Deaf perceptions about treatment for alcohol use and mental health.

INTRODUCTION: Recent research suggests that alcohol use disorder may be more prevalent in the Deaf community, a diverse sociolinguistic minority group. However, rates of treatment-seeking among Deaf individuals are even lower than in the general society. This study used the Theory of Planned Behavior to identify Deaf adults' beliefs about treatment that may prevent their treatment-seeking behaviors. METHODS: This study conducted elicitation interviews with 16 Deaf adults. The study team recruited participants from across the U.S. and conducted interviews on Zoom. Participant ages ranged from 27 to 67 years (M = 40, SD =10.8). Seventy-five percent of the sample was male, 75 % were White, and 12.5 % were Hispanic/Latine. The study conducted interviews in American Sign Language, subsequently interpreted into English by a nationally certified interpreter, and transcribed for data analyses. The study analyzed transcripts using the Framework Method. The study team coded the interviews in groups and assessed for saturation (≤ 5 % new themes) of themes throughout the analysis. This study reached saturation in the third group (six total groups). RESULTS: Identified themes followed the Theory of Planned Behavior constructs. The study identified nine Behavioral Beliefs with four advantages and five disadvantages of seeking treatment, four Normative Beliefs with one support and three oppositions to seeking treatment, and thirteen Control Beliefs with five facilitators and eight barriers to seeking treatment. Overall, the Deaf participants reported several unique beliefs based on their cultural and linguistic perspectives, including a concern about unqualified providers, experiencing stress in treatment with hearing providers, stigma within the Deaf community, less access to cultural information about alcohol and mental health, less encouragement of traditional treatment in marginalized communities, and additional barriers (e.g., communication, limited Deaf treatment options, discrimination, etc.). CONCLUSIONS: A thorough understanding of individual beliefs about treatment is necessary to develop interventions that may increase treatment-seeking behaviors. Previous research has demonstrated that individual beliefs may be modified using Cognitive Behavioral Therapy techniques to increase treatment-seeking behaviors among hearing individuals. Similar interventions may be useful with Deaf individuals; however, they must consider the unique cultural and linguistic perspectives of the community.

Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users.

BACKGROUND: Deaf individuals who communicate using American Sign Language (ASL) seem to experience a range of disparities in health care, but there are few empirical data. OBJECTIVE: To examine the provision of common care practices in the emergency department (ED) to this population. METHODS: ED visits in 2018 at a U.S. academic medical center were assessed retrospectively in Deaf adults who primarily use ASL (n = 257) and hearing individuals who primarily use English, selected at random (n = 429). Logistic regression analyses adjusted for confounders compared the groups on the provision or nonprovision of four routine ED care practices (i.e., laboratories ordered, medications ordered, images ordered, placement of peripheral intravenous line [PIV]) and on ED disposition (admitted to hospital or not admitted). RESULTS: The ED encounters with Deaf ASL users were less likely to include laboratory tests being ordered: adjusted odds ratio 0.68 and 95% confidence interval 0.47-0.97. ED encounters with Deaf individuals were also less likely to include PIV placement, less likely to result in images being ordered in the ED care of ASL users of high acuity compared with English users of high acuity (but not low acuity), and less likely to result in hospital admission. CONCLUSION: Results suggest disparate provision of several types of routine ED care for adult Deaf ASL users. Limitations include the observational study design at a single site and reliance on the medical record, underscoring the need for further research and potential reasons for disparate ED care with Deaf individuals.

Brief, cognitive-behavioral intervention to promote treatment seeking in adults with severe alcohol use disorder: A randomized controlled trial.

