1
|
Ambrosca R, Bolgeo T, Zeffiro V, Alvaro R, Vellone E, Pucciarelli G. The Role of Spirituality in Stroke Survivors and Their Caregivers: A Systematic Review. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02029-0. [PMID: 38564160 DOI: 10.1007/s10943-024-02029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
Although several studies have analyzed the effects of spirituality on stroke survivors' physical functioning and their caregiver's outcomes, no systematic review or meta-synthesis was found to identify the lived experiences of stroke survivors and caregivers regarding spirituality. For these reasons, this study aimed to analyze quantitively and qualitatively research relating to stroke survivors' and caregivers' experiences. The included studies were RCT studies, quasi-experimental studies, qualitative, descriptive, ethnographic, and phenomenological studies, and cross-sectional studies (n = 37), with a total of 6850 stroke survivors and 1953 caregivers enrolled. Spirituality appears to play an important role in improving the quality of life and decreasing anxiety and depression of both stroke survivors and their caregivers.
Collapse
Affiliation(s)
- Rossella Ambrosca
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Tatiana Bolgeo
- Department of Activities Research Innovation, "San Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | - Valentina Zeffiro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| |
Collapse
|
2
|
Caballero-Domínguez CC, Ceballos-Ospino GA, Campo-Arias A. Fatalism, Emotional Regulation, and Suicide Risk in Colombian Adults During the SAR-Cov-2 Disease Epidemic. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1591-1605. [PMID: 34961371 DOI: 10.1177/00302228211066385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current pandemic of Severe Acute Syndrome (SAR-CoV-2) is a public health problem with implications for mental health. The study aimed to determine the prevalence of suicide risk and its association with fatalism and emotional regulation during SARS-CoV-2 in Colombia's adult population. A cross-sectional study was designed, an online format was used, which evaluated sociodemographic variables, CES-D-SI, the Fatalism Questionnaire against COVID-19, and the Emotional Regulation Scale. 435 Colombian adults participated, aged between 18 and 79 years. A prevalence of suicide risk was found in 5.3%, and it was associated with the interaction between living in rural area and less education (OR = 5.60, 95%CI 1.28-24.53), emotional dysregulation (OR = 3.54, 95%CI 1.77-7.09), and fatalistic beliefs (OR = 3.09, 95%CI 1.53-6.27). 5.3% of the population presented an elevated suicide risk. It was associated with less education, rural areas, fatalistic beliefs, and emotional dysregulation in the Colombian population during mandatory confinement due to SAR-CoV-2.
Collapse
Affiliation(s)
| | | | - Adalberto Campo-Arias
- Programa de Medicina, Facultad de Ciencias de la Salud, Universidad del del Magdalena, Santa Marta, Colombia
| |
Collapse
|
3
|
Psychometric characteristics of the WHOQOL-SRPB Scale in a population of stroke survivors and caregivers. Qual Life Res 2020; 29:1973-1985. [DOI: 10.1007/s11136-020-02446-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
|
4
|
Bailoor K, Shafie-Khorassani F, Lank RJ, Case E, Garcia NM, Lisabeth LD, Sánchez BN, Kim S, Morgenstern LB, Zahuranec DB. Time Trends in Race-Ethnic Differences in Do-Not-Resuscitate Orders After Stroke. Stroke 2019; 50:1641-1647. [PMID: 31177986 DOI: 10.1161/strokeaha.118.024460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Do-not-resuscitate (DNR) orders are common after stroke, though there are limited data on trends over time. We investigated time trends in DNR orders in a community with a large minority population. Methods- Cases of ischemic stroke (IS) or intracerebral hemorrhage (ICH) were identified from the BASIC study (Brain Attack Surveillance in Corpus Christi) from June 2007 through October 2016. Cox proportional hazards models were used to assess time to DNR orders, with an interaction term added to allow separate hazard ratios for early (≤24 hours) and late (>24 hours) DNR. Stroke type-specific calendar trends were assessed with an interaction term between calendar year (linear) and stroke type. Results- Two thousand six hundred seventy-two cases were included (ICH, 14%). Mean age was 69, 50% were female, and race-ethnicity was Mexican American (58%), non-Hispanic white (37%), and African American (5%). Overall, 16% had a DNR order during the hospitalization. For ICH, DNR orders (early and late) were stable over the study period. However, early DNR orders became more common over time after ischemic stroke (hazard ratio for 2016 versus 2007: 1.89; 95% CI, 1.06-3.39), with no change over time for late DNR orders after ischemic stroke. Mexican Americans (hazard ratio, 0.65; 95% CI, 0.50-0.86) and African Americans (hazard ratio, 0.17; 95% CI, 0.04-0.71) were less likely than non-Hispanic whites to have early DNR orders, though there were no race-ethnic differences in late DNR orders. There was no change in race-ethnic difference in DNR orders over the time of the study (interaction P>0.60). Conclusions- Despite revised national guidelines cautioning against early DNR orders in ICH, presence of DNR orders after ICH was stable between 2007 and 2016, with only slight increases in early DNR orders after ischemic stroke. Mexican Americans and African Americans remain less likely than non-Hispanic whites to have early DNR orders after stroke.
