Measuring Depression in Aphasia: Development of an Ecological Momentary Assessment Tool

Purpose: Post-stroke depression is highly prevalent in aphasia, yet existing depression measures rely heavily on language and lack sufficient validity for this population. Our aim was to develop an aphasia-friendly Ecological Momentary Assessment (EMA) of depression based on the input of people with aphasia, their care partners, and speech-language pathologists (SLPs).Methods: Nine focus groups were conducted with people with aphasia (n=15), care partners (n=13), and SLPs (n=13) to identify relevant depression symptoms. Items were selected based on factors such as endorsement rates and accessibility. Participants with aphasia also took part in individual cognitive interviews to ensure comprehensibility and accessibility of the final items, corresponding pictures, and pictorial affect scale. The process of selecting items to include in the final EMA considered both endorsement ratings and qualitative feedback across stakeholder groups.Results: The final set of items to be included in the EMA consisted of three positive valence items (determined, proud, interested) and three negative valence items (sad, like a failure, angry). Cognitive interviews confirmed comprehensibility and accessibility of the items, though the picture for interested required revision. Additionally, participants found 3-4 daily assessments feasible.Conclusion: Stakeholder engagement revealed that positive valence dysregulation (e.g., reduced interest in previously rewarding activities) may be particularly salient for depression in aphasia in addition to negative valence dysregulation (e.g., increased feelings of failure and anger). The resulting six-item EMA uses multimodal supports (e.g., text, pictures, pictorial affect scale, audio recordings) to capture both valence systems.