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.
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.
Authors: Lesli E Skolarus; Lynda D Lisabeth; Brisa N Sánchez; Melinda A Smith; Nelda M Garcia; Jan M H Risser; Lewis B Morgenstern Journal: J Relig Health Date: 2012-12
Authors: Lewis B Morgenstern; Melinda A Smith; Lynda D Lisabeth; Jan M H Risser; Ken Uchino; Nelda Garcia; Paxton J Longwell; David A McFarling; Olubumi Akuwumi; Areej Al-Wabil; Fahmi Al-Senani; Devin L Brown; Lemuel A Moyé Journal: Am J Epidemiol Date: 2004-08-15 Impact factor: 4.897
Authors: Anjail Z Sharrief; Brisa N Sánchez; Lynda D Lisabeth; Lesli E Skolarus; Darin B Zahuranec; Jonggyu Baek; Nelda Garcia; Erin Case; Lewis B Morgenstern Journal: J Stroke Cerebrovasc Dis Date: 2017-07-31 Impact factor: 2.136
Authors: Paul J Mills; Kathleen Wilson; Navaid Iqbal; Fatima Iqbal; Milagros Alvarez; Meredith A Pung; Katherine Wachmann; Thomas Rutledge; Jeanne Maglione; Sid Zisook; Joel E Dimsdale; Ottar Lunde; Barry H Greenberg; Alan Maisel; Ajit Raisinghani; Loki Natarajan; Shamini Jain; David J Hufford; Laura Redwine Journal: J Behav Med Date: 2014-12-23
Authors: Paul J Mills; Laura Redwine; Kathleen Wilson; Meredith A Pung; Kelly Chinh; Barry H Greenberg; Ottar Lunde; Alan Maisel; Ajit Raisinghani; Alex Wood; Deepak Chopra Journal: Spiritual Clin Pract (Wash D C ) Date: 2015-03