Academic journal article Journal of Rehabilitation Research & Development

Use of Mental Health Services by Veterans Disabled by Auditory Disorders

Academic journal article Journal of Rehabilitation Research & Development

Use of Mental Health Services by Veterans Disabled by Auditory Disorders

Article excerpt

INTRODUCTION

The 2003 President's New Freedom Commission on Mental Health report articulated a concern about understanding and treating special populations, especially those with medical comorbidities and accompanying psychiatric disorders [1]. Although hearing loss is the third most prevalent chronic health condition in the United States [2], limited attention has been paid to the association between hearing loss and psychopathology or its potential role in impeding access to mental health services [3-5]. In 2001, 17.4 percent of the U.S. adult population had some type of trouble hearing according to estimates of a sample population [6]. Even after adjusting for age, researchers found that the prevalence of auditory disorders increased by 14.0 percent between 1971 and 1990 to 1991 [7]. Such disorders typically include tinnitus (ringing of the ears) and/or conductive or sensorineural hearing loss. Factors such as an aging baby boomer population and differing survey methods may account for this rapid increase of auditory disorders over the past two decades [8]. Additionally, some people have difficulty distinguishing whether they have trouble hearing because of their tinni tus or hearing loss, thus it is unknown whether population studies include both persons with tinnitus and hearing loss. Therefore, the term "auditory disorder" describes some type of auditory problem when it is unknown whether tinnitus, hearing loss, or both are present.

The U.S. population includes 25 million veterans, many of whom have auditory disorders and/or mental health disorders. Although there is the expectation of communication difficulties, it is unknown whether those with adult-onset hearing loss and tinnitus encounter barriers to receipt of mental health services at Department of Veterans Affairs (VA) medical centers (VAMCs) [9].

Identifying whether veterans with auditory disorders access VA mental health services at a similar rate as veterans with other disabilities offers the potential to improve clinical services to meet the needs of veterans and inform future studies regarding the comorbidity of mental health and auditory disorders. Furthermore, the number of veterans disabled by auditory disorders has been steadily increasing since 2001, and auditory disorders are the most common new disability among veterans [10]. As Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans return from service, this disability rate is likely to increase further. This study seeks to determine whether there are barriers to the receipt of VA mental health services by veterans with auditory disorders.

Several studies have found an association between adult-onset hearing loss and mental health disorders [9,11]. Hearing loss reduces one's ability to communicate with others, which can exacerbate a mental health disorder, such as depression or anxiety, or create a period of adjustment during which mental health services may be needed [9]. Many people with adult-onset hearing loss grieve this loss before finally accepting and adapting to it. Mental health providers can assist with the adjustment process by teaching effective coping strategies and by offering treatment and support [12].

Further, tinnitus severity ratings strongly correlate with measures of psychological distress, indicating that tinnitus may exacerbate mental health disorders [13-15]. Measures of anxiety and depression are often elevated among tinnitus sufferers, suggesting that tinnitus and some mental health disorders may affect similar neural mechanisms in the central nervous system that can affect attention, emotions, and perception [13-14]. Posttraumatic stress disorder (PTSD) was present in 34 percent of 300 veterans seeking help for tinnitus over a 4-year period [13]. Tinnitus may serve as a constant reminder of a traumatic event, such as a blast exposure [15]. When a blast occurs, even in the absence of shrapnel or debris, a wave of energy from the blast may damage cells of the human body, including the ears, brain, and internal organs. …

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