A Systematic Scoping Review of Measures Used to Evaluate Treatment-Induced Changes in Depression, Anxiety, and Chronic Stress in People with Post-Stroke Aphasia

Abstract

Background: People with aphasia have an increased risk of developing symptoms of depression, anxiety, and chronic stress - all of which interfere with rehabilitation and limit functional outcomes. Interventions addressing the mental health needs of people with aphasia are critically important and rapidly emerging. Most self-rated questionnaires are highly language-dependent. It is unclear how aphasia researchers are managing this potential study limitation.

Aims: To examine how treatment-induced changes in depression, anxiety, and chronic stress are currently being measured in people with stroke-induced aphasia and identify areas of concern and implications for future research.

Methods & procedures: PsycINFO, CINAHL, PubMed, Embase, and Google Scholar were searched in February 2024. Key search terms included "depression", "anxiety", "chronic stress", "measurement", "aphasia", "stroke", and "treatment". Quantitative intervention studies reporting pre-post and/or group comparisons of depression, anxiety, or chronic stress, as either a primary or secondary outcome, with samples consisting of at least 50% of people with aphasia (or those reporting separate data for people with aphasia) were included in the review. Psychometric properties of the 10 most commonly used measures in the included studies were also evaluated.

Outcomes & results: Thirty-six studies (out of 1518 screened) met inclusion criteria (13 randomized controlled trials; 23 non-randomized), from which 33 distinct measures were identified, including observer/clinician-rated (proxy), language-dependent self-rated, as well as visual scale/picture-supported measures. Most frequently used measures include the Stroke Aphasic Depression Questionnaire (SADQ-21 and SADQ-Hospital) and Visual Analog Mood Scale (VAMS) for depression; the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) for anxiety; the modified Perceived Stress Scale (mPSS) for chronic stress. Most significant treatment effects reported by studies were derived from measures with weak psychometric support for use with people with aphasia.

Conclusions: Measures used to evaluate treatment-induced changes in depression, anxiety, and chronic stress in people with aphasia varied widely across studies. This variability may stem from a lack of validated measures available for this population and/or the absence of best practice recommendations for measuring mental health outcomes in people with aphasia. Given these limitations, caution is urged when interpreting treatment studies using current measures, and there is an urgent need for valid and reliable self-report measures specifically designed with and tested for people with aphasia.

Keywords: Anxiety; Aphasia; Chronic Stress; Depression; Measurement.