Affiliation:
1. From the Stroke Program (L.B.M., L.E.S., N.G., M.A.S., D.B.Z., L.D.L.), University of Michigan Medical School, Ann Arbor, MI; the Departments of Epidemiology (L.B.M., L.D.L.) and Biostatistics (B.N.S., J.J.W.), University of Michigan School of Public Health, Ann Arbor, MI; and the Department of Epidemiology (J.M.H.R.), University of Texas at Houston School of Public Health, Houston, TX.
Abstract
Background and Purpose—
We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality.
Methods—
Stroke cases from June 2004 to December 2008 were ascertained in Nueces County, TX. Patients without aphasia were queried on their recall of depressive symptoms, fatalism, optimism, and nonorganizational spirituality before stroke using validated scales. The association between scales and stroke outcomes was studied using multiple linear regression with log-transformed National Institutes of Health Stroke Scale and Cox proportional hazards regression for recurrence and mortality.
Results—
Six hundred sixty-nine patients participated; 48.7% were women. In fully adjusted models, an increase in fatalism from the first to third quartile was associated with all-cause mortality (hazard ratio, 1.41; 95% CI, 1.06–1.88) and marginally associated with risk of recurrence (hazard ratio, 1.35; 95% CI, 0.97–1.88), but not stroke severity. Similarly, an increase in depressive symptoms was associated with increased mortality (hazard ratio, 1.32; 95% CI, 1.02–1.72), marginally associated with stroke recurrence (HR, 1.22; 95% CI, 0.93–1.62), and with a 9.0% increase in stroke severity (95% CI, 0.01–18.0). Depressive symptoms altered the fatalism–mortality association such that the association of fatalism and mortality was more pronounced for patients reporting no depressive symptoms. Neither spirituality nor optimism conferred a significant effect on stroke severity, recurrence, or mortality.
Conclusions—
Among patients who have already had a stroke, self-described prestroke depressive symptoms and fatalism, but not optimism or spirituality, are associated with increased risk of stroke recurrence and mortality. Unconventional risk factors may explain some of the variability in stroke outcomes observed in populations and may be novel targets for intervention.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Reference27 articles.
1. The relevance of fatalism in the study of Latinas' cancer screening behavior: a systematic review of the literature;Espinosa de Los Monteros K;Int J Behav Med,2010
2. Religious Fatalism and Its Association With Health Behaviors and Outcomes
3. A Prospective Study of the Effects of Optimism on Adolescent Health Risks
4. The influence of spirituality on health care-seeking behaviors among African Americans;Figueroa LR;ABNF J,2006
5. Depression predicts unfavourable functional outcome and higher mortality in stroke patients: The Bergen Stroke Study
Cited by
34 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献