Introduction

According to the latest report of “Deafness and hearing loss” (WHO, 2021), hearing impairment is becoming increasingly prevalent worldwide, and nearly 2.5 billion people will suffer from some degree of hearing loss by 2050. Moreover, almost four-fifths of hearing impairments live in low- and middle-income countries, like China. Based on the Second National Sample Survey on Disability in 2006, the data on the estimated prevalence in China reported that the number of people with hearing impairment reached 27.8 million; of these, approximately 110,000 were children (National Bureau of Statistics of the People’s Republic of China, 2016). Due to the growing prevalence, there has been an increasing interest in hearing-impaired people, especially hearing-impaired students. A number of the literature showed that hearing impairment impacted many aspects of life for students, such as cognitive development, social interaction, and mental health (Millen et al., 2019; Qi et al., 2020; Zhao & Wu, 2022).

Well-Being of Hearing-Impaired Students

One crucial concern for hearing-impaired individuals is well-being, which refers to individuals’ mental health and the fulfillment of human potential and meaningful life (Chen et al., 2013; Hsieh, 2016). Well-being consists of multiple components, such as life and social satisfaction (Hsieh, 2016; Ma et al., 2022). Previous studies found that hearing-impaired adolescents were at risk of low well-being (Ma et al., 2022; Wolters et al., 2012). For example, Jaiyeola and Adeyemo (2018) found that most of their sample of hearing-impaired students reported poor quality of life which encompassed individuals’ well-being.

Although scarce, there is research on the protective and risk factors of well-being in hearing-impaired students, including discrimination, identity, and peer and teacher relations (Blom et al., 2018; Ma et al., 2022; Mousley & Chaudoir, 2018; Wolters et al., 2012). Yet, to the best of our knowledge, there is little research investigating the relationship between hearing-impaired students’ well-being and parent-adolescent attachment; the latter was frequently associated with well-being in normal adolescents and adults (Abubakar et al., 2013; Bohn et al., 2020; Borelli et al., 2019; Lucktong, Salisbury & Chamratrithirong, 2018; Weisskirch, 2018).

Relationship Between Parent-Adolescent Attachment and Well-Being

Parent-adolescent attachment is understood as the strong affectional bonds of adolescents to their parents (Ainsworth, 1989; Bowlby, 1977). If the parents appropriately respond to their children’s needs, they could develop secure attachments and have worthy and reliable self-concepts (Bretherton, 1992). Much research has shown significant correlations between parent-adolescent attachment and well-being in adolescents (Abubakar et al., 2013; Bohn et al., 2020; Lucktong, Salisbury & Chamratrithirong, 2018). For example, adolescents with secure parent-adolescent attachment reported better well-being (Bohn et al., 2020). Similarly, Abubakar et al. (2013) found that parental attachment played a crucial role in the psychological well-being of disabled adolescents. However, it remains unclear whether parent-adolescent attachment contributes to well-being among adolescents with hearing impairment. The current study examined this relationship in the Chinese sample of hearing-impaired students. Given the above, we hypothesized a positive relationship between parent-adolescent attachment and well-being among hearing-impaired students.

Furthermore, the evidence presented in the previous studies suggested potential mediators or moderators in the relationship between parental attachment and well-being (Lucktong et al., 2018; Mónaco, Schoeps & Montoya-Castilla, 2019; Moreira et al., 2021; Qu et al., 2021). Therefore, there is a need to investigate the potential indirect pathways between parent-adolescent attachment and well-being in hearing-impaired students. We propose that resilience (as a mediator) and emotional and behavioral problems (as a moderator) may influence this relationship.

