table 6. Lip-reading
Ability to lip-read: (3 missing)
Not at all or to a small extent 46 (37.2)
Moderately well or very well 73 (59.8)
Attended lip-reading classes: Yes 69 (56.5)
Benefit receive from the classes:
Some or considerable benefit 58 (84.0)
720 International Journal of Audiology, Volume 45 Number 12
through lip-reading, supplemented by aided hearing where this
was possible. More than half of our sample had attended lip-
reading classes. Finger spelling and pencil and paper were more
commonly employed than signing. Similar findings have been
obtained in other studies; Stewart-Kerr (1992) found that 75%
used lip-reading and 20% signs or finger-spelling. In a sample of
35 working adults with severe to profound hearing impairment,
94% wore hearing aids and only 6% used sign language (Grimby
& Ringdahl, 2000). The reliance on lip-reading and the rarity of
signing are perhaps the chief characteristics that mark out
APHL as a distinct group.
There are few questions in the general survey that have a direct
bearing on the hypothesis that the psychosocial impact of APHL
is greater than that found with a lesser severity of hearing
impairment. It is important to bear in mind that the participants
also reported high levels of associated neuro-otological symp-
toms that are likely to be distressing and must have contributed
to the psychosocial impact. Tinnitus ‘moderately’ or ‘severely’
annoying was reported by 55%, and tinnitus interfering with
sleep to a ‘moderate’ or ‘severe degree’ was reported by 22%.
Dizziness and balance problems affecting quality of life ‘mod-
erately’ or ‘severely’ was reported by 30%. The results of a survey
of 71 people with APHL, also sourced from LINK (Sherbourne
& White, 1999), revealed that, with respect to ‘severe’ distress,
27% were affected by tinnitus and 25% by balance difficulties.
Stewart-Kerr (1992) gave a figure of 57% distressed by tinnitus in
her sample of 79 people with APHL. These levels of distress
contrast sharply with the statement of Thomas (1984, p. 155)
that a ‘small minority’ of subjects whose severe AHL was
associated with tinnitus found the latter distressing. In the
general population, 1520% of the population experience a
noticeable degree of tinnitus but only 15% could be said to be
significantly distressed (Great Britain, OPCS, 1983; Smith &
Coles, 1987).
The results of the psychometric tests of mental health in the
interview sample gave a more direct indication of psychosocial
impact. Like Knutson & Lansing (1990) mentioned earlier, we
found evidence of a bimodal distribution of emotional distress
scores. The standard deviations were larger than those
presented in published norms and the modal score was often
in the normal range. On average, depressed mood as measured
by the hospital anxiety and depression scale was significantly
elevated above the level of the general population for both the
APHL group and second informants. The rate of clinically
significant depressed mood was 4.8 times greater than the
population average. In a comparable sample, Sherbourne et al
Table 7. Frequency of using techniques in conversation
always/almost always
(3 missing)
very often
(10 missing)
occasionally
(6 missing)
never
(6 missing)
lip-reading 75 (61.4) 24 (19.7) 13 (10.6) 07 (05.7)
signing 05 (04.1) 06 (04.9) 49 (40.1) 50 (41.0)
finger spelling 07 (05.7) 18 (14.7) 53 (43.4) 38 (31.1)
pen and paper 05 (04.1) 17 (13.9) 64 (52.4) 30 (24.6)
Table 8. Other ENT and health problems
Tinnitus lasting longer than 5 minutes: 89 (72.9)
Tinnitus moderately to severely annoying: 67 (54.9)
Tinnitus interferes with getting to sleep or remaining asleep:
Moderate to severe degree 27 (22.1)
Problem with your eyesight (vision when wearing glasses):
A moderate or severe problem 24 (19.7)
Feelings of spinning, unsteadiness or loss of balance affecting quality
of life as a whole:
A moderate or severe degree 36 (29.5)
General fatigue:
A moderate to severe problem 42 (34.4)
Concentration:
A moderate to severe problem 18 (14.7)
Health in general:
Good to excellent 92 (75.4)
Fair 17 (13.9)
Poor 19 (08.2)
Acquired profound hearing loss: Mental
health and other characteristics of a large
sample
Hallam/Ashton/Sherbourne/Gailey 721
(2002) found that 61% of entrants to a programme of
audiological rehabilitation for APHL obtained scores (on a
different questionnaire) indicating clinical depression, exceed-
ing the high levels in the present study. However, rates of
clinically significant depression were also found to be high in
two studies of AHL reported by Thomas (1984). The rates
were nearly four times greater than population norms across a
wide range of levels of hearing impairment. Emotional distress
was nevertheless correlated with pure tone thresholds and
speech discrimination scores.
