Article summary with Longitudinal effects of emotion awareness and regulation on mental health symptoms in adolescents with and without hearing loss by Adva Eichengreen a.o. - 2022

Emotion regulation (ER) and emotion awareness (EA) are both associated with mental health symptoms, but research on them in adolescences is limited, especially regarding hard-hearing and deaf adolescents (DHH) who are more vulnerable to mental health symptoms. This study investigates the development and contributing factors of ER (avoidance, approach, rumination) and EA (bodily unawareness, emotion communication and emotion differentiation) to externalizing and internalizing behaviors in adolescents with and without hearing problems.

What is the background of this study?

The influence of emotion regulation and emotion awareness on the prevention of psychopathology has been the subject of many studies. Being able to identify your emotions, associate them with the triggering situation and select a regulatory strategy makes it easier to cope with negative feelings. However, most studies did not investigate ER and EA jointly.

People acquire ER and EA abilities through social learning, but not much is known about them with regard to hard-hearing and deaf adolescents, who engage less in social interaction.

Emotional awareness is deemed a necessity for adaptive regulation. EA is considered an attentional process that enables people to identify the cause of their emotions, differentiate between them and locate their previous experienced emotions. EA also involves an attitudinal process: being able to communicate emotions to others.

EA skills are especially important in the transitioning period between childhood and adolescence, in which people are more vulnerable to mental health issues. This phase is characterized by the emerge of intense cognitive, emotional and physiological changes. However, in the same period, adolescents gain more meta-cognitive skills. Previous research found that EA skills are negatively related to internalizing symptoms (anxiety, depression). Emotion differentiation is a predictor for less depressive symptoms over time. Emotion differentiation is negatively related to externalizing symptoms.

Apart from being aware of emotions, the ability of emotion regulation is also essential for mental health. A key regulation strategy is approaching the stressor to modify it, for example by thinking about a solution. The approach strategy is negatively related to externalizing (aggression) and internalizing (depression) symptoms. Cognitive avoidance from the cause of stress is also a potential regulator of internal stress. However, little research is done on the influence of approach strategies on mental health over time.

Research found rumination to be a maladaptive regulation strategy. Continuous worrying or thinking about something is related to anxiety and depression. Rumination or worrying is also underlying externalizing symptoms in boys (aggression). It may evoke a transition from depression to aggression.

Peers and parents play an essential role in EA and ER during childhood and adolescence. Emotion socialization occurs either directly (responding to the emotion expression of the child) or indirectly by modelling skills and attitudes, which is observed or overheard by the child. Hard-hearing and deaf children have less access to social interactions. These children often exhibit elevated rates of mental health problems compared to their hearing peers.

What is the goal of this study?

This study aims to examine to longitudinal contributing factors of ER and EA to mental health (externalizing and internalizing) symptoms, and whether there are differences between adolescents with and without hearing loss.

Who participated?

307 adolescents aged 9-15 years participated (227 hearing, 80 hard-hearing or deaf). They did not differ in gender, age, language ability, parental education level and IQ score.

What were the results?

The findings regarding the developmental trajectories of EA and ER showed no developmental trends for bodily unawareness, communication emotions and differentiating emotions. With regard to ER, an increased use of approach strategies with age was observed. The used of rumination decreased with age, while the use of avoidance strategies showed no developmental trend.

The findings regarding the longitudinal effects of EA and ER on mental health showed no relation between age and the levels of depression. Higher baseline levels and increasing levels over time in communicating emotions, approach strategies, avoidant strategies and differentiating emotions contributed to the development of less depressive symptoms. A lower baseline level and a decreased level in rumination over time contributed to developing less depressive symptoms.

No association was found between age and the levels of anxiety symptoms. An increased use of approach strategies and a decreased use of rumination over time contributed to the development of less anxiety symptoms. Levels of externalizing behaviors decreased with age. Lower baseline levels of bodily unawareness and creasing levels in rumination over time contributed to the development of less externalizing symptoms.

Regarding the baseline levels and developmental trends of ER and EA skills, no differences emerged between DHH and hearing adolescents. Neither did they differ in levels of externalizing behaviors or anxiety over time, but DHH adolescents did show higher levels of depression. No differences were observed with regard to the longitudinal relations between mental health symptoms and ER and EA.

Also examined were potential differences between participants attending regular and special schools. The findings displayed that DHH adolescents in special schools scored higher on depressive symptoms and made less use of approach strategies. No other differences were observed.

The developmental and socio-demographic profiles of the participants were also examined (IQ, language, parental education). The findings suggest that DHH adolescents with high language scores are better at differentiating emotions. Hearing adolescents with high scores also exhibited less externalizing symptoms. All participants with low language competency displayed more depressive symptoms in comparison to those with high scores, but among the low scores groups, the DHH participants exhibited the most depressive symptoms. Also, DHH adolescents with a low level of parental education displayed more depressive symptoms in comparison to low- and high-profile hearing peers.

What is the conclusion of this study?

The findings of this study display the importance of various aspects of ER and EA during adolescence by demonstrating their contributions to the development of mental health. Decreases in several emotion skills could be alarming predictors of mental health symptoms. Intervention targeted at these emotion skills is recommendable.

The findings also show that DHH adolescents attending special schools may be more vulnerable to mental health issues, and that language competency and parental education also influence the development of mental healthy symptoms. Future research is needed in order to address these possible risk factors.