The Mediating and Moderating Roles of Resilience and Emotional and Behavioral Problems

Resilience is commonly defined as the mechanism of adapting well over time in the face of life-changing situations and adversity conditions, such as stress and distress (APA, 2020). Several studies showed that resilience was positively associated with adolescent well-being (Guo et al., 2020; Migerode et al., 2012; Shek & Liang, 2018). Children with high levels of resilience have a better sense of well-being. Similarly, resilience is strongly related to parent-adolescent attachment (Guo, 2019). Children are more likely to report high levels of resilience if their parent-adolescent attachment is secure. More importantly, resilience is an important mediating variable of parent-adolescent relations and well-being (Qu et al., 2021). For instance, a recent study found that resilience resources mediated the relationship between mother-adolescent relationship quality and subjective well-being (Qu et al., 2021). Thus, it can be inferred that resilience was crucial in mediating the relationship between parent-adolescent attachment and well-being among hearing-impaired students.

Adolescents’ emotional and behavioral problems are most commonly measured by the strengths and difficulties questionnaire (Guo et al., 2021). It played an essential role in parent-adolescent attachment and well-being (Shenaar-Golan et al., 2022). Based on cognitive appraisal theory (Charkhabi, 2019), parent-adolescent attachment and emotional and behavioral problems were integrated to explain well-being. Thus, it is plausible that emotional and behavioral problems moderated between parent-adolescent attachment and well-being.

The Current Study

The present study examined the relationship between parent-adolescent attachment and well-being and the underlying mechanism of this relationship in Chinese hearing-impaired students. It was hypothesized that (1) parent-adolescent attachment positively correlated with well-being among hearing-impaired students; (2) resilience mediated the relationship between parent-adolescent attachment and well-being; (3) emotional and behavioral problems moderated the relationship between parent-adolescent attachment and well-being.

Method

Participants and Procedure

A total of 512 hearing-impaired students from 8 special education centers and schools in Anshun, Zunyi, and Guiyang participated in this study, and 26 participants (5.08%) were excluded from the analyses because they failed to complete the self-report measures. According to the Classification and grading criteria of disability (GB/T 26,341 − 2010) in China (China, 2011), approximately 37.65, 28.60%, 6.58%, and 5.76% of participants are defined as the first, second, third, and fourth levels of hearing impairment separately. And 21.40% of students report “unknown” about their levels of hearing impairment. The age of the students ranged from 10 to 22 (Mage = 17.28, SDage = 2.99). A total of 223 students were females, and 263 were males. This study obtained ethical approval (ID:ASU-JYXY-202106) from the School of Educational Sciences, Anshun University, China. Informed consent was obtained from the students, parents and/or school officials. Each participant took approximately 30 min to complete all measurements in the regular classroom environment. Participants were informed of the study’s purposes and procedures before data collection.

Measures

Well-Being

The 16-item scale measured the well-being of students with hearing impairment, including the subscales of satisfaction with schoolwork, satisfaction with life, interpersonal harmony, and self-satisfaction (Hsieh, 2014). The scale uses a four-point response with scores from 1 (strongly disagree) to 4 (strongly agree). The English-translated sample items are as follows: “I am satisfied with my academic performance” (satisfaction with schoolwork); “I am satisfied with my current life” (satisfaction with life); “When I am in trouble, my classmates will be willing to help me” (interpersonal harmony); and “I like myself” (self-satisfaction). The scores of 16 items were added as the total score. A higher total score indicates a higher level of well-being. The scale has been validated and utilized in the sample of Chinese adolescents (Hsieh & Kenagy, 2014). The Cronbach’s α of the scale was 0.89 in this study.

Parent-Adolescent Attachment

Based on Bartholomew and Horowitz (1991), a 22-item scale assessed the parent-adolescent attachment of hearing-impaired adolescents, consisting of sensitivity, trust, caring, self-competence, self-worth, and sociability subscales (Tang, 2009). The sensitivity, trust, and caring subscales are constructed to the model of parents, and the other subscales are built to the model of self. The participants responded to the items on a 4-point response ranging from 1 (strongly disagree) to 4 (strongly agree). The English-translated sample items are as follows: “Even if I did not say it, my parents understood my thoughts very well”(Sensitivity); “When I am in trouble, I turn to my parents for help” (Trust); “I did not get much attention from my parents” (Caring); “I think I can do anything well” (Self-competence); “I can not gain the care and approval of others” (Self-worth); and “I treat others very friendly” (Sociability). The mean of 22 items was recorded as the total score, with a higher score indicating a more secure relationship between adolescents and their parents. The scale had good validity and reliability (Wang & Lin, 2018). The Cronbach’s α of the scale was 0.82.

