Psychosocial status and the moderation effect of social support on the relationship between quality of Life and psychological burden among mothers of children with hearing loss

Psychosocial status and the moderation effect of social support on the relationship between quality of Life and psychological burden among mothers of children with hearing loss | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Psychosocial status and the moderation effect of social support on the relationship between quality of Life and psychological burden among mothers of children with hearing loss Ayman Hamdan-Mansour, Margaret Zuriekat, Pauline Karabetian, Sana Batarseh, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6779155/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background : Hearing loss represents one significant problem affecting children and their mothers, who are the main caregivers. Therefore, the mental and psychosocial well-being of mothers of children with hearing loss does affect their willingness to meet the healthcare needs of their children. The purposes of this study are to: 1) assess the levels of burden, perceived social support, willingness to seek professional psychological counseling, and quality of life of mothers of children with hearing loss, and 2) to assess the moderation effect of social support on the relationship between quality of life and psychological burden among mothers of children with hearing loss. Methods : A cross-sectional descriptive-exploratory design was used to recruit a sample of 168 mothers of children with hearing loss. Data collected regarding quality of life, psychological burden, perceived social support, and willingness to seek psychological counselling. Results : The analysis showed that mothers are suffering moderate to high levels of psychological burden, moderate levels of quality of life, perceived social support, and a moderate level of willingness to seek psychological counselling. Perceived social support was found to minimally buffer the relationship between psychological burden and quality of life (F2, 166 = 3.8, p = .025; R2 = .044), although quality of life was associated significantly and negatively with psychological burden (r= -.18, p= .025). Conclusion : There is a need to enhance and integrate mental health and psychosocial support services for mothers of children with hearing loss. Keywords: Hearing Loss; Children, Mothers; Psychological Burden; Social Support, Quality of Life; Seeking Psychological Counseling. Humanities/Health humanities Humanities/Medical humanities Social science/Psychology Introduction The last few decades have alerted researchers and health professionals to the mental health consequences of hearing loss. In particular, children with hearing loss represented a challenge to their parents and primary caregivers. Studies showed that hearing loss, which is one of the most common health problems at birth, is prevalent with 1.0 to 5.0 per 1000 live births (Lieu, et al., 2020). Several studies indicated that children born with hearing loss are suffering several psychological problems that require attention and careful follow-up care from healthcare professionals and their caregivers, as well (Alramamneh, et al., 2020). The literature has adequately addressed the impact of hearing loss on affected children and the role of healthcare providers; however, the impact on caregivers has been less addressed (Scherer, et al., 2023; Zaitoun, Alqudah, & Nuseir, 2022). Issues such as quality of life, social support, and burden among mothers of children with hearing loss received little attention in research. Generally, it has been reported that parents of children with neurological and physical disabilities are found to be at higher risk of psychological disturbances (Syed, Awan, & Syeda, 2020). The general outcomes of research regarding the impact of caring for children with disability would provoke attention to emphasize further the uncovered areas of such an impact. The controversial reports regarding which disability would need the caregivers to pay more attention and negatively impact their lives were also a point of discussion in the literature. For example, parents of intellectually-challenged children needed more respite and other psychosocial services compared to parents of children with hearing loss (Syed, Awan, & Syeda, 2020). On the other hand, the assumed role and gender of the primary caregiver are also significant issues to be discussed. In the Arabian culture, mothers are the usual and most reported caregivers (Ghannam, Hamdan-Mansour, Al Abaiat, 2017; Nuwara, Masa'Deh, Hamdan-Mansour, & Qhah, 2019). Therefore, studies supported the notion that female caregivers do have more negative experiences than their male counterparts, which was also found not only in the Arabian culture (Mashayekhi et al., 2015). Caring for children with disability caused further feelings of burden on mothers compared to caring for non-disabled children (Morris & Zaidi, 2020). Such a burden contributed to a dysfunctional life, causing further psychosocial problems for mothers as caregivers. For instance, studies reported that caring of children with disability found to be beyond the psychological ones, and did show a negative consequences on the economic stability and mothers’ career life including quitting jobs and being dependent on their spouses causing further burden and social instability (Vinck & Brekke, 2020; Wondemu et al., 2022). Furthermore, it has been reported that caregivers and their children with hearing loss have unmet needs for psychological support, which is often overlooked, as the primary focus tends to be on the child’s audiological care (Hoffman et al., 2023). This would inquire the status of Arabian mothers of children with hearing loss who are struggling to provide care for their children given the socioeconomic and cultural constraints and limited hearing healthcare support. Numerous factors contribute to childhood hearing loss, encompassing both genetic and environmental influences. Genetic predisposition, whether syndromic or non-syndromic, stands as a common contributor to hearing loss, which might not be manifested only at birth but also emerge clinically later in childhood (Al-Rawashdeh et al., 2024). Families with a genetic predisposition to hearing loss often face the added challenge of multiple affected children, imposing additional burdens on mothers and creating financial barriers to accessing proper hearing solutions (Al-Rawashdeh et al., 2024). These challenges can lead to psychosocial detriments, burden, and a reduced quality of life. Alongside genetic factors, various environmental factors such as infections, noise exposure, ototoxicity, and perinatal complications heighten the risks of childhood hearing loss (Joint Committee on Infant Hearing, 2019). Mothers of affected children often lack awareness of hearing loss and risk factors (Hussein, D’Alessandro, Batuk, Ekhwan, & Sennaroğlu, 2022) that impact their ability to communicate effectively with their children, leading to heightened stress and burden (Ammerman, 2009). Understanding the perspectives of mothers of children with hearing loss regarding the psychosocial well-being and quality of life enables tailoring supportive care for them more effectively. One aspect that seems to be significant to assess further is their willingness to seek professional psychological counseling once they feel they need it. No doubt that mothers of children with hearing loss do need psychological counseling, as counselling enables them to improve their coping skills and minimize psychological consequences related to caring for their children. Jordan, similar to other countries in the developing world, lacks mental health and psychological counseling services for parents of children with disabilities. Although the prevalence of hearing loss in Jordan is higher than in many other countries, the psychosocial aspects remain largely overlooked in both research and available services (Zaiton, et al., 2021; Zureikat et al., 2024), reflecting a similar gap at the international level. This provokes attention toward the resources of psychological counseling available for mothers and the willingness of mothers of children with hearing loss to seek such services from professional counselors. Furthermore, their burden and psychological disturbances resulting from caring for their children with hearing loss are not well-documented and reported. Therefore, this study came to address these issues and their impact on mothers' quality of life. The purposes of this study are To assess the levels of burden, perceived social support, willingness to seek professional psychological counseling, and quality of life of mothers of children with hearing loss To assess the moderation effect of social support on the relationship between quality of life and psychological burden among mothers of children with hearing loss. Methods Design : This study uses a sequential triangulated mixed-methods design. At this phase of the study, a quantitative, cross-sectional design was used to assess the psychosocial and quality of life of the mothers of children with hearing loss. Data was collected from ENT and audiology outpatient clinics using a self-reported format in relation to levels of psychological burden, perceived social support, willingness to seek professional psychological counseling, and quality of life. Setting : Mothers were recruited from various ENT and audiology outpatient clinics targeting outpatient clinics at Jordan Ministry of Health’s tertiary referral hospitals and university-affiliated hospitals. The targeted hospitals were selected due to the fact that those units represented the major and highly specialized medical audiology services in Jordan. Furthermore, these hospitals have electronic data logs of their referred patients with hearing loss, which have access and approach of the mothers, the targeted sample of this study. Sample and sampling : The target sample of this study is mothers of children with hearing loss. A census sampling of mothers with children with hearing loss was conducted in the targeted outpatient departments of the major referral and university-affiliated hospitals used to recruit mothers. Inclusion criteria include: 1) being at 18 years or above, 2) having a child with permanent hearing loss, and 3) having a child on a treatment plan for more than three months to ensure that mothers are well oriented to the hardships of caring for the child. Exclusion criteria: 1) Mothers of children who have child/ren with hearing loss comorbid with other disabilities to avoid the aggravated hardiness of mothers in caring of child, and 2) mother who are grieving for loss of significant others for the past six months due to overlap of signs and symptoms of grieving with variables of the study. All mothers of children referred to these clinics were approached and invited to the study via liaisons and facilitators in the units to avoid coercion and allow the self-determination principle of human rights. Data collection procedure : Data collection started after obtaining the ethical approval from XYZ University and the targeted hospitals. Facilitators were assigned per clinic and took the responsibility to invite mothers to participate in the study. Mothers who expressed interest were referred to the research team, who explained the purpose of the study and provided mothers with information regarding the purpose, significance, and what was expected from the participants if they decided to participate in the study. In addition, researchers assured mothers of confidentiality, voluntary participation, and that their approval or refusal to participate in the study would not affect the quality of care received at the unit. After having all their questions answered, mothers asked to sign a consent form that includes all abovementioned information to ensure maintaining their human rights according to the 64 th WMA General Assembly, declaration of Brazil, 2013. Data collection took place in a private designated room within the audiology and ENT clinics. There was a child care assistant to assist mothers in taking care of their children during the time of filling out the survey. Filling out the survey took an average of 10 minutes. All data is saved at the PI's locked cabinet, where no one has access except the PI and research team. Measures: The Arabic versions of the scales were used. The scales were: Burden was assessed through the Burden Assessment Schedule (Thara, Padmavati, Kumar, & Rinivasan, 1998). The Arabic version used in this study (Ghannam, et al., 2017). This scale consisted of 40 items, assessing both subjective and objective burden. The participants are required to make their responses on a 3-point Likert scale ranging from “not at all (1)” to “very much (3)”. The original scale showed good reliability with a Kappa of 0.8 (Thara et al. 1998). Also, the Arabic version has good reliability with Cronbach's Alpha of .73 (Ghannam, et al., 2017). Perceived social support was measured using the Multidimensional Perceived Scale of Social