Screening Depression and Suicidality in Post Stroke Aphasia: A Theory of Planned Behaviour Study

Figures & data

Table 1. Location and Work Setting of Sample (N = 118).

		N	%
Location
	England - South	41	34.7%
	England - East	37	31.4%
	Scotland, Northern Ireland or Wales	17	14.4%
	England - North	17	14.4%
	England – West	6	5.1%
Work Setting
	Hospital stroke unit	51	43.2%
	Early Supported Discharge (ESD)	14	11.9%
	Community neuro-rehabilitation team	13	11.0%
	Community stroke team	12	10.2%
	Hospital neuro-rehabilitation ward	11	9.3%
	Hospital other	5	4.2%
	Private healthcare	4	3.4%
	Voluntary sector	4	3.4%
	Other settings (primary care, outpatient clinics, university clinics)	4	3.4%
Profession
	Speech and Language Therapist (SLT)	40	33.9%
	Occupational Therapist	16	13.6%
	Nurse	16	13.6%
	Clinical Psychologist	12	10.2%
	Stroke Physician	10	8.5%
	Clinical Neuropsychologist	6	5.1%
	Other Psychological Practitioners (Assistant Psychologists, Trainee Clinical Psychologists, Senior Psychological Practitioners, Psychotherapists, Educational Psychologists)	6	5.1%
	Physiotherapist	4	3.4%
	Medical Doctor	3	2.5%
	Nursing and Therapy Assistants	3	2.5%
	Stroke Support Coordinator	2	1.7%

Table 2. Individual Likelihood of Screening People with Post-Stroke Aphasia for Depression and Suicidality by Professional Group.

Professional Groups, listed according to likelihood of screening for Depression and Suicidality^a	Individual likelihood to screen a person with post-stroke aphasia for depression during usual clinical practice (%)		Individual likelihood to screen a person with post-stroke aphasia for suicidality during usual clinical practice (%)		Statistical Significance^b
	Mean	SD	Mean	SD
Psychology (N = 21)	92.2	19.3	76.3	31.8	t (22) = 3.38, p = .003
Voluntary Sector (N = 3)	91.7	14.4	67.0	57.2	^c
Occupational Therapy (N = 17)	91.5	15.0	39.7	34.2	t (16) = 5.265, p < .001
Speech and Language Therapy (N = 40)^d	63.8	36.5	34.0	35.4	t (39) = 5.847, p < .001
Medicine (N = 13)	58.9	36.9	25.8	37.0	t (12) = 3.16, p = .008
Nursing (N = 17)	54.7	39.5	32.9	38.9	t (16) = 3.08 p = .007
Physiotherapy (N = 4)	46.3	39.5	18.8	21.0	^c
Total (N = 117)^d	71.6	34.7	42.4	39.0	t (116) = 9.53, p < .001

^a Pre- and post-registration members and sub-specialties of professional groups have been combined to avoid risk of de-anonymisation.

^b Significance was tested using paired, two-tailed, t-tests.

^c No analysis possible due to small numbers.

^d One missing data point

Table 3. Depression Screening Approaches, Adaptions and Accommodations Reported (N=118).

Screening Approaches Used	n	%	n	%
Reported Methods Used to Screen	Depression		Suicidality
Clinical Interview with Patient	86	73	70	61
Standardised Self-Report Measure with Patient	75	64	45	39
Clinical Interview with a Family Member, Carer or Staff	63	53	42	37
Standardised Self-Report Measure with a Family Member, Carer or Staff	49	42	27	24
Observer Rating Scale	36	31	16	14
Other (e.g., Visual Scales, Talking Mats™ Assessment, Observation)	23	19	12	10
No screening used currently	9	8	33	29
Standardised Self-Report Measures Used
The Depression Intensity Scale Circles (DISCS, Turner-Stokes et al., 2005)	62	53
Visual Analogue Mood Scale (VAMS, Stern et al., 1997)	47	40
Hospital Anxiety and Depression Scale (HADS, Zigmond & Snaith, 1983)	37	31
Patient Health Questionnaire (PHQ, Kroenke et al., 2001)	31	26
Distress Thermometer (Gillespie & Cadden, 2013)	24	20
Aphasia Impact Questionnaire (Swinburn et al., 2015)	19	16
CORE 10 (Barkham et al., 2013)	11	9
Brief Assessment Schedule Depression Cards (BASDEC, Adshead et al., 1992)	5	4
Cornell Depression Scale (Alexopoulos et al., 1988)	4	3
Other	18	15
Standardised Observer Rating Scale Used
Stroke Aphasic Depression Questionnaire (SADQ-21, Sutcliffe & Lincoln, 1998)	24	20
Stroke Aphasic Depression Questionnaire (SADQ-H10, Lincoln et al., 2000)	19	17
Signs of Depression Scale (SODS, Hammond et al., 2000)	15	13
Aphasia Depression Rating Scale (ADRS, Benaim et al., 2004)	5	4
Hamilton Depression Rating Scale (HDRS, Hamilton, 1960)	2	2
Reported Frequency of Adaptions to Clinical Interviews
Always	68	58
Routinely (>75%)	25	22
Often (>50%)	6	5
Occasionally (<25%)	9	8
None	8	7
Reported Adaptions Used to Support People to Understand Questions
Accepting Non-verbal Answers e.g., gesture	110	93
Checking Understanding	109	92
Additional Time	105	89
Provide Pictorial Support	100	85
Provide Options for Answers e.g., words or picture	99	84
Closed Questions	97	82
Use Short Sentences	97	82
Provide Pen & Paper	96	81
Repetition	94	80
Provide Written Support e.g., Key Words	89	75
Re-phrasing Questions	87	74
Use Only One Topic Per Sentence	81	69
Explain Written Material	80	68
Multiple Choice	77	65
Providing Written Information in Alternative Formats e.g., Easy Read	69	58
Joint Session with a Speech & Language Therapist	64	54
Personalised Questions	63	53
Talking Mats™	44	37
Joint Session with a Psychologist	17	14

Table 4. Descriptive Statistics for TPB Variables (N=105*).

Theory of Planned Behaviour Component	Possible Range	Observed Range	Mean	SD
Attitudes	13-130	62- 130	110.03	12.97
Normative Beliefs	4-40	7- 40	29.53	8.57
Control Beliefs	10-100	27- 89	58.77	12.97

*13 (15%) participants did not fully complete all TPB questions so only 105 participants were included in the multiple regression

Table 5. Multiple Regression: Predicting the Likelihood to Screen for Depression from TPB variables (N=105).

Variables	B	SE B	β
Attitudes	0.15	0.21	0.05
Normative Beliefs	2.54	0.33	0.62**
Control Beliefs	0.31	0.23	0.11
R^2	.48
F	30.60**

**p<.001

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Data Availability Statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.