Previous research has shown that hearing loss alone does not predict emotional functioning or psychological distress. This study adopts a cultural model perspective, viewing disability as a lived experience that shapes distinct cultural and social worlds. For Deaf and Hard of Hearing (DHH) individuals, communication modes—such as the choice of spoken or signed language—define interaction patterns, including who they engage with and how frequently, which in turn influences mental health.


This study categorizes Taiwanese DHH adults into four groups: (1) signers who use sign language but not speech, (2) speakers who use speech but not sign, (3) bimodal users of both sign and speech, and (4) individuals relying mainly on lip-reading and writing. Differences in schooling, caregiver communication, and presence of DHH partners were examined alongside psychological outcomes. A total of 257 adults participated in an online survey, with 240 valid responses (mean age = 39; 61% female). Participants completed either a text version or a Taiwanese Sign Language video version of the Negative Emotion Scale, tailored to DHH life contexts, and a translated Dissociative Experiences Scale-II.


Findings showed that signers tended to live within Deaf communities, while speakers engaged primarily with hearing peers. Bimodal users employed multiple channels, often learning sign through special education or self-choice. Lip-writing participants also used multiple strategies, with writing more frequent than others. Across groups, no significant differences emerged in negative emotions or dissociation scores. However, among signers, growing up with communicative companions—such as Deaf family members, sign-using caregivers, or Deaf schools—was associated with lower dissociation scores, though negative emotions showed no difference. For the other groups, no clear peer effect was observed, possibly due to sample size or individual heterogeneity. These results underscore the importance of communicative companionship in shaping DHH psychological well-being.