Existing reviews on mental health disparities between deaf and hard-of-hearing (DHH) and hearing populations have focused predominantly on children, adolescents, or older adults, leaving a gap for working-age adults. We conducted a systematic review comparing the prevalence, incidence, and severity of any DSM-5-TR or ICD-11 mental disorder between DHH and hearing adults aged 18-60 years. We aimed to quantify disparities and examine disorder-specific patterns to inform future research, policy, and service development. On 13 December 2025, we searched Ovid Medline, Embase, APA PsycINFO and Web of Science. We included analytical observational studies involving DHH and hearing adults aged 18-60 years, reporting mental disorder prevalence, incidence, or severity. Two researchers independently extracted data, and risk of bias (RoB) was assessed using the modified CLARITY tool. We narratively synthesised findings by aggregating outcomes at the study level using two approaches: summary and majority of the effect directions within a study. Subgroup syntheses examined outcome type, study RoB, age group and mental disorder category. Sixty studies (n = 8 578 466) met inclusion. In the summary-direction synthesis, 58.3% (35/60) of studies reported higher mental disorder outcomes for DHH adults, 21.7% (13/60) found no difference and 20.0% (12/60) had mixed findings; none indicated lower mental disorder outcomes for DHH. Under the majority-direction approach, 65.0% (39/60) showed higher mental disorder outcomes and 35.0% (21/60) no difference. These patterns were consistent across prevalence (62.8-72.1% higher) and severity (61.1% higher). Studies with higher RoB more often reported higher mental disorder outcomes (66.7-72.2%) than lower-RoB studies (54.8-61.9%), though both mirrored the overall synthesis. Effects were similar across younger (61.9-71.4%) and older adult samples (61.1-66.7% higher). Disorder-specific syntheses identified psychotic disorders, post-traumatic stress disorder and suicidal outcomes as having the strongest disparities (≥72.2% higher), followed by general mental disorders, anxiety and depression. Fewer than five studies examined each of the other disorders, thereby limiting conclusions for these disorders. Most available evidence indicates that the prevalence and severity of mental disorders are higher among DHH adults aged 18-60 years than among hearing adults, with limited evidence on incidence. No studies reported lower aggregated mental disorder outcomes for DHH adults. Addressing these disparities requires targeted intervention research, supported by population-based, longitudinal and (quasi-)experimental studies including comprehensive reporting of participant characteristics. This will inform more tailored interventions, improve screening and ultimately contribute to better mental health and quality of life for DHH adults.
This study explored how sign language use and social connectedness influenced the life satisfaction of twelve British Deaf community members (n = 12, m = 2, f = 10, aged 23-79). During in-person and remote interviews, participants compared experiences of sign language use and social connectedness with experiences of spoken language and exclusion. Reflexive thematic analysis generated two main themes. (1) Gaining Deafness: which explored how sign language use and social connectedness created positive perceptions of deafness, enabling authenticity and agency. (2) Empowering Deaf pride: which examined how feeling connected to sign language and Deaf culture produced Deaf pride and self-advocacy, empowering participants. These findings support the implementation of sign language in early education for all children. The findings call for the social reconstruction of deafness, and for deaf-led development of inclusive definitions and terminology. This research provides new qualitative evidence on how sign language and Deaf cultural connectedness enhance the life satisfaction of Deaf adults.
Deaf and hard-of-hearing Multilingual Learners (DMLs) are Deaf and hard-of-hearing students who are either born outside of the country they currently receive schooling in or have both parents born outside of that country, using a language other than the national spoken language at home. This group is growing in numbers and contributes significantly to the increasing linguistic and cultural diversity in Deaf education. This systematic review synthesizes findings from 17 peer-reviewed empirical studies, identifying four educational levels relevant to DMLs: context, organization, educators, and student. Parents are key agents across all levels. While DML education generally aligns with that of other deaf and hard-of-hearing students, educators attest to difficulties teaching DMLs due to a lack of adequate assessments, strategies, and materials, adapted to DMLs' specific needs. Educators and parents highlight difficulties in establishing effective home-school collaboration, despite its recognized importance for academic success. DMLs value all their languages equally but especially emphasize the national sign language for learning. Parents are an underused resource. This review underlines the pressing need for empirical research on effective teaching strategies and materials for DMLs, improved internal and external school collaboration strategies, and a deeper understanding of DMLs' experience.
