Mood Screening

4.7 People with aphasia should be screened by health professionals, including speech pathologists, for mood problems (depression and/or anxiety).

References: Campbell-Burton et al., 2012: Systematic review and meta-analysis of 44 studies; Eccles et al., 2017: Phase 1: a cross-sectional questionnaire. Phase 2: a randomised longitudinal design; Hackett & Pickles, 2014: Systematic review and meta-analysis of 61 studies; Hilari, 2011: Non-randomised observational study; Kauhanen et al., 2000: non-randomised observational study; Knapp et al., 2020: Systematic review and meta-analysis of 97 studies; Mitchell et al. 2017: Meta-analysis of 108 studies; Morris et al., 2017: Non-randomised observational study; Thomas & Lincoln, 2008: Non-randomised observational study; Van Dijk et al., 2016: Systematic review of 15 quantitative studies; Zanella et al., 2023: Non-randomised observational study. 

NHMRC Levels of Evidence: GPP

Rationale: Mood disorders occur frequently after stroke (Campbell-Burton et al., 2012; Hackett & Pickles, 2014; Knapp et al., 2020), with people with aphasia at particularly high risk of depression and anxiety (Hilari, 2011; Mitchell et al., 2017; Morris, et al., 2017; Kauhanen et al., 2000; Thomas & Lincoln, 2008; Zanella et al., 2023). 

For these reasons, people with aphasia should be routinely screened for mood problems using supported communication techniques to enable self-report (e.g., Depression Intensity Scale Circles – Turner-Stokes et al., 2005) and/or validated observational tools (e.g., The Stroke Aphasia Depression Questionnaire – Sutcliffe & Lincoln, 1998; The Behavioural Outcomes of Anxiety – Linley-Adams et al., 2014; Eccles et al., 2017) (see Van Dijk et al., 2016).

References: 

• Campbell-Burton, C.A., Murray, J., Holmes, J., Astin, F., Greenwood, D., & Knapp, P. (2012). Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies. International Journal of Stroke, 8, 545-559. DOI: 10.1111/j.1747-4949.2012.00906.x
• Eccles, A., Morris, R., & Kneebone, I. (2017). Psychometric properties of the Behavioural Outcomes of Anxiety questionnaire in stroke patients with aphasia. Clinical Rehabilitation, 31(3), 369-378. DOI: 10.1177/0269215516644311.
• Hackett, M.L. & Pickles, K. (2014). Part I: Frequency of depression after stroke: An updated systematic review and meta-analysis of observational studies. International Journal of Stroke, 9(8), 1017-1025. DOI: 10.1111/ijs.12357
• Hilari, K. (2011). The impact of stroke: Are people with aphasia different to those without? Disability and Rehabilitation, 33(3), 211-218. DOI: 10.3109/09638288.2010.508829
• Kauhanen, M.-L., Korpelainen, J. T., Hiltunen, P., Määttä, R., Mononen, H., Brusin, E., Sotaniemi, K. A., & Myllylä, V. V. (2000). Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke. Cerebrovascular Diseases (Basel, Switzerland), 10(6), 455–461. https://doi.org/10.1159/000016107
• Knapp, P., Dunn-Roberts, A., Sahib, N., Cook, L., Astin, F., Kontou, E., & Thomas, S.A. (2020). Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies. International Journal of Stroke, 15(3), 244-255. DOI: 10.1177/1747493019896958
• Mitchell, A. J., Sheth, B., Gill, J., Yadegarfar, M., Stubbs, B., Yadegarfar, M., & Meader, N. (2017). Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder. General Hospital Psychiatry, 47, 48–60. https://doi.org/10.1016/j.genhosppsych.2017.04.001
• Morris, R., Eccles, A., Ryan, B., & Kneebone, I.I. (2017). Prevalence of anxiety in people with aphasia after stroke. Aphasiology, 31(12), 1410-1415. DOI: 10.1080/02687038.2017.1304633
• Thomas, S. A. & Lincoln, N. B. (2008). Predictors of Emotional Distress After Stroke. Stroke (1970), 39(4), 1240–1245. https://doi.org/10.1161/STROKEAHA.107.498279
• Van Dijk, M.J., De Man-van Ginkel, J.M., Hafsteinsdóttir, T.B., & Schuurmans, M.J. (2016). Identifying depression post-stroke in patients with aphasia: A systematic review of the reliability, validity, and feasibility of available instruments. Clinical Rehabilitation, 30(8), 795-810. DOI: 10.1177/026921551559966
• Zanella, C., Laures-Gore, J., Dotson, V.M., & Belagaje, S.R. (2023). Incidence of post-stroke depression symptoms and potential risk factors in adults with aphasia in a comprehensive stroke center. Topics in Stroke Rehabilitation 30(5), 448-458. DOI: 10.1080/10749357.2022.2070363