Factors Related to Depression Symptoms in Chronic Poststroke Aphasia

Abstract

Objective: To examine relationships of depression symptoms with demographic factors and different types of stroke-related disability and impairment in adults with chronic left-hemisphere stroke and a history of aphasia.

Design: Cross-sectional study.

Setting: General community.

Participants: A convenience sample of (N = 92) chronic left-hemisphere stroke survivors (>6mo) with a history of aphasia and (N = 70) people without stroke participated.

Interventions: Not applicable.

Main outcome measures: The Beck Depression Inventory-II (BDI-II) measured depression symptoms. The Stroke Impact Scale 3.0 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 NIHSS total motor score measured language and motor impairment. Spearman correlations examined bivariate relationships between variables. Regression Model 1 examined group differences in BDI-II scores, accounting for demographic factors, including age, education, race, sex, socioeconomic status, and antidepressant medication status. Regression Model 2 examined the disability and impairment measures above that predicted BDI-II scores, accounting for the same demographic factors included in Model 1, plus time-since-stroke.

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 stroke impact scale Cognitive, Social Participation, and Recovery scores. Model 2 found that these 3 measures independently predicted BDI-II scores.

Conclusions: 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 to improve psychological intervention and rehabilitation.

Keywords: Aphasia; Chronic stroke; Communication; Depression; Disability; Rehabilitation; Social participation; Stroke recovery.