A Psychological Cascade Model for Persisting Voice Problems in Teachers

Abstract

In 76 teachers with persisting voice problems, the maintaining factors and coping strategies were examined. Physical, functional, psychological and socioeconomic factors were assessed. A parallel was drawn to a psychological cascade model designed for patients with chronic back pain. The majority of the patients were found to be in a deadlocked situation (phase 1 of the cascade model), for which the combination of externalization and unawareness of the situation is the main risk factor. Subjective rating of the voice problem was assessed by the Voice Handicap Index (VHI) and a visual analogue scale (VAS). Patients in phase 1 of the cascade model showed higher VHI and VAS scores compared with the other patients. For a high VHI score, the combination of socioeconomic factors and being in phase 1 was the most important risk factor. Socioeconomic factors were the most important risk factors for a high VAS score. We introduce the term ‘chronicity’, which means that the problems are maintained, the patient finds himself in a deadlocked situation, and is sliding down into a chronic disease. ‘Chronicity’ is essentially different from ‘chronic’, which refers only to the duration of the disease. We consider maintaining factors and (inadequate) coping factors, which consist of emotional/psychological, physical and socioeconomic aspects, as indicators for chronicity.

A Cross‐sectional Survey of Voice Disorders among Primary School Teachers in Hong Kong

“…A number of previous studies have also shown a positive relationship between voice disorders and various psychological problems [32][33][34][35][36][37] . However, because most of these studies used crosssectional designs, the causal relationship between the voice disorders and psychological conditions could not be determined.…”

“…As voice disorders can adversely affect quality of life, they have been suggested as a cause of psychological symptoms such as stress, depression, and anxiety 32) . On the other hand, psychogenic factors might cause voice disorders by increasing tension in the laryngeal muscles, especially for muscle tension dysphonia [34][35][36] . A bidirectional relationship between psychogenic factors and voice disorders has also been proposed by other authors 33,35,37) .…”

The consequences of spasmodic dysphonia on communication-related quality of life: A qualitative study of the insider's experiences

“…Evidence was not found that coping strategies have been the focus of prior research with people with SD. While coping styles have been explored in teachers with voice disorders (de Jong et al, 2003), caution should be exercised in extrapolating results from that study to the SD population because of different diagnoses and populations. Caution is also warranted in attempting to reconcile psychological coping profiles defined from the researchers' perspectives with the participants' interpretations of what it means to cope with a disability.…”

Utility of the Type D Scale 16 and Voice Handicap Index to Assist Voice Care in Student Teachers and Teachers

“…Research about personality scales in relation to voice problems in teachers is a new area of study. There are reports that psycho-emotional factors are also associated with some voice problems [4,11,12,15,21,[26][27][28] . Certain studies have suggested that personality traits and psychological factors may even infl uence the ability of the voice to withstand a profession demanding on the voice [26,27,29,30] .…”

“…There are reports that psycho-emotional factors are also associated with some voice problems [4,11,12,15,21,[26][27][28] . Certain studies have suggested that personality traits and psychological factors may even infl uence the ability of the voice to withstand a profession demanding on the voice [26,27,29,30] . Personality has also been linked to important life outcomes [31][32][33] .…”