This paper examines the ontological, axiological, and epistemological commitments of a deaf-led team, which informs their implementation of story dramas with deaf preschoolers in a Western Canadian preschool. A bimodal bilingual teaching team co-constructed a story drama delivery model for deaf children based on training provided by the researcher to the instructional staff at the preschool. The training presented story drama interventions originally developed with hearing preschoolers and elementary students. To examine the ontological, axiological, and epistemological commitments of the deaf-led instructional team, the researcher observed how the deaf-led team applied the training to their story dramas delivery to their deaf preschool students. Multimodal discourse analysis of video recorded classroom sessions of story dramas with deaf preschoolers revealed how the deaf-led team provided a strong ocularcentric, multimodal, and interactive approach to story drama, which differed significantly from the training model developed from sources on story dramas for non-deaf children. The study also included interviews with the deaf-led instructional team, which were coded according to themes arising from the interviews. The study interviews explore the deaf-led team's perceptions of the impact of their delivery of three story dramas on their deaf students, reporting significant changes in their students, including increased linguistic production, development of concepts, collaborative behaviors, and social and emotional development. The study recommends a deaf story drama training model for deaf preschoolers according to deaf ontological, axiological, and epistemological commitments of deaf-led instructors and teams.
This paper, representing a multilingual Global South-Global North deaf research collaboration, reports and critically analyzes findings from interviews with 5 deaf adult and 5 sign language interpreter participants regarding their educational and training experiences in the postcolonial Caribbean environment of Trinidad and Tobago. Caribbean sign languages are frequently said to be varieties of American Sign Language (ASL) and/or to have been displaced by ASL in schools with deaf learners. In the anglophone Caribbean context, deaf children have not had access to early childhood care and education in the medium of sign language, and most deaf students arrive at primary school without having acquired a named sign language variety. Moreover, despite a lack of formal standards for interpreter training and evaluation, deaf secondary school students are placed in regular schools with sign language interpreters. Findings from interviews reveal ideologies surrounding named sign language varieties, deaf multilingualism, and interpreter roles within schools, and point to the need for deaf leadership within organizations and institutions providing services to deaf people.
Deaf epistemology, which focuses on the unique ways deaf individuals navigate and experience the auditory world, has become a critical area of study in recent years, particularly in the U.S. This literature review explores key themes in deaf U.S. epistemology, focusing on the comparison between traditional (hearing-centered) epistemology and deaf epistemology, as well as the influences of identity, culture, and sign language. Findings reveal that deaf epistemology in the U.S. is deeply shaped by identity, cultural pride, Deafhood, and the recognition of American Sign Language and situated homecoming, raising questions about how deaf experiences contribute to knowledge. These findings suggest that it may be useful to explore the concept of deaf epistemology in countries such as Indonesia, where historical context, Indonesian Sign Language (Bisindo), identity, and culture have developed under different social and political conditions. This review seeks to use the U.S. deaf epistemology framework to investigate how a distinct deaf Indonesian epistemology might emerge, given the challenges of language suppression, limited educational access, and the struggle for recognition of Bisindo. This work contributes to ongoing advocacy for the recognition of Bisindo and deaf culture in Indonesia, providing a foundation for future research on how deaf Indonesians construct knowledge in their own cultural context.
This study examined whether stereotype threat degrades deaf and hard-of-hearing (DHH) college students' math performance. The DHH participants self-assigned their social identity as "deaf" or "hard of hearing" irrespective of audiological assessment. Social identity is central to experiencing stereotype threat and being deaf or hard of hearing may activate negative biases which trigger a stereotype threat that impacts test performance. A sample of college students (216 deaf, 128 hard of hearing, 152 hearing) were randomly assigned to either a stereotype threat or no-threat test condition and tested on arithmetic, modular arithmetic, and quantitative Graduate Record Examination-type math problems. The deaf and hard-of-hearing participants tested under the stereotype threat condition underperformed compared to those under the no-threat condition. Further exploratory analyses demonstrated that female participants underperformed male participants and African American/Black DHH participants underperformed White DHH participants. This double-threat jeopardy finding of multiple marginalized identities is consistent with the minority stress model. Overall, results are consistent with previous research in which a social identity is linked to a negative stereotype and both the stereotype and linked identity impact performance. This study demonstrated that deaf and hard of hearing are social constructs, and the results provide empirical support for the social model of disability.