BACKGROUND AND AIMS: There is little RCT evidence that brief interventions improve treatment seeking in individuals with severe alcohol use disorder (AUD) or treatment seeking reduces alcohol use. The aim was to test the efficacy of a brief intervention to increase treatment seeking in treatment naïve adults with severe AUD and measure its effects on alcohol use. DESIGN: Parallel group, non-pharmacologic RCT with intervention (n = 197) and active control (n = 203) conditions, with blinded assessors conducting follow-ups at 1, 3 and 6 months. SETTING: Online recruitment in a 17-county region of upstate New York, USA. PARTICIPANTS: Inclusion criteria consisted of ages ≥18 years, Alcohol Use Disorders Identification Test score ≥16, exceeds recommended limits for alcohol use and no history of AUD treatment. n = 400; 50% female; 79% white; mean age, 40.7; mean education, 14.6 years. INTERVENTION AND COMPARATOR: One-session telephone-delivered interventions: Cognitive-Behavioral Therapy for Treatment Seeking (CBT-TS; intervention), review of a National Institute on Alcohol Abuse and Alcoholism pamphlet on AUD treatment (control). MEASUREMENTS: Self-report of any AUD treatment use over 3 months (primary outcome) and two standard measures of alcohol use over 6 months (secondary outcomes). FINDINGS: Intent-to-treat analyses were used. Assessment follow-up rates were ≥93%. Any alcohol-related treatment use over 3-month follow-up was obtained by 38 (19%) intervention participants and 36 (18%) control participants, a non-significant difference, χ2 [1] = 0.16, P = 0.689. Secondary analysis showed a significant interaction term between sex and intervention assignment (ß = -1.197, P = 0.027). The interaction suggested CBT-TS was effective in men (22% vs 13%), although the evidence was somewhat weak (P = 0.071), and it was not effective in women (17% vs 24%). CONCLUSIONS: A one-session cognitive-behavioral therapy intervention to increase treatment seeking in treatment naïve adults with severe alcohol use disorder did not increase treatment seeking.

Acculturative Stress, Mental Health, and Well-Being among Deaf Adults.

Acculturative stress is associated with negative mental health among culturally diverse individuals. Deaf and Hard-of-Hearing (DHH) individuals experience acculturative stress as they navigate within and between the Hearing and Deaf communities, yet, research has not examined the relationship between deaf acculturative stress and psychological functioning. This study examined the relationships between deaf acculturative stress, well-being, and symptoms of depression and anxiety. One hundred and ten DHH adults (71.6% female, 82.7% White, median age = 30-39) completed an online survey including the Multidimensional Inventory of Deaf Acculturative Stress (MIDAS), demographic questions, and measures of psychological functioning. After controlling for relevant sociodemographic factors, the MIDAS Stress from the Deaf and Hearing Community scales emerged as significant predictors of well-being and symptoms of anxiety and depression. Findings are discussed within the context of DHH sociocultural experiences, and suggestions for future research are offered to inform clinical work with DHH individuals.

Alcohol use during COVID-19 in adults with severe untreated AUD.

Evidence demonstrating increased alcohol use during COVID-19 comes from low- to moderate-alcohol use samples and has yet to use adults with severe but untreated AUD. Using a community sample of adults with severe AUD, this exploratory, cross-sectional study examined associations of COVID-19 alcohol use. Participants were recruited for a phase-II RCT. Only baseline measures, completed prior to randomization, were analyzed in the present study. Key variables were alcohol consumption, COVID-19-related worries and experiences, and qualitative responses of 1) alcohol use and 2) positive changes during COVID-19. 176 pariticpants recruited since COVID-19 were on average 41.4 years old, 49.1% female, and 79% White. Participants drank alcohol nearly 23 of the past 30 days, consumed 7 standard drinks per drinking day, and nearly 90% reported increased alcohol use. More heavy episodic drinking was reported in the first six-months of COVID-19 and more COVID-related concerns in the most recent six-months. Participants reported drinking increased due to "more time on their hands", but the pandemic also "strengthened relationships". Results affirm an increase in alcohol use during COVID-19 in adults with severe, untreated AUD. Findings underscore the need to understand how alcohol use and pandemic-related circumstances may influence one another for adults with severe AUD.

Development of the Multidimensional Inventory of Deaf Acculturative Stress.

Deaf adults may experience acculturative stress as they navigate within and between the Hearing and Deaf communities. However, no measure has been developed to assess levels of deaf acculturative stress. This study aimed to develop the Multidimensional Inventory of Deaf Acculturative Stress (MIDAS). The MIDAS was developed through a sequential and iterative scale development procedure and then tested on a sample of 104 deaf adults across the United States (age range = 18-79; 74% female). Principal component analyses were run for item refinement and selection. The final analyses yielded four factors for Stress from the Hearing Community, three factors for Stress from the Deaf Community, and two factors for Intersectionality. Construct validity was demonstrated through correlations in the expected directions with measures of Hearing and Deaf acculturation identity and ethnic/racial identity. The utility of the MIDAS is discussed with regard to future research.

