Impact statement
This study sheds light on the mental health experiences of Deaf adults in Bangladesh, a population that has been largely overlooked in both research and policy. Drawing on participants’ own accounts, it explores how communication barriers, family exclusion and limited access to services shape well-being, while also foregrounding the protective role of peer support and Deaf community networks. Although focused specifically on Deaf adults, the article also contributes to wider discussions on the mental health of persons with disabilities by showing how distress may be produced or intensified by inaccessible communication, social exclusion, stigma and services that are not designed around people’s lived realities. The findings point to areas where mental health services and service design could become more accessible and inclusive for Deaf people and underscore the importance of meaningfully integrating Deaf voices into healthcare and education systems. While this small, urban sample represents an initial and exploratory step, the study contributes to a growing evidence base and signals the need for larger-scale, geographically diverse and more participatory research to inform policy and practice in Bangladesh and comparable low- and middle-income country contexts.
Introduction
Globally, over 430 million people live with disabling hearing loss, a number projected to rise to 700 million by 2050 (World Health Organization, 2026). This large population experiences disproportionately high rates of mental health problems compared with the general population (Fellinger et al., Reference Fellinger, Holzinger and Pollard2012; SignHealth, 2023). Yet access to inclusive and appropriate mental health services remains severely limited. Deaf individuals face unique challenges, including language deprivation, communication barriers, service gaps and widespread stigma (Fellinger et al., Reference Fellinger, Holzinger and Pollard2012). Although studies consistently show elevated risks of emotional and behavioural disorders among Deaf individuals, their mental health conditions often remain underdiagnosed and undertreated (Fellinger et al., Reference Fellinger, Holzinger and Pollard2012; Mprah et al., Reference Mprah, Duorinaah, Adwan-Kamara and Tawiah2024).
Even in high-income countries with greater resources, systemic inequities persist. Limited interpreter access, linguistic barriers and a lack of culturally competent clinicians frequently result in misdiagnosis or exclusion from care (Crowe, Reference Crowe2021; Morisod et al., Reference Morisod, Malebranche, Marti, Spycher, Grazioli and Bodenmann2022). These challenges are likely amplified in low- and middle-income countries (LMICs), where health systems are frequently under-resourced, policies are underfunded and urban-centric and workforce shortages, limited mental health awareness and pervasive stigma create additional barriers to care. These barriers often intersect with the well-established association between disability and poverty in LMICs (Anderson et al., Reference Anderson, Wolf Craig and Ziedonis2017; Banks et al., Reference Banks, Kuper and Polack2017; Opoku et al., Reference Opoku, Mprah, Duorinaah, Gyimah, Nketsia and Adwan-Kamara2024). Bangladesh exemplifies many of these challenges. Approximately 1 in 10 people lives with some form of hearing loss, making it the second most prevalent disability in the country (Tarafder et al., Reference Tarafder, Akhtar, Zaman, Rasel, Bhuiyan and Datta2015). While Bangladesh has made notable progress in public health, its mental health system remains under-resourced and concentrated in specialist services (Hossain et al., Reference Hossain, Ahmed, Chowdhury, Niessen and Alam2014; World Health Organization, 2022a). The WHO Mental Health Atlas 2020 country profile for Bangladesh reported 270 psychiatrists, 565 psychologists and 700 mental health nurses, with an overall mental health workforce of 1.10 per 100,000 population, compared with 201.14 per 100,000 in the United Kingdom (World Health Organization, 2022a, 2022b).
Crucially, these barriers are particularly pronounced for the Deaf community. A regional report published in 2015 documented 30 accredited sign language interpreters in Bangladesh, portraying a historical indication of limited national availability at that time (World Association of Sign Language Interpreters, 2015). The limited availability of standardised Bangla Sign Language (BdSL) mental health terminology and accessible glossaries can make clinical communication more difficult (Hasan et al., Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026). In addition to this, persistent social stigma surrounding both deafness and mental illness can further exacerbate barriers to care (Duorinaah et al., Reference Duorinaah, Mprah, Adwan-Kamara and Mawugbe2023). For Deaf women, gender, disability and socioeconomic disadvantage may intersect to intensify barriers and constrain autonomy (Wickenden, Reference Wickenden2023).
Despite these challenges, research on Deaf mental health in Bangladesh remains emergent, with only a small number of studies examining Deaf people’s experiences in depth. A recent study by Hasan et al. (Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026) employed a community-engaged participatory action research design to explore how Deaf individuals and caregivers in Bangladesh conceptualise mental health, experience psychological distress and navigate help-seeking. That study also co-developed a culturally relevant and digitally accessible Bangla Mental Health Sign Language Bank in collaboration with Deaf community members, sign language interpreters and mental health professionals. The current study complements this emerging body of work by exploring the lived experiences and barriers that shape Deaf adults’ mental health in Bangladesh, identifying factors that influence their ability to seek and receive care and generating in-depth insights to inform future mental health service improvement.
In this study, “Deaf” is used primarily to refer to sign-using adults who identify with, or are connected to, cultural-linguistic Deaf communities, whereas “hearing loss” refers to a broader audiological category used in epidemiological estimates. Deafness is not solely an individual medical deficit but also a sociocultural and linguistic experience shaped by language rights, identity and community (Higgins and Lieberman, Reference Higgins and Lieberman2016). The approach to the study therefore seeks to balance recognition of structural barriers and unmet needs with attention to Deaf agency, peer support and resilience.
Methods
Study design
A qualitative phenomenological design was adopted to explore the lived experiences of Deaf adults in Bangladesh. A phenomenological approach was selected to capture the essence of participants’ subjective experiences in depth. This approach facilitated the generation of rich, detailed insights through empathetic engagement. Reflexive thematic analysis was used as the analytic strategy to identify, interpret and represent patterns within participants’ narratives.
