Elsevier

The Lancet

Volume 379, Issue 9820, 17–23 March 2012, Pages 1037-1044
The Lancet

Review
Mental health of deaf people

https://doi.org/10.1016/S0140-6736(11)61143-4Get rights and content

Summary

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.

Introduction

Hearing loss affects about 15–26% of the world's population, with the highest prevalence in low-income countries.1, 2, 3 This Review focuses on individuals with severe to profound deafness, with onset before language has been established. Roughly seven per 10 000 people in the general population are in this group.4, 5 The population covered by this report includes all deaf individuals who prefer to communicate via a signed language and many others who do not use sign language yet who cannot use the sense of hearing alone for effective communication.

Deafness is associated with large heterogeneity in cognitive, social, and emotional development.6 Availability and frequency of medical interventions, worldwide variations in access to deaf education, societal attitudes, and opportunities for deaf people contribute to these differences. Communities, known as Deaf communities, are made up of individuals with severe deafness who prefer to use sign language and whose social intercourse defines a distinctive culture referred to in some reports.7, 8 These Deaf communities are essential to their members; nevertheless, they are difficult for hearing individuals, including medical professionals, to access. This isolation might be one reason why very few studies of prevalence rates of mental disorders in large deaf population samples have been done. Available studies show high rates of mental health problems in deaf adults (table).9, 10, 11, 12 Rates of emotional and behavioural problems in deaf children are about two times higher than they are for hearing children.13, 14, 15, 16, 17, 18

Section snippets

Factors affecting mental health of deaf people

Some perinatal infections (eg, rubella) and syndromal causes of deafness are associated with other disabilities and poor mental health.17, 19 After 1990, rates of hearing impairment associated with rubella and unknown causes declined.20 In a 2011 population-based Dutch study,21 a hereditary cause for permanent childhood hearing impairment was recorded in 39% of participants, an acquired cause in 30%, miscellaneous causes in 7%, and unknown causes in 24%. An acquired cause—mostly through

Specific mental health disorders in deaf people

Although no reports exist of incidence rates of specific mental illnesses in large adult deaf population samples based on usual epidemiological methods, published work suggests that deaf people do not have a specific psychopathology and that mental health problems in deaf populations are mostly common mental disorders. In a study of the Austrian deaf community,11 individuals had raised scores on all the symptom scales, with scores for anxiety and somatisation higher in women than in men (table

Management and treatment

Deaf patients report fear, mistrust, and frustration in health-care settings.70 They appreciate efforts from care providers to improve communication (panel 1), provision of medically skilled interpreter services, and especially providers who know sign language.70, 71 Enhanced communication with deaf patients results in improved patient compliance with medical recommendation.72 Possible limitations in access to health information for members of the Deaf community should be taken into account.73

Implications

Despite a shortage of epidemiological and service-effectiveness studies of mental health and deafness, there is ample evidence for higher rates of mental health problems in people who are deaf than in hearing individuals. Research into associated factors emphasises the heterogeneity of mental health problems in deaf people and helps clinicians to understand the individual patient. These findings can also guide preventive measures. Newborn hearing screening must be used to allow parents and

Search strategy and selection criteria

We searched Medline, Embase, PsycINFO, PSYNDEXplus, PsycCritiques, PsycEXTRA, and the Cochrane Database of Systematic Reviews for reports published in any language between Jan 1, 2005, and March 10, 2011. We used the search terms “hearing disorders”, “deafness”, “deaf-blind disorders”, “hearing loss-functional”, “hearing loss-sensorineural”, “cochlear implants”, “sign language”, and “interpreters” in combination with specific terms for mental health or health services. We transformed all these

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