Support (MDPSS) . The Arabic version used in this study (Yehia, Calliste, Hamdan-Mansour, 2013). The scale is a 12-item self-reported scale used to assess the perception of social support adequacy from the family, friends, and significant others, including the healthcare professional (Zimet, Dahlem, Zimet & Farley, 1988). Each item measures the adequacy of social support using a 7-point Likert scale ranging from very strongly disagree (1) to very strongly agree (7). The scale is using a continuous scaling measure with a mean score of 12-35 indicating low perceived social support, 36-60 indicates a medium perceived social support, and 61-84 indicates a high level of perceived social support (Zimet, Dahlem, Zimet & Farley, 1988). The Arabic version has good internal consistency reliability with Cronbach's Alpha of .88 (Yehia, et al., 2013). Quality of life was measured using the WHOQOL-BREF. The scale is composed of 26 self-administered items, which are a short version of the WHOQOL-100 scale (Orley, 1996). In this study, the Arabic version was used (Dalky, Meininger, & Al-Ali, 2017). The respondents are required to make their responses on a 5-point Likert response scale ranging from 1 (very dissatisfied/very poor) to 5 (very satisfied/very good). Mothers were asked to rank each item accordingly. Mothers are reminded that these questions reflect their quality of life for the past six months. The scale is formed of four domains in addition to one general health facet: physical health, psychological health, social relations, and environment. The general health facet is assessed using the remaining two items reflecting their subjective satisfaction with health (Ohaeri & Awadalla, 2009). A higher score in any of the domains indicates a higher QOL rating. The Arabic version has good internal consistency with Cronbach’s alpha coefficient of 0.70 (Dalky, et al., 2017). Willingness to seek psychological counseling was measured using the Attitudes towards Seeking Professional Psychological Help- short form (ATSPPH-SF; Fischer & Farina, 1995). The scale is available in Arabic in its short version that consists of 10 items (Rayan et al., 2020). The respondents are required to make their answers in a four-point Likert scale ranging from agree (3) to disagree (3). There are five items (2, 4, 8, 9, and 10) to be reversed before a total score can be calculated, with a higher score indicating more positive attitudes and a lower score indicating a tendency toward negative scores. The tool is tested and found to be appropriate across cultures. The Arabic version has good reliability with a Cronbach's alpha of .84 (Rayan et al., 2020). Data analysis The computer program, IBM-SPSS v. 25, window used to describe psychosocial health variables. Categorical variables were analyzed for frequencies and percentages, while continuous variables were described using the central tendency measures (means and medians), the dispersion measures (standard deviation), and inter-percentile measures (P 25 , P 50 , P 75 ). The association between variables of the study was examined through the Pearson product-moment correlation coefficient ( r ) and a regression model that was developed for specific purposes to test the moderation effect. In addition, to assess the difference in the variables of the study in relation to demographic characteristics, a t-test was used for variables with two levels, and one-way ANOVA for variables with more than two levels to assess differences in relation to selected socio-demographics. Alpha set at .05 Results Demographic characteristics of mothers and their children More than 600 mothers over three months have been approached, and a total of 168 agreed to participate in the study. No specific reason was defined by the mothers for not taking part in this study. The analysis (see table 1) shows that the mean age of the mothers was 36.9 (SD = 8.3), ranging from 20-65 years. Of the mothers, 90.5% (n=152) were currently married, 65.4% (n=110) have high school or less education, and 80.4% (n=135) are unemployed. Their mean hours of hearing-related caring of their children were 4.6 (SD = 3.3), ranging from 1 to 12 hours or more. About 10.1% (n = 17) reported that they provide more than 12 hours of caring for their children. The mean number of children reported by women was 1.5 (SD=.88), ranging from 1 to 6 children. Of the children, 57.7% (n = 97) were males and 40.5% (n 68) were females. It is noted that 50% (n=84) of the women have only one child. Regarding their children's ages, the mean age of the children was 9.3 (SD=4.6), ranging from 1-17 years. 50% (n=84) of the children were at the age of 9.7 years or less. Furthermore, the analysis showed that the total number of children ranged from 1-6 children, with 50% (n=84) of mothers having one child with a hearing problem. Hearing loss status Regarding the type of ear and level of severity of the hearing loss among children, the analysis (see table 2) showed that 77.4% (n = 130) of the children have sensorineural type of loss. Of the children, 81.5%(n=137) have severe to profound hearing loss in the right ear compared to 83.9% (n=141) having severe to profound hearing loss in the left ear. It was also found that 77.4% (n=130) are currently using hearing aids. Only 39.9% (n = 67) have surgery of any form related to a hearing problem, and the mean time of ever being admitted to hospital was 1.5 (SD = 2.7), ranging from 0-9 times, 75.0% (n = 126) being admitted only one time. Variables of the study Psychological burden : The analysis (see table 3) showed that the mean score of the psychological scale was 83.7 (SD = 12.1) with scores ranging from 42.5 to 120.0. The analysis also showed that 50% (n = 84) had a score of 82.5. Using the interquartile equation, and given that the expected scores on the scale range from 40.0 to 120.0 (midpoint of 80.0), the analysis showed that 50.0% (n=84) had a score between 77.5 (percentile 25 th ) and 92.5 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate to high level of psychological burden. Perceived social support : The analysis (see table 3) showed that the mean score of the perceived social support scale was 49.1 (SD = 15.8) with scores ranging from 16.0 to 76.0. The analysis also showed that 50% (n = 84) had a score of 51.0. Based on the value of the mean score of 49.1, which is located in the medium level of perceived social support. This indicates that mothers of children with hearing loss had, in general, a moderate level of global perceived social support. Specifically, the mean of perceived social support from others that may also include the healthcare professionals was 17.6 (SD=6.0) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 18.0. The mean score of 17.6 indicates a medium perceived social support from others. Using the interquartile. Regarding perceived social support from family, the mean of perceived social support from family was 16.9 (SD=6.7) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 18.0. The mean score of 16.9 indicates that mothers of children with hearing loss had a medium level of perceived social support from family. Regarding perceived social support from friends, the mean of perceived social support from friends was 14.8 (SD=6.7) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 15.0. The mean score of 14.8 indicates that mothers of children with hearing loss had a medium level of perceived social support from friends. Willingness to seek psychological counseling : The analysis (see table 3) showed that the mean score of the Willingness to seek psychological counseling was 15.2 (SD = 4.7) with scores ranging from 0 to 30.0. The analysis also showed that 50% (n = 84) had a score 15.0. Using the interquartile equation, and given that the expected scores on the scale is ranging from 0 to 30.0 (midpoint of 15.0), the analysis showed that 50.0% (n=84) had a score between 12.0 (percentile 25 th ) and 18.5 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate level of willingness to seek psychological counseling. Quality of life: Regarding the quality of life of mothers, the analysis (see table 3) showed that the mean score of the quality of life was 68.1 (SD = 12.9) with scores ranging from 32.0 to 102.0. The analysis also showed that 50% (n = 84) had a score of 68.0. Using the interquartile equation, and given that the expected scores on the scale range from 26.0 to 130.0 (midpoint of 78.0), the analysis showed that 50.0% (n=84) had a score between 59.0 (percentile 25 th ) and 79.0 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate level of quality of life. Specifically, regarding domains of quality of life, the mean score of the subject's quality of life was 7.0 (SD = 1.9) with scores ranging from 2 to 10.0. The analysis also showed that 50% (n = 84) had a score of 7.0. Using the interquartile equation, and given that the expected scores on the scale range from 2.0 to 10.0 (midpoint of 6.0), the analysis showed that 50.0% (n=84) had a score between 6.0 (percentile 25 th ) and 8.0 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate to high level of subjective quality of life. Regarding the physical domain, the mean score was 20.4 (SD = 3.5) with scores ranging from 7.0 to 29.0. The analysis also showed that 50% (n = 84) had a score of 21.0. Using the interquartile equation, and given that the expected scores on the scale range from 7.0 to 35.0 (midpoint of 21.0), the analysis showed that 50.0% (n=84) had a score between 18.0 (percentile 25 th ) and 23.0 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate level of physical perception of quality of life. Regarding the psychological domain, the mean score was 18.8 (SD = 3.8) with scores ranging from 9.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 19.0. Using the interquartile equation, and given that the expected scores on the scale range from 6.0 to 30.0 (midpoint of 18.0), the analysis showed that 50.0% (n=84) had a score between 16.0 (percentile 25 th ) and 26.0 (percentile 75 th ). This indicates that mothers of children with hearing loss had a high level of psychological perception of their quality of life. Regarding the environmental domain, the mean score was 22.19 (SD = 6.1) with scores ranging from 8.0 to 38.0. The analysis also showed that 50% (n = 84) had a score of 22.0. Using the interquartile equation, and given that the expected scores on the scale range from 8.0 to 40.0 (midpoint of 24.0), the analysis showed that 50.0% (n=84) had a score between 18.0 (percentile 25 th ) and 26.0 (percentile 75 th ). This indicates that mothers of children with hearing loss had a moderate level of environmental perception of their quality of life. Bivariate analysis Initially, the correlation among the main variables. The analysis showed that quality of life is associated significantly and negatively with psychological burden (r= -.18, p= .025). While all other associations were not statistically significant (p>.05). Regarding the association and differences in quality of life in relation to sociodemographic, only quality of life was statistically significant in relation to the severity of hearing loss in the right ear (F 3,153 = 3.3, p= .021), while all other categorical or continuous variables were not. The significant difference in quality of life, according to post hoc comparison of Scheffe, between those with mild and moderate levels of severity (p=.032). On the other hand, there was a statistical negative correlation between psychological burden and the subjective domain of quality of life (r=-.19, p <.001), and the environmental domain of quality of life (r =-.24, p <.001). Moreover, perceived social support from others was correlated positively and significantly with the subjective domain of quality of life (r = .15, p =.048) and the physical domain of quality of life (r =.16, p =.048). Testing the moderation effect The two-step hierarchical regression analysis was used to test the moderation effect of perceived social support on the relationship between psychological burden and quality of life of mothers of children with hearing loss. In model 1, psychological burden was entered as the independent factor (predictor), while in model 2, perceived social support was entered as a moderator. The analysis (see table 4) showed that model 1 was statistically significant (F 1, 166 = 4.9, p = .028). In that model, R 2 = .03 (3.0%), indicating that psychological burden explains only 3.0% variation in the quality of life of women. In model 2, where perceived social support entered, the analysis showed that the model was significant (F 2, 166 = 3.8, p = .025). in model two R 2 = .044 (4.4%) indicating that perceived social support has positive moderating effect on the relationship between is psychological burden and quality of life. The moderation effect explained 4.4=% % of variation and an increase of 1.5% due to the effect of perceived social support. Such an increase in R 2 was not statistically significant (p=.106). Nevertheless, in model 1, psychological burden was a statistically significant predictor (risk factor) ( β = -.17, p = .028). In model 2, the effect of