Participants
Participants were Deaf adults aged 18 years or older. Individuals unable to provide informed consent were excluded. Capacity to consent was assessed during the consent process, informed by participants’ self-report and, where necessary, consultation with the Team Inclusion Bangladesh Foundation (TIBF), a disability rights organisation with close community knowledge. Seven participants were recruited through purposive sampling. As the study used reflexive thematic analysis, sample size was not determined with reference to data saturation (Braun and Clarke, Reference Braun and Clarke2021). Instead, the final sample size reflected the researchers’ judgement of the richness of participants’ accounts in relation to the research questions, together with practical constraints, including the study timeline, budget and interpreter availability. Given the intensive, interpreter-mediated nature of the interviews and the phenomenological focus of the study, depth was prioritised over breadth. The sample was not intended to represent the full diversity of Deaf experiences in Bangladesh (Tables 1 and 2); rather, the focus was on an in-depth exploration of participants’ mental health journeys.
Characteristics of Deaf participants
Table 1. Long description
The table consists of seven columns: Participant, Gender, Age range, Education, Age at hearing loss, Age at first B d S L exposure, and Severity of hearing loss.
* Participant D 1: Female, 30-39, Bachelor, From birth, 18, Profound.
* Participant D 2: Female, 20-29, Secondary School Certificate, Chittagong, From birth, 13, Profound.
* Participant D 3: Male, 20-29, Higher Secondary Certificate, Dhaka, From birth, 14, Severe.
* Participant D 4: Male, 30-39, Bachelor, Dhaka, From birth, 21, Profound.
* Participant D 5: Male, 20-29, B S c ongoing, Dhaka, From birth, 9, Profound.
* Participant D 6: Male, 30-39, Bachelor, Chittagong, From birth, 6, Profound.
* Participant D 7: Male, 30-39, Bachelor, Dhaka, From birth, 10, Severe.
A note specifies that D stands for deaf participant and B d S L stands for Bangla Sign Language. Hearing loss severity and age at first B d S L exposure were self-reported.
Note: D = Deaf participant; BdSL = Bangla Sign Language. Hearing-loss severity and age at first BdSL exposure were self-reported.
Aggregate background characteristics of Deaf participants
Table 2. Long description
The table is organized into four main columns: Characteristic, Category, n, and percentage.
* Schooling pathway (N = 7):
- Deaf school only: 5 participants (71.4 percent).
- Mainstream school followed by Deaf school: 2 participants (28.6 percent).
* Family hearing background (N = 7):
- Hearing family: 4 participants (57.1 percent).
- Deaf family: 2 participants (28.6 percent).
- Hearing parents with Deaf sibling(s): 1 participant (14.3 percent).
* Connection to Deaf community (N = 7):
- Deaf organisation/community network: 4 participants (57.1 percent).
- Friends, family or social circle: 2 participants (28.6 percent).
- School-based: 1 participant (14.3 percent).
* Age at first B d S L exposure:
- Range: 6 to 21 years.
- Median: 13 years.
- Mean: 13.0 years.
Note: Schooling pathway, family hearing background and connection to the Deaf community are reported in aggregate rather than by individual participants, to protect the anonymity of a small and digitally connected sample.
Participants varied in age (22–39 years), education, family background, severity of self-reported hearing loss, age at first exposure to sign language and urban locations (Dhaka and Chittagong). All seven participants reported hearing loss from birth; five reported profound hearing loss and two reported severe hearing loss. These characteristics were self-reported and documented with support from TIBF. Age at first sign language exposure was also self-reported and ranged from 6 to 21 years. All participants had attended Deaf schools. Two participants also described earlier periods of mainstream schooling before later transitioning to Deaf schools. Family backgrounds varied: two participants reported Deaf families, four reported hearing families and one reported hearing parents and two Deaf siblings. Participants described connections to Deaf communities through schools, friends, organisations and community networks. No diagnostic mental health assessment was administered; references to distress, depression or suicidality in this article reflect participants’ narratives rather than clinical diagnoses.
Recruitment
Recruitment for this study was designed with careful consideration of cultural sensitivity, accessibility and practicality in collecting data from Deaf participants, drawing on recent Deaf mental health research in Bangladesh (Hasan et al., Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026). The study collaborated closely with the Team Inclusion Bangladesh Foundation (TIBF), a disability rights organisation actively engaged with Deaf communities in Bangladesh. TIBF supported recruitment, identification of interpreters, and cultural guidance. Potential participants were approached through trusted channels, including WhatsApp groups, social media platforms and direct communication within the community. The invitation included a summary of the study and contact details for the lead researcher. No invited participant declined participation, and no participant withdrew after enrolment.
Interested individuals received a Participant Information Sheet and a link to the online Consent Form translated into Bengali to ensure cultural appropriateness and clarity. They were also provided with a link to the Microsoft Teams session for the interview. Participants were given sufficient time to review study materials and consider their participation before consenting via Microsoft Forms. No financial incentives were offered for participation.
Procedure
Interviews followed a flexible, semi-structured guide with open-ended questions that encouraged participants to lead the conversation. Prompts and follow-up questions were used to deepen reflections and achieve rich storytelling. Interviews were conducted online through Microsoft Teams with support from professional interpreters selected through TIBF on the basis of their professional experience. Five interpreters supported the study in total, with some facilitating more than one interview. During each interview, one interpreter led the semi-structured discussion in Bangla Sign Language (BdSL), while another rendered participants’ signed responses into spoken Bangla. The first author attended the sessions to coordinate logistics and recording but did not interrupt the interviews. Interpretation was understood as an active process rather than a neutral transfer of meaning. Interpreters were therefore briefed to avoid unnecessary summarising or rephrasing where possible, and transcript review procedures were incorporated to reduce potential distortion. All interviews were video-recorded to retain the signed interactions and spoken Bangla renditions. The spoken Bangla renditions were transcribed for analysis. The transcripts provided for analysis were reviewed by a second interpreter, and no substantial discrepancies were identified. Participant checking was conducted after transcription. Selected quotations were translated from Bengali into English for reporting. Participants were free to pause or stop interviews at any time if they felt distressed. After each interview, participants received a debriefing document containing mental health resources and contact information for the research team.
