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Mental Health within the deaf population

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DOCUMENT 5 FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only

Mental Health within the deaf population

The content of this document is OFFICIAL. Please note: The research and literature reviews collated by our TAB Research Team are not to be shared external to the Branch. These are for internal TAB use only and are intended to assist our advisors with their reasonable and necessary decision-making. Delegates have access to a wide variety of comprehensive guidance material. If Delegates require further information on access or planning matters, they are to call the TAPS line for advice. The Research Team are unable to ensure that the information listed below provides an accurate & up-to-date snapshot of these matters

Research question: How common is anxiety and depression within the deaf population? Date: 11/10/2022 Requestor: Jeán s22(1)(a)(ii) - irrelevant Endorsed by: Jane s22(1)(a)(ii) - irrelev Researcher: Stephanie s22(1)(a)(ii) - irrelevant mate Cleared by: Stephanie s22(1)(a)(ii) - irrelevant mat

  1. Contents Mental Health within the deaf population ……………………………………………………………………….. 1
  2. Contents ……………………………………………………………………………………………………….. 1
  3. Summary ………………………………………………………………………………………………………. 2
  4. Prevalence of anxiety and depression in the deaf population ………………………………… 2
  5. Risk factors for mental health disorders in the deaf population ………………………………. 2 4.1 General risk factors………………………………………………………………………………………. 3 4.2 Language Deprivation Syndrome …………………………………………………………………… 3
  6. Barriers to mental health care for the deaf population ………………………………………….. 4
  7. References ……………………………………………………………………………………………………. 5

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FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only 2. Summary Accurate information about the prevalence of anxiety and depression in the deaf population is lacking due to a paucity of research focusing on the mental health of this demographic. While there is conflicting research data, it is generally accepted that the deaf population are at higher risk of mental health problems than the general population, which is attributed to the deaf population’s greater experience of significant adverse life events including social isolation, childhood and domestic abuse, and poorer educational achievement. Although the deaf population are at higher risk of mental health problems, they also face greater barriers to accessing mental health services than the general population. These barriers faced by the deaf population may affect the diagnosis and effective treatment of mental health problems. Note: in this paper ‘deaf’ refers to people with severe or profound hearing loss and have limited oral communication, and ‘Deaf’ refers to the cultural identify of person who has severe or profound hearing loss and uses sign language as their primary language. 3. Prevalence of anxiety and depression in the deaf population The prevalence of anxiety and depression is not well studied specifically for the deaf population, and existing research does not always recognise that different causes of deafness may impact mental health differently (Kushalnager et al., 2019; Levine, 2014; National Deaf Center, 2019). Fellinger et al. (2012) notes that the lack of studies regarding prevalence rates of mental disorders in the deaf population may be reflective of the isolation experienced by deaf individuals. Additionally, it is highlighted that the potential for systematic review/meta- analysis to evaluate the current literature is limited by the different assessment tools used, that not all assessment tools are validated for the deaf population, and that cultural misunderstandings may impact assessment of anxiety or depression symptoms (Long et al., 2021; Shoham et al., 2019). Nonetheless, while there are disparities in the research findings, some papers indicate that mental health problems, such as anxiety, depression, emotional distress and poor self-esteem, are higher in both deaf children and adults compared to the general population (Fellinger et al., 2012; Levine, 2014; Shoham et al., 2019; Wright, 2021). The National Deaf Center (2019) cites research that deaf children and adults are 3-5 times more likely to have a serious emotional disturbance compared to their hearing peers. Further indicating that deafness may be associated with anxiety, it has been found that for some individuals’ anxiety level has decreased after surgical intervention to improve hearing (Shoham et al., 2019). 4. Risk factors for mental health disorders in the deaf population

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FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only 4.1 General risk factors The experience of adverse events through life results in a greater potential for psychosocial difficulties. The deaf population are exposed to more mental health risk factors compared to the general population, including: • peer rejection and being bullied as a child (Hall et al., 2017; Levine, 2014; Wright, 2021) • experiencing greater social isolation (Levine, 2014; Pertz et al., 2018) • greater incidence of abuse during childhood and domestic abuse in adulthood (Hall et al., 2017; Kvam et al., 2006; Levine, 2014; Wright, 2021) • poorer educational attainment and greater unemployment (Levine, 2014) • parental anxiety, depression or over-protection due to the child’s deafness (Wright, 2021) • deaf children who attend mainstream schools may lack a meaningful peer group with whom they can share experiences (Wright, 2021) • some perinatal infections (e.g., rubella) and syndromal causes of deafness are associated with poor mental health along with other comorbid disability (Fellinger et al., 2012) • inability to easily communicate with family members and in general (National Deaf Center, 2019) • poor access to intervention health services (described further in Section 5) (National Deaf Center, 2019; Pertz et al., 2018)

4.2 Language Deprivation Syndrome While Language Deprivation Syndrome is currently not a recognised diagnosis and has no consensus regarding diagnostic criteria (Glickman et al., 2020), there is an emerging trend in the literature describing the association between language deprivation in the early years with the development of socio-emotional issues as well as cognitive and behavioural problems (Fellinger et al., 2012; Glickman et al., 2020; Hall et al., 2017). The focus of this emerging research are deaf children who grow up without the opportunity to learn native language, including exposure to natural sign language, such that they do not develop the ability communicate fluently (Glickman et al., 2020). It has been suggested that this ‘syndrome’ may fundamentally be a result of inadequate neural development of environmental origin (Gulati, 2019; Hall et al., 2017). Children with cochlear implants are not excluded from this ‘syndrome’, and it is noted that many deaf children with cochlear implants are significantly delayed in language skills despite the implant (Hall et al., 2017). It is speculated by Glickman et al. (2020) that children who are likely to be suitable for cochlear implant may be discouraged from exposure to early childhood sign language, therefore depriving them of foundational language skills. Mental Health and Deafness Page 3 of 6 OFFICIAL Page 101 of 113

FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only Guilati (2019) describes some preliminary characteristics noted in a person with ‘language deprivation syndrome’: • may superficially appear to use sign language fluently but upon closer inspection show linguistic deficits • struggles with the concept of time • struggles with cause and effect • lack awareness of context in conversation • lack theory of mind • struggles with emotional regulation • struggles with interpersonal relationships. 5. Barriers to mental health care for the deaf population There is consideration in the literature regarding mental health care, and common barriers to care, for the deaf population. Difficulties accessing mental health care may arise from communication and language barriers, cultural conflict due to clinicians not having adequate training to care for Deaf signers (Pertz et al., 2018), and limited access to Australian Medicare rebated services. Adherence to medical treatment can also be problematic for the deaf population, which may arise from a lack of understanding about the care plan or from cultural differences (Pertz et al., 2018). A lack of information in a primary language can result in poor treatment and post-care that increases the likelihood of further health episodes impacting the individual’s health and wellbeing (Boxall, 2021). As noted in Section 3, mental health diagnostic tools are often not validated for the deaf population and are English based, which can provide further barriers to timely diagnosis, or lead to misdiagnosis, and adequate treatment of mental health disorders (Levine, 2014; Shoham et al., 2019). An additional concern raised by Dr Anne-Marie Boxall, 2021, on behalf of Deaf Australia was the Australian Federal Government’s decision to bring the National Auslan Payment and Booking Services system under the NDIS umbrella. According to Dr Boxall, this transition may reduce a deaf individual’s access to adequately trained interpreting services within the medical and allied health setting, further exacerbating existing health care barriers for the deaf population.

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FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only 6. References Boxall, A.-M. (2021). Accessible services for Deaf people who use Auslan in hospitals and health services. Deaf Australia, for the Department of Health. Accessed from https://deafaustralia.org.au/wp-content/uploads/2022/09/Accessible-Services-for-Deaf- People-who-use-Auslan-in-the-Hospitals-and-Health- Services.pdf#:~:text=Deaf%20people%20who%20use%20Auslan%20access%20medic al%20services,access%20to%20interpreting%20is%20like%20playing%20Russian%20 roulette. Fellinger, J., Holzinger, D., & Pollard, R. (2012). Mental health of deaf people. Lancet (London, England), 379(9820), 1037–1044. https://doi.org/10.1016/S0140-6736(11)61143-4 Glickman, N. S., Crump, C., & Hamerdinger, S. (2020). Language Deprivation Is a Game Changer for the Clinical Specialty of Deaf Mental Health. JADARA, 54(1). Gulati, S. (2019). Language deprivation syndrome. In N. Glickman & W. Hall (Eds.), Language deprivation and Deaf mental health. New York City: Routledge. Hall, W. C., Levin, L.L., & Anderson, M. L. (2017). Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins. Social Psychiatry and Psychiatric Epidemiology, 52(6), 761-776. DOI: 10.1007/s00127-017-1351-7 Kvam, M. H., Loeb, M., & Tambs, K. (2006). Mental health in deaf adults: symptoms of anxiety and depression among hearing and deaf individuals. Journal of Deaf Studies and Deaf Education, 12(1). doi:10.1093/deafed/enl015 Kushalnagar, P., Reesman, J., Holcomb, T., & Ryan, C. (2019). Prevalence of Anxiety or Depression Diagnosis in Deaf Adults. Journal of deaf studies and deaf education, 24(4), 378–385. https://doi.org/10.1093/deafed/enz017 Levine J. (2014). Primary care for deaf people with mental health problems. British journal of nursing (Mark Allen Publishing), 23(9), 459–463. https://doi.org/10.12968/bjon.2014.23.9.459 Long, J., Attuquayefio, T., & Hudson, J. L. (2021). Factors Associated With Anxiety Symptoms in Australian Deaf or Hard of Hearing Children. Journal of deaf studies and deaf education, 26(1), 13–20. https://doi.org/10.1093/deafed/enaa035 National Deaf Center. (2019). Mental health care for deaf individuals: needs, risk factors, and access for treatment [fact sheet]. Accessed from https://www.nationaldeafcenter.org/resource/mental-health-care-deaf-individuals-needs- risk-factors-and-access-treatment Pertz, l., Plegue, M., Diehl, K., Zazove, P., & McKee, M. (2018). Addressing mental health needs for deaf patients through an integrated health care model. Journal of Deaf Studies and Deaf Education, 23(3). doi:10.1093/deafed/eny002

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FOI 24/25 - 0002 [Research paper] OFFICIAL For Internal Use Only Shoham, N., Lewis, G., Favarato, G., & Cooper, C. (2019). Prevalence of anxiety disorders and symptoms in people with hearing impairment: a systematic review. Social psychiatry and psychiatric epidemiology, 54(6), 649–660. https://doi.org/10.1007/s00127-018-1638-3 Wright, B. (2021). Mental health in deaf children. The Association for Child and Adolescent Mental Health. Accessed from https://www.acamh.org/research-digest/mental-health-in- deaf-children/

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