Johannes Fellinger

Mental health of deaf people

Deafness is a heterogeneous condition with far-reaching effects on social, emotional, and cognitive development. Onset before language has been established happens in about seven per 10,000 people. Increased rates of mental health problems are reported in deaf people. Many regard themselves as members of a cultural minority who use sign language. In this Review, we describe discrepancies between a high burden of common mental health disorders and barriers to health care. About a quarter of deaf individuals have additional disabilities and a high probability of complex mental health needs. Research into factors affecting mental health of deaf children shows that early access to effective communication with family members and peers is desirable. Improved access to health and mental health care can be achieved by provision of specialist services with professionals trained to directly communicate with deaf people and with sign-language interpreters.

Mental distress and quality of life in a deaf population

BackgroundHigh risks of mental illness within the deaf community are reported. The assessment of the level of mental distress and quality of life in the deaf community is difficult due to communication problems in spoken and written language. The deaf community is characterized by the use of sign language.MethodsA new measure of acceptable reliability using sign language is described. The interactive computerised package including special versions of the World Health Organisations Brief Quality of Life questionnaire (WHOQOL-BREF), the 12-Item General Health Questionnaire (GHQ-12) and five subscales of the Brief Symptom Inventory (BSI) was administered to a large community sample of deaf people (n=236), and results were compared with normative data for German-speaking hearing people.ResultsThe deaf sample has a significantly poorer quality of life than the general population for the physical and psychological domains (p<0.01) as measured by the WHOQOL-BREF. However, in the domain of social relationships, no significant difference (p=0.19) was demonstrated. All findings with the GHQ-12 and the BSI show much higher levels (p=0.01) of emotional distress among the deaf.ConclusionAlthough a poorer quality of life and a higher level of mental distress are demonstrated, the similarity to the general population in the domain social relationships shows that this does not affect all domains. These findings show the need for easily accessible health services for the deaf which offer sensitive communication with them.

Correlates of mental health disorders among children with hearing impairments

Aim  The aim of this study was to elucidate factors related to the high rate of mental health disorders seen in those with impaired hearing, including social factors and audiological measures.

Negative association between plasma cortisol levels and aggression in a high-risk community sample of adolescents

In this study, the association of aggressive behavior and personality traits with plasma cortisol levels was investigated in a high-risk community sample of adolescents. Plasma cortisol levels were collected in 245 fifteen-year-olds (118 males, 127 females) from an epidemiological cohort study of children at risk for psychopathology. Additionally, measures of reactive and proactive aggression, externalizing behavior and callous-unemotional together with impulsive personality features were assessed. Both subtypes of aggression as well as delinquent behavior and impulsive personality traits showed significant negative correlations with plasma cortisol levels. This association was observed in males, but not in females. In both gender groups, callous-unemotional traits were unrelated to plasma cortisol levels. This result suggests that the association between cortisol levels and aggression in adolescents is mediated rather by impulsivity than by unemotional or psychopathic traits.

An innovative and reliable way of measuring health-related quality of life and mental distress in the deaf community

BackgroundStructured assessment of quality of life and mental distress in deaf people is difficult for various reasons. This paper describes the development and reliability of an interactive computer-based assessment package for measuring quality of life and psychological distress in the deaf population.MethodsThe Brief version of the WHO Quality of Life (WHOQOL) Questionnaire, the 12-item General Health Questionnaire (GHQ-12) and the Brief Symptom Inventory (BSI) had been translated into sign-language and videotaped. A total of 236 members of the deaf community in Upper Austria participated by responding to a programme consisting of self-administered written and videotaped test-items presented to them on a notebook computer. The reliability of the various assessments was established on this large community sample.ResultsWhen reliability of the versions for the deaf was compared with that of written versions of the same measures in general population samples, it was found to be somewhat lower, although still in an acceptable range, for the WHO-QOL and the GHQ-12. For the BSI, the reliability was even higher than that of the general population.ConclusionsFor deaf individuals whose preferred communication is sign language, quality of life and mental distress can be effectively and reliably assessed with the use of carefully translated and adapted common instruments.

Early onset of family centred intervention predicts language outcomes in children with hearing loss

OBJECTIVE To investigate the impact of age at diagnosis and age at onset of intervention on language outcomes in children with hearing impairments. METHODS Receptive and expressive language outcomes of a sample of 63 children (mean age 5;1 years) with hearing loss (mean 78dB, SD 25.3) enrolled in the only specific early intervention program in Upper Austria were assessed. The sample can be regarded as representative for children with significant hearing loss. For 89% the hearing loss was congenital. Language results were related to age at diagnosis, age at first fitting of hearing aids and age at enrolment in the intervention program. Confounding variables such as IQ, degree of hearing loss and family parameters were controlled for in regression analyses. RESULTS Early commencement of family centred intervention had a significant impact on language outcomes as opposed to age at diagnosis and age at fitting of hearing aids. CONCLUSION In managing intervention in children with hearing loss, time between diagnosis and onset of early intervention should be kept as short as possible. However, age of entry to early intervention explained only about 4% of the variance in language outcomes.

Health Care Access Among Deaf People

Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health knowledge for deaf people including those with even higher risk of marginalization. Examples of approaches to improve access to health care, such as providing powerful and visually accessible communication through the use of sign language, the implementation of important communication technologies, and cultural awareness trainings for health professionals are discussed. Programs that raise health knowledge in Deaf communities and models of primary health care centers for deaf people are also presented. Published documents can empower deaf people to realize their right to enjoy the highest attainable standard of health.

Motor performance and correlates of mental health in children who are deaf or hard of hearing.

This cross‐sectional study investigates the relationship between motor performance and mental health in a representative population of children with hearing impairment.

Effects of Social Networks on the Quality of Life in an Elder and Middle-Aged Deaf Community Sample.

This article endeavors to investigate the role of social networks in contributing to the quality of life of an elder and middle-aged Deaf population. In particular, it poses the question of whether a certain network composition (deaf and hearing network persons) provides positive resources to improve quality of life and attempts to identify moderating and mediating connections between social networks and quality of life. Based on the data collected in a survey of 107 members of the Deaf community aged 45-81 years, it was possible to ascertain the fact that a larger social network is significantly associated with a higher quality of life, but the size of the deaf network is principally decisive. The hypothesis that a bicultural network composition would have a particular positive effect on the quality of life could not be confirmed. Findings revealed that the effect of deaf network size on the quality of life is mediated by personal resources concerning self-efficacy and communication skills. Moreover, evidence was sound for the functional equivalence of social and personal resources, which suggests that potential negative effects of reduced personal resources on the quality of life could possibly be compensated by a larger deaf network and vice versa.

Creating innovative clinical and service models for communication: Institut fuer Sinnes- und Sprachneurologie.

ABSTRACT: Disorders that affect communication are multifaceted and have significant impact throughout the life cycle, leading to different needs at different stages of life. This article describes the development of a comprehensive program that provides services for the whole range of patients with communication and problems over the life span.