Data analysis
Data were analysed using reflexive thematic analysis, following Braun and Clarke’s six-phase framework (Braun and Clarke, Reference Braun and Clarke2006). The first author coded the verbatim Bengali transcripts after familiarising himself with the video-recorded interviews. Then, focused coding was done to refine codes and build themes in Excel. Themes were reviewed against the full dataset and refined through regular debriefing discussions with the academic supervisor and external collaborator. Analysis was conducted in Bengali. Selected quotations were translated into English for reporting. Square brackets in quotations indicate text altered or removed to protect participants’ anonymity.
Reflexivity and positionality
The first author (SNSH, male) is a hearing researcher without lived experience of deafness or interpreting; this positionality may have shaped the framing of the research questions, the interview context and the interpretation of findings. The authorship team is multidisciplinary and includes researchers based in Bangladesh, Australia and the United Kingdom, with backgrounds spanning digital health, public health, human–computer interaction and disability advocacy. Two co-authors (MKH and MS) are Bangladeshi-born digital health researchers working in Australia with extensive experience working with Deaf communities in Bangladesh, and one co-author (MJI) is a Bangladeshi disability advocate with lived experience of physical disability. JW is an Australia-based public health researcher with extensive experience in digital health. DV is an Australia-based human–computer interaction researcher with specific expertise in community engagement. RM is an Australia-based human–computer interaction researcher with over a decade of experience in digital health. Among the senior authors, MTH is a Bangladeshi digital mental health researcher with extensive experience working on Deaf community mental health in Bangladesh, and MCC is a UK-based mental health researcher and clinician. None of the authors are Deaf or identify as having lived experience of deafness.
Reflexive discussions were held throughout the research process within this multidisciplinary team to surface and interrogate assumptions arising from the team’s predominantly hearing perspective. Cultural guidance was sought from the Team Inclusion Bangladesh Foundation (TIBF), and linguistic uncertainties were discussed with professional interpreters where needed. However, the study did not adopt a formal co-design or participatory methodology, and no Deaf individuals were involved in the research design, analysis, interpretation of findings or manuscript preparation. These limitations are important when considering whose knowledge and interpretive authority are centred in this study, and underscore the need for future research to meaningfully embed Deaf leadership and co-design from the outset.
Ethics
Full ethical approval was obtained from Queen Mary University’s Ethics of Research Committee (QMERC) (reference QME25.0932). Following this approval, an additional application was submitted to the Public Health Foundation Bangladesh Ethics Review Committee (PHFBD-ERC) for local clearance, in accordance with national research guidelines. The PHFBD-ERC registered the study with full awareness of its scope and objectives. The study was conducted in accordance with relevant institutional and national guidelines and regulations in Bangladesh. Informed consent was obtained from all participants before data collection.
Throughout the study, participants were reminded of their right to withdraw at any stage without providing a reason and could request that their data be removed up to 1 week after the interview. Consent was reconfirmed before each session through sign language. To protect confidentiality, all participants were assigned unique pseudonyms, and identifiable information was removed from transcripts. Sign language interpreters signed an online confidentiality agreement developed specifically for this study.
Results
This section highlights the lived experiences of Deaf individuals in Bangladesh. The findings reveal the significant challenges they face and their resilience in coping with adversity. Through analysing insights from Deaf individuals (n = 7), four major themes emerged that reflect the complexities of their mental health journey. Expressions such as “hearing- and speech-impaired” and “Deaf and speech-impaired” reflect participants’ own wording and do not represent the terminology adopted by the authors.
Theme 1: Communication barriers and structural inaccessibility
For participants in this study, communication barriers were the most pervasive challenge, influencing nearly every aspect of daily life, from family and community interactions to education, work and access to services like healthcare. Participants repeatedly described how not being able to communicate fluently with non-signers left them isolated and prone to misunderstanding, marginalisation and humiliation. Even basic daily interactions could be stressful when people around them could not or would not try to understand their communication needs. One participant shared:
I went to a store, and the shopkeeper asked me a question. I couldn’t understand him, and I couldn’t explain to him what I needed… I felt humiliated… He probably thought I was being rude. The reality is, I just couldn’t hear or speak, and no one around me could understand that (D2, F).
Social interactions with extended family were also painful: “When my relatives talked, I would ask others, ‘What is my aunt saying?’ Although they moved their hands a lot while speaking, I couldn’t understand what they were saying. That really hurt me” (D6, M). This isolation extended even to close relationships: “I can’t communicate with my family in sign language because they don’t understand it” (D6, M).
For some, this lack of shared language extended even to intimate relationships and marriage: “I had a Deaf friend. Her husband could speak. Somewhere there was a complete mismatch because communication with her husband was not happening properly” (D1, F).
These community-level barriers were closely linked to structural inaccessibility in formal settings such as education and employment. Inaccessible communication shaped participants’ opportunities and self-esteem. One participant shared:
I couldn’t continue my education because I studied in a regular school, where non-disabled students study. I am a hearing- and speech-impaired person. So I couldn’t keep up with everyone. There was a big communication gap between me and others. It wasn’t making me happy at all. I eventually started hating going to school. This continued throughout my education, and I just felt like an outsider (D6, M).
Some participants reported periods in mainstream classrooms without any sign language or communication support, leaving them unable to follow lessons, participate with peers or keep up academically. One participant reflected:
At school, I always felt like I was a step behind. I was placed in a regular school with no special accommodations for students like me. I couldn’t understand most of what the teachers were saying because they didn’t know sign language. I had no way to keep up with my studies. I’d see other kids taking notes, talking to the teacher, and I was just sitting there, unable to participate. It was frustrating. No one understood how difficult it was for me to learn the way they were learning. This lack of communication left me feeling left out and made my self-esteem drop. I eventually dropped out of school, feeling like I would never be able to learn the way others did (D1, F).