Resilience

The 27-item self-report scale was administered to assess the resilience of hearing-impaired students, including the subscales of goal focus, emotional control, positive cognition, family support, and interpersonal assistance (Hu & Gan, 2008). The scale uses a Likert response scale ranging from 1 (strongly disagree) to 5 (strongly agree). Sample items are as follows: “I have a clear goal in my life” (Goal focus); “Failure and frustration can make me doubt my ability” (Emotional control); “I think there is a positive side to everything” (Positive cognition); “My parents respect my opinion” (Family support); and “When I am in trouble, I will take the initiative to talk to others” (Interpersonal assistance). The mean of 27 items was calculated as the total score, with a higher score indicating a higher level of resilience. Previous studies suggested that this scale had good validity and reliability in samples of Chinese adolescents (Jiang et al., 2022). In this study, the internal consistency coefficient of the scale was 0.83.

Emotional and Behavioral Problems

The revised 25-item strengths and difficulties questionnaire assessed the emotional and behavioral problems of students with hearing impairment. It included five subscales: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior (Goodman et al., 2018). The response scales were coded 0 (not true), 1 (somewhat true), and 2 (certainly true). Sample items are as follows: “I worry a lot” (emotional symptoms); “‘I am often accused of lying or cheating” (conduct problems); “I am restless, I cannot stay still for long” (hyperactivity); “Other children or young people pick on me or bully me” (peer problems); and “I am kind to younger children” (prosocial behavior). A total score was created by averaging all items, which a higher total score represents a higher level of emotional and behavioral problems. This scale had good validity and reliability in Chinese samples of adolescents (Wang et al., 2021). In the current study, the scale yielded an internal consistency coefficient of α = 0.78.

Data Analysis

The data analyses were conducted using SPSS software (Version 27.0). First, Harman’s single-factor test was conducted to assess the common method bias (Aguirre–Urreta & Hu, 2019). The result showed that the most significant factor accounted for 14.94% of the variance, and the value is less than the accepted significance cut-off of 50%. It indicated that no significant common method bias was found among all variables in this study. Second, considering the gender differences in psychological well-being (Geng & He, 2021), we conducted the t-test analysis to examine the gender differences in the levels of well-being. Third, Zero-order correlation analyses were conducted to investigate the relationships among all variables. Finally, we used PROCESS macro in SPSS to examine the mediated and moderated roles of resilience and emotional and behavioral problems on the relationship between parent-adolescent attachment and well-being among Chinese hearing-impaired students (Hayes, 2018). If the parent-adolescent attachment is significantly related to well-being and resilience is significantly related to parent-adolescent attachment and well-being, respectively, resilience could mediate the relationship between parent-adolescent attachment and well-being (Kraemer et al., 2008). If the parent-adolescent attachment is significantly correlated with well-being and emotional and behavioral problems are not correlated or less correlated with parent-adolescent attachment, emotional and behavioral problems could moderate the relationship between parent-adolescent attachment and well-being (Kraemer et al., 2008). All variables’ scores were normalized before the moderated mediation analysis. Then, we performed the moderated mediation analyses using Model 5 with 5,000 bias-corrected bootstrap samples. Bias-corrected bootstrap confidence intervals (CIs) were calculated with a yield of 95%. If CI excluded zero, the moderated mediation model was significant.

Results

Descriptive Statistics and Correlation Analyses

First, the results of the t-test showed the significant effect of gender in the level of well-being, t = 3.72, p < 0.001, Cohen’s d = 0.34. Females (M = 2.94, SD = 0.44) reported higher levels of well-being than males (M = 2.78, SD = 0.48).

