key: cord-0880692-eoqky6mv authors: Kaya, Sule; Deniz Senli, Fahrettin; Mecit, Hilal; Kagitcibasi, Betul; Karabulut, Mustafa title: A study on stress and resilience among hearing‐impaired people during the COVID‐19 pandemic date: 2021-09-21 journal: Int J Clin Pract DOI: 10.1111/ijcp.14861 sha: 7656163906565200cc7d2fe0c1de0904dc18f6ae doc_id: 880692 cord_uid: eoqky6mv AIM: The aim of the study is to determine the acute stress and psychological resilience level of people with hearing impairment during the COVID‐19 pandemic and to investigate the relationship between the grade of hearing impairment, psychological resilience and perceived stress level in this period. METHODS: A cross‐sectional study. A total of 135 hearing‐impaired individuals using hearing aids (study group) and 125 healthy individuals (control group) participated. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T‐AIADH) was also applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated. RESULTS: There was a statistically significant difference between the control group and the study group in terms of ASSS results (Z = −4.4, P = .00). No statistically significant difference was found between the control group and the study group in terms of BRS scores (Z = −0.248, P = .804). Furthermore, T‐AIADH scale was observed not to correlate either with ASSS or BRS (P > .05). In the study group, the change in income level after the pandemic, age and sex variables were determined as a significant predictor of ASSS. CONCLUSION: Identifying risks and protective factors for hearing‐impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the COVID‐19 health crisis and to reduce stress. Stress is defined as the natural reaction of the body in the presence of any danger that requires adaptation. 1 It has been proven to have adverse effects on health and mental well-being. 2 Psychological resilience is defined as the adaptation and coping skills of the individual when faced with stressful situations. 3 The functioning of stress and psychological resilience has been studied in some population groups at risk, such as people affected by traumatic events (eg violence) 4 and those with chronic diseases. 5 On the other hand, the number of studies evaluating stress and psychological resilience in hearing-impaired individuals is limited. [6] [7] [8] Hearing loss is a condition that can be seen in all age groups and causes many handicaps if early intervention is not provided. At least 15% of the Methods: A cross-sectional study. A total of 135 hearing-impaired individuals using hearing aids (study group) and 125 healthy individuals (control group) participated. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Turkish version of Amsterdam Inventory for Auditory Disability and Handicap (T-AIADH) was also applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated. Results: There was a statistically significant difference between the control group and the study group in terms of ASSS results (Z = −4.4, P = .00). No statistically significant difference was found between the control group and the study group in terms of BRS scores (Z = −0.248, P = .804). Furthermore, T-AIADH scale was observed not to correlate either with ASSS or BRS (P > .05). In the study group, the change in income level after the pandemic, age and sex variables were determined as a significant predictor of ASSS. Identifying risks and protective factors for hearing-impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the COVID-19 health crisis and to reduce stress. adult population experiences a noticeable hearing impairment in their daily lives 9 . Untreated hearing impairment has been proven to cause poor health outcomes such as deterioration in cognitive functions, reduced quality of life and limitations in mobility 10, 11 . Such poor health outcomes have been further shown to bring negative psychosocial consequences, such as stress, depression and anxiety 12, 13 . On the other hand, it is a fact that the use of the hearing aid has very significant positive effects on psychosocial lives of hearing-impaired people. A recent subject Coronavirus Disease 2019 (COVID-19), which is expected to affect the majority of the world population with a very high transmission rate 14, 15 , has been shown to increase anxiety, depression and stress levels in the overall population [16] [17] [18] . Due to global restrictions, hearing-impaired people may have not reached services as easy as before the COVID-19 pandemic which may bring some limitations. We think that these limitations may be interrelated with the psychological resilience and acute stress levels of hearingimpaired individuals during the COVID-19 pandemic. Therefore, this study aimed to determine the psychological resilience and acute stress level of people with hearing impairment during the COVID-19 pandemic and to investigate the relationship between the grade of hearing impairment and psychological resilience and perceived stress level in this period. A total of 135 hearing-impaired individuals (study group) and 125 healthy individuals (control group), who were aged 18-85 years, were included in the study. The sample size was determined by G-Power analysis. The study group consisted of individuals with hearing loss for at least one year and using hearing aids. The data of the study group were obtained by contacting individuals, who had previously applied to a hearing aid centre in Bursa and used hearing aids, via phone or e-mail. Individuals with normal hearing (pure-tone average [PTA]<20 dB) and without any psychological disorders were included in the control group. Control group data were obtained from people the researchers knew, and they were asked to deliver the questionnaires to their acquaintances using the snowball method. Individuals with a known neurological or psychiatric illness and those who were illiterate were excluded from the study. Before starting the questionnaire, six questions about demographic information were asked to the