A comparison of peer relationships and depressive symptom levels of children with cochlear implants and children with normal hearing

Objective: The purposes of this study are to compare peer relationships and depressive symptom levels in children with cochlear implant (CI) and their normal hearing peers and also to investigate the factors associated with peer relationships and depressive symptom levels in children using CI. Material and Methods: Thirty-five children with normal hearing and thirty-five children with CI between the ages of 48 and 76 months were included in the control group and study group. Children's peer relationships became rated with the Ladd and Profilet Child Behavior Scale (CBS) by their pre-school teachers. Six subscales constitute the structure of the CBS: Aggressive with peers, prosocial with peers, asocial with peers, excluded by peers, anxious-fearful, and hyperactive. At the same time, children's depressive symptom levels were rated using the Child Depressive Symptom Scale (CDSS) by their parents. This scale consists of eight subscales: Aggression, social adaptation, loss-separation anxiety, primitive anxiety, impulsivity, deterioration in cognitive processes and somatization. Results: The analyses showed that there were statistically significant differences between anxious-fearful (p=0.015), deterioration in cognitive processes (p=0.000), aggression (p=0.001) and total depressive symptom scale (p=0.002) scores of the study group and the control group. However, there were no statistically significant differences between aggressive with peers (p=0.095), prosocial with peers (p=0.082), asocial with peers (p=0.966), excluded by peers (p=0.505), hyperactive (p=0.254), social adaptation (p=0.131), loss-separation anxiety (p=0.200), primitive anxiety (p=0.181), impulsivity (p=0.211), and somatization (p=0.445) scores of the study group and the control group. The correlation analyses showed that significant association between the age of diagnosis of hearing loss, age of implantation, and aural rehabilitation with peer relationships, depressive symptoms (p<0.05). Conclusion: Children with CI showed higher anxious-fearful, deterioration in cognitive processes, aggression, and total depressive symptom scores than normal hearing children, whereas other subscales were similar between children using CI and normal hearing peers. Earlier age when hearing loss was detected, early cochlear implantation, and earlier beginning to the rehabilitation programs are associated with better peer relations and lower depressive symptom levels. These findings add to the existing knowledge that CIs for children with hearing loss have benefits on peer relations and levels of depressive symptoms, having a CI alone is not sufficient. In addition to the use of CI, factors related to the age of diagnosis of hearing loss, age of implantation, and auditory rehabilitation should be also taken into consideration.