Second, the descriptive statistics and Zero-order correlations of all variables after controlling for the effect of gender are presented in Table 1. The results found that well-being positively correlated with parent-adolescent attachment (r = 0.48, p < 0.001) and resilience (r = 0.36, p < 0.001), but did not significantly correlated with emotional and behavioral problems (r = 0.05, p = 0.287). Parent-adolescent attachment positively correlated with resilience (r = 0.34, p < 0.001) and negatively correlated with emotional and behavioral problems (r = -0.11, p = 0.017). Resilience negatively correlated with emotional and behavioral problems (r = -0.13, p = 0.004). These findings provided initial support for the hypothesized moderation mediation model.

Table 1 Descriptive statistics and Zero-order correlations matrix after controlling for the effect of gender (n = 486)
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Third, we ran a linear regression analysis with parent-adolescent attachment as a predictor and well-being as the outcome after controlling the gender effect. As shown in Table 2, even controlling the effect of gender, the parent-adolescent attachment still predicted a significant effect of well-being, β = 0.48, p < 0.001.

Table 2 Multiple linear regression results for testing parent-adolescent attachment in predicting well-being (n = 486)
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The Moderated Mediation Analyses

Two models were conducted to assess the mediating role of resilience and the moderating role of emotional and behavioral problems in the relationship between parent-adolescent attachment and well-being after controlling the effect of gender (See Table 3; Fig. 1). We found that the parent-adolescent attachment had a direct effect on resilience(β = 0.34, p < 0.001) in model (1). And both parent-adolescent attachment and resilience had significant positive effects on well-being (β = 0.44, p < 0.001; β = 0.24, p < 0.001) in model (2). Importantly, the bootstrapping analysis revealed a significant indirect effect between parent-adolescent attachment and well-being (β = 0.08, 95% CI [0.05, 0.12]) with resilience as the mediator. The mediating effect of resilience accounted for 15.4% of the total effect. In sum, parent-adolescent attachment was directly and indirectly related to well-being through resilience. The whole model explained 32.1% of the variance in well-being. All 95% CI did not contain zero.

Table 3 The mediated moderation model of resilience and emotional and behavioral problems in the relationship between parent-adolescent attachment and well-being after controlling the effect of gender (n = 486)
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Further, we explored the moderated role of emotional and behavioral problems after controlling the effect of gender. As shown in Table 3, emotional and behavioral problems had a significant positive effect on well-being (β = 0.10, p = 0.008), and the interaction of parent-adolescent attachment and emotional and behavioral problems also had a significant positive effect on well-being (β = 0.11, p = 0.002). These results indicated that emotional and behavioral problems moderated the relationship between parent-adolescent attachment and well-being. Then, we presented the moderated effect of emotional and behavioral problems in Fig. 1. It was found that the interaction term for parent-adolescent attachment and emotional and behavioral problems was significant in predicting well-being. Compared with hearing-impaired students with low levels of emotional and behavioral problems, the relationship between parent-adolescent attachment and well-being was stronger among those with high levels of emotional and behavioral problems.

Fig. 1
figure 1

The moderated effect of emotional and behavioral problems on the relationship between parent-adolescent and well-being

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Discussion

This study empirically assessed the relationship between parent-adolescent attachment and well-being and the moderated mediation effects of resilience and emotional and behavioral problems on this relationship among Chinese hearing-impaired students. The present study may help us understand what factors influence hearing-impaired students’ well-being and how to improve it.

Aligning with the study’s initial hypothesis, we found that parent-adolescent attachment was positively associated with well-being even after controlling for the effect of gender. It means that the more harmonious the parent-child relationship is, the higher the well-being is. This finding is consistent with previous studies linking parent-adolescent attachment to well-being in normal students (Abubakar et al., 2013; Bohn et al., 2020; Borelli et al., 2019; Lucktong, Salisbury & Chamratrithirong, 2018; Weisskirch, 2018). A study of adolescents with and without disabilities also found that attachment significantly impacted the well-being of both adolescents with and without disabilities (Abubakar et al., 2013). It suggested that parent-adolescent attachment may be an essential element of well-being.