This online ethnography narrates the learning experiences of Deaf students in a public high school in Quezon City, Philippines, and the institutional factors that affected the learning processes and deliveries for Deaf students during the COVID-19 pandemic. Deaf students encountered various difficulties during the 2 years of online learning: (a) intermittent internet connection, (b) hearing-centric class discussions, (c) failure of teachers and parents to accommodate Deaf students' needs, (d) discriminatory acts against Deaf students, and (e) the inferior societal regard for Deaf individuals and their community. Guided by the principles of critical ethnography and utilizing online ethnography, this study affirmed that the Filipino Deaf community remains a linguistic minority and marginalized community. However, while societal processes are mostly dominated by hearing communities' ideologies, the visual meaning-making-the process of encoding and decoding signs visually-and the unique assemblage of Deaf students' community are ever present and visible despite the physical separation brought about by the pandemic.
Educational interpreters' roles and responsibilities have long been one of the most ambiguous and controversial aspects of inclusive education for Deaf and hard of hearing students. Although it is largely agreed upon that sign language interpreters are expected to fulfill expanded roles and responsibilities in educational settings, the field has yet to reach a consensus regarding where those extended boundaries are to be drawn. Furthermore, the longstanding lack of standardized expectations for educational interpreters has left many of them making unguided guesses regarding how to best support the students whom they serve, often in domains for which they have little-to-no formal preparation or training. Through a national survey, this mixed-method study explored 482 educational interpreters' fulfillment of various roles and responsibilities and their perspectives regarding appropriateness, with particular attention to their level of involvement as Individualized Education Program team members. Results indicate that educational interpreters continue to engage in a myriad of roles and responsibilities, of varying frequencies, and while there is some diversity among their perspectives regarding specific tasks, overarchingly, they aspire to contribute more comprehensively as educational professionals. These results further compel the call for a paradigm shift in which qualified educational interpreters possess the education, training, support, and confidence required to serve as accessibility specialists within the educational team.
This article examines how deaf students and interpreters experience positioning within mainstream educational settings, with a focus on environments where a critical mass-defined as multiple deaf students and interpreters-is present. Drawing on interviews with 41 formerly mainstreamed deaf individuals and interpreters, the study explores how critical mass influences engagement, participation, and perceived membership in the school community. Findings suggest that critical mass enhances access to Deaf Community Cultural Wealth (DCCW) and fosters collaborative positioning. These environments strengthen support systems for both deaf students and interpreters. These environments also promote professional development among interpreters and contribute to more inclusive school climates. The study is framed by positioning theory and DCCW, offering insights into how systemic and interpersonal dynamics shape educational experiences. Implications are discussed for both deaf education and interpreter education communities.
Deaf scholars have long worked at the margins of academic institutions not designed for them. Designated deaf academic spaces-where deaf ways of knowing, teaching, and communicating are centered-remain rare. This study explores what becomes possible when such a space exists, presenting Dr Deaf as a case study. Drawing on interviews with participants and teachers, we show how deaf epistemologies and pedagogies are enacted through cross-stage responsibility and academic becoming through re-alignment of deaf participants and teachers. We also identify a distinct deaf rhythm that emerges in this space. At the same time, we recognize that these practices are not experienced or valued equally by all participants and teachers: needs, priorities, and ways of engaging differ, and Dr Deaf's approaches may not resonate for all. Yet its values offer a flexible framework for imagining and sustaining other deaf academic and broader educational spaces.