Heterogeneity in Alcohol-Related Severity and Interests in Going to Treatment in Community Adults with Alcohol Use Disorder (AUD).

RATIONALE: Alcohol use disorder (AUD) is highly prevalent among adults in the US and is associated with substantial personal and societal costs. Yet only a small percentage of adults with AUD initiate treatment, including those with severe AUD symptoms who are most in need of treatment. In this paper we use latent profile analysis (LPA) to describe differences in symptoms of AUD severity and alcohol-related consequences among untreated adults with severe AUD symptoms who were recruited from the community. Identification of such differences will result in better understanding of this population and will improve methods of treatment outreach. METHOD: The LPAs were conducted on the baseline data of 403 (50% male, 77% White, M age = 40.74 with severe AUD recruited from the community and enrolled in a trial of an intervention designed to encourage treatment initiation. Participants reported no prior AUD treatment history. The LPAs were based on indicators of AUD severity, alcohol-related negative consequences, and self-reported intention to initiate AUD treatment. RESULTS: The LPAs revealed 4 profiles. Profile membership was predicted by baseline participant sex and whether they were living with a partner and was associated with baseline past 30-days alcohol consumption. CONCLUSIONS: The findings characterize and describe the variability among adults in the community with untreated severe AUD on variables that tend to motivate such individuals to seek treatment, which could significantly advance treatment outreach efforts.

No Taxation Without Representation: Addressing the "Deaf Tax" in Academic Medicine.

Minority faculty and trainees experience unique factors that can hinder their success in academic medicine-collectively referred to as "minority tax." The authors argue that a similar "deaf tax" of unique barriers, experiences, and responsibilities disproportionately burdens deaf trainees and faculty. The cumulative effects of these deaf tax experiences represent a significant disadvantage for deaf professionals in academic medicine. Through a combination of relevant literature and the authors' personal experiences as deaf professionals, several causative domains of deaf tax are outlined, including the fight for reasonable accommodations, prejudice and discrimination, training and diversity barriers, and a lack of deaf mentorship. In addition, a number of practical steps are offered for institutional leaders to consider implementing to improve equity and inclusion in academic medicine, including facilitating language equity and communication access, implementing deaf awareness training, fostering effective deaf mentorship, and promoting deaf professionals into leadership positions. Addressing these issues would help remove the obstacles that create the high deaf tax burden and lower the near-insurmountable barrier of entry, advancement, and retention in academic medicine for deaf professionals.

Alcohol-related consequences and the intention to seek care in treatment naïve women and men with severe alcohol use disorder.

INTRODUCTION: Research on treatment utilization for alcohol use disorder (AUD) is based primarily on clinical samples and community samples of low AUD severity that may not need formal care. Using a community sample of adults with untreated but severe AUD symptoms, we tested the hypothesis that alcohol-related consequences, but not alcohol consumption levels, are associated with the intention to seek AUD treatment, examined associations of specific types of alcohol-related consequences with intention, and explored sex differences in these associations. METHODS: The sample was recruited using social media ads for a randomized controlled trial to test a brief intervention to promote AUD treatment seeking. This report is based on analysis of baseline data collected prior to treatment intervention. Multiple linear regressions examined associations of measures of alcohol consumption, alcohol-related consequences broadly, and specific alcohol-related consequences with the intention to seek treatment. Moderating effects of sex on associations were explored. RESULTS: Subjects (n = 349) averaged 41 years of age, 48% were female, 6% were Latinx, 80% were white, 15% were Black, and 92% met criteria for severe AUD. Alcohol consumption measures were not associated with intention to seek treatment whereas interpersonal- and intrapersonal- consequences were associated with intention. Sex served as a moderator, with intrapersonal consequences (e.g., sad mood) showing a stronger association with intention in women and social responsibility consequences (particularly financial) associated with intention in men. CONCLUSION: Select alcohol-related consequences may be keys to understanding increased intention to seek AUD treatment including intrapersonal consequences in women and financial consequences in men.

Psychological Assessment Reports for Linguistically Minoritized Clients: Considerations for Ethical and Professional Practice.

