Persons with hearing or vision impairments (HI/VI) are at increased risk for mental health problems. Several studies have examined the efficacy of psychological interventions on the mental health of both populations. However, evidence-based research on psychological interventions for these populations is still in its early stages. For these reasons, we conducted a literature review and the first meta-analysis of psychological interventions for persons with either HI or VI.
Procedure
The meta-analysis included a database search of 1,908 studies (duplicate-free) and effect size calculations using a random effects model. Eleven randomized controlled trials (RCTs) were included in the analysis in order to assess the state of research on high-quality studies. In addition to the RCT design, a psychological intervention and mental health outcome measures had to be included. Moreover, the samples had to be drawn from individuals with HI or VI (World Health Organization criteria), starting with
- slight hearing loss (you have difficulty understanding quiet/whispered conversations)
- mild visual impairment (you cannot drive a car)
Results
Our meta-analysis showed a small but significant effect of psychological interventions for persons with HI or VI on mental health outcomes (e.g., depression, anxiety, stress) (d = 0.14; 11 studies; 95% confidence interval, CI [0.02, 0.25]). A large and significant effect was found for persons with HI (d = 0.82; two studies; 95% CI [0.32, 1.32]), which included the only intervention with a clear psychotherapy approach (CBT). RCTs for persons with VI showed no significant effects (d = 0.05; nine trials; 95% CI [-0.03, 0.12]) and for subgroup analysis for depression and anxiety.
Discussion and Call to Action
Due to the small number of eleven RCTs and methodological limitations of the studies, the evidence for the effects are questionable. In summary, the findings of our meta-analysis showed a lack of generalizability for the efficacy of psychological interventions involving persons with HI or VI. In this regard, the current state of research is sobering for both populations. Given the large and still growing literature on effective treatments for depression and anxiety as well as other mental health outcomes, this study leads to the conclusion that, in relation to evidence-based and effective psychotherapy treatment, persons with a HI or VI are an orphaned group that needs much more attention at the research, policy, and clinical levels.
Research:
- evidence-based psychological treatment should be adapted and tested for both populations
- psychological interventions for persons with HI or VI could benefit from other areas of research with a greater number of adapted interventions focused on mental health care (e.g., interventions for persons with intellectual disabilities)
Policy:
- research funding should expand in this field to provide more projects and progress
- mental health problems of persons with HI or VI should be more widely recognized by the general public
Clinicians:
- professionals should be informed about the current state of research for persons with HI or VI and gain a better understanding of possible methods to improve the accessibility of psychological treatment
- experienced therapists who are themselves affected by HI or VI could be seen as role models and experts
Finally, the development and implementation of psychological treatment for persons with hearing or vision impairment should be a participatory process involving persons from both populations.
Discussion Questions
- How could evidence-based research on psychological interventions be adapted for persons with hearing or vision impairments?
- What is needed to raise public awareness of the mental health issues faced by persons with hearing or vision impairments?
- What models of participatory research could be considered for the further development of psychological interventions for persons with hearing or visual impairments (e.g., experienced therapists who are themselves affected as role models)?
About the Authors
Bastian Hardt, M.Sc. is a psychologist and research assistant at the Department of Rehabilitation and Special Education at University of Cologne (Germany). Previously, he worked at the Department for Psychology and Psychotherapy at Witten/Herdecke University, where he started his PhD. His research focuses on accessible mental health care for persons with sensory impairments. He is legally blind himself (congenitally) and volunteers in a self-help organization for persons with sensory impairments (PRO RETINA, Germany). In his free time, he enjoys spending time with his family, books, music and movies. Bastian Hardt can be contacted at bastian.hardt@uni-wh.de.
Johannes Graser, PhD is a Deputy Professor at the Department for Psychology and Psychotherapy at Witten/Herdecke University (Germany). His research mainly focuses on Compassion Focused Therapy (CFT) and adapting CFT to people with intellectual disabilities and mental disorders. He is founder of a German volunteering platform to bring together volunteers and social institutions (www.freizeit-helden.de). In his free time, he writes jokes which he loves to perform at rather small standup-comedy clubs.
Thomas Heidenreich, PhD is a Full Professor at the Faculty Social Work, Health and Nursing Sciences at the University of Applied Sciences in Esslingen (Germany). His research interests include mindfulness-based interventions, service user involvement in social work education and the development of assistive systems to improve inclusion of people with impairments.
Johannes Michalak, PhD is a Full Professor at the Department for Psychology and Psychotherapy at the Witten/Herdecke University (Germany). His research primarily focuses on mindfulness-based interventions, embodiment in mental disorders and psychotherapy for individuals with disabilities.
References Cited
UN General Assembly (2007). Convention on the Rights of Persons with Disabilities: resolution / adopted by the General Assembly, 24 January 2007, A/RES/61/106.