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. 2011 Dec;42(12):3518-23.
doi: 10.1161/STROKEAHA.111.625491. Epub 2011 Sep 22.

Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis

Lewis B Morgenstern  1 , Brisa N Sánchez, Lesli E Skolarus, Nelda Garcia, Jan M H Risser, Jeffrey J Wing, Melinda A Smith, Darin B Zahuranec, Lynda D Lisabeth
Affiliations

Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis

Lewis B Morgenstern et al. Stroke. 2011 Dec.

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.

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Conflict of interest statement

CONFLICT OF INTEREST

None

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves (solid) and confidence intervals (dashed) for a) stroke recurrence, b) mortality
Figure 2
Figure 2
Distribution of responses for the three psychological factor scales and depression. a) Fatalism, b) Optimism, c) Spirituality and d) Depression
See this image and copyright information in PMC

References

    1. Espinosa de Los Monteros K, Gallo LC. The relevance of fatalism in the study of Latinas’ cancer screening behavior: A systematic review of the literature. Int J Behav Med. 2010 [ePub ahead of print] - PMC - PubMed
    1. Franklin MD, Schlundt DG, McClellan LH, Kinebrew T, Sheats J, Belue R, et al. Religious fatalism and its association with health behaviors and outcomes. Am J Health Behav. 2007;31:563–572. - PMC - PubMed
    1. Patton GC, Tollit MM, Romaniuk H, Spence SH, Sheffield J, Sawyer MG. A prospective study of the effects of optimism on adolescent health risks. Pediatrics. 2011;127:308–316. - PubMed
    1. Figueroa LR, Davis B, Baker S, Bunch JB. The influence of spirituality on health care-seeking behaviors among African Americans. ABNF J. 2006;17:82–88. - PubMed
    1. Naess H, Lunde L, Brogger J, Waje-Andreassen U. Depression predicts unfavourable functional outcome and higher mortality in stroke patients: The Bergen Stroke Study. Acta Neurol Scand Suppl. 2010;190:34–38. - PubMed

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