Examining Perceived Stress and Anxiety in Post-Stroke Aphasia: Exploring Self-Reports, Proxy Ratings, Qualitative Patient Experiences, and Predictors of Perceived Stress

Perceived stress and anxiety are distinct psychological constructs, yet they are often used interchangeably in aphasia research and clinical practice. This misclassification may impact assessment accuracy, communication between people with aphasia (PWA) and healthcare providers, and intervention strategies affecting recovery. This dissertation examines: (1) the association between self-reported acute and chronic perceived stress and anxiety in PWA; (2) the accuracy of proxy ratings of perceived stress and anxiety; (3) how PWA describe their experiences of stress and anxiety; and (4) whether months post-onset (MPO), binary sex, and aphasia severity predict perceived stress. Methods: A mixed-methods approach was used. Quantitative analyses included Pearson correlations and regression models to examine associations between self-reported acute and chronic stress, anxiety, and predictors (MPO, binary sex, aphasia severity). Proxy ratings were compared with PWA self-reports. Qualitative interviews were thematically analyzed to explore PWA’s experiences of stress and anxiety. Results: RQ1: Chronic perceived stress was strongly correlated with anxiety (r = .73, p < .001), whereas acute perceived stress showed a moderate but non-significant correlation (r = .45, p = .062). RQ2: Proxy-reported stress and anxiety were moderately inversely correlated, and proxy ratings showed weak, negative correlations with PWA self-reports. RQ3: Qualitative analysis revealed emotional and behavioral responses, including post-traumatic growth, cognitive distortions, and coping strategies ranging from adaptive (e.g., social support, reframing) to maladaptive (e.g., avoidance, self-blame). RQ4: MPO significantly predicted perceived stress, with longer recovery periods associated with lower stress levels (p = .003), while binary sex and aphasia severity were not significant predictors. Conclusion: The relationship between chronic stress and anxiety suggests chronic perceived stress, but not acute stress, may be related to anxiety PWA. Proxy ratings were inconsistent with self-reports, highlighting limitations in proxy assessments. PWA’s lived experiences varied, underscoring the need for individualized interventions. The significant role of MPO suggests stress decreases over time, while binary sex and aphasia severity do not. Findings emphasize the need to differentiate stress and anxiety in clinical practice, interpret proxy ratings cautiously, and develop tailored psychological interventions. Future research should explore longitudinal tracking, integrate physiological markers, and refine interventions to support PWA in stress management.