Validating an Aphasia-Accessible Ecological Momentary Assessment for Daily Depressive Affect: A Preliminary Investigation

Background:Up to 60% of individuals with aphasia have post-stroke depression, resulting in worse quality of life. However, extant measures of depression in aphasia are insufficient, and people with aphasia are often excluded from studies of depression due to a lack of valid assessment tools. Ecological momentary assessment (EMA) involves brief, repeated surveys that capture fluctuations in the real world, and may be adapted for individuals with communication impairments. We created a novel, aphasia-accessible EMA of affective depressive symptoms and evaluated its feasibility and usability in a sample of people with aphasia. Methods: 27 people with aphasia (Western Aphasia Battery-Aphasia Quotient (WAB-AQ) range: 32.9-97.4) completed a six-item EMA survey assessing positive and negative affect through the app m-Path four times per day for 14 days (up to 56 assessments). We analyzed feasibility, validity, and user experience of the app and surveys. Results: Participants completed 89.6% of the EMA surveys, indicating strong compliance and feasibility. EMA items correlated strongly with the Center for Epidemiologic Studies Depression Scale-Revised and Patient-Reported Outcomes Measure Information System (PROMIS) Depression measures, reflecting high convergent validity. Participants gave positive feedback about their experience using the app and answering the survey questions. Conclusions: These results suggest that EMA is a useful tool for identifying affective depression symptoms in people with aphasia and could be a way to address the gap in mental health care for people with aphasia. Future research should include more diverse samples as well as add passive, ecologically valid measures of depression in order to extend these findings. Keywords: aphasia, stroke, depression, mental health, ecological momentary assessment, feasibility