perceived social support was minimal, although psychological burden remained a significant predictor ( β = -.18, p = .019), while perceived social support was not statistically significant ( β =.10, p = .106). The analysis indicates that mothers with higher scores of psychological burden are more likely to have lower scores of quality of life, and that perceived social support has a minimal moderating positive effect (buffered effect) on the relationship. Discussion The impact of caring for children with disabilities is receiving attention from healthcare professionals; however, mothers of children with hearing loss are not well-addressed in the literature nor in the healthcare plans. This study emphasizes the psychosocial health and quality of life of mothers of children with hearing loss. We found that mothers of children with hearing loss with higher scores of psychological burdens are more likely to have lower scores of quality of life, and that perceived social support has a minimal buffering effect on the relationship between psychological burden and quality of life. We have also found that mothers have a moderate level of global perceived social support, a moderate level of willingness to seek psychological counseling, a moderate level of quality of life, and a moderate to high level of psychological burden. There are various factors that might explain the findings of this study. initially, mothers are the most reported caregivers for children in the Arabian culture (Ghannam et al., 2017). In this study, the majority of mothers received less than a high school education, and are mostly not working. In other words, mothers of children with hearing loss do experience career life difficulties and a higher rate of unemployment. One possible reason, other than caring issues, could be related to their low level of education, which contributes to reducing their opportunity for employment. In general, previous studies found that mothers caring of children with hearing loss do lose their jobs for the sake of child's care (Vinck & Brekke, 2020 ), while in this study mothers did not work at all making their decision to take of their children or due to their low level of education. On the other hand, mothers had a positive perception of seeking psychological counseling, which could be due to the mothers' sense of responsibility toward their children's hearing. This also could explain why their quality of life did not deteriorate, which may reflect their satisfaction with their performance and caring aspects. The high mothers’ psychological burden suggests that mothers are suffering psychologically due to caring of their children with hearing loss, which may also rationalize their willingness to seek psychological counselling. The majority of mothers in this study have children with severe hearing loss in both ears and are using hearing aids, which may contribute to such a high level of burden. While social support is assumed to have a positive effect on the relationship between psychological burden and quality of life, we have just detected a minimal effect. Although mothers had moderate to high level of psychological burden, their scores on quality-of-life domains were moderate to high, in particular, the psychological domain of quality of life. Such controversial reports from mothers can be explained in two ways. First, more than 80% of mothers are not working and have a low level of education, which may indicate that mothers are finding their satisfaction in caring and commitment to their responsibility toward their affected children. Another explanation is related to the children themselves, where their mean age was nine years, and almost 80% of them are using hearing aids, which might have contributed to easing the communication that led to enhancing mothers’ perception of subjective and psychological components of the quality of life. Such a notion is considered a pioneer in the field of hearing studies. Previous studies did indicate that mother's quality of life is low, and their perceived social support, although might be high might be an influential factor to enhance quality of life and lower stress and burden due to caring of their children with disabilities and hearing problems (Peker, Korkmaz, & Cukurova, 2020). Nevertheless, mothers did confirm their need for psychological counselling, assuming that such counseling with enhance their acceptance and lower their level of psychological burden. Such findings are in line with other previous studies where mothers with children with hearing loss expressed their needs for psychological intervention to overcome the burden of caring for their family members, including the affected child (Munoz, Nichols, & Hill, 2021). Furthermore, from a cultural perspective, mothers are the primary caregivers and they assume the responsibility and accountability for their family members' health and sickness. Therefore, they might deny being in a low quality of life, fearing that she will be considered negligent in fulfilling her duties towards her family or escaping her responsibility toward her sick child, which might lead to spousal and social reprimand. The literature did assert that mothers are blamed for deserting their ski children (Francis, 2023). The study also indicated that the sociodemographic and personal factors were not influential. This has been noted for almost all selected sociodemographic and personal factors. Contrary to our findings, level of education, unemployment or losing a job, level of severity of hearing loss, and having sick children at school age have been reported in the literature to influence the psychosocial well-being of caring mothers of children with hearing loss (Wondemu et al., 2022). Such inconsistent reports could be related to the homogeneity of the characteristics of this study sample, where most ( ≥ 80.0%) mothers had a low level of education, are unemployed, their children had higher degrees of severity of hearing loss in both ears, and most of them have their children using hearing aids. One limitation of this study is related to the relatively small sample size, where research reached out to most of the mothers of children with hearing loss, while only 168 agreed to participate in this study (response rate = 28%). Another limitation is related to the fact that using a self-reported format might not reveal the real lived experience of the mothers, and that, more in-depth qualitative approach, or an observational one, or a longitudinal one would enable better understanding. Conclusion This study found that perceived social support, although positive among mothers of children with hearing loss, has a minimally significant buffering effect on the relationship between psychological burden and quality of life, despite the expressed need for psychological counseling. It is noted that the socio-demographics and personal characteristics of both mothers and their children with hearing loss have no contribution to the psychosocial and quality of life components of mothers. The study has pioneering findings and implications for healthcare providers in the mental health and audiology medical field. For example, the audiology healthcare professionals need to be aware of the psychological needs of caregivers of children with hearing loss, and training would enable them, as well, to detect early patients and their caregivers' psychological problems and needs for referral to professional psychological counseling. The study indicates the need to integrate and incorporate mental health screening for children and mothers at ENT units, and that otorhinolaryngologists and mental health professionals need to work together to identify areas of intervention to buffer the impacts of the burden on mothers. Using mental health screening and allowing optional psychosocial counseling would enable mothers to independently seek counseling once they felt the need. There is also a need to enhance our understanding of the real lived experience of mothers and all types of caregivers of children with hearing and other disabilities within the cultural and underserved populations and families. We found that most mothers were not well-educated, not working, and had more than one child with a disability. This forms a new area of research to be well-investigated within cultural and socioeconomic perspectives. Declarations Ethical approval The research conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Brazil, 2013). The study has been ethically approved by the Research Ethics Committee at the XYZ Hospital (Dec 11 th , 2024). Approval is given meeting the criteria for full board approval from formal ethical review under Jordanian Measures for the Ethical Review of Life Science and Medical Research Involving Humans, as it involved questionnaire data collection without sensitive content or human experimentation. Following institutional research governance standards, the protocol received approval from the Research Ethics Committee at the XYZ Hospital (14475/2024) on 12 June 2024. The study design ensured participant protection through comprehensive anonymization measures that minimized risks of physical or psychological harm, privacy breaches, or commercial conflicts Informed consent This study employed the online survey platform for data collection. Before participation, all respondents received comprehensive information regarding the study’s objectives, their rights as research participants (including voluntary participation and the right to withdraw at any time without penalty), and the parameters of their informed consent. All participants acknowledged this information by selecting the consent option before gaining survey access. Informed consent was obtained between November 30, 2023 to April 30 2024. Rigorous confidentiality protocols were implemented throughout the study, including guarantees of complete anonymity, strict limitations on data usage for academic research purposes only, and explicit assurances that no participant information would be shared with third parties. Author Contribution A.H.M: conceptualization, supervision, writing up draft, review, analysis, methodologyM.Z: writing draft, conceptualization, writing upP.K.: writingS.B: writingR.H.M.: Data collectionR.H.: Data collectionN.A.: Data collectionS.B.S: Data collectionN.M: Data collectionL.H.M: Analysis, writing draft Acknowledgement The author acknowledges the support of the Deanship of the academic research at the University of Jordan for financial and academic support (3241/2023-2024 on Aug 13-2023). , and the Jordan Ministry of Health for their support Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Alramamneh, A., Sabayleh, O., Hazim, S., & Drei, S. (2020). Psychological and social problems of hearing-impaired students and the adopted coping strategies in deaf schools. The Journal of Educational Research, 10 (2), 205-2015. Doi: 10.36941/jesr-2020-0039. Al-Rawashdeh, B., Zuriekat, M., Alhanbali, S., Alananbeh, L., Rammaha, D., Al-Zghoul, M., . . . Tawalbeh, M. (2024). Sensorineural hearing loss among children at risk: A 16-year audiological records review in a tertiary referral center. International Journal of Pediatric Otorhinolaryngology, 176 , 111780. Ammerman, S. B. (2009). The impact of hearing loss on mother-infant bonding : The University of Arizona. Carver, C. S. (1997). You want to measure coping but your protocol’too long: Consider the brief cope. International Journal of Behavioral Medicine , 4 (1), 92-100. Cavanagh, A., Caputi, P., Wilson, C. J., & Kavanagh, D. J. (2016). Gender differences in self‐reported depression and co‐occurring anxiety and stress in a vulnerable community population. Australian Psychologist , 51 (6), 411-421 Chadda, R. K., Singh, T. B., & Ganguly, K. K. (2007). Caregiver burden and coping. Social Psychiatry and Psychiatric Epidemiology , 42 (11), 923-930. Dalky, H. F., Meininger, J. C., & Al-Ali, N. M. (2017). The reliability and validity of the Arabic World Health Organization quality of life-BREF instrument among family caregivers of relatives with psychiatric illnesses in Jordan. Journal of Nursing Research, 25 (3), 224-230. Francis, A. (2023). Abandoned: How Children Suffer when a Parent Deserts Them . Bloomsbury Publishing USA. Fisher, E. H., & Farina, A. (1995). Attitudes Toward Seeking Professional Psychological Help: A shortened form and considerations of research. Journal of College Student Development, 36 , 368-373. https://doi.org/10.1037/t05375-000 Ghannam, B., Hamdan-Mansour, A., Al Abaiat, D. (2017). Psychosocial predictors of burden among caregivers of patients with serious mental illness in Jordan. Perspectives of Psychiatric Care, 53 (4), 299-306 doi: 10.1111/ppc.12179. Hamdan-Mansour, A. (2017). Sociodemographic correlates of somatic symptoms of older persons in Jordan. Jordan Medical Journal, 51 (3), 119-130. Hamdan Mansour, A., Al Shibi, A., Khalifeh, A., Hamaideh, S., Abu Al-khair, F., Khraisat, O., & Alhalaiqa, F. (2023). Exploring mental health and psychosocial well-being of recovered individuals with COVID-19: A phenomenological approach. The Journal of Nursing Research, 31 (3):3272. doi: 10.1097/jnr.0000000000000559 Hamdan-Mansour, A., Dagmash, R. (2023). Moderating effect of coping on the relationship between depression and medical complications among patients with diabetes mellitus. International Journal of Diabetes in Developing Countries, 43 (1), pp. 12–19. Doi:10.1007/s13410-021-01034-3 Hoffman, M.F., Landsman, R.A., Fasano-McCarron, M.E., Schoffstall, S.J., Witkin, G.A. and Parkes, W.J., 2023. Integrating psychology into pediatric audiology/otolaryngology clinics: Gaps and a model of care. Clinical Practice in Pediatric Psychology , 11 (3), p.338. Hussein, D., D’Alessandro, H. D., Batuk, M. Ö., Ekhwan, A., & Sennaroğlu, G. (2022). Views of Syrian Mothers in Ankara on Infant Hearing Loss: Cross-sectional Survey. Maternal and Child Health Journal, 26 (11), 2247-2253. doi:10.1007/s10995-022-03488- Joint Committee on Infant Hearing. (2019). Year 2019 position statement: Principles and guidelines for early hearing detection and intervention programs. The Journal of Early Hearing Detection and Intervention (JEHDI), 4 (2), 1-44. doi:https://doi.org/10.15142/fptk-b748 Kataoka, Y., Maeda, Y., Fukushima, K., Sugaya, A., Shigehara, A., Kariya, S., & Nishizaki, K. (2020). Prevalence and risk factors for delayed-onset hearing loss in early childhood: A population-based observational study in Okayama Prefecture, Japan. International Journal of Pediatric Otorhinolaryngology , 138 , 110298, https://doi.org/10.1016/j.ijporl.2020.110298 . Lieu, J. E., Kenna, M., Anne, S., & Davidson, L. (2020). Hearing loss in children: a review. JAMA, 324 (21), 2195-2205 Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional state Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33 (3), 335–343. https://doi.org/10.1007/BF02511245 . Mashayekhi, F., Pilevarzadeh, M., & Rafati, F. (2015). The assessment of caregiver burden in caregivers of hemodialysis patients. Materia socio-medica , 27 (5), 333-336. Munoz, K. F., Nichols, N., & Hill, S. (2021). Psychosocial experiences of parents of young children who use hearing devices: A scoping review. Journal of Early Hearing Detection and Intervention , 6 (1), 90-95 Moussa, M. T., Lovibond, P., Laube, R., & Megahead, H. A. (2017). Psychometric properties of an arabic version of the depression anxiety stress scales (DASS). Research on Social Work Practice , 27 (3), 375-386 Nuwara, A., Masa'Deh, R., Hamdan-Mansour, A., & Qhah, I. (2019). Risk of Posttraumatic Stress Disorder and Its Relationship with Perceived Social Support among Family Caregivers of Individuals with Schizophrenia or Bipolar Disorder. Journal of Psychosocial Nursing and Mental Health Services . 57(8), 37-43. https://doi.org/10.3928/02793695-20190405-01 Ohaeri J. U., Awadalla A. W. (2009). The reliability and validity of the short version of the WHO quality of life instrument in an Arab general population. Annals of Saudi Medicine , 29(2), 98–104. Orley J. (1996). WHOQOL-BREF: Introduction, administration, scoring, and generic version of the assessment: Field trial version . Geneva, Switzerland: World Health Organization. Peker, S. V., Korkmaz, F. D., & Cukurova, I. (2020). Quality of life and parental care burden in cochlear implanted children: A case–control study. International Journal of Pediatric Otorhinolaryngology, 136, 110164 Rayan, A., Baker, O., & Fawaz, M. (2020). The psychometric properties of attitudes toward seeking professional psychological help scale-Short form in Jordanian University students. Journal of Muslim Mental Health, 14 (1). Sharma, S. D., Cushing, S. L., Papsin, B. C., & Gordon, K. A. (2020). Hearing and speech benefits of cochlear implantation in children: A review of the literature. International Journal of Pediatric Otorhinolaryngology, 133 , 109984 Scherer, N., Smythe, T., Hussein, R., Wapling, L., Hameed, S., Eaton, J., ... & Polack, S. (2023). Communication, inclusion and psychological well-being among deaf and hard of hearing children: A qualitative study in the Gaza Strip. PLOS Global Public Health, 3 (6), e0001635. Selby, J. V., Beal, A. C., & Frank, L. (2012). The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. JAMA, 307 (15), 1583-1584. Shields, C. G., Franks, P., Harp, J. J., McDaniel, S. H., & Campbell, T. L. (1992). Development of the Family Emotional Involvement and Criticism Scale (FEICS): A self‐report scale to measure expressed emotion. Journal of Marital and Family Therapy , 18 (4), 395-407. Syed, I. H., Awan, W. A., & Syeda, U. B. (2020). Caregiver burden among parents of hearing impaired and intellectually disabled children in Pakistan. Iranian Journal of Public Health, 49 (2), 249 Thara, R., Padmavati, R., Kumar, S., & Srinivasan, L. (1998). Instrument to assess burden on caregivers of chronic mentally ill. Indian Journal of Psychiatry , 40 (1), 21. Vaddadi, K. S. (1997). Burden of care in the home: issues for community management. Advances in Psychiatric Treatment , 3 (3), 146-153. Zaitoun, M., Alqudah, S., & Nuseir, A. (2022). Knowledge, attitude, and practice of hearing loss among physicians in Jordan. American Journal of Audiology, 31 (2), 370-379. Zaitoun, M., Rawashdeh, M., AlQudah, S., Nuseir, A., & Al-Tamimi, F. (2021). Knowledge and practice of hearing screening and hearing loss management among ear, nose, and throat physicians in Jordan. International Archives of Otorhinolaryngology, 25 (01), e98-e107. Zuriekat, M., Qarmout, S., Alsous, M., Nanah, A., Al-Halasa, F., Alqudah, S. and Alhanbali, S., 2024. Hearing loss in Jordan: an overlooked public health challenge: Hearing loss and hearing healthcare in Jordan. Jordan Medical Journal , 58 (3). 357-372. https://doi.org/10.35516/jmj.v58i3.3244 Yehia, D., Calliste, L., Hamdan-Mansour, A. (2013). Prevalence and Predictors of Postpartum Depression among Arabic Muslim Jordanian Women Serving in the Military. Journal of Perinatal and Neonatal Nursing, 27 (1), 25–33. Tables Table 1: Demographic characteristics of mothers and their children (N=168) Variable M SD Min Max P 25 P 50 P 75 Mothers' age 36.93 8.27 20 65 32.0 36.0 42.0 Child's age 9.29 4.62 1 17 6.0 9.7 13.0 Caring hours 4.58 3.33 1 12 2.0 4.0 6.0 # of children with hearing loss 1.50 .88 1 6 1.0 1.0 2.0 # of ever admission to hospital 1.55 2.72 0 12 0 0 2.0 Table 2: Description of personal and hearing-related factors (N=168) Variable n % Marital status Married 152 90.5 Divorced/Separated 10 7.1 Widow 4 2.4 Educational level Elementary School 54 32.1 High school 56 33.3 Diploma 18 10.7 Bachelor 35 20.8 Master/PHD 5 3.0 Working status Unemployed/Housewife 135 80.4 Part time 7 4.2 Full time 23 13.7 Retired 1 .6 Child's sex Male 97 57.7 Female 68 40.5 Type of hearing loss Conductive 12 7.1 Sensorineural 130 77.4 Mixed 26 15.5 Right ear severity of hearing loss Mild 6 3.6 Moderate 21 12.5 Severe 54 32.1 Very Severe 83 49.4 Left ear severity of hearing loss Mild 3 1.8 Moderate 24 14.3 Severe 66 39.3 Very Severe 75 44.6 Using hearing aids Yes 130 77.4 No 37 22.0 Any surgeries for ear problems Yes 67 39.9 No 100 59.5 Table 3: Descriptive statistics of the psychosocial and quality of life variables of mothers of children with hearing loss (N=168) Variable M SD Min Max P 25 P 50 P 75 Psychological Burden 83.73 12.08 42.5 120.0 77.5 82.5 92.5 PSS-total 49.12 15.85 16.0 76.0 38.0 51.0 62.0 PSS-Other 17.60 6.00 4.0 28.0 13.0 18.0 24.0 PSS-Family 16.92 6.73 4.0 28.0 10.8 18.0 24.0 PSS-Friends 14.81 5.68 4.0 26.0 10.8 15.0 19.0 Seeking Psych. Counsel 15.21 4.71 3.0 25.0 12.0 15.0 18.5 QoL-total 68.07 12.92 32.0 102.0 59.8 68.0 76.0 QoL-Subjective 7.04 1.86 2.0 10.0 6.0 7.0 8.0 QoL-physical 20.36 3.49 7.0 29.0 18.0 21.0 23.0 QoL-Psychological 18.75 3.78 9.0 28.0 16.0 19.0 21.0 QoL-Environmental 22.19 6.05 8.0 38.0 18.0 22.0 26.0 PSS: Perceived Social Support Table 4 Two steps Hierarchical Regressing psychological burden, perceived social support on quality of life of mothers of children with hearing loss in Jordan (N = 168) Variables Model 1 Model 2 β β p - value Psychological burden -.17 .028 -.19 .019 Perceived social support .10 .106 F= 4.89, p = .028 F= 3.79, p = .025 R 2 .029, p .028 .044, p=.106 Adjusted R 2 .023 .032 R 2 change -- .015 Additional Declarations No competing interests reported. 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In particular, children with hearing loss represented a challenge to their parents and primary caregivers. Studies showed that hearing loss, which is one of the most common health problems at birth, is prevalent with 1.0 to 5.0 per 1000 live births (Lieu, et al., 2020). Several studies indicated that children born with hearing loss are suffering several psychological problems that require attention and careful follow-up care from healthcare professionals and their caregivers, as well (Alramamneh, et al., 2020). The literature has adequately addressed the impact of hearing loss on affected children and the role of healthcare providers; however, the impact on caregivers has been less addressed (Scherer, et al., 2023; Zaitoun, Alqudah, \u0026amp; Nuseir, 2022). Issues such as quality of life, social support, and burden among mothers of children with hearing loss received little attention in research. Generally, it has been reported that parents of children with neurological and physical disabilities are found to be at higher risk of psychological disturbances (Syed, Awan, \u0026amp; Syeda, 2020). The general outcomes of research regarding the impact of caring for children with disability would provoke attention to emphasize further the uncovered areas of such an impact.\u003c/p\u003e\u003cp\u003eThe controversial reports regarding which disability would need the caregivers to pay more attention and negatively impact their lives were also a point of discussion in the literature. For example, parents of intellectually-challenged children needed more respite and other psychosocial services compared to parents of children with hearing loss (Syed, Awan, \u0026amp; Syeda, 2020). On the other hand, the assumed role and gender of the primary caregiver are also significant issues to be discussed. In the Arabian culture, mothers are the usual and most reported caregivers (Ghannam, Hamdan-Mansour, Al Abaiat, 2017; Nuwara, Masa'Deh, Hamdan-Mansour, \u0026amp; Qhah, 2019). Therefore, studies supported the notion that female caregivers do have more negative experiences than their male counterparts, which was also found not only in the Arabian culture (Mashayekhi et al., 2015). Caring for children with disability caused further feelings of burden on mothers compared to caring for non-disabled children (Morris \u0026amp; Zaidi, 2020). Such a burden contributed to a dysfunctional life, causing further psychosocial problems for mothers as caregivers. For instance, studies reported that caring of children with disability found to be beyond the psychological ones, and did show a negative consequences on the economic stability and mothers\u0026rsquo; career life including quitting jobs and being dependent on their spouses causing further burden and social instability (Vinck \u0026amp; Brekke, 2020; Wondemu et al., 2022). Furthermore, it has been reported that caregivers and their children with hearing loss have unmet needs for psychological support, which is often overlooked, as the primary focus tends to be on the child\u0026rsquo;s audiological care (Hoffman et al., 2023). This would inquire the status of Arabian mothers of children with hearing loss who are struggling to provide care for their children given the socioeconomic and cultural constraints and limited hearing healthcare support.\u003c/p\u003e\u003cp\u003eNumerous factors contribute to childhood hearing loss, encompassing both genetic and environmental influences. Genetic predisposition, whether syndromic or non-syndromic, stands as a common contributor to hearing loss, which might not be manifested only at birth but also emerge clinically later in childhood (Al-Rawashdeh et al., 2024). Families with a genetic predisposition to hearing loss often face the added challenge of multiple affected children, imposing additional burdens on mothers and creating financial barriers to accessing proper hearing solutions (Al-Rawashdeh et al., 2024). These challenges can lead to psychosocial detriments, burden, and a reduced quality of life. Alongside genetic factors, various environmental factors such as infections, noise exposure, ototoxicity, and perinatal complications heighten the risks of childhood hearing loss (Joint Committee on Infant Hearing, 2019). Mothers of affected children often lack awareness of hearing loss and risk factors (Hussein, D\u0026rsquo;Alessandro, Batuk, Ekhwan, \u0026amp; Sennaroğlu, 2022) that impact their ability to communicate effectively with their children, leading to heightened stress and burden (Ammerman, 2009). Understanding the perspectives of mothers of children with hearing loss regarding the psychosocial well-being and quality of life enables tailoring supportive care for them more effectively. One aspect that seems to be significant to assess further is their willingness to seek professional psychological counseling once they feel they need it.