participants. The questions about demographic information were created by the researchers. The Turkish versions of the Acute Stress Symptoms Scale (ASSS) and Brief Resilience Scale (BRS) were applied to all participants. The Handicap (T-AIADH) was applied to the study group in addition to other scales. The presence of any difference between the groups in terms of ASSS and BRS scores was investigated. In the study group, whether T-AIADH was correlated with ASSS and BRS was investigated. It is a self-report scale consisting of seven items and measures the severity of acute stress disorder symptoms and associated discomfort. The Likert-type scale (0 = never, 4 = always) is designed to evaluate the severity of acute stress disorder symptoms, which occur after a stressful event or experience, based on self-report in individuals over 18 years of age. Ascibasi et al 19 conducted the reliability and validity study of the Turkish form of the scale. • Covid-19 may increase anxiety, depression and stress levels in the overall population. • Hearing-impaired people may overcome hearing loss handicap with hearing aid usage. • Evidence-driven research to investigate predicting factors to psychological impacts of the epidemic is needed. • Although psychological resilience levels are similar, hearing-impaired individuals have higher acute stress exposure during the pandemic than normal hearing people. • Hearing-impaired individuals are more likely to experience acute stress during the pandemic process, despite using hearing aids. • The change in income level after pandemic and age variables are significant predictors of acute stress symptoms for hearing-impaired individuals. This scale was developed to measure individuals' psychological resilience. This scale focuses on the ability of individuals to bounce back or recover from stress, return to the former functionality and re-adapt. It is a five-point Likert-type self-report scale consisting of six items. After the reverse-coded items in the survey are adjusted accordingly, the high scores obtained indicate a high level of psychological resilience. The scale was adapted into Turkish by Dogan et al 20 . It is one of the questionnaires used to assess hearing impairment and handicap. The questionnaire consists of five domains and 30 items. These domains are distinction of sounds, localization of sounds, speech intelligibility in quiet, speech intelligibility in noise and detection of sounds. There are four answers for each question: almost never (3 points), occasionally (2 points), frequently (1 point) and almost always (0 point). 21 Mujdeci et al adapted the questionnaire into Turkish. Statistical analyses were performed using SPSS version 26.00 package program for Windows. Results were analysed by visual (histogram and scatter plots) and statistical (Kolmogorov Smirnov-Shapiro-Wilk) methods. If the data did not show normal distribution, the quantitative data were expressed as median ± interquartile range (IQR) (median ± IQR). Categorical parameters were expressed as the number of observations (n) and the overall cohort percentage (%). Significant group differences were evaluated using the nonparametric Mann-Whitney U test. Spearman's correlation coefficient was used for correlation analysis. Multiple linear regression analysis was performed to evaluate the predictive effect of change in income level after the pandemic, age and sex variables on ASSS and BRS. In the analysis, a P value of <.05 was considered statistically significant. Correlation Test, P = .491) psychological resilience. As a result of the analysis, three variables were found not to predict psychological resilience in both the control group and the study group (P > .05). In the present study, the correlation of auditory disability and handicap with acute stress and psychological resilience was tested, and no significant correlation was observed in both groups. The T-AIADH scale was used to evaluate the detection, distinction and localization of sounds, and speech intelligibility in quiet and noise in individuals with hearing impairment. Previous studies have proven that there is a correlation between stress and hearing problems 34 . Thomas found that difficulties in discerning speech were associated with measures of stress, depression and anxiety 35 . In a study by were in a middle-aged and elderly group, were reported to have higher levels of stress compared to those with normal hearing. Stress symptoms have been reported to be related to the degree of disability as well as the ability to discern speech 36 . In the present study, the degree of disability and handicap did not cause a significant difference in the acute stress and psychological resilience levels of who may be affected more by restrictions. We further believe that changes in income levels have turned into concern on livelihood and affected the stress factor negatively in hearing-impaired individuals. In the control group, only the age factor was found to be a significant predictor of acute stress. Conversano et al 42 However, it was not possible to achieve them due to the unpredictableness of pandemic. In light of these data, identifying risks and protective factors for hearing-impaired individuals at the early stage of the epidemic is considered to be of critical importance to predict the psychological impact of both the epidemic and the response to the health crisis, and to reduce stress. The COVID-19 crisis has significantly affected and continues to affect many different populations around the world. Researchers those with hearing impairment, may require special approaches and need to be supported during pandemics. We believe that this result made this study valuable. The authors declared no potential conflicts of interest concerning the research, authorship, and publication of this article. All A study of causes of stress and stress management among youth Mental health and general well-being. 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