Participants also described how these early educational exclusions translated into later disadvantages in employment. One participant explained that some Deaf people fall behind because they cannot participate fully in interviews: “Since they cannot attend interviews, they fall behind in the job market. Not all deaf and speech-impaired individuals get jobs” (D3, M).
Even when they found employment, Deaf individuals often faced stigma and hurtful remarks from colleagues: “When I go to work, people say all kinds of (bad) things about me. That really hurts me” (D5, M). In some cases, these negative experiences led to job loss. “Eventually, they even fired me” (D4, M).
The problem became especially consequential in healthcare. In mental health services, where language is central to assessment and support, this gap was experienced as especially harmful: “At mental health services where psychologists or psychiatrists work, the first and most important thing needed is a sign language interpreter” (D4, M). Another participant described the difficulty of explaining complex symptoms: “There are many complexities and serious illnesses within the body that we cannot explain to the doctor through sign language. As a result, the doctor may not be able to provide the appropriate treatment” (D3, M). Participants also described clinicians’ discomfort or annoyance when interacting with Deaf patients: “Doctors get scared when they see Deaf and speech-impaired patients” (D1, F). Another shared: “Normally, when I visit doctors and they realise I’m Deaf, they get annoyed” (D4, M).
Interpreter access was therefore central, but even when interpreters were present, participants worried that their words might be simplified or altered, creating further misunderstanding in highly sensitive encounters. One participant noted: “Sometimes when I say something, the interpreter may rephrase it in different ways. This causes problems” (D3, M). Another participant connected interpreter access directly to treatment quality: “If there were a sign language interpreter, I could properly explain my issues and get the exact treatment I needed from the doctor” (D4, M).
For participants in this study, these narratives suggest that communication barriers were not isolated inconveniences but interconnected forms of exclusion affecting education, healthcare, family life, employment and social participation. Collectively, the limited interpreter availability, lack of sign language proficiency among service providers and families, inadequate accommodations, misinterpretations and bias may restrict opportunities and undermine dignity, belonging and mental well-being.
Theme 2: Emotional isolation and family neglect
Beyond practical barriers, participants described deep emotional and psychological consequences resulting from chronic isolation. Inaccessible communication excluded them from family conversations, school settings and social gatherings. Many reported feeling belittled, ignored or infantilised by family members who assumed that they would not understand. This emotional neglect often led to loneliness, depression and a tendency to internalise distress rather than seek help. One participant shared their experience of isolation:
Many years later, [at one point], I became involved with the Deaf community again. Before [then], I used to feel very down. I was very family-centred. I couldn’t talk to anyone. My family was all I had, and yet, I felt so disconnected from them. I couldn’t share my thoughts or feelings with anyone. They couldn’t understand me, and I couldn’t understand them. It was like I was living in my own world, isolated from everyone around me. After joining the Deaf community, I finally found people who could understand me. I began to feel like I wasn’t alone anymore, but the pain from those years of isolation still lingers (D6, M).
Participants described being dismissed or ignored by family members and peers due to their inability to engage in verbal conversations. This exclusion left them feeling belittled and disconnected from loved ones. One participant shared: “When my family discussed various topics and I wanted to know what was going on, I would ask my younger sister. She would always say, ‘You won’t understand.’ That’s why I don’t enjoy talking to my family” (D2, F). This sense of exclusion was not limited to immediate family but extended to broader relationships. As another participant explained: “In my family, with parents, siblings, and relatives, I can’t really communicate or have conversations. So I get avoided and often belittled” (D5, M). The feeling of isolation also followed them into educational settings, as one participant reflected: “Later, I enrolled in another mainstream school. There, once again, I became isolated” (D6, M).
Deaf individuals experienced restrictive environments in their homes. Often, the family members were the ones limiting their mobility and freedom. One participant shared a story from one of her Deaf friends about being confined at home: “Her family has essentially confined her inside the house” (D1, F). Another described the broader pattern of control experienced by people with disabilities: “Families never really give disabled individuals any freedom” (D6, M). For some, repeated questioning about their movements led to internal withdrawal: “When I wanted to go outside and tried to communicate with them, they would ask, ‘Where are you going?’ Then I created a separate world of my own, where I stayed by myself” (D2, F). This pattern of restriction often started in childhood and continued throughout life: “The disabled child is not allowed to go outside the home much” (D6, M).
Continuous exclusion, judgement and misunderstanding could wear down Deaf individuals’ coping mechanisms over time. Participants reported feeling unable to express their distress, leading to emotional suppression and deterioration of mental health. One participant shared: “I can’t tell anyone that I’m hurt by their behaviour. I keep it to myself and feel the pain internally, but people around me don’t understand that” (D5, M).
Another participant explained how fear could prevent them from seeking help: “They’re afraid to discuss their problems with others or seek solutions. That fear stops them. In this way too, they experience mental breakdowns” (D1, F).
This emotional suppression extends beyond mental health to confusion about everyday health needs: “When someone gets sick, what medicine to take, where to go, how to access healthcare—we don’t know. We keep this confusion to ourselves for years. We internalise it” (D6, M). One participant expressed the emotional toll of this isolation:
I always felt a gap in communication with my family. They never fully understood what I was going through. I always felt like I was a burden on them. They didn’t make any effort to understand my needs. My family wanted to help, but they didn’t know how. It hurt me that I couldn’t get the emotional support I needed from the people closest to me. I felt disconnected from everyone around me, even though I was surrounded by family (D3, M).