\u003c/p\u003e\u003cp\u003eNo doubt that mothers of children with hearing loss do need psychological counseling, as counselling enables them to improve their coping skills and minimize psychological consequences related to caring for their children. Jordan, similar to other countries in the developing world, lacks mental health and psychological counseling services for parents of children with disabilities. Although the prevalence of hearing loss in Jordan is higher than in many other countries, the psychosocial aspects remain largely overlooked in both research and available services (Zaiton, et al., 2021; Zureikat et al., 2024), reflecting a similar gap at the international level. This provokes attention toward the resources of psychological counseling available for mothers and the willingness of mothers of children with hearing loss to seek such services from professional counselors. Furthermore, their burden and psychological disturbances resulting from caring for their children with hearing loss are not well-documented and reported. Therefore, this study came to address these issues and their impact on mothers' quality of life. The purposes of this study are\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo assess the levels of burden, perceived social support, willingness to seek professional psychological counseling, and quality of life of mothers of children with hearing loss\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eTo assess the moderation effect of social support on the relationship between quality of life and psychological burden among mothers of children with hearing loss.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDesign\u003c/strong\u003e\u003c/em\u003e: This study uses a sequential triangulated mixed-methods design. At this phase of the study, a quantitative, cross-sectional design was used to assess the psychosocial and quality of life of the mothers of children with hearing loss. Data was collected from ENT and audiology outpatient clinics using a self-reported format in relation to levels of psychological burden, perceived social support, willingness to seek professional psychological counseling, and quality of life.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/em\u003e: Mothers were recruited from various ENT and audiology outpatient clinics targeting outpatient clinics at Jordan Ministry of Health\u0026rsquo;s tertiary referral hospitals and university-affiliated hospitals. The targeted hospitals were selected due to the fact that those units represented the major and highly specialized medical audiology services in Jordan. Furthermore, these hospitals have electronic data logs of their referred patients with hearing loss, which have access and approach of the mothers, the targeted sample of this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eSample and sampling\u003c/strong\u003e:\u003c/em\u003e The target sample of this study is mothers of children with hearing loss. A census sampling of mothers with children with hearing loss was conducted in the targeted outpatient departments of the major referral and university-affiliated hospitals used to recruit mothers. Inclusion criteria include: 1) being at 18 years or above, 2) having a child with permanent hearing loss, and 3) having a child on a treatment plan for more than three months to ensure that mothers are well oriented to the hardships of caring for the child. Exclusion criteria: 1) Mothers of children who have child/ren with hearing loss comorbid with other disabilities to avoid the aggravated hardiness of mothers in caring of child, and 2) mother who are grieving for loss of significant others for the past six months due to overlap of signs and symptoms of grieving with variables of the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll mothers of children referred to these clinics were approached and invited to the study via liaisons and facilitators in the units to avoid coercion and allow the self-determination principle of human rights.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eData collection procedure\u003c/strong\u003e\u003c/em\u003e: Data collection started after obtaining the ethical approval from XYZ University and the targeted hospitals. Facilitators were assigned per clinic and took the responsibility to invite mothers to participate in the study. Mothers who expressed interest were referred to the research team, who explained the purpose of the study and provided mothers with information regarding the purpose, significance, and what was expected from the participants if they decided to participate in the study. In addition, researchers assured mothers of confidentiality, voluntary participation, and that their approval or refusal to participate in the study would not affect the quality of care received at the unit. After having all their questions answered, mothers asked to sign a consent form that includes all abovementioned information to ensure maintaining their human rights according to the 64\u003csup\u003eth\u003c/sup\u003e WMA General Assembly, declaration of Brazil, 2013. Data collection took place in a private designated room within the audiology and ENT clinics. There was a child care assistant to assist mothers in taking care of their children during the time of filling out the survey. Filling out the survey took an average of 10 minutes. All data is saved at the PI\u0026apos;s locked cabinet, where no one has access except the PI and research team. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMeasures:\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe Arabic versions of the scales were used. The scales were:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBurden was\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eassessed through the Burden Assessment Schedule (Thara, Padmavati, Kumar, \u0026amp; Rinivasan, 1998). The Arabic version used in this study (Ghannam, et al., 2017). This scale consisted of 40 items, assessing both subjective and objective burden. The participants are required to make their responses on a 3-point Likert scale ranging from \u0026ldquo;not at all (1)\u0026rdquo; to \u0026ldquo;very much (3)\u0026rdquo;. The original scale showed good reliability with a Kappa of 0.8 (Thara et al. 1998). Also, the Arabic version has good reliability with Cronbach\u0026apos;s Alpha of .73 (Ghannam, et al., 2017). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived social support\u003c/em\u003e\u003c/strong\u003e was measured using the Multidimensional Perceived Scale of Social Support (MDPSS)\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe Arabic version used in this study\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Yehia, Calliste, Hamdan-Mansour, 2013). The scale is a 12-item self-reported scale used to assess the perception of social support adequacy from the family, friends, and significant others, including the healthcare professional (Zimet, Dahlem, Zimet \u0026amp; Farley, 1988). Each item measures the adequacy of social support using a 7-point Likert scale ranging from very strongly disagree (1) to very strongly agree (7). The scale is using a continuous scaling measure with a mean score of 12-35 indicating low perceived social support, 36-60 indicates a medium perceived social support, and 61-84 indicates a high level of perceived social support (Zimet, Dahlem, Zimet \u0026amp; Farley, 1988). The Arabic version has good internal consistency reliability with Cronbach\u0026apos;s Alpha of .88 (Yehia, et al., 2013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u003cem\u003eQuality of life\u003c/em\u003e\u003c/strong\u003e was measured using the WHOQOL-BREF. The scale is composed of 26 self-administered items, which are a short version of the WHOQOL-100 scale (Orley, 1996). In this study, the Arabic version was used (Dalky, Meininger, \u0026amp; Al-Ali, 2017). The respondents are required to make their responses on a 5-point Likert response scale ranging from 1 (very dissatisfied/very poor) to 5 (very satisfied/very good). Mothers were asked to rank each item accordingly. Mothers are reminded that these questions reflect their quality of life for the past six months. The scale is formed of four domains in addition to one general health facet: physical health, psychological health, social relations, and environment. The general health facet is assessed using the remaining two items reflecting their subjective satisfaction with health (Ohaeri \u0026amp; Awadalla, 2009). A higher score in any of the domains indicates a higher QOL rating. The Arabic version has good internal consistency with Cronbach\u0026rsquo;s alpha coefficient of 0.70 (Dalky, et al., 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWillingness to seek psychological counseling\u003c/em\u003e\u003c/strong\u003e was measured using the Attitudes towards Seeking Professional Psychological Help- short form (ATSPPH-SF; Fischer \u0026amp; Farina, 1995). The scale is available in Arabic in its short version that consists of 10 items (Rayan et al., 2020). The respondents are required to make their answers in a four-point Likert scale ranging from agree (3) to disagree (3). There are five items (2, 4, 8, 9, and 10) to be reversed before a total score can be calculated, with a higher score indicating more positive attitudes and a lower score indicating a tendency toward negative scores. The tool is tested and found to be appropriate across cultures. The Arabic version has good reliability with a Cronbach\u0026apos;s alpha of .84 (Rayan et al., 2020).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe computer program, IBM-SPSS v. 25, window used to describe psychosocial health variables. Categorical variables were analyzed for frequencies and percentages, while continuous variables were described using the central tendency measures (means and medians), the dispersion measures (standard deviation), and inter-percentile measures (P\u003csub\u003e25\u003c/sub\u003e, P\u003csub\u003e50\u003c/sub\u003e, P\u003csub\u003e75\u003c/sub\u003e). The association between variables of the study was examined through the Pearson product-moment correlation coefficient (\u003cem\u003er\u003c/em\u003e) and a regression model that was developed for specific purposes to test the moderation effect. In addition, to assess the difference in the variables of the study in relation to demographic characteristics, a t-test was used for variables with two levels, and one-way ANOVA for variables with more than two levels to assess differences in relation to selected socio-demographics. Alpha set at .05\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics of mothers and their children\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMore than 600 mothers over three months have been approached, and a total of 168 agreed to participate in the study. No specific reason was defined by the mothers for not taking part in this study. The analysis (see table 1) shows that the mean age of the mothers was 36.9 (SD = 8.3), ranging from 20-65 years. Of the mothers, 90.5% (n=152) were currently married, 65.4% (n=110) have high school or less education, and 80.4% (n=135) are unemployed. Their mean hours of hearing-related caring of their children were 4.6 (SD = 3.3), ranging from 1 to 12 hours or more. About 10.1% (n = 17) reported that they provide more than 12 hours of caring for their children. The mean number of children reported by women was 1.5 (SD=.88), ranging from 1 to 6 children. Of the children, 57.7% (n = 97) were males and 40.5% (n 68) were females. It is noted that 50% (n=84) of the women have only one child. Regarding their children\u0026apos;s ages, the mean age of the children was 9.3 (SD=4.6), ranging from 1-17 years. 50% (n=84) of the children were at the age of 9.7 years or less. Furthermore, the analysis showed that the total number of children ranged from 1-6 children, with 50% (n=84) of mothers having one child with a hearing problem.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHearing loss status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding the type of ear and level of severity of the hearing loss among children, the analysis (see table 2) showed that 77.4% (n = 130) of the children have sensorineural type of loss. Of the children, 81.5%(n=137) have severe to profound hearing loss in the right ear compared to 83.9% (n=141) having severe to profound hearing loss in the left ear. It was also found that 77.4% (n=130) are currently using hearing aids. Only 39.9% (n = 67) have surgery of any form related to a hearing problem, and the mean time of ever being admitted to hospital was 1.5 (SD = 2.7), ranging from 0-9 times, 75.0% (n = 126) being admitted only one time. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePsychological burden\u003c/em\u003e\u003c/strong\u003e: The analysis (see table 3) showed that the mean score of the psychological scale was 83.7 (SD = 12.1) with scores ranging from 42.5 to 120.0. The analysis also showed that 50% (n = 84) had a score of 82.5. Using the interquartile equation, and given that the expected scores on the scale range from 40.0 to 120.0 (midpoint of 80.0), the analysis showed that 50.0% (n=84) had a score between 77.5 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 92.5 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate to high level of psychological burden.