Katherine Sewell, Postdoctoral Research Fellow, Alfred Health
Research focus: Depression or grief after stroke: Distinguishing psychological conditions for targeted care
This research is supported by the George Perry Fund, The Appel Family Bequest, and Preston and Loui Geduld Trust Fund (Equity Trustees).
Katherine Sewell is a recipient of a Monash Partners Strategic Translation and Research (STAR) Clinician Fellowship. The program invests in emerging and mid-career clinical academics to support their career pathway development and train the next generation of researchers. Monash Partners spoke to Katherine upon accepting this Fellowship.
What is your career background and research history?
I am a postdoctoral research fellow in the Brain Recovery and Rehabilitation Group at the School of Translational Medicine at Monash University. My doctoral research focused on post-stroke depression, identifying the optimal timing and frequency for depression screening and highlighting the importance of patient-reported outcomes in evaluating recovery. I hold a Master of Public Health and bachelor’s degrees in psychology and occupational therapy. My experience includes clinical, academic, and advisory roles in public health, mental health, brain disorders and neurorehabilitation.
How did you become interested in focusing on depression?
My interest in depression grew from a broader curiosity about the relationship between mental and physical health, particularly the observation that, in clinical practice, they are often treated separately. From a neurobiological perspective, post-stroke depression (unlike primary depression, which occurs without a clear neurological insult) provides a unique opportunity to explore whether mood disorders arise from brain injury, neuroinflammation, disrupted neural networks, psychological and psychosocial factors, or a combination of these. More recently, I have become interested in grief after stroke, particularly because a defining feature of prolonged grief disorder – a condition typically described in the context of bereavement in the DSM – is the “disruption of one’s sense of identity.” This concept is highly relevant for stroke survivors, who may grieve their pre-stroke selves and experience a loss comparable to bereavement. Differentiating grief from depression in stroke survivors could have important clinical implications.
What is the prevalence of depression or grief after stroke in Australia and current issues that patients and families face?
Depression affects about one in three stroke survivors, making it far more common than in the general adult population, where prevalence is estimated at roughly 13%. Notably, post-stroke depression also appears more frequent than in cancer or myocardial infarction patients. It reduces engagement in rehabilitation, impairs functional outcomes and hinders recovery and quality of life, making it a key determinant of long-term prognosis.
Research on grief after stroke is limited, with scarce evidence on its prevalence, lived experience, effective screening tools and best-practice management.
Tell us about your research study.
Depression and grief are interrelated psychological responses to loss and life-changing events; however, post-stroke depression has received considerably more research attention. After stroke, the sudden loss of independence, social and occupational roles, personal identity, and envisioned future may trigger a distinct, poorly understood form of grief that can hinder rehabilitation, compromise functional outcomes, and affect recovery – independently of depression. While post-stroke grief and depression share features, evidence from non-stroke populations shows they are distinct conditions and differentiating them may have important clinical implications. Recognising grief as separate from depression can guide treatment decisions and interventions based on bereavement-care models and other non-pharmacological approaches.
To explore grief after stroke and how it may differ from depression, I plan to conduct a cohort study of stroke survivors using a grief measure adapted from spinal cord and brain injury populations. I will also perform a systematic review of grief following other sudden, catastrophic injuries and illnesses to inform understanding and management in the stroke population. Finally, I will carry out a qualitative study with stroke survivors to capture their lived experiences of grief.
What are you hoping to achieve with your research?
This research program aims to understand the experience of grief in stroke survivors and clarify how it differs from depression. I hope the findings will guide the development of a grief screening tool and interventions based on bereavement care and non-pharmacological therapies. Ultimately, I hope this work informs local and national stroke guidelines, strengthens psychological care and helps clinicians better recognise and support stroke survivors experiencing grief and other psychological conditions.
Why did you apply for a Monash Partners STAR Clinician Fellowship?
The Monash Partners Strategic Translation and Research (MP STAR) Fellowship provides an invaluable opportunity and support for me to dedicate time to research depression and grief after stroke, aiming to understand the experience of grief in survivors, clarify how it differs from depression and translate findings into clinical practice. It also enables me, as part of my research program, to collaborate with stroke survivors, their families and clinicians to understand their perspectives on the psychological sequelae following stroke.
Why is support for emerging and mid-career clinical academics crucial?
Supporting emerging and mid-career clinical academics is important because we are well–placed to identify unmet patient needs and practice limitations and to translate findings into meaningful improvements in care.
Early and mid-career stages are crucial for developing an independent research program and establishing oneself in the field, yet they are often challenging due to competing pressures. Mentorship, funding and protected time enable clinician academics to identify and address gaps in practice and improve patient care and outcomes through innovative research and translation.
What is the significance of receiving the Star Clinician Fellowship for your career and research?
Receiving this fellowship will be invaluable to my career, providing protected research time, mentorship and resources to build an independent program and translate findings directly into clinical practice. I feel truly privileged and grateful to receive this fellowship.
What are your future aspirations for your research/career?
I aim to establish a research program that improves patient outcomes by developing evidence-based ways to identify and manage the emotional and psychological effects of stroke. This includes creating the first grief screening tool for stroke survivors and designing culturally responsive interventions that can be applied in practice. I also hope to mentor and support more clinicians in research.