Our salient finding is the presence of a sub-group within the
sample with extreme scores and this was particularly evident
in the results of the Glasgow health status inventory and the
Los Angeles scale. On the GHSI over half fell below the
lowest score of the general population, and on the LASC 14%
scored in the range of Vietnam veterans with diagnosed
PTSD. We know from our interviews of participants that
there are potentially multiple sources of stress including
relationship breakdown, loss of employment or work status,
and a widespread inability of close or distant others to
accommodate to the communication needs of the person
with APHL (LINK Centre, 2005). Although all participants
had received one-week of intensive rehabilitation at LINK
(described in Sherbourne et al, 2002), the problems that some
attendees experienced would need to be addressed over a
much longer period of time, the appropriate form of therapy
being dependent on the nature of the problem. Family
members are also expected to attend the LINK course. As
noted above, levels of emotional distress were almost as high
in second informants as in the person with APHL. Despite
their evident needs, not one partner or family member said in
their interview that they had received counselling or ther-
apeutic support apart from that provided at LINK.
The views of our respondents to the survey gave some insight
into their experience of professional services and the kinds of
help they wanted. As one might expect, professional help was
most frequently obtained, and most highly valued, from
audiologists and medical consultants. Apart from these forms
of help, respondents to the internet survey were more likely to
rate all other forms of current help as being of ‘no use’ than ‘of
use’. Counselling/psychotherapy received the least number of
endorsements of usefulness in both interview and internet
samples. However, when asked in an open-ended question
what service they would want, both sub-samples frequently
mentioned counselling and support. It would appear that
participants had either not received this kind of help as part of
a systematic or intensive programme, or it had not been supplied
by suitably trained professionals. These results mirror those of
two Canadian studies; Aguayo & Coady (2001, p. 274), note that
rehabilitation was ‘woefully inadequate’ as no mental health
professionals appeared to have been involved to help address
participants’ psychosocial needs. David & Trehub (1989) note
how few of their deafened subjects had used vocational or
counselling services and they were struck by the absence of any
relationship between use of these services and subjective reports
of successful adjustment.
Our respondents also wanted more advice and information
from deaf-aware professionals and a more responsive service
from the medical profession. Similarly, in a Swedish study of the
quality of life of 311 adults with a profound hearing impairment,
Ringdahl & Grimby (2000, p. 273) found that there were ‘rather
numerous enquiries for audiological service such as counselling
by the audiological physician.’ Only 28% had received informa-
tion about cochlear implants.
In conclusion, our results strongly reinforce the findings of
other surveys which indicate that the psychosocial needs of
people with APHL are not being recognized or met, and that
this is probably true cross-nationally. The emotional impact of
APHL may not be that much greater, on average, than in
moderate to severe AHL but there appears to be a subgroup
who are deeply affected or even traumatized. It should prove
possible to identify this sub-group by standardized tests or by
a relatively brief screening interview. Future research could be
directed at clarifying the additional handicaps, coping styles,
and other features that characterize this sub-group. There
remains a doubt that our sample was not representative of the
wider population of people with APHL, but the close
similarity of results from our two sub-samples suggests that
our findings were likely to be typical. In fact, they may
have given a conservative estimate of the psychosocial
impact because we met with a number of refusals to volunteer
for our study, in some cases because individuals were in
crisis.
