Anxiety, Apathy, and Depression in First-Time Stroke Survivors with Aphasia in the Post-Stroke Period

Abstract

Emotional disorders specifically, anxiety, apathy and depression, in the post-stroke period are prevalent, long lasting and detrimental. Aphasia, an acquired communication disorder, is experienced by 40% of all stroke survivors. As the leading cause for disability, stroke affects multiple aspects of the stroke survivors life. Moreover, physical disability, social isolation, and emotional distress further complicate stroke rehabilitation compromising recovery and increasing mortality. Seventy-one percent of stroke studies exclude stroke survivors with aphasia. Thus, the impact of emotional distress in aphasic stroke survivors remains a gap within the stroke literature. This study examined emotional distress in first-time stroke survivors with aphasia in the post-stroke period. A descriptive, cross-sectional study design using non-probability sampling was used. Participants were recruited from rehabilitation hospitals, the community and a stroke database. Using primary data collection a sample size of 16 stroke survivors was obtained. A battery of instruments assessing aphasia, physiological, sociological, and neuropsychological aspects of stroke recovery were administered in a 2-hour interview session. Within this sample of stroke survivors with aphasia, 68.8% reported anxiety, 100% reported apathy, and 43.8% reported depression. With the majority of the population reporting apathy mixed disorders were identified. Sixty-eight percent of stroke survivors screened for anxiety and apathy and 66.7% reported depression and apathy. The mean stroke severity score was 2.2. Forty-three percent were functionally independent, 93.8% had below average neuropsychological scores, and 62.5% had left hemisphere lesions. Ethnicity and gender was associated with depression. Chi square analysis (p = .041, Fishers exact test) and Mann Whitney U associate non-blacks (n=8, Mdn=6.0) with higher depression scores than blacks (n=8, Mdn=2.5) (U= 12.000, z= -2.11, p=, 03). Emotional distress is a pervasive in stroke survivors with aphasia. Thoughtful selection of instruments modified for this stroke population may effectively detect post-stroke emotions. Despite the small sample size, this study contributes to the body of research by screening for social isolation, apathy, and neuropsychological status within this stroke sub-population. Going forward, incorporation of social, neuropsychological and psychological screening as standard of care in facilities serving the stroke population, will improve stroke outcomes in the stroke survivor with aphasia.