This sense of exclusion and emotional neglect was echoed across several participants, who described the profound psychological toll of being persistently unseen and unheard within their families and communities. As one participant shared: “That feeling of being invisible and ignored is what broke me emotionally. It made me feel like I didn’t matter” (D7, M). Another participant echoed this emotional suffocation, explaining, “It’s like I’m suffocating emotionally. I try to keep it inside, but it eventually becomes too much to handle” (D4, M). Another participant shared: “It was as though I was invisible, just another person who didn’t matter. But the emotional pain was too much. It still is” (D5, M). This reflection revealed the internalised burden of silence and the unacknowledged pain many Deaf individuals experience when emotional expression and support remain inaccessible, highlighting how isolation often manifests as hidden psychological suffering.
These narratives illustrate how inaccessible communication and family neglect can create profound emotional isolation. Participants linked these experiences with fear, suppressed distress and reduced mental well-being.
Theme 3: Mental health distress and suicidality
This theme explores the psychological consequences of prolonged communication barriers, emotional isolation and family neglect. Several participants reported experiencing depression, hopelessness and feelings of worthlessness. Some disclosed suicidal thoughts, while others described suicide attempts or deaths among peers and acquaintances. These accounts were not clinically assessed and should be interpreted as participants’ reported experiences.
Participants associated exclusion, miscommunication and neglect with deep distress. Several participants described their depression and persistent loneliness that they had learned to carry silently. One participant shared her personal struggles with overwhelming emotional pain: “Because I became deaf, I stayed home for a long time, away from family and others. Staying home like that made me suffer from depression” (D2, F). Another shared how isolation impacted her daily function: “I had to do everything alone. I didn’t know what to do. I used to be deeply depressed” (D2, F). In some cases, the emotional invisibility was strong: “I felt alone, silent, and isolated within my family and society” (D2, F). For some participants, internalisation of pain was a common coping strategy: “Most Deaf people around us don’t want to talk about their problems – they feel ashamed” (D4, M). “When we see people mocking or laughing at us, we just keep the pain inside ourselves” (D5, M). One participant expressed how the feeling of being different and isolated led to intense emotional pain:
When I was born as a hearing- and speech-impaired person, while growing up, I saw that everyone around me could speak, could hear. Everyone would express everything beautifully with just a few words. They would respond nicely. I saw all of this. Actually, it made me feel really bad. I felt sad (D6, M).
In some cases, accumulated mental health distress was associated with suicidal thoughts. Deaf participants shared their experiences of overwhelming emotional pain without any way to express it. Others described witnessing suicide attempts or deaths within their peer group. One participant shared: “I felt like I wasn’t mentally well. I wasn’t able to feel okay. Sometimes I felt like I would commit suicide” (D1, F).
Another shared:
I wasn’t doing well in my studies. I would feel like I was making a lot of mistakes in my studies. It made me feel that I wasn’t mentally okay. I wasn’t able to feel good. Sometimes I even felt like committing suicide, these thoughts came to me. That was when I realized that I was going through something deep, emotionally. I couldn’t connect with my family, I couldn’t communicate properly with my classmates, and I started feeling like I was lost. I was stuck in my own world. The isolation, the constant feeling of being different, it was suffocating. At that point, I thought I could never escape this mental struggle (D1, F).
Participants also spoke of witnessing close friends or community members facing similar crises: “I have a deaf friend who was in deep mental distress. He tried to commit suicide, [details removed]” (D6, M). The consequences of prolonged suffering were clear in: “I had another Deaf acquaintance. His family and those around him harassed him so much, and he faced so many barriers, that he eventually committed suicide” (D1, F). Participants reflected on how mental health struggles are sadly normalised within the Deaf community due to long-term neglect: “In our community, it’s sadly very common that when someone breaks down mentally, their will to live disappears” (D1, F).
The pressure to perform and constantly deal with emotional and social struggles took its toll on participants’ mental health. One participant shared how the emotional weight of their struggles affected them physically:
It feels like I am carrying an invisible weight on my shoulders. The emotional pain of being constantly misunderstood, of feeling disconnected from everyone around me, has left me mentally exhausted. I remember having days when I couldn’t bring myself to get out of bed because I felt like there was no point. When you feel isolated like that, even the smallest things feel insurmountable. I started questioning my worth and my place in the world. Some days, the thought of just not existing seemed like a way to stop the pain (D7, M).
The constant battle to be understood, alongside the emotional toll of isolation, led to overwhelming feelings of hopelessness. One participant explained:
I remember the first time I realized that my mental health was affected. It was after a series of failed job interviews and constant rejection. I felt like I wasn’t good enough, like I didn’t matter. That feeling of hopelessness crept in slowly. I would go to work, but there was no joy in it. I’d wake up in the morning with a sense of dread, not wanting to face another day of pretending to be okay. The feeling of being stuck in a situation where I couldn’t move forward made me question everything about myself. It was a scary time, and I often thought about whether things would ever get better (D4, M).
Finally, one participant expressed the deep emotional pain that comes with feeling misunderstood and invisible:
I have felt that no one understands my suffering. It has become a silent pain, and that silence becomes unbearable at times. The lack of communication and the constant feeling of being misunderstood have been like a weight on my chest. It’s not just the physical pain, but the mental exhaustion of always having to explain myself, to fight for my place in the world, that has taken a toll on me. Some days, I feel like I am invisible, like my emotions don’t matter. That’s when the thoughts of not wanting to exist creep in. The pain feels endless, and it’s hard to find a way out (D5, M).
These accounts suggest that prolonged communication barriers, emotional isolation and systemic inaccessibility may compound severe psychological distress. Suicidal thoughts were described by some participants, and suicide attempts or deaths were described in accounts concerning peers or acquaintances. These narratives underscore the need for further investigation and for culturally and linguistically accessible mental health support.
Theme 4: Resilience and peer support
Alongside these barriers, participants described resilience through support networks within Deaf communities. They highlighted Deaf-led support, informal conversations among friends and a sense of belonging. Participants also expressed hope that greater awareness and more inclusive communication could encourage families and wider society to become more supportive. One participant shared: “To reduce the pain I felt from my family, I used to talk to my friends in the Deaf community. Gradually, I tried to make myself feel better” (D2, F).