Collapse
Affiliation(s)
- Kunal Bailoor
- From the Department of Internal Medicine (K.B.), Michigan Medicine, Ann Arbor
| | - Fatema Shafie-Khorassani
- Department of Biostatistics (F.S.-K., B.N.S., S.K.), University of Michigan School of Public Health, Ann Arbor
| | - Rebecca J Lank
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor
| | - Erin Case
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor.,Department of Epidemiology (E.C., L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
| | - Nelda M Garcia
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor
| | - Lynda D Lisabeth
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor.,Department of Epidemiology (E.C., L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
| | - Brisa N Sánchez
- Department of Biostatistics (F.S.-K., B.N.S., S.K.), University of Michigan School of Public Health, Ann Arbor
| | - Sehee Kim
- Department of Biostatistics (F.S.-K., B.N.S., S.K.), University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor.,Department of Epidemiology (E.C., L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
| | - Darin B Zahuranec
- Stroke Program (R.J.L., E.C., N.M.G., L.D.L., L.B.M., D.B.Z.), Michigan Medicine, Ann Arbor
| |
Collapse
|
5
|
Burns SP, White BM, Magwood G, Ellis C, Logan A, Jones Buie JN, Adams RJ. Racial and ethnic disparities in stroke outcomes: a scoping review of post-stroke disability assessment tools. Disabil Rehabil 2018; 41:1835-1845. [PMID: 29569497 DOI: 10.1080/09638288.2018.1448467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings.
Collapse
Affiliation(s)
- Suzanne Perea Burns
- a WISSDOM Center , Medical University of South Carolina , Charleston , SC , USA
| | - Brandi M White
- b College of Health Sciences , University of Kentucky , Lexington , KY , USA
| | - Gayenell Magwood
- a WISSDOM Center , Medical University of South Carolina , Charleston , SC , USA.,c College of Nursing , Medical University of South Carolina , Charleston , SC , USA
| | - Charles Ellis
- d Department of Communication Sciences and Disorders , East Carolina University , Greenville , NC , USA
| | - Ayaba Logan
- e Department of Library Science and Informatics , Medical University of South Carolina , Charleston , SC , USA
| | - Joy N Jones Buie
- a WISSDOM Center , Medical University of South Carolina , Charleston , SC , USA
| | - Robert J Adams
- a WISSDOM Center , Medical University of South Carolina , Charleston , SC , USA.,f Department of Neurology , Medical University of South Carolina , Charleston , SC , USA
| |
Collapse
|
6
|
Willis K, Timmons L, Pruitt M, Schneider HL, Alessandri M, Ekas NV. The Relationship Between Optimism, Coping, and Depressive Symptoms in Hispanic Mothers and Fathers of Children with Autism Spectrum Disorder. J Autism Dev Disord 2017; 46:2427-40. [PMID: 27017210 DOI: 10.1007/s10803-016-2776-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined gender differences in the relationship between dispositional optimism, coping, and depressive symptoms of Hispanic mothers (n = 46) and fathers (n = 43) of children with autism spectrum disorder. Coping was hypothesized to mediate the relationship between optimism and depressive symptoms. The results revealed that mothers reported greater depressive symptoms and greater use of positive and support coping than fathers; however, both mothers and fathers reported similar levels of optimism and use of avoidant coping. In addition, positive and avoidant coping strategies mediated the association between optimism and depressive symptoms for both mothers and fathers. Clinical implications for this study include interventions for improving optimistic outlooks as well as interventions that improve parents' coping skills and therefore reduce negative outcomes.
Collapse
Affiliation(s)
- Kelcie Willis
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA
| | - Lisa Timmons
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA
| | - Megan Pruitt
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA
| | - Hoa Lam Schneider
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Naomi V Ekas
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA.
| |
Collapse
|
7
|
Sharrief AZ, Sánchez BN, Lisabeth LD, Skolarus LE, Zahuranec DB, Baek J, Garcia N, Case E, Morgenstern LB. The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke. J Stroke Cerebrovasc Dis 2017; 26:2686-2691. [PMID: 28774795 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/01/2017] [Accepted: 06/25/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychological and social factors have been linked to stroke mortality; however, their impact on stroke disability is unclear. The purpose of this study was to evaluate the impact of pre-stroke fatalism, depressive symptoms, and social support on 90-day neurologic, functional, and cognitive outcomes. METHODS Ischemic strokes (2008-2011) were identified from the Brain Attack Surveillance in Corpus Christi Project. Validated scales were used to assess fatalism, depressive symptoms, and social support during baseline interviews. The National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living (ADL/IADL) scale, and Modified Mini-Mental State Exam (3MSE) were used to assess 90-day outcomes. The associations between the pre-stroke variables and 90-day outcomes were estimated from regression models adjusting for demographics, risk factors, tissue-type plasminogen activator treatment, and comorbidities. RESULTS Among 364 stroke survivors, higher pre-stroke fatalism was associated with worse functional (.17 point higher ADL/IADL per interquartile range [IQR] higher fatalism; 95% confidence interval [CI]: .05, .30) and cognitive (2.81 point lower 3MSE per IQR higher fatalism; 95% CI: .95, 4.67) outcomes. Higher pre-stroke depressive symptoms were associated with worse functional (.16 point higher ADL/IADL per IQR higher Patient Health Questionnaire-9; 95% CI: .04, .28) and cognitive (2.28 point lower 3MSE per IQR higher Patient Health Questionnaire-9; 95% CI: .46, 4.10) outcomes. Participants in the middle tertile of social support had better cognitive outcomes (3.75 points higher 3MSE; 95% CI: .93, 6.56) compared with the highest tertile. CONCLUSIONS The associations between pre-stroke fatalism, depressive symptoms, and social support and 90-day outcomes suggest that psychosocial factors play an important role in stroke recovery.