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerceived social support\u003c/em\u003e\u003c/strong\u003e: The analysis (see table 3) showed that the mean score of the perceived social support scale was 49.1 (SD = 15.8) with scores ranging from 16.0 to 76.0. The analysis also showed that 50% (n = 84) had a score of 51.0. Based on the value of the mean score of 49.1, which is located in the medium level of perceived social support. This indicates that mothers of children with hearing loss had, in general, a moderate level of global perceived social support. Specifically, the mean of perceived social support from others that may also include the healthcare professionals was 17.6 (SD=6.0) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 18.0. The mean score of 17.6 indicates a medium perceived social support from others. Using the interquartile. Regarding perceived social support from family, the mean of perceived social support from family was 16.9 (SD=6.7) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 18.0. The mean score of 16.9 indicates that mothers of children with hearing loss had a medium level of perceived social support from family. Regarding perceived social support from friends, the mean of perceived social support from friends was 14.8 (SD=6.7) with scores ranging from 4.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 15.0. The mean score of 14.8 indicates that mothers of children with hearing loss had a medium level of perceived social support from friends.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWillingness to seek psychological counseling\u003c/em\u003e\u003c/strong\u003e: \u0026nbsp;The analysis (see table 3) showed that the mean score of the Willingness to seek psychological counseling was 15.2 (SD = 4.7) with scores ranging from 0 to 30.0. The analysis also showed that 50% (n = 84) had a score 15.0. Using the interquartile equation, and given that the expected scores on the scale is ranging from 0 to 30.0 (midpoint of 15.0), the analysis showed that 50.0% (n=84) had a score between 12.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 18.5 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate level of willingness to seek psychological counseling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality of life:\u0026nbsp;\u003c/strong\u003eRegarding the quality of life of mothers, the analysis (see table 3) showed that the mean score of the quality of life was 68.1 (SD = 12.9) with scores ranging from 32.0 to 102.0. The analysis also showed that 50% (n = 84) had a score of 68.0. Using the interquartile equation, and given that the expected scores on the scale range from 26.0 to 130.0 (midpoint of 78.0), the analysis showed that 50.0% (n=84) had a score between 59.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 79.0 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate level of quality of life. Specifically, regarding domains of quality of life, the mean score of the subject\u0026apos;s quality of life was 7.0 (SD = 1.9) with scores ranging from 2 to 10.0. The analysis also showed that 50% (n = 84) had a score of 7.0. Using the interquartile equation, and given that the expected scores on the scale range from 2.0 to 10.0 (midpoint of 6.0), the analysis showed that 50.0% (n=84) had a score between 6.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 8.0 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate to high level of subjective quality of life. Regarding the physical domain, the mean score was 20.4 (SD = 3.5) with scores ranging from 7.0 to 29.0. The analysis also showed that 50% (n = 84) had a score of 21.0. Using the interquartile equation, and given that the expected scores on the scale range from 7.0 to 35.0 (midpoint of 21.0), the analysis showed that 50.0% (n=84) had a score between 18.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 23.0 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate level of physical perception of quality of life. Regarding the psychological domain, the mean score was 18.8 (SD = 3.8) with scores ranging from 9.0 to 28.0. The analysis also showed that 50% (n = 84) had a score of 19.0. Using the interquartile equation, and given that the expected scores on the scale range from 6.0 to 30.0 (midpoint of 18.0), the analysis showed that 50.0% (n=84) had a score between 16.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 26.0 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a high level of psychological perception of their quality of life. Regarding the environmental domain, the mean score was 22.19 (SD = 6.1) with scores ranging from 8.0 to 38.0. The analysis also showed that 50% (n = 84) had a score of 22.0. Using the interquartile equation, and given that the expected scores on the scale range from 8.0 to 40.0 (midpoint of 24.0), the analysis showed that 50.0% (n=84) had a score between 18.0 (percentile 25\u003csup\u003eth\u003c/sup\u003e) and 26.0 (percentile 75\u003csup\u003eth\u003c/sup\u003e). This indicates that mothers of children with hearing loss had a moderate level of environmental perception of their quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Initially, the correlation among the main variables. The analysis showed that quality of life is associated significantly and negatively with psychological burden (r= -.18, p= .025). While all other associations were not statistically significant (p\u0026gt;.05). Regarding the association and differences in quality of life in relation to sociodemographic, only quality of life was statistically significant in relation to the severity of hearing loss in the right ear (F\u003csub\u003e3,153\u003c/sub\u003e = 3.3, p= .021), while all other categorical or continuous variables were not. The significant difference in quality of life, according to post hoc comparison of Scheffe, between those with mild and moderate levels of severity (p=.032). On the other hand, there was a statistical negative correlation between psychological burden and the subjective domain of quality of life (r=-.19, p \u0026lt;.001), and the environmental domain of quality of life (r =-.24, p \u0026lt;.001). Moreover, perceived social support from others was correlated positively and significantly with the subjective domain of quality of life (r = .15, p =.048) and the physical domain of quality of life (r =.16, p =.048).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTesting the moderation effect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe two-step hierarchical regression analysis was used to test the moderation effect of perceived social support on the relationship between psychological burden and quality of life of mothers of children with hearing loss. In model 1, psychological burden was entered as the independent factor (predictor), while in model 2, perceived social support was entered as a moderator. The analysis (see table 4) showed that model 1 was statistically significant (F\u003csub\u003e1, 166\u0026nbsp;\u003c/sub\u003e= 4.9, p = .028). In that model, \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= .03 (3.0%), indicating that psychological burden explains only 3.0% variation in the quality of life of women. In model 2, where perceived social support entered, the analysis showed that the model was significant (F\u003csub\u003e2, 166\u0026nbsp;\u003c/sub\u003e= 3.8, p = .025). in model two \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003e= .044 (4.4%) indicating that perceived social support has positive moderating effect on the relationship between is psychological burden and quality of life. The moderation effect explained 4.4=% % of variation and an increase of 1.5% due to the effect of perceived social support. Such an increase in \u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003ewas not statistically significant (p=.106). Nevertheless, in model 1, psychological burden was a statistically significant predictor (risk factor) (\u003cem\u003e\u0026beta;\u003c/em\u003e = -.17, p = .028). In model 2, the effect of perceived social support was minimal, although psychological burden remained a significant predictor (\u003cem\u003e\u0026beta;\u003c/em\u003e= -.18, p = .019), while perceived social support was not statistically significant (\u003cem\u003e\u0026beta;\u003c/em\u003e =.10, p = .106). The analysis indicates that mothers with higher scores of psychological burden are more likely to have lower scores of quality of life, and that perceived social support has a minimal moderating positive effect (buffered effect) on the relationship.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe impact of caring for children with disabilities is receiving attention from healthcare professionals; however, mothers of children with hearing loss are not well-addressed in the literature nor in the healthcare plans. This study emphasizes the psychosocial health and quality of life of mothers of children with hearing loss. We found that mothers of children with hearing loss with higher scores of psychological burdens are more likely to have lower scores of quality of life, and that perceived social support has a minimal buffering effect on the relationship between psychological burden and quality of life. We have also found that mothers have a moderate level of global perceived social support, a moderate level of willingness to seek psychological counseling, a moderate level of quality of life, and a moderate to high level of psychological burden. There are various factors that might explain the findings of this study. initially, mothers are the most reported caregivers for children in the Arabian culture (Ghannam et al., 2017). In this study, the majority of mothers received less than a high school education, and are mostly not working. In other words, mothers of children with hearing loss do experience career life difficulties and a higher rate of unemployment. One possible reason, other than caring issues, could be related to their low level of education, which contributes to reducing their opportunity for employment. In general, previous studies found that mothers caring of children with hearing loss do lose their jobs for the sake of child's care (Vinck \u0026amp; Brekke, 2020 ), while in this study mothers did not work at all making their decision to take of their children or due to their low level of education. On the other hand, mothers had a positive perception of seeking psychological counseling, which could be due to the mothers' sense of responsibility toward their children's hearing. This also could explain why their quality of life did not deteriorate, which may reflect their satisfaction with their performance and caring aspects. The high mothers\u0026rsquo; psychological burden suggests that mothers are suffering psychologically due to caring of their children with hearing loss, which may also rationalize their willingness to seek psychological counselling. The majority of mothers in this study have children with severe hearing loss in both ears and are using hearing aids, which may contribute to such a high level of burden.\u003c/p\u003e\u003cp\u003eWhile social support is assumed to have a positive effect on the relationship between psychological burden and quality of life, we have just detected a minimal effect. Although mothers had moderate to high level of psychological burden, their scores on quality-of-life domains were moderate to high, in particular, the psychological domain of quality of life. Such controversial reports from mothers can be explained in two ways. First, more than 80% of mothers are not working and have a low level of education, which may indicate that mothers are finding their satisfaction in caring and commitment to their responsibility toward their affected children. Another explanation is related to the children themselves, where their mean age was nine years, and almost 80% of them are using hearing aids, which might have contributed to easing the communication that led to enhancing mothers\u0026rsquo; perception of subjective and psychological components of the quality of life. Such a notion is considered a pioneer in the field of hearing studies. Previous studies did indicate that mother's quality of life is low, and their perceived social support, although might be high might be an influential factor to enhance quality of life and lower stress and burden due to caring of their children with disabilities and hearing problems (Peker, Korkmaz, \u0026amp; Cukurova, 2020). Nevertheless, mothers did confirm their need for psychological counselling, assuming that such counseling with enhance their acceptance and lower their level of psychological burden. Such findings are in line with other previous studies where mothers with children with hearing loss expressed their needs for psychological intervention to overcome the burden of caring for their family members, including the affected child (Munoz, Nichols, \u0026amp; Hill, 2021). Furthermore, from a cultural perspective, mothers are the primary caregivers and they assume the responsibility and accountability for their family members' health and sickness. Therefore, they might deny being in a low quality of life, fearing that she will be considered negligent in fulfilling her duties towards her family or escaping her responsibility toward her sick child, which might lead to spousal and social reprimand. The literature did assert that mothers are blamed for deserting their ski children (Francis, 2023).