Investigating the Impacts of Cochlear Implantation on the Happiness and SelfEsteem of Mothers of Children with Severe Hearing Loss Nader Saki, Ali Yadollahpour, Someyeh Moniri, Majid Karimi, Arash Bayat, Hassan Abshirini & Soheila Nikakhlagh International Journal of Mental Health and Addiction ISSN 1557-1874 Int J Ment Health Addiction DOI 10.1007/s11469-016-9672-4
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Author's personal copy Int J Ment Health Addiction DOI 10.1007/s11469-016-9672-4
Investigating the Impacts of Cochlear Implantation on the Happiness and Self-Esteem of Mothers of Children with Severe Hearing Loss Nader Saki 1 & Ali Yadollahpour 2 & Someyeh Moniri 3 & Majid Karimi 3 & Arash Bayat 1 & Hassan Abshirini 1 & Soheila Nikakhlagh 1,4
# Springer Science+Business Media New York 2016
Abstract Children with severe hearing loss often struggle to communicate. Mothers of children with hearing loss may also suffer psychologically in their caregiving due to this communication barrier. Cochlear implant surgery improves child’s hearing sense, parent and children’s psychological well-being, and communication between children and their mothers. The aim of the present study is to compare happiness and self-esteem among the mothers of children with severe hearing loss before and after cochlear implantation. This cross sectional study was conducted with 40 mothers of children under the age of 7 with severe hearing loss, all of who were candidates for cochlear implant surgery in Imam Hospital, Ahvaz, Iran. A consecutive non-probabilistic sampling method was used. Mothers of children awaiting cochlear implantation completed the Oxford Happiness Questionnaire and Rosenberg SelfEsteem Inventory before and after their child’s surgery, in addition to a demographic information form. Paired t tests and Wilcoxon tests were used. A significant difference was observed between the happiness and self-esteem scores before and after surgery (p < 0.001). Cochlear implantation surgery increases happiness and self-esteem in mothers of children with hearing loss. When a child with hearing loss goes through cochlear implant surgery, all family members will benefit from improved hearing in their child and thus, improved family communication overall.
* Soheila Nikakhlagh
[email protected]
1
Hearing and Speech Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2
Department of Medical Physics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3
Apadana Clinical Research Center, Ahvaz, Iran
4
Head and Neck Surgery, Imam Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Keywords Mothers of children with severe hearing loss . Hearing cochlear implantation . Happiness . Self-esteem People with hearing loss are at an increased risk of developing mental disorders due to the inability to establish desirable relationships and feelings of inadequacy (Kushalnagar et al. 2007). Having a child with hearing loss poses unique challenges for the individual and family, which is often associated with Bfrustration, sadness, depression, infertility and anger and helplessness, sense of guilt, shame and humiliation^ (Ghasempour et al. 2012, p.54). Taking care of children in such conditions puts children with hearing loss at heightened mental health risks during adulthood, likely due to stressful home environments (Movallali and Nemati 2010). Other possible causes for elevated mental health risks in individuals with hearing loss include organ problems, behavioral issues, delays in access to services, and struggles in education (Movallali and Nemati 2010). Several factors are involved in the formation and growth of self-esteem, including the attitudes of parents and their parenting style, which is considered as an initial factor in creating a sense of self-worth in children (Hosseinian and Kalantari 2008). In typically hearing teenagers, self-esteem is affected by educational and occupational achievement. For teenagers with hearing loss, however, self-esteem is more heavily influenced by communication, emotional adaptation, participation in social affairs, self-advocacy, and opportunity taking, as these factors are closely linked with hearing (Hosseinian and Kalantari 2008). Loeb and Sarijani (as cited in Saki et al. (2015), Blake and Rust (2002), Jambor and Elliott (2005), and Hosseinian and Kalantari 2008 reported that students who are deaf have lower self-esteem and happier compared to typical hearing students. Happiness is a related concept to self-esteem, comprised of positive emotions and life satisfaction (Hosseinian and Kalantari 2008). Diner (as cited in Babamiri et al. 2011) defines happiness as a valuation of self-perceived life satisfaction, excitement, and positive mood. Happiness does not necessarily indicate the absence of depression, but rather indicates a number of positive cognitive and emotional states. When children with hearing loss are not diagnosed early in life and do not receive early intervention, their speech and language development will be delayed. Additionally, their hearing loss will also lead to other problems including