Alexandra Rose (CPsychol) is a Principal Clinical Psychologist based in a London hospital, working with patients with brain injury. Her research is focused on understanding the assessment of mood, depression and distress after severe brain injury. She is supervised by Professor Jonathan Evans and Dr Breda Cullen. Alex is in the 2nd year of pursuing her PhD in Psychological Medicine. She is studying remotely whilst continuing her clinical work and is being assisted financially by a Francis Newman Foundation grant. The following is part of her project exploring the assessment of mood after severe brain injury.
My name is Alexandra Rose and I am a clinical psychologist. I would like you to imagine that you are my patient.
I want you to take a moment and think about how you have been feeling emotionally over the last few weeks. Now, I would like you to answer this question: “do you often feel sad or depressed?”
How do you think you would respond if you found you are unable to speak, you can’t write and your hands aren’t making the gestures you want them to. Imagine you are not sure where you are or how you got there. You feel confused, disorientated and can’t remember much of the last few weeks.
How would I know if you were feeling low in mood and I should think about medication or therapy options? Similarly, how would I know if you felt fine and I shouldn’t worry? I am asking you to imagine what it may feel like to have a severe a brain injury and illustrating why it can be difficult to assess these patients.
My PhD aims to better understand how to assess mood in this group. This is a problem because these patients can have difficulties with processing information, understanding, communication, and they may lack capacity to make decisions independently. This is a group of vulnerable adults with lifelong disabilities, who are reliant on others to support them and often to act in their best interest.
As medical care has advanced, and with increased efficacy of major trauma centres, this has led to increased survival rates of those with severe brain injuries, and made this is a growing patient population within the UK.
Research tells us that up to 40% of those with a brain injury meet diagnostic criteria for depression, and that depression is associated with poorer functional outcomes and reduced quality of life. However, this research is based on evidence from patients with mild to moderate brain injury who can accurately self-report their mood, unlike my target population.
For patients with severe brain injury, self-reporting of mood may not be possible due to the complexity of their cognitive and communication difficulties. Additionally, the physical symptoms of the brain injury can overlap with symptoms of depression. This can confound existing observational tools.
The aims of my PhD project are to re-conceptualise the identification and management of mood and well-being in patients with severe brain injuries, and to develop appropriate assessment tools.
First, in order to understand the complexity of the problem and what we already know, I am completing a systematic review of the validity of mood screening tools in this population. Progress so far highlights that this population are often excluded from validation studies by researchers, as they are seen as “unassessable”. This may mean there is a great potential for healthcare inequality if these patients cannot be assessed effectively for mood disorder. This may consequently result in possible over or under-diagnosis, and the risk of inappropriate medical and therapeutic management.
In order to further understand the clinical issue of assessment, I am exploring the professional consensus in this field by surveying clinical psychologists who work with this group of people. More in-depth expert consensus is being explored via the use of thematic analysis and semi structured interviews.
It is hoped that themes from this data will provide a deeper understanding of the complexity of this problem, and allow me to develop and pilot a method of assessing mood in this patient population.
Alex can be contacted at:
This presentation was presented as part of an IHW PGR half-day conference, All aboard