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Predictors of Depressive Symptoms in Persons with Deafness and Hearing Loss Jill Friedman, M.S

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Predictors of Depressive Symptoms in Persons with Deafness and Hearing Loss Jill Friedman, M.S Predictors of Depression 1 PREDICTORS OF DEPRESSIVE SYMPTOMS IN PERSONS WITH DEAFNESS AND HEARING LOSS A Thesis Submitted to the Faculty of Drexel University by Jill Friedman In partial fulfillment of the Requirements for the degree of Doctor of Philosophy Drexel University April 2008 Predictors of Depression 2 ABSTRACT Predictors of Depressive Symptoms in Persons with Deafness and Hearing Loss Jill Friedman, M.S. Arthur M. Nezu, Ph.D., ABPP To date, there are very few studies that that have assessed predictors of depression in persons with deafness and hearing loss. The present study addressed this fundamental gap in the literature by predicting depressive symptoms with the following two constructs: loneliness and problem-solving coping. Just as loneliness and problem solving are thought to be important in predicting depressive symptoms in the hearing, it was hypothesized that these constructs would also be important predictors of depressive symptoms in the deaf and hard-of-hearing. The literature, while inconsistent, suggests that objective severity of one’s disability, speech discrimination, and the number of years one is deaf or hard-of-hearing, is related to psychopathology. This study included these factors as covariates. One hundred and twenty six women from the Drexel University Department of Otolaryngology completed a series of self-report questionnaires. The results indicated that loneliness was a significant, positive predictor of depressive symptoms. Additionally, the results indicated that problem solving was a significant, inverse predictor of depressive symptoms. A series of correlations designed to deconstruct the relationship between problem-solving and depression revealed a significant relationship between depressive symptoms and negative problem orientation, impulsiveness/carelessness style, and avoidance style. A multiple linear regression, in which components of problem solving were regressed on depressive symptoms, revealed a significant relationship between negative problem orientation and depressive symptoms and avoidance style and depressive symptoms. A hierarchical linear regression, which was employed to test the hypothesis that loneliness and problem solving predict Predictors of Depression 3 depressive symptoms above and beyond objective severity of deafness and hearing loss, speech discrimination, and number of years deaf and/or hard-of-hearing, indicated that these covariates did not significantly predict depressive symptoms and do not account for the relationship between loneliness, problem-solving and depressive symptoms. Finally, a mediator analysis was conducted to test the hypothesis that problem-solving would mediate the relationship between loneliness and depressive symptoms. This analysis demonstrated that problem-solving partially mediated the relationship between loneliness and depressive symptoms. This finding conveyed that there may be a direct contribution from loneliness to depressive symptoms. Furthermore, this finding conveyed that there may be an indirect path from loneliness to depressive symptoms through problem solving, but that the indirect path accounted for only a portion of the effect of loneliness on depressive symptoms. Clinical and research implications of the study, along with recommendations for future research, are discussed. Predictors of Depression 4 DEDICATIONS This dissertation is dedicated to my parents, Judy and Steve Friedman. If not for their devotion to me, personally and academically, I would not be where I am today. Thank you, Mom and Dad, for your unconditional love, inspiration, and support. This dissertation is also dedicated to my sister, Julie Friedman. Predictors of Depression 5 ACKNOWLEDGEMENTS Several people have contributed to the production of this dissertation and I am grateful to all of you. My dissertation chair and committee members helped me through this process. I would like to express my deep appreciation to my dissertation chair, Art Nezu, Ph.D., ABPP, who has been and will remain an integral part of my learning. Thank you for imparting your wisdom. Thank you, Dr. Christine Maguth Nezu, Dr. Jacqueline D. Kloss, Dr. Pamela C. Geller, and Dr. Robert Wolfson. Your expertise, time, and encouragement have been invaluable. I am indebted to the Drexel University Department of Otolaryngology. It would have been impossible to complete this dissertation without the support of many physicians, audiologists, and administrative support staff. Several people deserve special mention: Drs. Sataloff, Tucker, Lyons, Heman-Akeh, and Divi. Thank you, Tracy, Aliyah, Stephanie, Katina, Matt, Tracy, Natasha, and John. Thank you for providing the facilities and participants for this project and for adding your support and cooperation to make data collection flow smoothly. Finally, I would like to thank all of the participants who participated in this study for taking the risk of revealing their thoughts and feelings in support of research in the area of deafness and hearing loss. Predictors of Depression 6 TABLE OF CONTENTS 1. Abstract ...............................................................................................................ii Dedications ......................................................................................................................iii Acknowledgments............................................................................................................iv Table of Contents .............................................................................................................vi List of Tables ...................................................................................................................x 2. Introduction ..........................................................................................................1 3. Literature Review.................................................................................................11 3.1 Hearing .......................................................................................................................10 a. Deaf and Hard-of-Hearing ...........................................................................................11 b. Deafness & Hearing Loss: Causes ...............................................................................12 c. Measurement ................................................................................................................13 d. Management .................................................................................................................14 e. Medical and Psychological Considerations of a Deficit in Hearing ............................15 3.2 Changing Perspectives of Deafness & Hearing Loss ................................................16 a. Depression ....................................................................................................................16 b. The DSM-IV-TR & Diagnostic Criteria ......................................................................17 c. Course ..........................................................................................................................17 e. Depression and Depressive Symptoms in the Deaf and Hard-of-Hearing ...................18 f. Barriers in Communication in the Clinical and Medical Settings ................................19 g. Depression in the Deaf and Hard-of-Hearing ..............................................................24 3.3 Loneliness ..................................................................................................................31 a. Loneliness Defined .......................................................................................................31 Predictors of Depression 7 b. Loneliness versus Social Isolation ...............................................................................31 c. Research on Loneliness ................................................................................................32 d. Loneliness & Disability ...............................................................................................35 e. Loneliness & Depression .............................................................................................36 f. Loneliness in the Deaf and Hard-of-Hearing ...............................................................38 3.4 Problem-Solving ........................................................................................................45 a. Problem-Solving and Depression .................................................................................50 d. Problem-Solving: Deafness and Hearing Loss ............................................................53 3.5 Objective Severity of Deafness and Hearing Loss ....................................................56 3.6 Number of Years Deafened or Hard-of-Hearing .......................................................57 3.7 The Current Study ......................................................................................................59 a. Hypotheses ...................................................................................................................60 4. Materials and Methods .................................................................................................62 a. Participants ...................................................................................................................62 b. Inclusion Criteria .........................................................................................................62
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