Although the vast majority of our respondents had received
medical and audiological services that they valued, few rated
whatever other service they had received (apart from hearing
therapy and lip-reading classes) as being of use to them. Very
few appear to have received effective rehabilitation or family
support. Profound acquired hearing loss is relatively rarely
encountered, even in audiology clinics, and this may account
for the fact that this group has not received the attention it
merits.
Table 9. Hospital Anxiety and Depression Scale. Means and
standard deviations
APHL group 2
nd
Informants UK population
N 23 20 1792
Anxiety 7.47 (4.88) 6.52 (5.35) 6.14 (3.76)
Depression 6.52 (4.50) 5.35 (4.20) 3.68 (3.07)
/10 anxiety 30.4% 20.0% 12.4%
/10 depression 17.4% 15.0% 03.6%
Table 10. Glasgow Health Status Inventory
N Mean (sd) Range 50
th
percentile
Study group (APHL) 21 38.02 (19.9) 2.873.6 34.7
Test norms (hearing aid clinic) 19.696.0 69.4
Test norms (population sample) 44.899.4 79.4
Tinnitus (Rejali et al, 2004) 31 58.50 (10.0)
722 International Journal of Audiology, Volume 45 Number 12
Acknowledgements
We gratefully acknowledge the support of the UK National
Lottery Community Fund who funded this research (RG
10027416) and the participants who took part. We also
appreciate the assistance of Maria Priestly, and comments on
the manuscript from Roslyn Corney. The study was approved by
the University of Greenwich Research Ethics Committee, April,
2002.
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Table 11. Los Angeles Symptom Checklist. Means and
standard deviations
N Mean (sd)
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Test norms:
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Vietnam veterans (PTSD) 114 48.9 (11.1)
Acquired profound hearing loss: Mental
health and other characteristics of a large
sample
Hallam/Ashton/Sherbourne/Gailey 723
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... feeling handicapped) dodatnio koreluje z doświadczaniem psychicznego dystresu u osób z głuchotą postlingwalną, jak wykazali de Graaf i Bijl (2002) [9], a także depresji w grupie osób powyżej 54 lat z utratą słuchu różnego stopnia badanych w Australii [12]. Należy dodać, iż populacja osób z głuchotą postlingwalną cierpi na większe nasilenie objawów depresji i zaburzenia depresyjne niż populacja ogólna [32], choć nie stwierdzono tej zależności na przykład w Australii [21]. Jeśli chodzi o użytkowników implantów ślimakowych, którzy doświadczyli utraty słuchu w stopniu głębokim i znacznym, rezultaty badań nie są jednoznaczne, gdyż wskazują zarówno na podobne występowanie nasilenia symptomów depresyjnych w porównaniu z populacją ogólną [33], jak i na większe niż u ludzi słyszących [34]. ...
