Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

Abstract

Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales 'sad' item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue 'sad' (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia.

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

“…The diagnosis of major or minor depression was confirmed with a structured clinical interview consistent with the Diagnostic and Statistical Manual of Mental Disorders,4 th Edition criteria 87,88 or the Stroke Aphasic Depression Questionnaire 10-item hospital version (cutoff ≥6) or the visual analogue sad item (cutoff ≥50) completed by a nurse, relative, or caregiver. 89 The primary outcome of depression was measured using HDRS at 9 weeks, 6 months, and 1 year 87,88 in 2 trials by outcome assessors masked to the participant's study group and uninvolved in the treatment, and at 3 and 6 months after randomization using the Stroke Aphasic Depression Questionnaire 21-item hospital version completed by a relative or caregiver. 89 In the Living Well With Stroke Study (N=101), 87 ischemic stroke survivors were randomized to a brief psychosocial intervention (n=48), which comprised 9 sessions of counseling by psychosocial nurse practitioners about behavioral observation, information about adapting to stroke and mood, and problem solving, versus usual care (n=53) including follow-up with their own provider and informational literature from the American Stroke Association.…”

“…89 The primary outcome of depression was measured using HDRS at 9 weeks, 6 months, and 1 year 87,88 in 2 trials by outcome assessors masked to the participant's study group and uninvolved in the treatment, and at 3 and 6 months after randomization using the Stroke Aphasic Depression Questionnaire 21-item hospital version completed by a relative or caregiver. 89 In the Living Well With Stroke Study (N=101), 87 ischemic stroke survivors were randomized to a brief psychosocial intervention (n=48), which comprised 9 sessions of counseling by psychosocial nurse practitioners about behavioral observation, information about adapting to stroke and mood, and problem solving, versus usual care (n=53) including follow-up with their own provider and informational literature from the American Stroke Association. Antidepressants were recommended by the participants' providers for both groups.…”

An evaluation of treatment integrity in a randomized trial of behavioural therapy for low mood in stroke patients with aphasia

“…12 Informed by the frameworks described, our approach to assessing treatment integrity included stating the training of therapists, use of and adherence to the therapy manual, and documentation of therapy content. Competency in delivering the therapy was assessed by examining whether patients' levels of mood, physical and language ability affected the amount and duration of therapy.…”

Group cognitive behavioural therapy for stroke survivors with depression and their carers

“…12 However, more recently a behavioural intervention was found to be effective in treating depression in stroke survivors with aphasia. 13 Further studies are needed to develop and evaluate effective psychotherapeutic interventions for depression in stroke survivors.…”