Depression or anxiety mood assessment

4.8 People with suspected clinical depression or anxiety following mood screening should receive further mood assessment using a clinical interview by a medical practitioner and/or psychologist who is competent in communicating with people with aphasia.

References: Baker et al., 2021: Qualitative study; Bartoli et al., 2018: Systematicreview and meta-analysis of 7studies; Donnellan et al., 2010: Non-randomised observational studyCampbell-Burton et al., 2012: Systematic review and meta-analysis of 44 studies; Carragher et al., 2021: Qualitative study; Hackett & Pickles, 2014: Systematic review and meta-analysis of 61 studies; Hilari, 2011: Non-randomised observational study; House et al., 2001: Non-randomised observational study; Kagan et al., 1995: Theoretical review; 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; Zanella et al., 2023: Non-randomised observational study.

NHMRC Levels of Evidence: GPP

Rationale: Mood disorders occur frequently among stroke survivors (Campbell-Burton et al., 2012; Hackett & Pickles, 2014; Knapp et al., 2020), and the long-term negative impacts of this can be significant (Bartoli et al., 2018; Donnellan et al., 2010; House et al., 2001).

Stroke survivors with aphasia are at particularly high risk of anxiety and depression (Hilari, 2011; Kauhanen et al., 2000; Mitchell et al., 2017; Morris et al., 2017; Thomas & Lincoln, 2008; Zanella et al., 2023), while also being potentially harder to diagnose due to communication difficulties. For these reasons, after mood screening (see statement 4.7), people with aphasia who are suspected of having clinical depression or anxiety should receive further mood assessment from an appropriately qualified mental health professional (Kneebone, 2016).

Communication difficulties can impact the provision of healthcare, particularly in managing mood problems (Baker et al., 2021; Carragher et al., 2021; Kagan, 1995). It is therefore important that the assessing professional is familiar with aphasia. Aphasia-friendly information and supported communication strategies should be used in the clinical interview.

References:

• Baker, C., Worrall, L., Rose, M. & Ryan, B. (2021). Stroke health professionals’ management of depression after post-stroke aphasia: A qualitative study. Disability and Rehabilitation, 43(2), 212-228. DOI: 10.1080/09638288.2019.1621394.
• Bartoli, F., Di Brita, C., Crocamo, C., Clerici, M. & Carrà, G. (2018). Early post-stroke depression and mortality: Meta-analysis and meta-regression. Frontiers in Psychiatry, 9(530). DOI: 10.3389/fpsyt.2018.00530
• Donnellan, C., Hickey, A., Hevey, D., O’Neill, D. (2010). Effect of mood symptoms on recovery one year after stroke. International Journal of Geriatric Psychiatry, 25(12), 1288-1295. DOI: 10.1002/gps.2482.
• 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
• Carragher, M., Steel, G., O’Halloran, R., Torabi, T., Johnson, H., Taylor, N.F. & Rose, M. (2021) Aphasia disrupts usual care: The stroke team’s perceptions of delivering healthcare to patients with aphasia. Disability and Rehabilitation, 43(21), 3003-3014. DOI: 10.1080/09638288.2020.1722264
• 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
• House, A., Knapp, P., Bamford, J., & Vail, A. (2001). Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke, 32(2), 696-701. DOI: 10.1161/01.str.32.3.696
• Kagan, A. (1995). Revealing the competence of aphasic adults through conversation: A challenge to health professionals. Topics in Stroke Rehabilitation, 2(1), 15-28. DOI: 10.1080/10749357.1995.11754051
• 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
• 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