Drivers of Depression in Chronic Post-Stroke Aphasia

Abstract

Background: Approximately one third of stroke survivors develop post-stroke depression, which reduces quality of life. Previous studies have often focused on early phases of recovery and excluded people with significant aphasia. Here, we examine relationships of depression symptoms to demographic factors, and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia.

Methods: 92 chronic left-hemisphere stroke survivors with a history of aphasia and 70 controls participated in this cross-sectional study. The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 (SIS) assessed stroke-related disability in Cognitive, Physical, and Social Participation domains, as well as self-perceived Recovery. The Western Aphasia Battery Aphasia Quotient and the NIH Stroke Scale total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Ordinal regression models examined group differences in BDI-II scores (Model 1), and disability and impairment factors that predicted BDI-II scores (Model 2), accounting for demographic factors and antidepressant medication status.

Results: BDI-II scores were on average 3.4 points higher in stroke survivors than controls. Model 1 confirmed that this difference was significant, and found that age was inversely related to BDI-II scores. Bivariate correlations demonstrated that higher BDI-II scores were related to lower SIS Cognitive, Social Participation, and Recovery scores. Model 2 found that these three measures independently predicted BDI-II scores.

Conclusions: The factors related to depression may differ depending on the nature of the stroke, the types of deficits experienced, and the phase of recovery. In the chronic phase of left hemisphere stroke with aphasia, cognitive and communication disabilities, social participation, and self-perceived recovery are the primary correlates of depression symptoms. These findings highlight the importance of assessing for depression even long after left hemisphere stroke, and suggest potential targets for psychotherapy to improve depression.