According to the national census, approximately a fifth of the adult population in the United States uses a language other than English in their home. Less precise information is available regarding the language preferences of children and adolescents, D/deaf individuals, and other individuals in the United States who are not represented in national surveys. The field of psychology has increasingly acknowledged and addressed the lived experiences of culturally and linguistically minoritized individuals in the United States through relevant research and clinical practice guidelines. As a result, more accessible and equitable practices for psychological assessments have been developed when working with linguistically minoritized clients. Unfortunately, there is a paucity of information in the extant literature regarding drafting psychological assessment reports for linguistically minoritized clients. This article explores the ethical and professional responsibilities of psychologists when engaged in this work, and provides proposed practices for drafting and delivering accessible assessment reports for linguistically minoritized clients. Recommendations are provided regarding how psychologists can share the results of an assessment with a referral source using written English and also support a client in accessing the information in their primary language.

Navigating Deaf and Hearing Cultures: An Exploration of Deaf Acculturative Stress.

While there are many benefits of bilingualism and biculturalism, it is increasingly recognized that individuals may also experience acculturative stress as they navigate between different cultural environments. Acculturative stress results from struggles to acculturate, including pressures from the dominant culture and one's heritage culture to maintain specific languages, values, and customs. This study sought to explore experiences of acculturative stress among Deaf and Hard of Hearing (DHH) adults. Thirteen ethnically and racially diverse DHH adults, aged 21-52, participated in semi-structured focus groups. Krueger's (1994) framework analysis was used to analyze the data. Participants reported pressures from the Hearing community as Hearing, Speaking, and English Pressures; Hearing Cultural Expectations; and Family Marginalization. Pressures from the Deaf community included ASL Pressures; Deaf Cultural Expectations; and Small Community Dynamics. Participants also discussed unique stressors related to their intersecting cultural identities (Intersectionality). The psychosocial impacts of acculturative stress included anger, anxiety, depression, exhaustion, resentment, and trauma. Coping resources were also discussed. Results highlight the saliency of acculturative stress among DHH adults and the need for continued investigations of the construct, particularly as it relates to mental health.

Psychometric properties of the SAFE-D: A measure of acculturative stress among deaf undergraduate students.

PURPOSE/OBJECTIVE: Members of minority groups may face stress as they navigate between their native culture and the dominant culture. No measure exists for evaluating acculturative stress among deaf individuals in the United States. The current study examined the psychometric properties of a modified version of the 24-item Social Attitudinal Familial and Environmental Acculturative Stress Scale (SAFE; Mena, Padilla, & Maldonado, 1987) for use with deaf undergraduate students (SAFE-D). Research Method/Design: 145 (88 females and 57 males), deaf, undergraduate students (Median age = 20.0; SD age = 4.9) from a bilingual, multicultural university were included in the study. Seventy-four percent were White, 10.4% Hispanic/Latino, 9.7% Black/African American, 0.7% Asian, and 9% multiracial. The SAFE-D included 23 items. Ten items were modified, 2 items were deleted, and 1 item was added. RESULTS: The SAFE-D demonstrated high internal reliability (α = .931). Four factors were identified: Perceived Societal Barriers, Social Difficulties, Family Marginalization, and Discrimination. Evidence for construct validity was demonstrated through the association of SAFE-D scores with Deaf and Hearing acculturation. CONCLUSIONS/IMPLICATIONS: Levels of acculturative stress in the current sample were close to those reported among late immigrant and English as a Second Language undergraduate students. The 4 factors did not match those of the original SAFE scale but reflected a bidirectional model of acculturative stress unique to deaf individuals. These findings suggest that acculturative stress is a serious concern among deaf undergraduate students and that the SAFE-D can be used to assess deaf acculturative stress in this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Culture and Deaf Women's Body Image.

The sociocultural model of eating disorders highlights the role of internalization of the thin ideal in the development of negative body image and disordered eating. Considering the limited diversity of models in mainstream media, individuals belonging to minoritized cultural groups may resist identifying with and internalizing mainstream beauty messages. The extent of internalization may also depend on an individual's acculturation status and experiences of acculturative stress. This study applied the sociocultural model to culturally Deaf women. Data were collected from 96 deaf, female, undergraduate students. Results support the sociocultural model; higher rates of internalization were associated with negative body image and disordered eating behaviors. However, neither Deaf nor Hearing acculturation predicted internalization. Despite this finding, stronger acculturation with either Deaf or Hearing culture predicted more positive body image, and higher rates of acculturative stress predicted negative body image and disordered eating behaviors. Implications for clinical practice are discussed.