\u003c/p\u003e\u003cp\u003eThe study also indicated that the sociodemographic and personal factors were not influential. This has been noted for almost all selected sociodemographic and personal factors. Contrary to our findings, level of education, unemployment or losing a job, level of severity of hearing loss, and having sick children at school age have been reported in the literature to influence the psychosocial well-being of caring mothers of children with hearing loss (Wondemu et al., 2022). Such inconsistent reports could be related to the homogeneity of the characteristics of this study sample, where most (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;80.0%) mothers had a low level of education, are unemployed, their children had higher degrees of severity of hearing loss in both ears, and most of them have their children using hearing aids.\u003c/p\u003e\u003cp\u003eOne limitation of this study is related to the relatively small sample size, where research reached out to most of the mothers of children with hearing loss, while only 168 agreed to participate in this study (response rate\u0026thinsp;=\u0026thinsp;28%). Another limitation is related to the fact that using a self-reported format might not reveal the real lived experience of the mothers, and that, more in-depth qualitative approach, or an observational one, or a longitudinal one would enable better understanding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that perceived social support, although positive among mothers of children with hearing loss, has a minimally significant buffering effect on the relationship between psychological burden and quality of life, despite the expressed need for psychological counseling. It is noted that the socio-demographics and personal characteristics of both mothers and their children with hearing loss have no contribution to the psychosocial and quality of life components of mothers. The study has pioneering findings and implications for healthcare providers in the mental health and audiology medical field. For example, the audiology healthcare professionals need to be aware of the psychological needs of caregivers of children with hearing loss, and training would enable them, as well, to detect early patients and their caregivers' psychological problems and needs for referral to professional psychological counseling. The study indicates the need to integrate and incorporate mental health screening for children and mothers at ENT units, and that otorhinolaryngologists and mental health professionals need to work together to identify areas of intervention to buffer the impacts of the burden on mothers. Using mental health screening and allowing optional psychosocial counseling would enable mothers to independently seek counseling once they felt the need. There is also a need to enhance our understanding of the real lived experience of mothers and all types of caregivers of children with hearing and other disabilities within the cultural and underserved populations and families. We found that most mothers were not well-educated, not working, and had more than one child with a disability. This forms a new area of research to be well-investigated within cultural and socioeconomic perspectives.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe research conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Brazil, 2013). The study has been ethically approved by the Research Ethics Committee at the XYZ Hospital (Dec 11\u003csup\u003eth\u003c/sup\u003e, 2024). Approval is given\u0026nbsp;\u003c/p\u003e\n\u003cp\u003emeeting the criteria for full board approval from formal ethical review under Jordanian Measures for the Ethical Review of Life Science and Medical Research Involving Humans, as it involved questionnaire data collection without sensitive content or human experimentation. Following institutional research governance standards, the protocol received approval from the\u0026nbsp;Research Ethics Committee at the XYZ Hospital (14475/2024) on 12 June 2024. The study design ensured participant protection through comprehensive anonymization measures that minimized risks of physical or psychological harm, privacy breaches, or commercial conflicts\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eInformed consent\u003c/h2\u003e\n\u003cp\u003eThis study employed the online survey platform for data collection. Before participation,\u003c/p\u003e\n\u003cp\u003eall respondents received comprehensive information regarding the study\u0026rsquo;s objectives,\u003c/p\u003e\n\u003cp\u003etheir rights as research participants (including voluntary participation and the right to\u003c/p\u003e\n\u003cp\u003ewithdraw at any time without penalty), and the parameters of their informed consent. All\u003c/p\u003e\n\u003cp\u003eparticipants acknowledged this information by selecting the consent option before\u003c/p\u003e\n\u003cp\u003egaining survey access. Informed consent was obtained between November 30, 2023 to April 30 2024. Rigorous confidentiality protocols were implemented throughout the study, including guarantees of complete anonymity, strict limitations on data usage for academic research purposes only, and explicit assurances that no participant information would be shared with third parties.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.H.M: conceptualization, supervision, writing up draft, review, analysis, methodologyM.Z: writing draft, conceptualization, writing upP.K.: writingS.B: writingR.H.M.: Data collectionR.H.: Data collectionN.A.: Data collectionS.B.S: Data collectionN.M: Data collectionL.H.M: Analysis, writing draft\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe author acknowledges the support of the Deanship of the academic research at the University of Jordan for financial and academic support (3241/2023-2024 on Aug 13-2023). , and the Jordan Ministry of Health for their support\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlramamneh, A., Sabayleh, O., Hazim, S., \u0026amp; Drei, S. (2020). Psychological and social problems of hearing-impaired students and the adopted coping strategies in deaf schools. \u003cem\u003eThe Journal of Educational Research, 10\u0026nbsp;\u003c/em\u003e(2), 205-2015. Doi: 10.36941/jesr-2020-0039.\u003c/li\u003e\n \u003cli\u003eAl-Rawashdeh, B., Zuriekat, M., Alhanbali, S., Alananbeh, L., Rammaha, D., Al-Zghoul, M., . . . Tawalbeh, M. (2024). Sensorineural hearing loss among children at risk: A 16-year audiological records review in a tertiary referral center. \u003cem\u003eInternational Journal of Pediatric Otorhinolaryngology, 176\u003c/em\u003e, 111780.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAmmerman, S. B. (2009). \u003cem\u003eThe impact of hearing loss on mother-infant bonding\u003c/em\u003e: The University of Arizona.\u003c/li\u003e\n \u003cli\u003eCarver, C. S. (1997). You want to measure coping but your protocol\u0026rsquo;too long: Consider the brief cope. \u003cem\u003eInternational Journal of Behavioral Medicine\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(1), 92-100.\u003c/li\u003e\n \u003cli\u003eCavanagh, A., Caputi, P., Wilson, C. J., \u0026amp; Kavanagh, D. J. (2016). Gender differences in self‐reported depression and co‐occurring anxiety and stress in a vulnerable community population. \u003cem\u003eAustralian Psychologist\u003c/em\u003e, \u003cem\u003e51\u003c/em\u003e(6), 411-421\u003c/li\u003e\n \u003cli\u003eChadda, R. K., Singh, T. B., \u0026amp; Ganguly, K. K. (2007). Caregiver burden and coping. \u003cem\u003eSocial Psychiatry and Psychiatric Epidemiology\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(11), 923-930.\u003c/li\u003e\n \u003cli\u003eDalky, H. F., Meininger, J. C., \u0026amp; Al-Ali, N. M. (2017). 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Views of Syrian Mothers in Ankara on Infant Hearing Loss: Cross-sectional Survey. \u003cem\u003eMaternal and Child Health Journal, 26\u003c/em\u003e(11), 2247-2253. doi:10.1007/s10995-022-03488-\u003c/li\u003e\n \u003cli\u003eJoint Committee on Infant Hearing. (2019). Year 2019 position statement: Principles and guidelines for early hearing detection and intervention programs. \u003cem\u003eThe Journal of Early Hearing Detection and Intervention (JEHDI), 4\u003c/em\u003e(2), 1-44. doi:https://doi.org/10.15142/fptk-b748\u003c/li\u003e\n \u003cli\u003eKataoka, Y., Maeda, Y., Fukushima, K., Sugaya, A., Shigehara, A., Kariya, S., \u0026amp; Nishizaki, K. (2020). Prevalence and risk factors for delayed-onset hearing loss in early childhood: A population-based observational study in Okayama Prefecture, Japan. \u003cem\u003eInternational Journal of Pediatric Otorhinolaryngology\u003c/em\u003e, \u003cem\u003e138\u003c/em\u003e, 110298,\u0026nbsp;\u003ca href=\"https://doi.org/10.1016/j.ijporl.2020.110298\"\u003ehttps://doi.org/10.1016/j.ijporl.2020.110298\u003c/a\u003e.\u003c/li\u003e\n \u003cli\u003eLieu, J. E., Kenna, M., Anne, S., \u0026amp; Davidson, L. (2020). Hearing loss in children: a review. \u003cem\u003eJAMA,\u0026nbsp;324\u003c/em\u003e(21), 2195-2205\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLovibond, P. F., \u0026amp; Lovibond, S. H. (1995). The structure of negative emotional state Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. \u003cem\u003eBehaviour Research and Therapy, 33\u003c/em\u003e(3), 335\u0026ndash;343.\u0026nbsp;\u003ca href=\"https://doi.org/10.1007/BF02511245\"\u003ehttps://doi.org/10.1007/BF02511245\u003c/a\u003e.\u003c/li\u003e\n \u003cli\u003eMashayekhi, F., Pilevarzadeh, M., \u0026amp; Rafati, F. (2015). The assessment of caregiver burden in caregivers of hemodialysis patients. \u003cem\u003eMateria socio-medica\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(5),\u0026nbsp;333-336.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMunoz, K. F., Nichols, N., \u0026amp; Hill, S. (2021). Psychosocial experiences of parents of young children who use hearing devices: A scoping review. \u003cem\u003eJournal of Early Hearing Detection and Intervention\u003c/em\u003e, \u003cem\u003e6\u003c/em\u003e(1), 90-95\u003c/li\u003e\n \u003cli\u003eMoussa, M. T., Lovibond, P., Laube, R., \u0026amp; Megahead, H. A. (2017). Psychometric properties of an arabic version of the depression anxiety stress scales (DASS). \u003cem\u003eResearch on Social Work Practice\u003c/em\u003e, \u003cem\u003e27\u003c/em\u003e(3), 375-386\u003c/li\u003e\n \u003cli\u003eNuwara, A., Masa\u0026apos;Deh, R., Hamdan-Mansour, A., \u0026amp; Qhah, I. (2019). Risk of Posttraumatic Stress Disorder and Its Relationship with Perceived Social Support among Family Caregivers of Individuals with Schizophrenia or Bipolar Disorder. \u003cem\u003eJournal of Psychosocial Nursing and Mental Health Services\u003c/em\u003e. 57(8), 37-43.\u0026nbsp;\u003ca href=\"https://doi.org/10.3928/02793695-20190405-01\"\u003ehttps://doi.org/10.3928/02793695-20190405-01\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eOhaeri J. U., Awadalla A. W. (2009). The reliability and validity of the short version of the WHO quality of life instrument in an Arab general population. \u003cem\u003eAnnals of Saudi Medicine\u003c/em\u003e, 29(2), 98\u0026ndash;104.\u003c/li\u003e\n \u003cli\u003eOrley J. (1996). \u003cem\u003eWHOQOL-BREF: Introduction, administration, scoring, and generic version of the assessment: Field trial version\u003c/em\u003e. Geneva, Switzerland: World Health Organization.\u003c/li\u003e\n \u003cli\u003ePeker, S. V., Korkmaz, F. D., \u0026amp; Cukurova, I. (2020). Quality of life and parental care burden in cochlear implanted children: A case\u0026ndash;control study.\u0026nbsp;International Journal of Pediatric Otorhinolaryngology,\u0026nbsp;136, 110164\u003c/li\u003e\n \u003cli\u003eRayan, A., Baker, O., \u0026amp; Fawaz, M. (2020). The psychometric properties of attitudes toward seeking professional psychological help scale-Short form in Jordanian University students. \u003cem\u003eJournal of Muslim Mental Health,\u0026nbsp;14\u003c/em\u003e(1).\u003c/li\u003e\n \u003cli\u003eSharma, S. D., Cushing, S. L., Papsin, B. C., \u0026amp; Gordon, K. A. (2020). Hearing and speech benefits of cochlear implantation in children: A review of the literature. \u003cem\u003eInternational Journal of Pediatric Otorhinolaryngology,\u0026nbsp;133\u003c/em\u003e, 109984\u003c/li\u003e\n \u003cli\u003eScherer, N., Smythe, T., Hussein, R., Wapling, L., Hameed, S., Eaton, J., ... \u0026amp; Polack, S. (2023). Communication, inclusion and psychological well-being among deaf and hard of hearing children: A qualitative study in the Gaza Strip. \u003cem\u003ePLOS Global Public Health,\u0026nbsp;3\u003c/em\u003e(6), e0001635.