Notably, the mediation analyses showed that parent-adolescent attachment is indirectly related to well-being via resilience. Specifically, students with higher levels of parent-adolescent attachment tended to have high levels of resilience, leading to higher well-being levels. This finding is in line with previous studies, which suggested that resilience is essential in mediating the relationship between parent-adolescent attachment and subjective well-being (Qu et al., 2021; Sirois et al., 2016). The first part of parent-adolescent attachment → resilience highlights that parent-adolescent attachment may be a protective factor for resilience (Guo, 2019). Furthermore, the final part of the mediation model (resilience → well-being) indicates that resilience may be a crucial predictor of well-being (Redondo Elvira, Ibáñez del Prado & Cruzado, 2019). Resilience is the ability of individuals to adapt and recover in the face of stress and adversity. The development of resilience is closely related to family (Gebhardt & Hoss, 2022). Individuals who develop secure attachments with their parents become more resilient, and good resilience leads to greater well-being (Dobson et al., 2022). Especially for people with disabilities, resilience allows individuals to reach their full potential and experience more well-being. As can be seen, enhancing the resilience of hard-of-hearing students in the context of stable parent-adolescent relationships might enhance their well-being.

The current study also found that emotional and behavioral problems moderated the relationship between parent-adolescent attachment and well-being among hearing-impaired students. Concretely, the positive association between parent-adolescent attachment and well-being was stronger for hearing-impaired students with high levels of emotional and behavioral problems than those with low levels. One possible explanation might be that hearing-impaired students have more difficulty communicating with peers and experience more social problems than normal students (Huber et al., 2015; Yigider et al., 2020). When hearing-impaired students have emotional and behavioral problems, they are more likely to seek help from parents. Moreover, for hearing-impaired students with high levels of emotional and behavioral problems environment, individual resources (such as resilience) to improve their well-being might be scarce, and most or all of their other resources for well-being might come from families. Thus, for hearing-impaired students with severe emotional and behavioral problems, parent-adolescent relations (including parent-adolescent attachment) are more crucial for their well-being.

Implications and Limitations

These findings of this study have several important implications. First, to our best knowledge, this study is the first study to investigate the relationship between hearing-impaired students’ parent-adolescent attachment and well-being and the crucial effects of resilience and emotional and behavioral problems on this relationship. The finding deepens researchers’ understanding of well-being in hearing-impaired students. Second, our findings provide potential intervention implications. To improve hearing-impaired students’ well-being, parents and teachers might pay attention to developing secure parent-adolescent attachment, increasing resilience, and reducing emotional and behavioral problems. In cases where parent-adolescent relations (including parent-adolescent attachment) cannot be easily changed, it may be that interventions for hearing-impaired students’ positive traits (e.g., resilience) are more effective for their well-being.

The current study also must acknowledge several limitations. First, because of the cross-sectional design, this study was difficult to examine prospective and longitudinal changes in parent-adolescent attachment, resilience, emotional and behavioral problems, well-being, and their relationships. Second, this study focus on the effects of parent-adolescent attachment, resilience, and emotional and behavioral problems on well-being in hearing-impaired students. Future studies should consider other protective and risk factors for well-being, such as discrimination (Ma et al., 2022) and social support satisfaction (Lane & Fink, 2015).

Conclusion

The current study supported that parent-adolescent attachment positively correlates with well-being among Chinese hearing-impaired students. Additionally, resilience and emotional and behavioral problems mediate and moderate the effect of parent-adolescent attachment on well-being. These findings suggest that it is essential to investigate the predictors and underlying mechanisms of hearing-impaired students’ well-being and find the direction for the intervention.