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Wstęp Poczucie niepełnosprawności jest subiektywnym stanem doświadczanym często niezależnie od obiektywnych przejawów niepełnosprawności wrodzonej czy nabytej, np. głuchoty. Wykazuje związek z akceptacją niepełnosprawności i zdrowiem psychicznym danej osoby. Celem pracy jest ocena nasilenia poczucia niepełnosprawności i zbadanie jego związków z percepcją siebie, doświadczanymi objawami depresji i zmiennymi socjodemograficznymi, takimi jak: płeć, wiek, wykształcenie, status małżeński (partnerski), status zatrudnienia, oraz zmiennymi związanymi z głuchotą: czas doświadczania głuchoty i czas korzystania z implantu ślimakowego (CI), u osób z głuchotą postlingwalną z CI. Materiał i metody Badaniami objęto 94 osoby z głuchotą postlingwalną, nabytą w wieku powyżej 3 i pół roku, w tym 56 kobiet i 38 mężczyzn, którzy uczestniczyli w hospitalizacjach rehabilitacyjnych organizowanych przez Klinikę Rehabilitacji Instytutu Fizjologii i Patologii Słuchu (IFPS). Wiek badanych mieścił się w przedziale od 23 do 81 lat, wszyscy korzystali z jednego implantu ślimakowego, który otrzymali po 18 roku życia, a czas doświadczania głuchoty zawierał się w przedziale od 1 roku do 55 lat. Czas korzystania z CI wynosił od pół roku do 11 lat. Do opisu percepcji siebie, w tym także w wymiarze niepełnosprawności, posłużono się Kwestionariuszem Ja-Inni (modyfikacja Kwestionariusza Cech wg M. Jarymowicz), a nasilenie objawów depresji mierzono z wykorzystaniem kwestionariusza Beck Depression Inventory (BDI). Wyniki Poczucie niepełnosprawności o średnim i wysokim nasileniu doświadcza 58,4% biorących udział w badaniu. Z większym poczuciem niepełnosprawności wykazuje istotny związek spostrzeganie siebie w porównaniu z innymi ludźmi jako głupszego, słabszego, niesamodzielnego, samotnego i nieśmiałego, natomiast z mniejszym poczuciem niepełnosprawności wiąże się spostrzeganie siebie jako słyszącego, lubianego, wesołego i atrakcyjnego fizycznie (ANOVA). Osoby postlingwalnie ogłuchłe z CI o większym poczuciu niepełnosprawności spostrzegają siebie ogólnie mniej pozytywnie, jak i bardziej negatywnie w porównaniu z tymi z niskim poczuciem niepełnosprawności. Poczucie niepełnosprawności okazało się być istotnie wyższe u osób młodszych (poniżej 60 lat) w porównaniu ze starszymi. Ponadto większego poczucia niepełnosprawności należy spodziewać się u osób doświadczających objawów depresyjnych. Wnioski Osoby z głuchotą postlingwalną z CI, które mają nasilone poczucie niepełnosprawności związane z byciem osobą głuchą (ale nie tylko) potrzebują różnych form interwencji psychologicznej. Poczucie niepełnosprawności wraz z innymi pozostającymi z nim w istotnym związku cechami percepcji siebie wyraźnie tworzą „syndrom niepełnosprawności” w obrazie psychologicznego funkcjonowania osób z głuchotą postlingwalną z CI, który najprawdopodobniej ma charakter uniwersalny, a więc stosuje się też do osób z niepełnosprawnością inną niż głuchota. Poczucie niepełnosprawności pozostaje w dodatnim związku z objawami depresji. Podsumowując, niepełnosprawność stanowi ważny wymiar doświadczania siebie przez osoby z głuchotą postlingwalną z CI, a poczucie niepełnosprawności może także wskazywać, jak dana osoba radzi sobie ze swoją niepełnosprawnością.
... [20][21][22][23][24] Of those diagnosed with the COVID-19 virus, almost half experienced subsequent problems with hearing and balance. Concerns about hearing, tinnitus, cognition, and balance have been associated with psychological and psychosocial problems 25,26 and chronic illnesses; so, empathetic counseling and listening by HCPs is imperative. ...
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The United States does not ensure equitable access to hearing health care for all age groups, largely because these services are costly and even unobtainable in some places. Barriers to care are discussed within a context of the social determinants of health, under-representativeness of hearing-care professionals from historically marginalized communities, older adults and age-related hearing loss, and associated health conditions. The MarkeTrak 2022 study generated a sample of 15,138 respondents with information on 43,597 individuals. Data analysis revealed that self-reported hearing difficulty appears to increase with age with a rate of 12.4% for adults 18 years of age and older. A substantial proportion of individuals with hearing difficulty assumed that their problem was age-related, followed by exposure to loud sound and noise. Individuals with hearing difficulty were nearly three to four times more likely to have tinnitus, cognitive problems, and issues with balance and falling than those with no hearing problems. Self-reported hearing difficulty was lower for historically marginalized groups (7%) than for the White population (12%). Recommendations are presented to reduce the burden of hearing difficulty and hearing aid deserts for rural and urban populations.