psychological, educational, occupational and social issues (Samadi et al. 2006). These findings stress the importance of early diagnosis of hearing loss and prescription of hearing aids, as well as providing rehabilitation services when necessary. The cochlear implant device is an electronic device that is surgically implanted in the inner ear to improve hearing in people with hearing loss (Hosseynabady et al. 2008). When individuals with hearing loss receive cochlear implant, quality of life and speech perception will be improved. Mothers are often unprepared and challenged when their children have any type of disability, including hearing loss. This may lead to feelings of grief, sadness, anger, helplessness, guilt, shame and humiliation. These mother may gradually become dissociable, depressed, avoidant, and aggressive (Yazdkhasti FY 2010). Previous research has suggested that hearing loss and communication disorders may lead to depression, anxiety, low self-esteem and poor mental health for mothers and their children with hearing loss. For children with hearing loss who receive cochlear implants, it is unclear if mood and emotional changes will emerge for both the child and mother. There are only a small
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number of studies that have explored this topic and found positive results, notably that cochlear implantation leads to reduce psychological disorders. However, there is an absence of research that focuses on the impact of cochlear implantation on happiness and self-esteem in mothers of children with hearing loss. This study aims to investigate the impact of hearing improvement (through the cochlear implant) on the psychological variables of happiness and self-esteem of mothers of children with hearing loss.
Methods The population under study consisted of mothers of children with hearing loss who were candidates in Imam Hospital, Ahvaz, Iran. Forty mothers of children under 7 years old who had cochlear implant surgery were selected through a convenient sampling method. Subjects who met the study criteria were invited to participate. Inclusion criteria for the project included: – – – –
mothers with children under 7 years old who are candidates for cochlear implants mothers did not have psychiatric problems mothers are using any psychiatric medications mothers were not hospitalized due to psychiatric problems
Before cochlear implantation surgery, mothers completed the Oxford Happiness Questionnaire and Rosenberg Self-Esteem Questionnaire. After 1 year of their child’s cochlear implantation surgery and rehabilitation, mothers filled out the Oxford Happiness Questionnaire and Rosenberg Self-Esteem Questionnaire a second time. The Rosenberg Self-Esteem Scale (1965) measures the overall self-esteem and self-worth. This scale consists of 10 general items which measures the life satisfaction and positive feeling about oneself (Burnett and Wright 2002). The Rosenberg Self-Esteem Scale (SES) was created in order to provide an overall picture of positive and negative attitudes about oneself (Burnett and Wright 2002). The SES scale has a high validity in measuring levels of self-esteem (Burnett and Wright 2002). Retest correlations ranged from 0.82 to 0.88, and internal consistency coefficient or Cronbach’s alpha ranged 0.77 to 0.88 (Alizadeh et al. 2005). This scale has a satisfactory internal reliability (0.77). It has also high correlation with Gutmann and New York National Questionnaire in measuring self-esteem (Alizadeh et al. 2005). The SES’ reliability has been estimated by split method between two Persian and English versions at 0.73, which was statistically significant (Vahdatnia 2005). The reliability of the Persian version has been also calculated by retest method within 10 days by Vahdatnia (2005), with a correlation coefficient of 0.74. Erjil and colleagues proposed a 29-item questionnaire to measure happiness. Using the factorial analysis of the questionnaire’s results, 7 factors emerged: positive cognition, social commitment, positive mood, sense of control over life, physical health, and satisfaction of self and mental awareness (as cited in Allen 2006). The validity of this scale has been confirmed in various studies including Hills and Argyle (2002) with an alpha coefficient of 90 % with 347 subjects, Liaghatdar et al. 2008) with an alpha coefficient of 87 % with 101 subjects, Francis et al. (1998) with an alpha coefficient of 84 % with 180 subjects, and Alipour and Noorbala
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(1999) with an alpha coefficient of 93 % with 101 participants in Iran. The Oxford Happiness Inventory for measuring happiness among Iranians has been shown to have appropriate reliability and validity (Lu and Argyle 1992). Kolmogorov-Smirnov test was initially performed to determine the distribution of the data in order to analyze the variables of happiness and self-esteem. Paired t-test and Wilcoxon tests were used to compare these variables before and after cochlear implantation. The significance level for the above tests was considered 0.05.
