What can I do if I suspect my client with aphasia is depressed? As an SLP, can I screen for depression?
SLPs can screen for depressive symptoms, but cannot diagnose depressive disorders. Several evidence-based screening tools are available for SLPs to use with clients and family members. Two tools that may be used with individuals with aphasia (IWA) with mild to moderate aphasia are the Patient Health Questionnaire (PHQ) depression scales (Kroenke et al., 2009; Kroenke & Spitzer, 2002) and the PROMIS Emotional Distress-Depression scales (Pilkonis et al., 2011). These brief and simply worded scales inquire about the features of depression and provide Likert-scale response options for each item (e.g., “Never,” “Rarely,” “Sometimes,” etc.). The PHQ and PROMIS scales are open-access for clinicians (www.PHQScreeners.com, https://www.healthmeasures.net/search-view-measures).
Visual analog mood scales are often used with clients with more severe impairment (e.g., Barrows & Thomas, 2018), though studies of these measures report conflicting evidence of their validity (Kontou et al., 2012; Torrance et al., 2001). Alternatively, mood scales may be given to a family member or other observer of the client to complete as a proxy reporter, though research reports on the degree of agreement between self- and proxy-report on assessments are varied (e.g., Haley et al., 2019; Hernandez et al., 2021). Several versions of the Stroke Aphasia Depression Questionnaire (SAD-Q; Sutcliffe & Lincoln, 1998) were developed for family members and other proxy reporters, and a related study reported a high degree of agreement with other scales that assess similar symptoms via proxy report (Laures-Gore et al., 2017). The SAD-Q scales are open-access (https://www.nottingham.ac.uk/medicine/about/rehabilitationageing/publishedassessments.aspx).
Importantly, SLPs who suspect depression should refer their clients to their primary care provider or a qualified mental health provider as available. We will discuss this more below.
This Ask the Expert is an excerpt from the course, 20Q: Mental Health, Aphasia, and the SLP’s Role.