... It is well established that STPHL can lead to reduced quality of life (QoL), isolation, dependence, lack of energy, and frustration [1,2]. Furthermore, it can also lead to higher levels of anxiety and depression [3,4]. The grading system of hearing loss (HL) has recently been revised by the World Health Organization (WHO), and the following definitions are used: mild (20-34 dB), moderate (35-49 dB), moderately severe (50-64 dB), severe (65-79 dB), profound (80-94 dB), or complete HL (≥95 dB). ...
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Severe-to-profound hearing loss (STPHL) can affect a person negatively in many ways. Audiological rehabilitation is important for these patients. Patients receiving cochlear implants make up less than 10% of this group but have been studied extensively. In 2005, a national registry for adult patients with STPHL was introduced in Sweden. Its purpose was to evaluate and improve rehabilitation for all patients with STPHL. Data from the Swedish registry for adult patients with STPHL were used to evaluate variables affecting the audiological rehabilitation. Previous published data from the registry were reviewed, and new data from the follow-up questionnaire were presented. More than 90% of patients rehabilitated with hearing aids experienced a good or very good benefit of audiological rehabilitation. Tinnitus and vertigo affected quality of life negatively and were reported by many patients with STPHL (41% and 31%) at follow-up. To maintain the high number of patients who find audiological rehabilitation beneficial, individualized treatment plans and timely re-evaluations are crucial. Tinnitus and vertigo need to be addressed repeatedly in the rehabilitation process. Keywords: audiological rehabilitation; severe hearing loss; profound hearing loss; sensorineural hearing loss; mixed hearing loss; cochlear implant; hearing aid
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Background and objectives: : In this study, we investigated the effects of hearing loss on mental health and quality of life (QoL) using survey data in adults aged >40 years. Subjects and methods: : We obtained data from 10,921 individuals who responded to the fifth Korean National Health and Nutrition Examination Survey. Primary outcomes were measured using questionnaires that recorded stress perception, depressive mood, and suicidal ideation to evaluate mental health and motor ability, self-management, activities of daily living, pain or discomfort, and anxiety or depression to evaluate QoL. Results: : On multivariate analysis, suicidal ideation was more prevalent among older adults with hearing loss than in older adults without hearing loss. Motor ability was lower in individuals with hearing loss of >20 dB than in older adults with normal hearing. Categorization of the EuroQol-5 Dimension (EQ-5D) health state into upper and lower groups showed that the EQ-5D values were lower in the moderate-tosevere hearing loss group than in the mild hearing loss group. Conclusions: : Among adults aged >40 years, those with hearing loss experienced more suicidal ideation, had lower motor ability, and lower overall QoL compared with these variables in older adults with normal hearing. Additionally, QoL scores were low in individuals with poor hearing.
