Study Design
During the COVID-19 outbreak, we examined, in this research descriptive-comparative study, the prevalence of PTSD and depression, as the psychological consequences of this disease, in deaf and HH adolescents. We also compared adolescents with HL with their hearing peers in terms of PTSD and depression.
Sample and procedure
The statistical population comprised of adolescent students aged 12 -18, who had HL problem (either deaf or HH with HL ranging from mild to severe). A total of 56 with-HL students (33 HH and 23 deaf students) from different provinces of Iran, including Borujerd city, Lorestan Province [12 students (7 HH and 5 deaf)]; Malayer city, Hamadan Province [13 students (8 HH and 5 deaf)]; Nahavand city, Hamadan Province [15 students (9 HH and 6 deaf)]; and Tuyserkan city, Hamadan Province [16 students (9 HH and 7 deaf)] participated in the study. All of these HL adolescents attended special schools. All the participants and their parents signed informed consent forms. The participants filled out the questionnaires at home within 25 to 40 min. The control group was also consisted of 56 adolescents without HL. They were matched with HL adolescents in terms of age, education grade, and gender and randomly selected from among ordinary schools. In the final sample, 8.93%, 7.14%, 14.29%, 19.64%, 12.5%, 17.86%, and 19.64% of the participants were at the age of 12, 13, 14, 15, 16, 17 and 18 years old, respectively. Also, 37.5% and 62.5% of the subjects were females and males, respectively. Of the deaf adolescents, 78.26% of was prelingually deaf, while 21.74% was postlingually deaf. Besides, of the HH adolescents, 69.67% used hearing aids. These data were collected in November and December 2019 in previous the outbreak of COVID-19.
Because we wanted to help adolescents with PTSD and depression symptoms after collecting the data, we coded the data and wrote down the address and home phone number of the adolescents. We told the parents that we would help their children if they had any problems, and they agreed. After 5 months (April and May 2020), we returned to follow up the adolescents with PTSD and depression. Unfortunately, the condition of PTSD and depression in some deaf and HH adolescents and even hearing adolescents had worsened. Based on this conditions, we decided to repeat the study between two groups of children with HL and hearing peers. Because it was likely that this worsening of the problem was due to the prevalence of COVID-19 in Iran. Therefore, in April and May 2020, deaf and HH adolescents were reevaluated.
Measures
Child PTSD Symptom Scale for DSM-5 (CPSS-5)
The CPSS-5 [45] is a 27-item self-report instrument measuring the PTSD symptom (20 items) in children aged 8–18; items are scored on a 5-point Likert scale ranging from 0 (not at all) to 4 (6 or more times a week/almost always). The total score ranges from 0 to 80. The CPSS-5 includes 4 subscales: intrusion (5 items), avoidance (2 items), changes in cognition and mood (7 items), and increased arousal and reactivity (6 items). A cutoff score of 31 is also used for identifying PTSD symptoms [45]. The Cronbach’s alpha for the total scale was .92 and test–retest reliability was .80 [45]. In the present study, however, we found Cronbach's alpha coefficient of .93 for the total scale. The convergent validity (correlations above 0.50 between items and each dimension) also showed that the correlations of each item with sub-scales, such as intrusion (from 0.66 to 0.84), avoidance (from 0.77 to 0.81), changes in cognition and mood (from 0.56 to 0.69), and increased arousal and reactivity (from 0.52 to 0.65). Also, the correlations of intrusion, avoidance, changes in cognition and mood, and increased arousal and reactivity with the total score of the CPSS-5 were 0.83, 0.61, 0.88, and 0.91, respectively.
Children's Depression Inventory Short version (CDI: S)
The CDI: S [46] is a self-report inventory measuring the depression in children aged 8–18. It includes 10 items scored based on the three-option scales from 0=none to 2=definite. The total scores of the CDI: S ranges from 0 to 20. A cutoff score of ≥3 is also used for identifying depression symptoms [43] The Cronbach's alpha coefficient for CDI: S was .80 [46]. Further, the correlation between the CDI and the CDI: S was 0.86 [47]. In addition, the Cronbach's alpha coefficient for CDI: S in young people with physical disabilities was .84 and the validity was approved by the positive correlation between pain intensity, pain interference, and psychological functioning with the CDI: S [48]. The present study also found the test-retest (correlation between CID: S in previous and during the COVID-19) reliability CDI: S as 0.81.
Ethical Considerations
Researchers explained the aim of the study to the participants and their parents. Students, parents (father or mother, or guardian), and school managers signed the written consent forms. The participants were also assured that: 1) their data would be confidential, 2) the results would be published in an article without their personal information, and 3) whether or not they participate in the study, would have no impact on school services. The study was non-experimental; so, it did not pose any physical or psychological risk to the participants. In addition, due to the contagious nature of the coronavirus, health protocols were carefully considered in the research process. This study received the ethic approval from Ethics Committee of Malayer University, Iran (IR.MALAYERU.REC.1399.007).
Statistical analysis
Based on the cut-off point for the PTSD and depression, descriptive statistics (frequencies, percent, mean, and standard deviation) were provided. We used Chi-Square for comparing the frequencies of PTSD and depression in female and male deaf and HH adolescents in previous and during the COVID-19. Multivariate Analysis of Variance (MANOVA) was used for comparing the PTSD and depression in adolescents with and without HL during and in previous outbreak of the COVID-19. The IBM SPSS Statistics version 24 was used to data analysis.