\u003c/li\u003e\n \u003cli\u003eSelby, J. V., Beal, A. C., \u0026amp; Frank, L. (2012). The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda. \u003cem\u003eJAMA, 307\u003c/em\u003e(15), 1583-1584.\u003c/li\u003e\n \u003cli\u003eShields, C. G., Franks, P., Harp, J. J., McDaniel, S. H., \u0026amp; Campbell, T. L. (1992). Development of the Family Emotional Involvement and Criticism Scale (FEICS): A self‐report scale to measure expressed emotion. \u003cem\u003eJournal of Marital and Family Therapy\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(4), 395-407.\u003c/li\u003e\n \u003cli\u003eSyed, I. H., Awan, W. A., \u0026amp; Syeda, U. B. (2020). Caregiver burden among parents of hearing impaired and intellectually disabled children in Pakistan. \u003cem\u003eIranian Journal of Public Health,\u0026nbsp;49\u003c/em\u003e(2), 249\u003c/li\u003e\n \u003cli\u003eThara, R., Padmavati, R., Kumar, S., \u0026amp; Srinivasan, L. (1998). Instrument to assess burden on caregivers of chronic mentally ill. \u003cem\u003eIndian Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(1), 21.\u003c/li\u003e\n \u003cli\u003eVaddadi, K. S. (1997). Burden of care in the home: issues for community management. \u003cem\u003eAdvances in Psychiatric Treatment\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(3), 146-153.\u003c/li\u003e\n \u003cli\u003eZaitoun, M., Alqudah, S., \u0026amp; Nuseir, A. (2022). Knowledge, attitude, and practice of hearing loss among physicians in Jordan. \u003cem\u003eAmerican Journal of Audiology,\u0026nbsp;31\u003c/em\u003e(2), 370-379.\u003c/li\u003e\n \u003cli\u003eZaitoun, M., Rawashdeh, M., AlQudah, S., Nuseir, A., \u0026amp; Al-Tamimi, F. (2021). Knowledge and practice of hearing screening and hearing loss management among ear, nose, and throat physicians in Jordan. \u003cem\u003eInternational Archives of Otorhinolaryngology,\u0026nbsp;25\u003c/em\u003e(01), e98-e107.\u003c/li\u003e\n \u003cli\u003eZuriekat, M., Qarmout, S., Alsous, M., Nanah, A., Al-Halasa, F., Alqudah, S. and Alhanbali, S., 2024. Hearing loss in Jordan: an overlooked public health challenge: Hearing loss and hearing healthcare in Jordan. \u003cem\u003eJordan Medical Journal\u003c/em\u003e, \u003cem\u003e58\u003c/em\u003e(3). 357-372.\u0026nbsp;https://doi.org/10.35516/jmj.v58i3.3244\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYehia, D., Calliste, L., Hamdan-Mansour, A. (2013). Prevalence and Predictors of Postpartum Depression among Arabic Muslim Jordanian Women Serving in the Military. Journal of Perinatal and Neonatal Nursing, 27 (1), 25\u0026ndash;33.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Demographic characteristics of mothers and their children (N=168)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e25\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e50\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e75\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers\u0026apos; age\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e36.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e8.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e36.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e42.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild\u0026apos;s age\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 9.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCaring hours\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e# of children with hearing loss\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; .88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e# of ever admission to hospital\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Description of personal and hearing-related factors (N=168)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 418px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDivorced/Separated\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWidow\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElementary School\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh school\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiploma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBachelor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaster/PHD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnemployed/Housewife\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e80.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePart time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetired\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; .6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChild\u0026apos;s sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e57.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e40.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of hearing loss\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConductive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensorineural\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMixed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight ear severity of hearing loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e49.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft ear severity of hearing loss\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e44.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing hearing aids\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAny surgeries for ear problems\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp; 67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e59.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Descriptive statistics of the psychosocial and quality of life variables of mothers of children with hearing loss (N=168)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMax\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e25\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e50\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003csub\u003e75\u003c/sub\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological Burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e83.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e120.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e77.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e82.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS-total\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e49.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e15.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e51.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e62.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS-Other\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS-Family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp; 24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS-Friends\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeeking Psych. Counsel\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e15.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e25.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL-total\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e68.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e32.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e102.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e68.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL-Subjective\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e7.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL-physical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e29.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL-Psychological\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e18.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL-Environmental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e22.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e38.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e18.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePSS: Perceived Social Support\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTwo steps Hierarchical Regressing psychological burden, perceived social support on quality of life of mothers of children with hearing loss in Jordan (N = 168)\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychological burden\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e-.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerceived social support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e.106\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eF= 4.89, p = .028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eF= 3.79, p = .025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e.029, p .028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e.044, p=.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cem\u003eAdjusted R\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003csup\u003e2\u0026nbsp;\u003c/sup\u003echange\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6779155/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6779155/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Hearing loss represents one significant problem affecting children and their mothers, who are the main caregivers. Therefore, the mental and psychosocial well-being of mothers of children with hearing loss does affect their willingness to meet the healthcare needs of their children. The purposes of this study are to: 1) assess the levels of burden, perceived social support, willingness to seek professional psychological counseling, and quality of life of mothers of children with hearing loss, and 2) to assess the moderation effect of social support on the relationship between quality of life and psychological burden among mothers of children with hearing loss.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional descriptive-exploratory design was used to recruit a sample of 168 mothers of children with hearing loss. Data collected regarding quality of life, psychological burden, perceived social support, and willingness to seek psychological counselling.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The analysis showed that mothers are suffering moderate to high levels of psychological burden, moderate levels of quality of life, perceived social support, and a moderate level of willingness to seek psychological counselling. Perceived social support was found to minimally buffer the relationship between psychological burden and quality of life (F2, 166 = 3.8, p = .025; R2 = .044), although quality of life was associated significantly and negatively with psychological burden (r= -.18, p= .025).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: There is a need to enhance and integrate mental health and psychosocial support services for mothers of children with hearing loss. Keywords: Hearing Loss; Children, Mothers; Psychological Burden; Social Support, Quality of Life; Seeking Psychological Counseling. \u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Psychosocial status and the moderation effect of social support on the relationship between quality of Life and psychological burden among mothers of children with hearing loss","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 11:04:05","doi":"10.21203/rs.3.rs-6779155/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-14T17:24:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-13T06:55:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-27T21:11:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178140864878075662597523009265248546090","date":"2025-08-23T20:26:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296791766817513317801704112068440809421","date":"2025-08-21T19:12:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239342983383775016876244283765165758226","date":"2025-08-21T16:21:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T08:19:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45960480764915563745159077099373244435","date":"2025-07-14T20:32:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254327039897894021583871688290288205700","date":"2025-07-14T15:08:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115917998762010764865469571853119111619","date":"2025-07-10T07:28:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-09T17:51:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-09T15:35:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-21T12:44:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-13T18:05:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Humanities and Social Sciences Communications","date":"2025-06-13T18:01:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"78631551-fcc4-4ef5-92da-cb5b182f5572","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":51322498,"name":"Humanities/Health humanities"},{"id":51322499,"name":"Humanities/Medical humanities"},{"id":51322500,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-01T19:08:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-14 11:04:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6779155","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6779155","identity":"rs-6779155","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}