Mental health is written into our DNA, it is a feature of every single one of us. Studies reveal that for those living with a hearing impairment, additional factors can detrimentally affect a person's mental health. Sarah MacKinlay considers how by creating a supportive environment and through the use of hearing solutions it can be restored to a positive state.
Hearing Impairment and Its Consequences on Screen
It was something of a revolution when the star-crossed lover Jackson Maine, played by Bradley Cooper in the 2018 Oscar-winning film A Star Is Born, was depicted living with chronic tinnitus. Although it didn’t provide the leading narrative to the film it’s the subtext in which Maine realises he has a chronic hearing impairment, resonated with many in his (or similar) predicament.
Maine chooses, to keep his loss hidden and attempts to, carry on as normal, without seeking help. His mental health suffers as a result and we witness his fear and inevitably his anxiety increases which lead to his eventual decline with catastrophic consequences, all of which are palpable.
The story is told simply and maybe provides some insight and a better understanding of families of loved ones who experience any form of hearing impairment; the fear, the loneliness and the uncertainty of who to or where to turn for help are all subtly displayed in this film.
Although it was something of a departure for a Hollywood blockbuster to use such narrative is nevertheless something which millions of people worldwide live with. In the UK alone, for example, 7.1 million people live with Tinnitus like Jackson Maine.
An abundance of studies are available from across the globe which reveal the impact hearing loss has on an individual's mental health. Regardless of the structural support available they all come to roughly the same conclusion. An example which provides clarity: Almost 90% of those living with hearing loss cited social and personal problems, a report by Clear Living published in February 2020 found.
More detailed studies reveal the extent to which hearing loss can have on an individual’s mental health and cognitive function. In November 2018 Grainne Crealey and Ciaran O’ Neill published findings of their report in the Oxford Journal of Public Health. They concluded hearing loss consistently reduced aspects of cognition, autonomy, and mobility. They also found hearing loss related to other medical aspects including psychological stress, mental health, depression, dementia, and social isolation.
The research isn’t confined to the western world. In Japan, studies charting the impact of hearing loss on older people produced similar results: Hearing loss has a profound impact on older people, research published in 2016 from the University of Tsukuba, Japan, found. The report detailed how hearing loss experienced by older people can lead to anxiety, restricted activity, and perhaps even cognitive decline and dementia. The report co-author Yoko Kobayashi said: "Hearing loss takes an enormous toll on older people in so many ways, physically and mentally, while limiting activities of daily living. Greater awareness of the burden of hearing loss will help improve their quality of life. Measures such as hearing aids and social support by volunteers in the community can also provide them with assistance."
The author highlights the positive impact an early intervention has on individuals experiencing hearing loss, for example, through the use of hearing solutions.
Exploring options to support individuals living with hearing loss to enjoy the same standard and quality of life as friends, colleagues and loved ones may seem overwhelming, confusing, or even inaccessible for some. However, identifying the right solution could really have a positive result.
A significant 25-year study published in the Journal of American Geriatrics Society concluded the use of hearing solutions has been shown to reduce the risk of cognitive decline: “Self‐reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline”, it said.
Further evidence of the benefits of hearing solutions are found in a 4000-person study published in the Hearing Review in 2000. It revealed that those opting to use hearing solutions didn’t perceive themselves as depressed compared to those who didn’t use anything at all.
The same study, conducted by Sergei Kochkin and Carole Rogin, found those using proven solutions reported improvements in mental health as well as their physical, social, and emotional wellbeing. They reported having greater control over their lives and to being more socially active.
Creating Lasting Autonomy
Hearing loss can affect people of all ages, and while many may associate it with the aging process, it can occur at birth and in infancy. In its 2017 position statement the UK’s deaf children’s charity acknowledged that: “deaf children need to be aware of their deafness and empowered, confident and capable of dealing with the challenges it imposes.” The charity also explored the challenges faced by parents of deaf children, 90% of whom are born to parents who have no hearing loss. Inevitably much of its work focuses on supporting parents to help their children develop a positive identity.
The charity’s healthy minds resource is used to support schools to help children living with hearing loss thrive in mainstream settings. The key objective, it states, is to include the “promotion and maintenance of good mental health.” This may include utilising resources such as school counseling services, the development of peer support schemes, such as the helping hands project, which enables schools to train deaf buddies to support other deaf children.
European Study: New and expectant mothers living with hearing loss
In Latvia new and expectant hearing-impaired mothers received support from a European Union-funded project, Together Beyond Silence. The 51,000-euro project recognised the difficulties of hearing-impaired mothers; for example, when seeking to access medical assistance. Inevitably this can be distressing and has a detrimental impact on the mental health and well-being of both mother and infant. Furthermore, if complications arise the woman, experiencing childbirth may have difficulty conveying properly what the problem is, which only adds to the distress. A newly trained practitioner acting as a mediator between the medical staff and the mother in labour (funded by this initiative) helps reduce the risks for both mother and baby.
The project aimed to provide a safe environment in which mothers can give birth, ensuring they are provided with support in the crucial days and weeks following the infant's birth. A decade ago, the country had just 20 qualified sign language interpreters across the whole country. Until the initiative began there had been no specialist support for these women.
A Global Pandemic
As the greatest pandemic of our generation sweeps the globe, individuals, families and governments spend day and night exploring new ways of living in lockdown and beyond, seeking arrangements to create a ‘new normal’.
For those living with hearing loss there are additional complications. Professor of Audiology at the University of Manchester, in the UK, Kevin Munro points to a very specific problem. For those living with hearing impairments face masks have negative albeit unintended consequences. The issue, is that it impairs the ability for some people to communicate with ease, “because it prevents lip reading and can reduce the level of speech transmitted through the mouths,” he explains in an article written for The Conversation.
Professor Munro goes on to state how removing visual cues, “makes communication more taxing because of the mental exertion required to listen.” In other words, while people may be able to follow what is said in real-time, they burden their own mental resources while actively listening. This means they have fewer resources left to recall what they heard later on.
One solution would be to wear transparent masks, however, this is probably not a viable option because of the already complicated situation associated with access to PPE in certain countries.
Of course, the use of face masks are paramount for safety and help to ensure social distancing etiquette, but Professor Munro warns this may also lead to social isolation and impact the mental health of those living with hearing loss.
Furthermore, patients with hearing loss who are admitted to hospital for an illness or following an accident will almost certainly arrive alone because precautionary measures prohibit family or friends accompanying the patient. However, in this heightened and stressful environment, they become especially vulnerable and may very likely endure anxiety in the hospital environment where full PPE is essential on the front line.
Professor Munro believes that while specific respirator masks (such as the N95 and FFP3) are excellent at filtering particles, they significantly reduce and distort the level of speech making communication between care-giver and patient extremely difficult. He observes that this, combined with the continual hiss of an oxygen mask, general background noise or breathing through a nasal canula, the task of communicating effectively becomes almost completely impossible.
Practical advice identified by Professor Munro for those living with hearing loss in the Covid 19 world:
- If you use any form of hearing solution, ensure you have it with you before going to hospital, if possible.
- Ask care-givers to talk slowly, not shout and reduce external noise where possible.
- Some hospitals provide portable hearing amplifiers, ask them if they have any available.
- If you don’t have your hearing solution there are certain apps available on phones such as those which translate speech into text in real-time.
Source: The Conversation
The world is changing in unimaginable ways. The global race to rapidly find a solution to end the pandemic continues. But, for those living with a hearing impairment, sophisticated known solutions already exist. They act to support individuals living with hearing loss to alleviate anxiety and isolation depression and other impediments to good to mental health so they too can enjoy an autonomous, active and full life.