title: Psychological distress after stroke and aphasia: the first six months.
abstract: OBJECTIVE
  We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia.
  
  
  METHODS
  Prospective longitudinal observational study.
  
  
  METHODS
  Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke.
  
  
  METHODS
  Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months.
  
  
  RESULTS
  Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R(2) = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (chi(2) (1) = 8.61, P<0.01).
  
  
  CONCLUSIONS
  Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one's social network are particularly important and contribute to long-term psychological distress.
authors.affiliation: Department of Language and Communication Science, School of Community and Health Sciences, City University London, London, UK. k.hilari@city.ac.uk
authors.forename: Katerina
authors.initials: K
authors.lastname: Hilari
authors.forename: Sarah
authors.initials: S
authors.lastname: Northcott
authors.forename: Penny
authors.initials: P
authors.lastname: Roy
authors.forename: Jane
authors.initials: J
authors.lastname: Marshall
authors.forename: Richard D
authors.initials: RD
authors.lastname: Wiggins
authors.forename: Jeremy
authors.initials: J
authors.lastname: Chataway
authors.forename: Diane
authors.initials: D
authors.lastname: Ames
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001037:Aphasia / Q000209:etiology / Q000523:psychology* / Q000534:rehabilitation; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008132:Loneliness / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D020521:Stroke / Q000150:complications / Q000523:psychology*; D000071939:Stroke Rehabilitation; D055815:Young Adult