Participants described such conversations as a source of emotional relief. Another participant shared: “The only thing we do is talk with people in our community. Through those conversations, we try to maintain our well-being as much as possible” (D6, M).
Participants valued these networks and sometimes described Deaf peers as family. One participant explained: “When my friends go through a mental crisis or a difficult time, they call me. This whole community feels like my family” (D6, M).
Communicating in sign language with friends brought clarity and joy, as one participant expressed: “When I talk to other Deaf friends in sign language, I can express myself clearly. That brings me a lot of joy” (D6, M). Participants also emphasised the importance of expanding mental health education and advocacy within the Deaf community. One participant explained: “We need to raise awareness among Deaf individuals and let them know how important mental health services are” (D4, M). They highlighted that understanding mental health could change attitudes and reduce stigma: “If they understood what mental health means, maybe they wouldn’t treat me this way” (D5, M). The role of government was also seen as crucial for progress. One participant said: “The government also has a responsibility to help us move forward” (D6, M).
After becoming involved in the Deaf community, one participant shared:
Once I joined the Deaf community, everything changed. I found people who could understand me, and for the first time in my life, I felt like I was part of something bigger. I still have my frustrations, like not finding a job, but even then, being able to connect with others through sign language has been a huge relief (D6, M).
Overall, participants expressed a strong desire for widespread awareness campaigns to reach all Deaf individuals: “We want to spread awareness about mental health more effectively among everyone, so that all Deaf and speech-impaired individuals can learn about it” (D5, M).
Several participants emphasised learning from community initiatives and sharing that knowledge onward. One participant described how this shifted understanding and built local support: “I’ve learned a lot from Team Inclusion, and I share that with my community… I learned that mental health isn’t just about feeling ‘crazy’, it’s about how we feel emotionally, how we handle stress, and how we deal with our struggles… We are creating a support system in our community where we can talk about our feelings and help each other” (D1, F).
Beyond awareness, peer networks provided practical and emotional help. One participant described collaborative problem-solving around family communication stressors:
I’ve helped others with their mental health issues. I encourage them to share their struggles and try to find solutions together… together, we figured out ways for him to communicate better with his family… We’ve created a network where we share experiences, provide advice, and offer support to each other… Knowing that I’m not alone… helps me overcome my challenges (D3, M).
Others highlighted concrete assistance with employment. As one participant put it, peer guidance directly improved job prospects: “When I was struggling with finding a job, a friend… helped me with my resume… his advice helped me land my first job… Being able to lean on others in our community has made me stronger” (D7, M).
Finally, simple reassurance from peers was described as sustaining during setbacks: “When I was feeling mentally exhausted from job hunting and the constant rejection, one of my friends reached out to me. He told me to hang in there… Sometimes, it’s not about solving the problem, it’s just about knowing that someone cares and is there for you” (D4, M).
Amid widespread exclusion, participants demonstrated remarkable resilience through community-driven support systems. Peer networks provided emotional relief, practical guidance and a sense of belonging, countering the isolation imposed by inaccessible families and institutions. These mutual support structures not only sustain mental well-being but also foster empowerment, knowledge-sharing and collective advocacy. They underscore the strength of Deaf-led initiatives in promoting resilience and suggest that Deaf community networks may be important partners in advancing more inclusive mental health support.
Discussion
This study explored how Deaf adults in Bangladesh described their mental health experiences and barriers to support. Their accounts highlighted communication exclusion, emotional neglect, systemic inaccessibility and distress, alongside resilience, community solidarity and practical peer support. The findings are exploratory and contextually situated rather than a comprehensive portrayal of Deaf experiences across Bangladesh.
Participants described growing up in environments where sign language was either absent or not properly recognised. They were often excluded from family conversations, educational settings and employment opportunities. Deaf participants reported feeling emotionally isolated and misunderstood, overlooked not only by strangers but also by their closest family members. Many shared suicidal thoughts, depressive symptoms and traumatic experiences with startling openness. At the same time, they described coping through peer support alongside a clear desire for inclusion and understanding.