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Objectives: Hearing impairment is common in the middle-aged population but remains largely undiagnosed and untreated. The knowledge about to what extent and how hearing impairment matters for health is currently lacking. Thus, we aimed to comprehensively examine the adverse health consequences as well as the comorbidity patterns of undiagnosed hearing loss. Study design: Based on the prospective cohort of the UK Biobank, we included 14,620 individuals (median age 61 years) with audiometry-determined (i.e., speech-in-noise test) objective hearing loss and 38,479 individuals with subjective hearing loss (i.e., tested negative but with self-reported hearing problems; median age 58 years) at recruitment (2006-2010), together with 29,240 and 38,479 matched unexposed individuals respectively. Main outcome measures: Cox regression was used to determine the associations of both hearing-loss exposures with the risk of 499 medical conditions and 14 cause-specific deaths, adjusting for ethnicity, annual household income, smoking and alcohol intake, exposure to working noise, and BMI. Comorbidity patterns following both exposures were visualized by comorbidity modules (i.e., sets of connected diseases) identified in the comorbidity network analyses. Results: During a median follow-up of 9 years, 28 medical conditions and mortality related to nervous system disease showed significant associations with prior objective hearing loss. Subsequently, the comorbidity network identified four comorbidity modules (i.e., neurodegenerative, respiratory, psychiatric, and cardiometabolic diseases), with the most pronounced association noted for the module related to neurodegenerative diseases (meta-hazard ratio [HR] = 2.00, 95%confidence interval [CI] 1.67-2.39). For subjective hearing loss, we found 57 associated medical conditions, which were partitioned into four modules (i.e., diseases related to the digestive, psychiatric, inflammatory, and cardiometabolic systems), with meta-HRs varying from 1.17 to 1.25. Conclusions: Undiagnosed hearing loss captured by screening could identify individuals with at greater risk of multiple adverse health consequences, highlighting the importance of screening for speech-in-noise hearing impairment in the middle-aged population, for potential early diagnosis and intervention.
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A series of inquiries was conducted on the psychometric properties of the Los Angeles Symptom Checklist (LASC), a self-report measure of Posttraumatic Stress Disorder (PTSD) and associated features. Data were drawn from various samples of individuals who completed the LASC in prior studies: Vietnam veterans (n = 300), battered women (n = 123), adult survivors of child sexual abuse (n = 142), maritally distressed women (n = 36), psychiatric outpatients (n = 105), and high-risk adolescents (n = 168). The instrument was shown to possess high internal consistency (alphas ranging from .88-.95) and test-retest reliability (coefficients of .90 and .94 with a 2-week interval), to be dominated by a strong PTSD first factor, and to demonstrate acceptable levels of convergent validity. Normative information is provided for various samples, including help-seeking male combat veterans, help-seeking females, and high-risk adolescents. As a self-report PTSD assessment device, the LASC has potential for use with various trauma groups.
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As healthcare resources are limited, evidence of program effectiveness is necessary. To demonstrate this, measurement should be conducted at the specific illness level, the generic health status level, and the utility level. Instruments need to be parsimonious to avoid cognitive overload, response burden, or participation refusal. Critical analysis of the Glasgow Hearing Status Inventory (GHSI) suggested that several items were redundant and the instrument could be shortened. We administered the GHSI and Assessment of Quality of Life (AQoL) instruments to 148 deafened adults with cochlear implants (CIs) and to 54 without CIs, as part of a cross-sectional study. We used standard psychometric procedures to examine the GHSFs structure, resulting in the removal of half of the items. The short version of the GHSI we labeled the Hearing Participation Scale (HPS), to avoid confusion with the GHSI. The HPS is an 11-item instrument measuring self-esteem, social handicap, and hearing handicap. Factor analysis suggested that each sub-scale was unidimensional. All items loaded on the principal component. Correlation with the GHSI was 0.95, suggesting that the two instruments could be used interchangeably. Both the HPS and the GHSI pro-vided evidence of monotonicity when used to predict AQoL scores. They were equally sensitive at differentiating between implantees and non-implantees. Although these findings need to be confirmed, the HPS is ready to be used in studies of interventions for deafness. At a time when evaluators are being asked for evidence of program effect, the parsimonious HPS achieves similar results to the GHS but requires half the items. Sumario: Tomando en cuenta las limitaciones en recursos sanitarios es necesario contar con evidencias sobre la