While data attest to the epidemic proportions of interpersonal violence in the general population (e.g., Tjaden and Thoennes 2000; United States Department of Health and Human Services 2008; Zlotnick et al. 2006), the pervasiveness and characteristics of violence, and ensuing social isolation among minority groups and subcultures, have received a modicum of investigative attention (American Psychological Association 1996; National Domestic Violence Hotline 2008). In addition, stigma and a lack of specialized services are uniquely debilitating for domestic violence victims of minority status (National Institute of Justice 2000a, b). Lack of culturally-specific resources contribute to the isolation and silence about the abuse observed in victims from various ethnic groups, in homosexual relationships, or who have some form of physical or developmental disability. In particular, the able-bodiedness of an individual may impact their access to life-saving information and emergency services, capacity for self-protection, and sense of vulnerability and isolation.

Government health statistics estimate that approximately 17% of Americans are Deaf, Hard of Hearing, or have acquired deafness (National Institute of Deafness and Other Communication Disorders 2008). Further, more than 37 million individuals live with congenital or acquired hearing loss, ranging from mildly hard of hearing to profoundly deaf (Centers for Disease Control and Prevention 2008). While occupational and social functioning of Deaf and Hard of Hearing individuals are generally similar to that of the hearing population, there are indications that social isolation characterizes a significant portion of the developmental years of the former group (Barrett 1986). During childhood, parental acceptance of the hearing loss and subsequent parent-child interactions significantly influence the self-image and socialization of the child. More than 90% of children with congenital deafness are born to hearing parents (Nowell and Marshak 1994; Wrigley 1996). The inherent complexities of diverse communication styles may interfere with social interactions and, consequently, impact the social learning of a Deaf or Hard of Hearing child. In addition, social isolation appears to be a primary difficulty reported by individuals who acquire deafness at middle age or older (Stevens 1982). For example, feelings of loneliness and being misunderstood were reported by 40% of elderly participants with significant hearing losses (Thomas and Gilhome-Herbst 1980).

History of alienation and ongoing communication barriers have interfered with the integration of the Deaf community into the hearing world. Further, detachment and isolation of the Deaf community have been documented in previous research (Barrett 1986; Becker and Jauregui 1985; Egley 1983; Melling 1984; Steinberg 1991; Winzer 1986). This lack of access to information, readily available to hearing women, diminishes learning about current women’s issues. Acquisition of practical information regarding birth control, motherhood, and marital rights is frequently hindered. Moreover, this lack of vital information interferes with adequate preparation for crisis situations, such as illness, divorce, or domestic disputes (Becker and Jauregui 1985).

There is a relative paucity of research directed toward domestic violence in the relationships of Deaf and Hard of Hearing women. And, to the best of our knowledge, no previous studies have examined this problem in a clinical sample of Deaf and Hard of Hearing women. Yet, the frequency and severity of intimate violence appears to be a significant problem for Deaf and Hard of Hearing women (Egley 1983; Melling 1984). Indeed, there are indications that as many as six million of these women are victims of some form of intimate partner violence (National Domestic Violence Hotline 2008). However, programs and services for Deaf and Hard of Hearing victims of domestic violence are scarce. The Abused Women’s Advocacy Services (ADWAS) is currently the only agency of its kind working in collaboration with the National Domestic Violence Hotline to provide a TTY hotline for Deaf and Hard of Hearing victims. ADWAS employs Deaf and Hard of Hearing persons to operate the hotline and provide counseling, advocacy, and educational services to Deaf and Hard of Hearing victims of domestic violence.

The purpose of this study was to assess domestic violence in a clinical sample of Deaf and Hard of Hearing women. The study also explored the nature of the abuse between Deaf and Hard of Hearing women and their partners to ascertain possible distinctive characteristics of abuse within this unique subgroup. Further, perceived social support was examined as it related to domestic violence in these relationships. Common and diversified modes of communication within the intimate relationships, as well as historical experiences of childhood abuse and neglect, were evaluated as factors potentially contributing to domestic violence. Finally, exposure to domestic abuse in families of origin was examined as a potential risk factor for violence in adult relationships.

Method

Participants

Seventy Deaf and Hard of Hearing adult females who previously received, or were currently receiving mental health services in community outpatient clinics for Deaf and Hard of Hearing individuals, were asked to participate in this study. Of the 70 females initially identified, 46 (66%) agreed to participate and complete the research questionnaires.

For inclusion in this study, participants had to have a mild, moderate, severe, or profound hearing loss. Deafness was reported by 80.4% of the sample, while 19.6% reported that they were Hard of Hearing. Hearing loss classified as profound was reported by 67.4% of the sample. Severe hearing loss was reported by 15.2% and moderate loss was reported by 17.4% of the sample. None of the participants reported a mild hearing loss. Age of onset of hearing loss ranged from birth to 16 years (M = 1.64, SD = 3.31). (Summary data for participant’ hearing loss are presented in Table 1.)