The central role of communication barriers in shaping Deaf people’s mental health experiences is well documented (Pereira and Fortes, Reference Pereira and Fortes2010; Fellinger et al., Reference Fellinger, Holzinger and Pollard2012; Hall et al., Reference Hall, Levin and Anderson2017; Ngugi and Mwiti, Reference Ngugi and Mwiti2018). Participants’ accounts suggested that limited sign language access and communication support could restrict experiences ranging from education to healthcare. A regional report published in 2015 documented 30 accredited sign language interpreters in Bangladesh, offering a historical indication of limited national availability at that time; updated mapping is needed before drawing conclusions about the current workforce (World Association of Sign Language Interpreters, 2015). Similar interpreter-related barriers have been documented among Deaf trauma survivors in the United States (Anderson et al., Reference Anderson, Wolf Craig and Ziedonis2017), while research among Deaf adults in the United States has linked help-seeking and self-efficacy with social and contextual factors (Crowe, Reference Crowe2021). These studies are not direct contextual equivalents to Bangladesh, but they illustrate that language-access barriers can persist across markedly different health systems. In education and employment, participants’ accounts emphasised how limited language access and inaccessible environments could constrain opportunities and reinforce exclusion. Similar concerns about Deaf children’s language development, schooling and inclusion have been discussed in the literature (Higgins and Lieberman, Reference Higgins and Lieberman2016; Scherer et al., Reference Scherer, Smythe, Hussein, Wapling, Hameed, Eaton, Kabaja, Kakuma and Polack2023). The narratives of participants being treated as burdens within families, neglected, silenced and dismissed, align with findings reported in Europe, North America and Bangladesh (Fellinger et al., Reference Fellinger, Holzinger and Pollard2012; Hasan et al., Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026). Broader disability research has also shown that exclusion and discrimination can restrict participation and negatively affect health and well-being (Emerson et al., Reference Emerson, Madden, Robertson, Graham, Hatton and Llewellyn2009). Among Deaf and hard-of-hearing children specifically, limited access to effective communication and language deprivation may contribute to misunderstandings within families, social isolation and psychological distress (Hall et al., Reference Hall, Levin and Anderson2017; Scherer et al., Reference Scherer, Smythe, Hussein, Wapling, Hameed, Eaton, Kabaja, Kakuma and Polack2023). Recent evidence also suggests that exclusion from family conversations during childhood may be associated with adverse mental-health outcomes later in life (McRae et al., Reference McRae, Zorbas, O’Shea, Adam and Backholer2025). These experiences may be especially consequential during childhood, when adverse experiences and neglect can affect mental health across the life course (World Health Organization, 2022c). The study by Hasan et al. (Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026) used participatory co-design workshops with Deaf individuals and caregivers to surface a gap in BdSL mental-health vocabulary, producing a tangible output, the first Bangla Mental Health Sign Language Bank, with an analytic focus on communication infrastructure and terminology-building. The current study instead uses in-depth one-to-one phenomenological interviews with Deaf adults to surface lived emotional experience, yielding a more granular psychological account, emotional isolation, family neglect, suicidality and resilience/peer support as interrelated themes, rather than a vocabulary or design artefact. So where Hasan et al. (Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026) answers “what words are missing and how do we build them,” this study answers “what does it feel like to live without them,” extending the evidence base from infrastructural/co-design towards individualised emotional and mental-health-distress nuance, including suicidality, which the earlier study did not centre.
Gendered vulnerability also emerged in several stories shared by Deaf women. They described being married off at a young age, denied autonomy and subjected to additional scrutiny. They are consistent with an intersectional understanding that disability can interact with gender and socioeconomic disadvantage to shape distinct forms of marginalisation (Wickenden, Reference Wickenden2023). Research in Bangladesh has also documented financial, logistical, literacy and accessibility barriers to mental health help-seeking among people with disabilities (Saba et al., Reference Saba, Nessa, Islam, Kaley and Koly2024).
Consistent with findings reported by Hasan et al. (Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026), participants in this study also described how systemic exclusion from healthcare and education aggravated their mental health struggles, which led to feelings of isolation, distress and, in some cases, suicidal thoughts. International evidence indicates a disproportionate burden of mental health problems among Deaf people relative to hearing populations (Fellinger et al., Reference Fellinger, Holzinger and Pollard2012). More broadly, global mental-health treatment gaps particularly affect people who encounter inaccessible services and discrimination (World Health Organization, 2022c). The WHO Special Initiative for Mental Health situational assessment reported that 92.3% of people with diagnosable mental disorders in Bangladesh were not receiving mental health treatment (World Health Organization, 2020). In relation to persons with disabilities, Koly et al. (Reference Koly, Saba, Christopher, Hossain, Akter, Rahman, Ahmed and Eaton2024) highlighted the absence of community-level mental health services for this group in Bangladesh and found that peer responder training was a feasible approach to improving mental health literacy, basic psychosocial support and referral access.
Quantitative research helps situate participants’ narratives within a wider empirical picture of Deaf mental health. National survey data from the Health Information National Trends Survey in American Sign Language (HINTS-ASL), linked with hearing HINTS data, indicate that Deaf adults who use ASL report healthcare‑provider diagnoses of depression or anxiety somewhat more often than hearing adults (~ 25% vs. 22%), and at a younger average age (about 45 vs. 56 years) (Kushalnagar et al., Reference Kushalnagar, Reesman, Holcomb and Ryan2019). In a separate systematic review of 60 comparative studies involving adults aged 18–60 years, most available evidence shows higher prevalence or greater severity of mental disorders among deaf and hard-of-hearing adults than among hearing adults, with particularly pronounced disparities for psychotic disorders, post-traumatic stress disorder and suicidal outcomes, followed by anxiety and depression (de Ponti et al., Reference de Ponti, Diehl, van Klaveren, Cornelisz, de Vries, Wauters and Heppe2026). These quantitative findings do not imply that the present qualitative study provides prevalence estimates or evidence of causal relationships, but they do underscore that the distress and suicidality described by our participants arise against a backdrop of well-documented mental health inequities in Deaf and hard-of-hearing populations. Despite numerous barriers, Deaf participants described how they supported one another through strong peer networks. They shared experiences, offered emotional support and exchanged knowledge to cope with stress and isolation. These interactions highlight the critical role of peer support in promoting mental health and resilience within Deaf communities. Participants saw themselves as learners, helpers and advocates, demonstrating how shared lived experience can foster empowerment and collective growth. While some used digital tools to stay connected, the deeper message was clear: trust, empathy and shared understanding among peers often filled the gaps left by inaccessible or under-resourced services.
This study resists framing Deaf people solely through a lens of deficit or vulnerability. Participants described painful experiences, but they also demonstrated resilience, adaptation and solidarity. This duality is consistent with the social model of disability, which shifts attention from individual impairment to the barriers created by society (United Nations, 2006). It is also consistent with disability justice principles that emphasise intersectionality and the leadership of affected communities (Berne et al., Reference Berne, Levins Morales and Langstaff2018), as well as recent work on mental health and community integration among adults with sensory impairments (Victor et al., Reference Victor, Content, Finley, Kerns, Pyon, Richards and Schulz2026). The findings also resonate with the Deaf studies concept of audism: individual and institutional discrimination that privileges hearing norms and spoken language (Bauman, Reference Bauman2004). Participants’ accounts of being ignored, infantilised, or treated as burdens suggest that distress may be shaped not only by individual adversity but also by audist structures embedded in families, institutions and services. Participants’ use of expressions such as “hearing- and speech-impaired” should also be understood within wider societal and medical discourses in which deafness is routinely framed as an individual deficit rather than as a cultural-linguistic identity. Such expressions may reflect terminology commonly encountered in families, schools, healthcare services, disability organisations and public discourse and may also reflect the internalisation of deficit-based representation or audist norms. However, the present data do not allow us to determine how individual participants understood these expressions or whether they personally identified with the underlying representations (Bauman, Reference Bauman2004; Tomaszewski et al., Reference Tomaszewski, Krzysztofiak, Kowalska and Hauser2025).