efectividad de los programas. Para demostrar esto, se deben conducir mediciones sobre el nivel especifico de enfermedad, el nivel genérico del estado de salud y el nivel de utilidad. Los instruments deben ser equilibrados para evitar la sobrecarga cognitiva, el peso de la respuesta, o el rechazo a participar. Un análisis critico del “Inventario de Estado del Salud de Glasgow” (GHSI) sugirió que varios items eran redundantes y que el instrumento podia ser acortado. Aplicamos el GHSI y el instrumento de “Evaluación de la Calidad de Vida” (AqoL) a 148 adultos sordos con implante coclear (IC) y a 54 sin implante coclear, como parte de un estudio de sección transversal. Utilizamos procedimientos psicométricos normados para examinar la estructura del GHSI, de los que resultó la remoción de la mitad de los reactivos. Denominamos como “Escala de Participacion Auditiva” (HPS) a la versión corta del GHSI, para evitar confusión con la GHSI. El HPS es un instrumento compuesto por 11 items que mide la autoestima, la discapacidad social y la discapacidad auditiva. Un análisis factorial sugirió que cada sub-escala era unidimensional. Todos los items se cargaron al componente principal. La correlación con el GHSI fue de 0.95, sugírìendo que los dos instrumentos podrían ser intercambiables. Tanto el HPS como el GHSI aportaron evidencia de monotonicidad cuando se usaron para predecir puntajes de calidad de vida (QoL). Fueron igualmente sensibles para diferencìar entre aquellos sujetos implantados y los no implantados. Aunque estos hallazgos requieren de confirmación, el HPS está listo para ser utilizado en estudios de intervención en sordera. En un momento donde a los evaluadores se les demanda por evidencias sobre la efectividad de los programas, el equilibrio del HPS permite obtener los mismos resultados que el GHSI pero con la ventaja de requerir de la mitad del tiempo.
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In keeping with the general move towards evidence-based medicine that has culminated in the creation of the National Institute for Clinical Excellence and other bodies assessing the effectiveness of resources, the LINK Centre for Deafened People undertook a study to evaluate the immediate and longer-term impact of attending the Centre's rehabilitation programme. It aimed to document the clinical outcomes of this model of rehabilitation and thereby to evaluate the effectiveness of the intervention so that deafened people and professionals working in this field are aware in what dimensions benefits are likely to occur. Results from a questionnaire survey of attendees demonstrated highly significant short-term improvements in psychological state, clinical depression, general health, quality of life, communication effectiveness and social functioning immediately following the programme. These benefits were sustained for a period of at least 6 months.
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ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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Acquired hearing loss has frequently been reported to cause strains in everyday life, but few attempts have been reported where the affliction is related to the concept of stress. In this within-subjects investigation of 48 middle-aged to elderly hearing impaired patients, the relationships between hearing measurements, experienced disability and handicap (HMS), and psychological and somatic distress symptoms (SCL-90(R)) were analyzed. The variations in experienced hearing disability was found to correlate to the occurrence of a few, but more severe distress symptoms, and by loss of hearing for high frequencies. The experienced handicap, defined as emotional responses and personal opinions, was found to correlate to a general level of distress. In particular those distress items expressing insecurity were related to handicap experience. It was suggested that insecurity in social settings, and diminished hearing for contextual sounds, could cause a perceived loss of control, which could induce stress reactions.
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Communication strategies, accommodations to deafness, and perceptions of the communication environment by profoundly deaf subjects were correlated with indices of psychosocial adjustment to determine whether accommodations to deafness could play a role in the presence of psychological difficulties among deaf persons. Persons with postlingually acquired profound deafness were administered the Communication Profile for the Hearing Impaired (CPHI) and several standardized tests of psychological functioning and adjustment. Inadequate communication strategies and poor accommodations to deafness reported on the CPHI were associated with depression, social introversion, loneliness, and social anxiety. Limited communication performance at home and with friends was related to both social introversion and the experience of loneliness; perceived attitudes and behaviors of others correlated with depression as well as loneliness. In general, the pattern of correlations obtained suggests that specific communication strategies and accommodations to deafness, rather than deafness per se, may contribute to the presence of some psychological difficulties in individuals.