This scoping review examined health literacy among Deaf populations and identified gaps in current evidence. A systemic search of PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane was conducted from database inception to December 31, 2024. English-language quantitative, qualitative, and mixed-methods studies reporting from the perspective of Deaf individuals of any age were included, alongside studies evaluating educational interventions. Data were charted using a standardized extraction framework and analysed thematically. Fifty-seven studies from 14 countries met the inclusion criteria. Four themes emerged: health literacy of Deaf people, factors affecting the health literacy of Deaf people, source of health information, and impact of interventions on health literacy levels. Overall, Deaf people demonstrated poorer health literacy levels than hearing populations, largely due to communication barriers and inaccessible health information. While educational interventions improved knowledge, evidence on their sustained impact remains limited. Findings underscore the need for culturally-competent, sign-language-accessible health education to reduce health inequities.
This study explores the implementation of accommodations and modifications (A&Ms) for deaf and hard-of-hearing (DHH) students in Malaysian schools, addressing the gap between inclusive policy, holistic support, and actual classroom practice. A mixed-methods approach was used, combining a cross-sectional survey (n = 196) with focus group discussions involving teachers from inclusive education (IE), special education integration programs (SEIP), and special education schools (SES) across four states. Survey results indicated that communication strategies were the most frequently implemented by teachers, with repetition and rephrasing being the most commonly used techniques. While implementation varied across other domains, the findings revealed areas for growth, including the need for enhanced training, more effective integration of hearing technologies, stronger collaboration with multidisciplinary teams and greater utilization of assistive tools. Teachers also expressed the need for increased access to inclusive teaching resources and more intentional classroom adjustments to support listening needs. The findings underscore the importance of flexible, multimodal communication strategies tailored to individual student needs. Sustainable participation and equitable access for DHH students require the systemic implementation of inclusive design across curriculum, learning environments, technology, assessment and teacher professional development. Guided by universal design for learning (UDL), the ICF-CY framework and the Malaysia Education Blueprint 2013-2025, strengthening inclusive practices depends on enhanced teacher preparation, effective use of assistive technologies and sustained cross-sector collaboration to translate inclusive policy into meaningful classroom practice.
Studying health-related quality-of-life during adolescence involves examining interpersonal adaptation and self-efficacy perception. Among deaf and hard-of-hearing (DHH) adolescents this task is complex due to additional factors related to hearing loss. This is a crucial issue, since it reflects the degree of well-being and social integration in individuals at risk of margination and exclusion. The study aimed to validate the Italian/Italian Sign Language (LIS) version of Youth Quality-of-Life for Deaf or Hard-of-Hearing (YQOL-DHH) questionnaire. 105 deaf adolescents were recruited from a hospital and a school. After administration, we assessed internal consistency using Cronbach's alpha, concurrent validity with the Children's Depression Inventory-CDI through Pearson's correlation coefficient and mean score differences across the instrument's domain (advocacy, perceived stigma, participation) according to demographic and clinical variables. Internal consistency revealed significant data with Cronbach's Alpha 0.86 for advocacy and participation and 0.76 for perceived stigma domain. Regarding concurrent validity we observed significant correlations between CDI and each domain (p < 0,0001). Furthermore, we investigated the effect of variables: gender, age, and hearing device use on domains' scores but found no significant differences. In conclusion, the Italian/LIS version of YQOL-DHH proved to be a reliable, valid, quick, and easy-to-use tool for clinical and research purposes.
The importance of hearing parents of deaf and hard-of-hearing (DHH) children learning sign language is well documented. However, parents face many challenges in this learning process. This study investigates the experiences of Dutch hearing parents learning Dutch Sign Language (NGT) or Sign-supported Dutch through semi-structured interviews with 21 parents and 6 NGT teachers. The interviews explored parents' and teachers' perspectives on parental sign language courses, additional learning materials, and the challenges parents face in learning sign language. The findings highlight the value of DHH teachers and home-based initial courses, as well as the importance of courses aligning with the child's developmental stage and extending beyond vocabulary level. Both parents and teachers appreciated learning materials that could be used together by parent and child but expressed a need for additional and more elaborate resources. Common challenges included language-specific difficulties, such as mastering sign order and adapting to a visual language, and external barriers, such as difficulties accessing courses and conflicting expert advice regarding the use of sign language. These findings underscore the need for more accessible courses, longer-duration support, and greater consistency among professionals in their advice. This would better support hearing parents in effectively learning sign language and ensuring their DHH children have full access to language from an early age.
