Hearing loss is the sixth most common disability in the US with a prevalence of 9.4%.1 According to the National Institute of Health, 2 or 3 out of every 1000 children are born with a detectable hearing loss in one or both ears. More than 90% of children who are deaf are born to hearing parents. Approximately 15% of American adults aged 18 years and older have trouble hearing. Hence, the prevalence of hearing loss varies significantly with age.2
Hearing loss before the development of language has a major impact on communication, identity, and social development, as well as how mental health symptoms present. Learning to effectively perform a psychiatric evaluation and treat people who are deaf or hard of hearing is an important clinical skill. Few providers feel competent in this area.
In psychiatric training, we learn to ask questions about a person’s upbringing, his or her culture as well as educational background, current stressors, and physical health history. We assess a person’s language, communication skills, emotional health history, peer group, and available support system. When we assess people with hearing differences, we can expand on these basic probes. The first step in the assessment of people with hearing loss or deafness is to inquire about their language and the accommodations that are preferred by the patient for effective communication in the health care setting. Some people will prefer to rely on their residual hearing and will use hearing aids or FM system amplification.
A personal FM system is a wireless assistive hearing device that will enhance the use of hearing aids or cochlear implants. It can also help people who are hard of hearing who do not wear hearing aids over distance and noisy environments. FM systems enable sound to be picked up close to the speaker and transmitted directly to the patient’s ear to provide for greater clarity. Others can be fluent in American Sign Language and will request an interpreter.
It is important in a psychiatric assessment to review some basic issues such as:
• Degree of hearing loss
• Age of onset of hearing loss or deafness
• Language development and identity
• Perceptions and knowledge about mental health
• Manner that hearing loss or deafness has influenced their life
• Whether communication issues remain as a chronic stressor
• Accessibility of mental health resources
Dr Mathos is Assistant Professor, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA. She reports no conflicts of interest concerning the subject matter of this article.
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