Table 1 Summary of hearing classification and methods of communication
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Participants’ ages ranged from 18 to 69 (M = 36.22, SD = 12.43). The sample was 43.5% Caucasian, 41.3% Hispanic, 8.7% African American, 2.2% American Indian, 2.2% Caribbean Island, and 2.2% other. Most were single, never married (34.8%), or currently married (26.1%). Divorced participants comprised 15.2% of the sample, while 10.9% were cohabitating with a partner, and 6.5% were widowed. (Demographic data are provided in Table 2.)

Table 2 Summary of demographic variables
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Procedure

Participants were administered a packet of self-report measures. Each participant chose the mode of administration of the questionnaires: (1) use of a sign language interpreter to translate the measures (21.7%), (2) paper and pencil method of completing the questionnaire packet (34.8%), or (3) paper and pencil method with the option of having support staff/interpreter available to help with translation of items, if necessary (43.5%).

A state certified sign language interpreter with 15 years experience provided interpreter services for all Deaf and Hard of Hearing participants. Participants were informed that interpretive services would be offered at no cost. Those who preferred interpreter services were offered a choice of American Sign Language or Total Communication, which are both modes of communication commonly used in the Deaf and Hard of Hearing Community.

Measures

Demographic Questionnaire

Standard demographic information was obtained from participants via a form developed for this study. The Demographic Questionnaire solicited information about gender, age, race, education, occupation, presenting problem, length of treatment, disability status, degree of hearing loss, mode of communication, partner, family of origin, marital status, length of relationship, family income, history of abuse, and history of substance use.

Conflict Tactics Scale

(CTS; Straus 1979) The CTS assesses frequency and severity of abusive behaviors and is the most frequently utilized measure in domestic violence research. The CTS is unique in that it measures only abusive behaviors and not the attitudes, emotions, or cognitive appraisals of the behaviors (Straus 2007). In its original form, the coefficients of reliability for the reasoning index of the CTS were .50 for husband-to-wife, and .51 for wife-to-husband. Alpha coefficients for the CTS are high for the verbal aggression and physical violence indices. The husband-to-wife and wife-to-husband verbal aggression alpha coefficients were .80 and .79, respectively. Physical violence index coefficients of reliability were .83 for husband-to-wife and .82 for wife-to-husband violence (Straus 1979). For this study, the CTS was revised to include questions regarding sexual assault and questions specific to the experiences of Deaf and Hard of Hearing female victims. Examples of the additional information garnered from our modified CTS scale include whether or not the abusive partner is Deaf, Hard of Hearing, or hearing; the age of onset of partners’ hearing loss; the degree of partners’ hearing loss; and detailed descriptions of the most recent, worst, and first experiences of abuse from the abusive partner.

Interpersonal Support Evaluation List

(ISEL; Cohen et al. 1985) The ISEL is a 40-item list of true/false statements designed to assess respondents’ perceived availability of potential resources. This measure is composed of four subscales measuring social support: Appraisal, Belonging, Tangible, and Self-Esteem. The Appraisal subscale evaluates the perception of having someone with whom to talk about personal problems. The Belonging subscale assesses the perception of availability of other people with whom to do activities. The Tangible subscale measures the availability of material assistance, and the Self-esteem subscale evaluates positive self-perception when comparing self to others. The internal reliability of the ISEL scales ranges from .88 to .90 for the general population. Ranges in alpha coefficients for the four subscales include .70–.82 for appraisal, .73–.78 for belonging, .73–.81 for tangible, and .62–.73 for self-esteem. The ISEL has been used extensively to study perceived support in populations with medical illnesses (Stromberg and Olsen 2004), psychiatric disorders (Johnson et al. 2000), and victims of domestic violence (Crane and Constantino 2003).

Results

Responses on the Demographic Questionnaire indicated that nearly three-quarters (71.7%) of the participants reported that they had been in a relationship, at some time in their lives, in which they were victims of psychological or emotional abuse. Over one-half (56.5%) of the participants indicated that they had been victims of some type of physical violence in an intimate relationship. Sexual violence victimization was reported in the relationships of more than one-quarter (26.1%) of the participants. Violence potentially threatening to the life of the victim was reported by nearly one-third (30.4%) of the participants (see Fig. 1).

Fig. 1
figure 1

Frequency of domestic violence among deaf and hard of hearing women

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Results of T-test analysis indicated that scores on the ISEL did not differ significantly between participants who had experienced domestic violence and participants with no prior history of abuse. The range of ISEL total scores was 11 to 37, out of a possible 40 points, with higher scores indicating greater perception of social support. As measured by the ISEL, no significant differences were obtained in perceived social support of participants who experienced psychological abuse from an intimate partner and those with no history of psychological abuse, and between participants: (1) who experienced physical violence from their partners and those who had not, (2) with and without a history of sexual abuse from a partner, and (3) reporting a history of life-threatening domestic violence victimization and those who did not.

