Speech-Language Pathologists' Perspectives on Barriers to Recognizing Depression in People with Aphasia: A Reflexive Thematic Analysis.

Background: Post-stroke depression negatively impacts the quality of life of people with aphasia. Speech-language pathologists (SLPs) are in a unique position to identify signs of depression in people with aphasia because of their close involvement in the language rehabilitation process. Additionally, popular diagnostic manuals (e.g., Diagnostic and Statistical Manual of Mental Disorders) define depression based on typical populations, and assessments based on these manuals may not be reliable or valid for people with aphasia. While existing literature acknowledges the high prevalence of post-stroke depression and the challenges of diagnosing it in people with aphasia, few studies have explored the barriers in identifying symptoms of depression in people with aphasia from the perspectives of SLPs. Aim: This study sought to explore the barriers SLPs face in recognizing symptoms of depression in people with aphasia using a qualitative analytical approach. Methods and Procedures: We recruited 13 SLPs with a range of ages (M = 37 years, SD = 11.18) and experience working with people with aphasia (M = 13 years, SD = 11.13). Data were collected through three virtual focus group interviews, each lasting 90 to 120 minutes. We analyzed the focus group data using Dedoose software (version 9.2) to document initial codes that reflected participants' insights. Reflexive thematic analysis was used to generate themes related to barriers that SLPs face in recognizing depression in people with aphasia. Outcomes and Results: Four central themes and two subthemes were extrapolated from the data. First, it's difficult to disentangle symptoms of depression from post-stroke behaviors, complicating the recognition of depression for SLPs. Second, existing depression assessments are problematic, and SLPs discussed the need to modify these tools and make them more accessible for people with aphasia. Third, the lack of interdisciplinary collaboration surfaced as a barrier in accurately identifying depression. Finally, the influence of family involvement in identifying mental health issues revealed duality, with family members acting as both supportive proxies and, at times, a hindrance to accurate depression assessment. Conclusion: Our findings identify several key barriers that SLPs face in the recognition of depression in people with aphasia. Recognizing depression in people with aphasia requires a more interdisciplinary approach that includes SLPs, mental health clinicians, patients, and their family members. Speech-language pathologists across focus groups also noted the lack of valid assessment tools to measure depression in people with aphasia, offering suggestions to improve current assessments to better accommodate this population.