Sources of perceived stress in people with aphasia: a qualitative study.

Only 15 people were interviewed, all at one point in time, so this describes what these people said rather than proving anything about cause and effect. The authors state their data cannot establish direction or causality between the themes. Recruitment was through community aphasia support groups and word of mouth, so the people who took part were probably more socially connected than people with aphasia who stay at home. The authors say the sample may not represent everyone living with aphasia. Nobody with severe aphasia took part. Severity ranged from no aphasia on the language assessment to moderate, so this says nothing about the most disabled patients on your caseload. Most participants reported relatively low levels of stress on the questionnaire, so the accounts may not reflect what people under higher or more persistent stress experience. The sample was 12 of 15 White American, with one Black American participant, so experiences of people from other racial and ethnic backgrounds are not represented. Everyone had chronic aphasia (more than six months after stroke); stress in the first weeks and months after stroke may be different. The study did not collect information on outside stressors such as mobility problems, other health conditions or living circumstances, so these cannot be accounted for even though some participants raised them. The first author coded all 15 interviews herself and knew four of the participants beforehand from academic settings. Agreement with a second coder was 85% and with a third coder 72%, resolved by discussion, so interpretation bias may remain. The word "stress" means different things to different people, and people with aphasia may have particular difficulty naming negative emotions, so some participants may have been describing frustration or anxiety rather than stress.

The authors declared no potential conflicts of interest. No funding information is given in the text supplied, so it is not possible to say who paid for the work.

Do not read the described loop, where communication difficulty leads to isolation and stress then drives further avoidance, as a proven cause and effect. This is what 15 people said in interviews, the authors state that their data cannot establish direction or causality, and nobody with severe aphasia took part.