A Pearson Chi-Square test was utilized to analyze results of the CTS to determine whether occurrence of domestic violence differed based on whether the mode of communication used by the intimate partner was the same or different than that of the participant. No significant differences were found between the experiences of participants who had the same or different methods of communication with their intimate partners on the occurrence of psychological, physical, sexual, or life-threatening abuse. Further, no significant differences were observed in the occurrence of domestic violence (psychological, physical, sexual, or life-threatening) when mode of communication was the same or different from family of origin. Finally, no significant differences were found in participants with a history of childhood physical or sexual abuse, and those who denied a history of these types of child abuse, on the occurrence of psychological, physical, sexual, or life-threatening abuse.

Discussion

The purpose of this study was to examine the prevalence of domestic violence and perceptions of social support in a clinical sample of Deaf and Hard of Hearing women. Results indicated that nearly three-quarters (71.7%) of a clinical sample of Deaf and Hard of Hearing females experienced psychologically or emotionally abusive behaviors from their partners. Additionally, over one-half (56.5%) of the females reported at least one incident of physical violence at the hands of their partner. The reported frequency of domestic violence victimization in this sample is greater than that observed in the general and clinical populations of hearing victims, which generally ranges from 25% to 50% (American Psychological Association 1996). In addition, physical violence escalating to the point that the victim’s life was potentially threatened was reported by nearly one-third (30.4%) of the sample. This finding is consistent with prior investigations indicating that approximately one out of five (21%) female hospital emergency room patients has suffered injuries from a partner (Dickstein 1988). Sexual abuse of participants in our study was also higher (26.1%) relative to the hearing population. For example, Russell (1982) noted that 14% of females were victims of forced sexual intercourse or other forms of forced sexual behaviors during the course of their marriage.

Further, Deaf and Hard of Hearing women who indicated a history of psychological, physical, sexual, and/or life-threatening domestic abuse, had similar ISEL scores to those participants who denied any history of domestic violence. While the absence of social support has been empirically linked to the occurrence and perpetuation of domestic violence in the hearing population (e.g., Martin 1976; Nielsen et al. 1992; Walker 1979), our findings do not support this assertion with Deaf and Hard of Hearing females.

Mode of communication did not appear to be a primary factor distinguishing safe home environments from unsafe home environments. Results suggest that couples with similar communication styles displayed the same frequency of domestic violence as relationships with disparate communication styles. Similarly, there were no differences in domestic violence victimization of females who grew up in households using the same or different modes of communication with their families of origin. The present study also explored the child abuse experiences of this clinical sample and the relationship to victimization in adulthood. Results indicated that the occurrence of domestic violence victimization in adulthood did not differ based on childhood physical abuse, sexual abuse, or neglect. Deaf and Hard of Hearing adult females appear to have experienced domestic violence regardless of their abuse histories.

To our knowledge, this study is the first to evaluate domestic violence and social support in a clinical sample of Deaf and Hard of Hearing women. Our findings are consistent with previous research suggesting that children and adults with some form of physical or developmental disability are particularly at risk for abuse (Ammerman et al. 1994; Crosse et al. 1993; Sobsey and Varnhagan 1989). However, several limitations of this study deserve mention. First, the lack of standardized measures designed for use with the Deaf and Hard of Hearing population prompted the use of instruments utilized with hearing populations. Second, the language differences between English and American Sign Language may have presented translation difficulties. Since this investigation was conducted, a new version of the CTS has been published: the Revised Conflict Tactics Scale (CTS2; Straus et al. 1996). Anderson and Leigh (in press) recently found that CTS2 subscales measuring Victimization of Negotiation, Psychological Aggression, Physical Assault, and Injury are both reliable and valid with a sample of Deaf female college students. Future work in this area should employ the CTS2 with a sample of Deaf and Hard of Hearing women.

Additional research on the problem of domestic violence in Deaf and Hard of Hearing women is clearly needed. Substantiation of the present findings, which indicate that violence between intimate partners in a clinical sample of Deaf and Hard of Hearing women occurs with frequency and severity, is crucial for accuracy in dissemination of educational information to caregivers, victims, and their families. Moreover, future work in this area should include the development of specialized services to support Deaf and Hard of Hearing victims of domestic violence. In light of the present findings attesting to the high proportion of Deaf and Hard of Hearing women experiencing psychological abuse and physical violence from a partner, an acceleration of efforts to enhance awareness, assessment, prevention, and treatment strategies for this at-risk population is warranted.