Depression and aphasia after stroke

Background: Post-stroke depression (PSD) is a common phenomenon and has a negative impact on rehabilitation, recovery and quality of life. About one third of stroke patients suffer communication problems, including aphasia, which is a condition that mainly affects their ability in understanding and/or producing language. The frequency of depressive symptoms in post-stroke aphasia has been difficult to determine as most studies have excluded stroke patients with aphasia due to methodological limitations. As a result, depression remains often under-diagnosed and untreated in these patients. Objectives: The purpose of this thesis was 1) to develop and validate a revised version of the Visual Analogue Mood Scales (YAMS), and 2) to identify factors which may be associated with low mood in stroke patients with aphasia. Method: The items Happy and Energetic of the VAMS were reversed for a more consistent format. All participants completed a questionnaire including the revised version of the VAMS (VAMS-R), the Hospital & Anxiety Depression Scale (BADS), but also four key items of the VAMS-R which were repeated with and without verbal descriptors to assess their content and test-rest reliability. Aphasic stroke patients were recruited both from hospital and community settings and completed assessments at recruitment and at six months follow up. Participants were assessed on measures of communication, cognition, mood, activities of daily living, and disability associated with living with aphasia. Carers also completed assessments of caregiving strain and satisfaction with care at six months follow up. Results: The VAMS-R showed good evidence of validity and reliability in a community sample of 50 older adults and in 71 stroke patients with aphasia. In the main study, 132 aphasic stroke patients were invited to take part, 71 consented and completed baseline assessments and 63 were followed up at six months. Most participants (n=47) were recruited in the community, 38 were men, mean age was 70 years old and the mean time post-stroke was 15 months. Almost half of the aphasic stroke patients recruited had low mood at baseline (55%) and at follow up (44%) based either on their self-report or the observer-rated mood scores. Physical impairment, demographic and medical information, ADL and leisure activities were not shown to be significant predictors of depression. Communication impairment was significantly related to low mood, but was not predictive of self report mood outcomes at both end points. Disability and emotional consequences living with aphasia were predictive of low mood and accounted for 37% of the variance in self-report mood scores at recruitment and for 48% of the variance at follow up. Baseline language battery scores and follow up Carer Strain Index scores were predictive of the observer-rated mood scores at follow up. Conclusions: The VAMS-R, VASES and SADQ-21 could be used to screen for symptoms of low mood in aphasic stroke patients who cannot complete conventional mood assessments that rely on verbal communication. The main factors found to predict low mood in stroke patients with aphasia were disability associated with living with aphasia, carer strain and communication impairment. The factors identified are amenable to psychological intervention and future research should address interventions for the management of post-stroke depression in aphasia. The need to include people with aphasia in future post-stroke depression research is also highlighted