Research and impact | By Shamim Quadir

Peer-befriending may help people with aphasia

Led by City, University of London, a recent study suggests that peer-befriending may help reduce depressive symptoms when stroke patients with aphasia are discharged from hospital and active care is withdrawn.


While this is a preliminary finding, it helps pave the way for a larger clinical trial to confirm whether peer-befriending is beneficial to the person with aphasia, their family and carers.


What is aphasia and what is its impact?


Aphasia is a complex, language disorder caused by damage to the brain, usually following a stroke. People with aphasia may have difficulty speaking, reading, writing and/ or understanding language.


Approximately a third of people who have a stroke are affected, and there are over 350,000 people in the UK living with aphasia. Many will experience social isolation, reduced wellbeing and poor quality of life as a result of the condition.


Indeed, the psychological needs of people with aphasia seem greater than in the general stroke population, with a reported 62 per cent rate of depression one year after stroke for people with aphasia, compared to a third of stroke patients overall.


Despite their needs, people with aphasia are often excluded from mental health interventions, and from trials on the effectiveness of psychological therapies for post-stroke depression. This is due to their communication difficulties.


There is therefore a pressing need to systematically evaluate interventions to improve wellbeing for people with aphasia.


The SUPERB trial


The ‘Supporting wellbeing through peer-befriending’ (SUPERB) trial for people with aphasia was a feasibility, randomised controlled trial.


As a feasibility trial it aimed to investigate whether the intervention and study processes were acceptable to participants and whether a larger, phase-three randomised controlled trial, to comprehensively investigate the study research questions, was feasible.


In terms of clinical outcomes, the SUPERB feasibility trial investigated whether six one-hour peer-befriending visits, over three months, helped reduce the depression experienced by stroke patients with aphasia.


In the trial, 56 people with aphasia after a stroke were assigned either to an intervention group (to receive peer-befriending support as well as their usual care) or a control group which received usual care. A peer-befriender in this case was another person with experience of aphasia after having a stroke.


All participants had low levels of distress and were an average age of 70 years. They were assessed with questionnaires, including on their mental health, upon being discharged from hospital (baseline), and then four months and 10 months later.


The primary clinical outcome measure of the trial was the difference between the peer-befriending group and the control group on the change in score on the widely used GHQ-12 questionnaire to assess psychological disorders and strain.


On this measure, participants in the peer-befriending group scored better than those in the usual care group, at 4 and 10 months. There was an 88 per cent decrease in the odds of having high distress/depression for those in the peer-befriending group.


Goals for feasibility of recruitment to the trial and acceptability of the trial to participants, their family and carers, and peer-befrienders were also met, suggesting that a larger, phase three trial may be conducted.

Peer friending
Katerina Hilari, the project lead, believes the effects of peer-friending as means
to improving mood in people with aphasia should be further investigated.

Katerina Hilari, Professor of Acquired Communication Disorders, Division of Language and Communication Science at City, and lead of the project says:


“There was evidence that peer-befriending led to better mood outcomes than usual care alone. Moreover, in interviews, both peer befrienders and those having peer befriending were very positive about it. Peer-befriending is worth exploring further as an intervention to improve mood for people with aphasia; and, pending further evaluation, possibly integrated into routine care. This could improve services for all stroke survivors.”


Short videos of the SUPERB full findings are available here.