Communication is a significant barrier for persons who are Deaf and persons who are DeafBlind when accessing healthcare services. Most healthcare professionals are unfamiliar with sign language, which complicates the provision of holistic care. This cross-sectional study aimed to assess differences between employed nursing professionals and nursing students in three areas: motivation to learn Croatian Sign Language, knowledge about persons who are Deaf and persons who are DeafBlind, and opinions toward them. In both questionnaires, the same questions were asked for direct comparison between the examined groups. Nursing students showed statistically significantly more positive opinions compared to employed nursing professionals (p < .001), with first-year Master's nursing students scoring the highest (p = .019). Additionally, nursing students showed greater motivation to learn sign language (p = .015). These results are consistent with other studies showing similar trends, reporting low sign language knowledge and negative emotions when working with patients who are Deaf and patients who are DeafBlind, and highlight the need to integrate sign language training and communication skills into nursing education. Findings should be interpreted considering the convenience sample from one Croatian region and the use of non-parametric analyses.
This study explores the characteristics of cultural safety in Family-Centered Early Intervention services for d/Deaf and hard-of-hearing children and their families (FCEI-DHH). Perspectives of culturally and ethnically diverse families who have young DHH children and service providers in pediatric DHH services were gathered through online surveys. Quantitative analyses examined the influence of geographical location and parent self-identity (Deaf, Indigenous, racialized, marginalized (DIRM), and/or belonging to a dominant/privileged group) on aspects of FCEI services. Parents reported a high overall level of support from service providers, but lack of support was disproportionately experienced by DIRM parents with medical/diagnostic services. Cultural identity was important to make connections in DHH communities, but DIRM parents connected least. This study identifies areas for improvement and can inform the development of evidence-based practice guidelines for cultural safety and humility in the delivery of FCEI-DHH. This work can help mark progress towards achieving health equity.
Speech-language therapy (SLT) within deaf education in Aotearoa New Zealand remains influenced by oralist traditions. Māori deaf individuals also face barriers to their culture and native language. This qualitative study explored deaf adults' experiences and perceptions of SLT, including how SLTs should best support deaf children. Focus groups and interviews were conducted with 11 deaf adults (aged 28-65) who had engaged with SLT. Data were generated in New Zealand Sign Language or English and analysed using reflexive thematic analysis. Ensuring deaf children thrive and flourish was the overarching theme, with three subthemes (1) Hearing differences create a unique experience (2) Consider the child's unique ecosystem and (3) The profession's responsibilities. Participants wanted culturally affirming collaborative SLT practice, including signed and spoken languages. They prioritised early language access, communication success, strong therapeutic relationships and diversifying the workforce to ensure deaf children flourish.
The meaningful engagement of Deaf people in research poses ethical challenges, yet Deaf people are systematically underrepresented in discussions on ethical research conduct. Our study explores experiences and opinions of Polish Deaf people about research through a bilingual open-ended online survey. We gathered 52 responses and analysed them in collaboration with a Deaf advisory group using an experiential approach to reflexive thematic analysis. We developed six themes, reflecting the challenges, needs and aspirations of Deaf people, embraced under one overarching theme: Dialogue matters. Our study highlights social and epistemic inequalities faced by Deaf people in research, as well as the need for greater accessibility and trust. We discuss how the Polish context both reflects and differs from the experiences of Deaf people from other countries. The findings may inform evidence-based recommendations for scientific cooperation between Deaf and hearing people.
There is mounting evidence that maternal sensitivity contributes to optimal child development, but little is known about dyads including deaf mothers and their hearing infants. Deaf adults experience a range of adversities in their role as a parent, and it is unclear how these experiences influence early interactions with their child. Videos of 28 deaf mothers playing with their four-to-eight-month-old hearing infants were coded using the CARE-Index. Dyadic synchrony of most dyads were found to be sensitive or adequate. However, 21% of dyads were likely to benefit from education and/or intervention to increase sensitive interactions. Compared to the rest of the dyads, they displayed lower levels of maternal sensitivity and infant cooperativeness, as well as higher levels of maternal unresponsiveness and infant passivity. Results were influenced by socioeconomic status and potentially by vocal and social touch behaviour. Methodological, theoretical and clinical considerations are offered for professionals working with deaf mothers and their hearing infants.