Measuring affective symptoms of depression in aphasia: development of an accessible 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. The aim of this study was to develop an aphasia-accessible 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 ratings and qualitative feedback across stakeholder groups. Participants with aphasia also took part in individual cognitive interviews to ensure comprehensibility and accessibility of the final items, corresponding pictures, and pictorial rating scale. RESULTS: The final set of items to be included in the EMA consisted of three positive affect items (determined, proud, interested) and three negative affect 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 affect dysregulation (e.g., reduced interest in previously rewarding activities) may be particularly salient for depression in aphasia in addition to negative affect dysregulation (e.g., increased feelings of failure and anger). The resulting six-item EMA uses multimodal supports (e.g., text, pictures, pictorial rating scale, audio recordings) to capture both valence systems.