Results and Discussion The descriptive findings have been placed in Tables 1 and 2: Statistical paired t tests and Wilcoxon tests were used with a level of P < 0.001. The results were significant. This means that hearing cochlear implant surgery has an impact on the happiness and self-esteem scores in mothers of children with hearing loss (Table 3). This study sought to compare happiness and self-esteem in mothers of children with severe hearing loss before and after hearing cochlear implantation. Research findings indicate that hearing cochlear implantation in children with severe hearing loss has an impact on happiness and self-esteem in the mothers of these children. The results of the present study are consistent with the results of previous research (Hosseinian and Kalantari 2008; Van San et al. as cited in Yang et al. 2011; Schorr et al. 2009; Zhao et al. 2008; Cohen et al. 2004). Physical problems such as hearing loss or deafness can cause serious communication problems challenges. Along with problems in communication, related psychological problems such as anxiety and depression can emerge due to difficulties in hearing. Individuals with hearing loss may become frustrated, feel powerless, and experience low self-esteem. When these children compare themselves with other children, they may feel inadequate and experience increased intensity of negative mental symptoms. In a study conducted by Schorr et al. (2009) on the quality of life in 37 subjects ages 5–24, quality of life of participants significantly improved after cochlear implant. However, there are always concerns about the performance of the transplanted cochlear. Without speech training in these children, only uttering one-syllable words is increased; in contrast, speech training improves self-confidence and emotional relationships with others (Schorr et al. 2009). In a study of 24 patients 10 years after their cochlear implantation, Zhao et al. (2008) found that quality of life has been consistent with developmental changes after transplant implantation. For example, the ability to communicate, self-confidence, enjoyment of television, listening to music, and overall life satisfaction increased. In a research by Cohen et al. 2004 including 27 subjects with
Table 1 Descriptive data related to the age of fathers, mothers, children (girls and boys) Variable
Mean ± Standard Deviation
Minimum
Maximum
Mother age (year) Father age (year)
27 ± 5.2 32 ± 5.9
20 20
39 47
Boys age (month)
36.8 ± 16.1
13
65
Girls age (month)
34.3 ± 16.7
12
76
Author's personal copy Int J Ment Health Addiction Table 2 Descriptive data related to the gender, number of children, child rank, the amount of income, and the amount of cooperation and education of parents Variable
Percent / number
Gender Boy
24(60 %)
Girl
16(40 %)
Number of children single child
16(40 %)
Two children
17(42.5 %)
Three or more children
7(17.5 %)
Rank of child with hearing loss First
21(52.5 %)
Second
13(32.5 %)
Third rank or more
6(15 %)
Family history of parents
33(82.5 %)
Deaf history in the family
15(37.5 %)
Household income Good
9(22.5 %)
Average Weak
20(50 %) 11(27.5 %)
The amount of cooperation of father Good
21(52.5 %)
Average
5(12.5 %)
Weak
14(35 %)
Mother education level Elementary
7(17.5 %)
Under Diploma Diploma and higher
15(37.5 %) 18(45 %)
Father education level Elementary
9(22.5 %)
Under Diploma
18(45 %)
Diploma and higher
13(32.5 %)
cochlear implants and 54 subjects with hearing aids, the authors found that those who had cochlear implants were 2 times more satisfied than people who use hearing aids.
Table 3 Comparison of mean scores of self-esteem and happiness before and after hearing cochlear implantation surgery has been shown Before implantation
After implantation
p-value
Happiness *
32.75 ± 15.38
51.95 ± 14.87
