Aphasia is a multi-modality disturbance of language that is often acquired after a left hemisphere stroke. Post-stroke depression is two times higher in persons with aphasia (PWAs) than in the general stroke population. Post-stroke depression is associated with worse language and cognitive performance and overall decreased quality of life. However, PWAs are typically excluded from studies of post-stroke depression due to a lack of valid assessment tools. More importantly, studies of depression in PWAs only assess depression using weekly retrospective measures thus ignoring the day-to-day variability in mood. An innovative approach to assessing the dynamic nature of depression is ecological momentary assessment (EMA). EMAs involve repeated sampling of data over time in the real-time in real-world environments. EMAs are brief thus minimizing response burden and are typically collected using mobile phones which are owned by more than 85% of Americans. EMAs are ecologically valid but have not been used in PWAs due to their language disturbances. A goal of this study is to use user-centered design to create and validate an aphasia-friendly EMA of depression and investigate its association with communicative confidence (N = 95). Having the confidence to communicate despite aphasia is a robust predictor of overall quality of life. Aim 1 of the study will adapt a user-centered design by involving PWAs, their caregivers, and speech-language pathologists to design and construct brief (~less than 60s) EMA measure of depression. Validity of the EMA measure will be established using a convergent validity approach and use as its validator an established depression scale for PWAs. Aim 2 will establish the validity of the EMA assessment of depression using a smartphone-based measure of physical activity (i.e., step count). Reduced physical activity is a robust correlate of depression in both neurologically healthy individuals and those with stroke. Aim 3 will investigate the relationship between depression and communicative confidence and test the incremental validity of the EMA measure over the retrospective weekly measure of depression. Usability and feasibility of the EMA will also be established. Lastly, an exploratory aim will determine the association between smartphone-based physical activity and communicative confidence. The proposed career development award aims to provide Dr. Ashaie with training activities that will increase his knowledge of (1) psychopathology especially depression, (2) user-centered design, (3) EMA methods, and (4) analyzing smartphone-based sensor data. The training goals will be accomplished through mentored training, formal coursework, and seminars and workshops. His interdisciplinary mentorship team consists of leading experts in depression and transdiagnostic research (Dr. Shankman), user-centered design (Dr. Reddy), designing depression assessments (Dr. Griffith), statistics (Dr. Siddique), and analyzing passive smartphone-based sensor data (Dr. Jayaraman). The K23 will enable Dr. Ashaie to submit an R01 and become an NIH-funded independent scientist whose work in depression assessment can lead to better depression management and ultimately improve PWA’s quality of life.
