Kushalnagar Poorna, Ryan Claire, Paludneviciene Raylene, Spellun Arielle, Gulati Sanjay
Department of Psychology, Gallaudet University, Washington, District of Columbia.
Department of Educational Psychology, University of Texas at Austin, Austin, Texas.
Am J Prev Med. 2020 Oct;59(4):548-554. doi: 10.1016/j.amepre.2020.04.016. Epub 2020 Jul 4.
This study explores adverse childhood communication experiences and its RRs for acquiring specific chronic diseases and mental health disorders in adults who are deaf and hard of hearing.
A cross-sectional design with snowball sampling was used to recruit adults who were deaf and hard of hearing and were born or became deaf in both ears before age 13 years. Patient-reported outcomes surveys in American Sign Language and English were disseminated to collect data about early life communication experiences with caregivers. Modified Poisson regression with robust SEs was used to calculate RR estimates and 95% CIs for all medical conditions with early life communication experiences as main predictors.
Data collection occurred from May 2016 to July 2016, October 2016 to April 2018, and October 2018 to May 2019. The U.S. sample consisted of 1,524 adults who were born or became deaf early. After adjusting for parental hearing status and known correlates of medical conditions, poorer direct child-caregiver communication was significantly associated with an increased risk of being diagnosed with diabetes (RRR=1.12, 95% CI=1.01, 1.24), hypertension (RRR=1.10, 95% CI=1.03, 1.17), and heart disease (RRR=1.61, 95% CI=1.39, 1.87). Poor indirect family communication/inclusion increased risks for lung diseases (RRR=1.19, 95% CI=1.07, 1.33) and depression/anxiety disorders (RRR=1.34, 95% CI=1.24, 1.44). The absolute risk increase and number needed to harm are also reported.
Outcomes data reported by patients who were deaf and hard of hearing demonstrated that poorer direct child-caregiver communication and ongoing exclusion from incidental family communication were associated with increased risks for multiple chronic health outcomes. Practices should consider developing and utilizing an adverse childhood communication screening measure to prevent or remediate language deprivation and communication neglect in pediatric patients who were deaf and hard of hearing.
本研究探讨了童年时期不良沟通经历及其与成年后失聪及听力障碍者患特定慢性疾病和心理健康障碍的相对风险。
采用滚雪球抽样的横断面设计，招募13岁之前双耳失聪或后天失聪的成年失聪及听力障碍者。通过美国手语和英语进行患者报告结局调查，以收集有关与照顾者早期生活沟通经历的数据。采用稳健标准误的修正泊松回归分析，以早期生活沟通经历作为主要预测因素，计算所有医疗状况的相对风险估计值和95%置信区间。
数据收集时间为2016年5月至2016年7月、2016年10月至2018年4月以及2018年10月至2019年5月。美国样本包括1524名早期失聪或后天失聪的成年人。在调整了父母听力状况和已知的疾病相关因素后，较差的直接儿童与照顾者沟通与患糖尿病风险增加显著相关（相对风险比=1.12，95%置信区间=1.01，1.24）、高血压（相对风险比=1.10，95%置信区间=1.03，1.17）和心脏病（相对风险比=1.61，95%置信区间=1.39，1.87）。不良的间接家庭沟通/融入增加了患肺病（相对风险比=1.19，95%置信区间=1.07，1.33）和抑郁/焦虑障碍（相对风险比=1.34，95%置信区间=1.24，1.44）的风险。还报告了绝对风险增加和伤害所需人数。
失聪及听力障碍患者报告的结局数据表明，较差的直接儿童与照顾者沟通以及持续被排除在家庭偶然沟通之外与多种慢性健康结局风险增加相关。医疗机构应考虑制定和使用童年不良沟通筛查措施，以预防或纠正失聪及听力障碍儿科患者的语言剥夺和沟通忽视问题。
