Voicing the perspectives of stroke survivors with aphasia: A rapid evidence review of post‐stroke mental health, screening practices and lived experiences

Abstract

A rapid evidence review (RER) of empirical literature was conducted to explore aphasic stroke survivors' mental health outcomes and lived experiences, as well as the screening instruments for this cohort. The RER was informed by a critical disability theory approach and synthesised qualitative and quantitative evidence within and across 29 studies, published between 2000 and 2021, from a systematic search of three databases. Understanding the relationship between post-stroke aphasia and mental health outcomes is essential for developing comprehensive treatment strategies and designing appropriate long-term care. Available screening instruments currently only detect depression and anxiety, which are then used to detect further mental health issues.The RER revealed that the current screening instruments demonstrate reliability; however, research remains limited regarding their validity. Furthermore, limited studies include aphasic patients as participants and decision-makers in stroke research.Methodological limitations across studies include comparators and small sample sizes.Importantly, across the studies, there is a lack of representation of culturally diverse and minority participants. Overall, the RER results found a high prevalence of aphasic stroke survivors experiencing depression and other mental health outcomes, indicating that implementing mood screening in a timely manner is essential. In addition, the results support that psychological care pathways must be developed and evaluated in consultation with aphasic patients' and carers' lived experiences to identify stepped levels of care and establish appropriate screening instruments. Furthermore, the health system requires consistency, which would ideally be achieved by establishing staff roles and responsibilities regarding mood screening and supportive care in these psychological care pathways. Including mental health specialists such as social workers and establishing specialist training in the multidisciplinary team would support this endeavour. There is a need for further research regarding mood screening instruments, a diversity of aphasic stroke survivors' lived experiences and the clinical expertise of those providing psychological support.

‘Physical well‐being is our top priority’: Healthcare professionals' challenges in supporting psychosocial well‐being in stroke services

“…It should not be accepted as normal that people with stroke navigate the reconstruction of self and life on their own, with little support, 67 feeling isolated and abandoned by stroke services 68 . We contend that it should not be seen as inevitable that people have significant reductions in friendships, 11 and quality of life, 69 or that 20% of people experience anxiety after stroke 70 and 30% experience depression 71 —rates doubled if someone has aphasia 72 . This raises pressing questions about the overarching objectives and priorities of current stroke service approaches.…”

“… 68 We contend that it should not be seen as inevitable that people have significant reductions in friendships, 11 and quality of life, 69 or that 20% of people experience anxiety after stroke 70 and 30% experience depression 71 —rates doubled if someone has aphasia. 72 This raises pressing questions about the overarching objectives and priorities of current stroke service approaches. We ask whose needs are being served by current approaches to stroke service delivery and whose needs are not being met?…”

Developing consensus-based clinical competencies to guide stroke clinicians in the implementation of psychological care in aphasia rehabilitation

“…There is, however, an evidence-practice gap in the consistent and sustained provision of low-intensity psychological care after stroke and aphasia. Further research into how to address this gap is a priority (Kristo and Mowll 2022).…”

“You’ll find most people who got involved with the Café couldn’t do without it now” – Socialising in an online versus in-person Aphasia Café

“…However, recent research argues that the consequential negative social participation impact arising from aphasia, such as social exclusion, isolation, and depression, have equally profound ramifications as aphasia itself (Moss et al, 2021). Compared to people without post-stroke aphasia, people with aphasia (PwA) are at higher risk of detrimental psychosocial outcomes such as poor self-perception, social isolation, and loneliness (Kristo & Mowl, 2022). Baker et al (2019) report that post-stroke PwA self-reported negative mood changes and trauma related to their communication impairment, regardless of a formal diagnosis of depression.…”