Collapse
Affiliation(s)
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Stroke Program, University of Michigan Health System, Ann Arbor, Michigan
| | - Lesli E Skolarus
- Stroke Program, University of Michigan Health System, Ann Arbor, Michigan
| | - Darin B Zahuranec
- Stroke Program, University of Michigan Health System, Ann Arbor, Michigan
| | - Jonggyu Baek
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Nelda Garcia
- Stroke Program, University of Michigan Health System, Ann Arbor, Michigan
| | - Erin Case
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Lewis B Morgenstern
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Stroke Program, University of Michigan Health System, Ann Arbor, Michigan.
| |
Collapse
|
8
|
Shifren K, Anzaldi K. Optimism, well-being, depressive symptoms, and perceived physical health: a study among Stroke survivors. PSYCHOL HEALTH MED 2017; 23:46-57. [DOI: 10.1080/13548506.2017.1325505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kim Shifren
- Psychology Department, College of Liberal Arts Building, Towson University, Towson, MD, USA
| | - Kristen Anzaldi
- Psychology Department, College of Liberal Arts Building, Towson University, Towson, MD, USA
| |
Collapse
|
9
|
Avram E, Podina IR, Giosan C. A Cognitive-Behavioral Standpoint on the Perceived Consequences of a Major Seismic Event in Relation to Optimism and Pre-hazard Emotional Distress. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0231-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Reeves SL, Brown DL, Baek J, Wing JJ, Morgenstern LB, Lisabeth LD. Ethnic Differences in Poststroke Quality of Life in the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Stroke 2015; 46:2896-901. [PMID: 26286542 DOI: 10.1161/strokeaha.115.010328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Mexican Americans (MAs) have an increased risk of stroke and experience worse poststroke disability than non-Hispanic whites, which may translate into worse poststroke quality of life (QOL). We assessed ethnic differences in poststroke QOL, as well as potential modification of associations by age, sex, and initial stroke severity. METHODS Ischemic stroke survivors were identified through the biethnic, population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from medical records, baseline interviews, and 90-day poststroke interviews. Poststroke QOL was measured at ≈90 days by the validated short-form stroke-specific QOL in 3 domains: overall, physical, and psychosocial (range, 0-5; higher scores represent better QOL). Tobit regression was used to model associations between ethnicity and poststroke QOL scores, adjusted for demographics, clinical characteristics, and prestroke cognition and function. RESULTS Among 290 eligible stroke survivors (66% MA, 34% non-Hispanic whites, median age=69 years), median scores for overall, physical, and psychosocial poststroke QOL were 3.3, 3.8, and 2.7, respectively. Poststroke QOL was lower for MAs than non-Hispanic whites both overall (mean difference, -0.30; 95% confidence interval, -0.59, -0.01) and in the physical domain (mean difference, -0.47; 95% confidence interval, -0.81, -0.14) after multivariable adjustment. No ethnic difference was found in the psychosocial domain. Age modified the associations between ethnicity and poststroke QOL such that differences were present in older but not in younger ages. CONCLUSIONS Disparities exist in poststroke QOL for MAs and seem to be driven by differences in older stroke patients. Targeted interventions to improve outcomes among MA stroke survivors are urgently needed.
Collapse
Affiliation(s)
- Sarah L Reeves
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.).
| | - Devin L Brown
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Jonggyu Baek
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Jeffrey J Wing
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Lewis B Morgenstern
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| | - Lynda D Lisabeth
- From the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (S.L.R., J.B., J.J.W., L.B.M., L.D.L.); and Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B., L.B.M., L.D.L.)
| |
Collapse
|
11
|
Jones A, Cohen D, Johnstone B, Yoon DP, Schopp LH, McCormack G, Campbell J. Relationships Between Negative Spiritual Beliefs and Health Outcomes for Individuals With Heterogeneous Medical Conditions. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2015. [DOI: 10.1080/19349637.2015.1023679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
12
|
Morgenstern LB, Sánchez BN, Skolarus LE, Garcia N, Risser JMH, Wing JJ, Smith MA, Zahuranec DB, Lisabeth LD. Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis. Stroke 2011; 42:3518-23. [PMID: 21940963 DOI: 10.1161/strokeaha.111.625491] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
Collapse
Affiliation(s)
- Lewis B Morgenstern
- University of Michigan Medical School, Department of Epidemiology, Cardiovascular Center, Room 3194, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5855, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|