Study limitations
A strength of this study is the rich first-person material generated through in-depth interviews in BdSL, which provides an exploratory account of experiences that remain under-researched in Bangladesh. However, the study has important limitations. The sample was relatively small and skewed towards younger, urban and digitally connected participants. This may have limited the transferability of findings to Deaf individuals living in rural areas, gender-diverse individuals, older generations or those with limited access to technology. The purposive sampling approach may also have unintentionally favoured individuals with stronger community connections, leaving out more isolated or non-signing Deaf individuals. The study focused on depth and therefore should be interpreted as contextually situated rather than representative of all Deaf people in Bangladesh.
Interpreter-mediated interviews were essential for accessibility but introduced a layer of mediation in how participants’ experiences were conveyed. Interpretation is not neutral: interpreters may shape interaction through their positionalities and linguistic strategies, especially in emotionally sensitive discussions (Simcock et al., Reference Simcock, Manthorpe and Tinker2025). In this study, coding was conducted using Bengali transcripts derived from spoken renditions of signed responses. The transcripts provided for analysis were reviewed by a second interpreter, and no substantial discrepancies were identified. Participant checking was conducted after transcription. Nevertheless, nuances embedded in original sign language expressions may have been reduced or altered in spoken renditions and subsequent English translation, limiting access to the full richness of participants’ narratives (Young and Temple, Reference Young and Temple2014).
A further limitation relates to positionality and knowledge production. The researchers are hearing, and the study did not involve Deaf co-researchers or co-analysts. TIBF supported recruitment, interpreter identification and cultural guidance, but the project was not designed as participatory or co-produced research. Future studies should involve Deaf people more directly in research design, analysis, interpretation and dissemination.
The study also did not assess participants’ mental health status using diagnostic instruments; descriptions of depression, distress and suicidality reflect participant narratives rather than clinical diagnoses.
Taken together, these exploratory findings suggest several priorities for further investigation and service development in Bangladesh. Potential priorities include improving linguistic and cultural accessibility, training health professionals, strengthening interpreter access and developing mental health resources in Bangla Sign Language. These priorities should be refined through larger and more participatory research involving diverse Deaf communities (Morisod et al., Reference Morisod, Malebranche, Marti, Spycher, Grazioli and Bodenmann2022; Hulme et al., Reference Hulme, Young, Rogers and Munro2023; Hasan et al., Reference Hasan, Hossain, Watterson, Saha, Layton, Islam, Ahmed, Varghese and McNaney2026).
Conclusion
This exploratory study offers in-depth insights into how a small group of Deaf adults in Bangladesh described structural exclusion, neglect, resilience and adaptation. Their rich accounts identified recurring concerns around communication barriers, limited accessibility and a mental health system that appears ill-equipped to meet their needs. These findings point to potential priorities for rights-based, culturally sensitive and linguistically accessible support. Larger, more participatory studies involving diverse Deaf communities are needed to inform policy and service development. Addressing Deaf mental health is therefore not only a technical issue but also a question of inclusion, rights and whose voices shape future services.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2026.10316.
Acknowledgements
The authors would like to express their sincere gratitude to the Team Inclusion Bangladesh Foundation (TIBF) for their invaluable assistance in community outreach and recruitment. We also extend our deepest thanks to the sign language interpreters who facilitated the communication and data collection process. Finally, we are profoundly grateful to the Deaf adults who participated in this study for sharing their lived experiences and insights.
Author contributions
Conceptualization: M.T.H. and M.K.H. Methodology: M.T.H., M.C.C. and S.N.S.H. Investigation: S.N.S.H., M.J.I. and M.T.H. Formal analysis: S.N.S.H. and M.T.H. Resources/community liaison: M.J.I., M.T.H. and S.N.S.H. Writing – original draft preparation: S.N.S.H. and M.T.H. Writing – review and editing: S.N.S.H., M.K.H., M.S., J.W., M.J.I., D.V., R.M., M.T.H. and M.C.C. Visualisation/tables: S.N.S.H. Supervision: M.C.C. and M.T.H. Project administration: M.C.C. All authors approved the final manuscript.
Competing interest
The authors declare none.
Data availability statement
The qualitative datasets (video/audio recordings and verbatim transcripts) generated and analysed during this study contain sensitive personal information and cannot be publicly shared to protect participant privacy. De-identified materials, including the interview guide and the coding framework, are available from the corresponding author upon reasonable request, subject to institutional ethics approval.
Ethics and approvals
This study received full ethical approval from Queen Mary University’s Ethics of Research Committee (QMERC) (reference QME25.0932). The Public Health Foundation Bangladesh Ethics Review Committee (PHFBD-ERC) registered and acknowledged the study with awareness of its scope and objectives. All participants provided informed consent before participation. Consent was reconfirmed in sign language before each session to support participant autonomy.
Funding statement
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Inclusivity statement
This research was conducted in collaboration with the Team Inclusion Bangladesh Foundation (TIBF), a local disability rights organisation. TIBF supported recruitment, identification of interpreters and cultural guidance. Professional BdSL interpreters facilitated accessible data collection. The study did not adopt a formal participatory or co-design methodology, and Deaf individuals were not involved in research design, analysis, interpretation of findings or manuscript preparation. Greater Deaf leadership and participation should be prioritised in future research.
Open access
