Self-reported symptoms of anxiety and depression in chronic stroke patients with and without aphasia

Background: About half of the stroke population suffers from emotional difficulties, such as anxiety and depression post-stroke. Acquiring aphasia is seen to increase the risk of developing symptoms of emotional difficulties such as anxiety and depression.Aims: The aim of the present study was to investigate self-reported emotional difficulties in chronic stroke patients with and without aphasia 1year post-stroke. Further, we aimed to investigate the relationship between aphasia severity and self-reported symptoms of post-stroke depression and anxiety. We expected to find that patients with aphasia reported more symptoms of anxiety and depression than patients without aphasia. Furthermore, we expected to find that aphasia severity was associated with self-reported symptoms of anxiety and depression.Methods & Procedures: The Norwegian Basic Aphasia Assessment (NBAA) was used to assess aphasia severity. The Hospital Anxiety and Depression Scale (HADS) was administered to all patients to assess self-reported symptoms of anxiety and depression. To investigate group differences we used the patients' scores on the subscales communication, ability to carry out daily activities, and ability to participate in social/leisure activities from the Stroke Impact Scale (SIS), the modified Rankin Scale (mRS), and the Mini Mental State Examination (MMSE).Outcomes & Results: There were no significant differences between the groups regarding self-reported symptoms of anxiety and depression. We found a significant correlation between aphasia severity and symptoms of depression, indicating that patients with more aphasic difficulties reported more symptoms of depression. Specifically, the subscale repetition and reading comprehension from the NBAA correlated with the HADS total score. Furthermore, we found significant correlations between the patients' performance on reading comprehension, repetition, and reading out loud and the HADS depression subscale. There was a significant difference between the groups on the SIS communication scores and the patients' scores on the MMSE, whereas the aphasia group had more self-reported communication difficulties and a lower level of cognitive functioning 1year post-stroke. However, on the SIS daily activities the non-aphasia group scored significantly lower. Finally, the groups did not differ on functional disability as measured by the mRS at admission to the hospital.Conclusions: Although there were no significant differences between the aphasic and non-aphasic groups as to the degree of self-reported symptoms of anxiety and depression, patients with aphasia reported symptoms of anxiety and depression that seemed to be associated with specific language problems, as the ability to repeat, and to read and comprehend words and sentences.