Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis.
Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis.
复制标题
宿命论、乐观主义、灵性、抑郁症状和中风结果：基于人群的分析。
DOI：
10.1161/strokeaha.111.625491
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发表时间：
2011
期刊：
影响因子：
8.3
通讯作者：
Lisabeth,LyndaD
中科院分区：
文献类型：
--
作者：
Morgenstern,LewisB;Sánchez,BrisaN;Skolarus,LesliE;Garcia,Nelda;Risser,JanMH;Wing,JeffreyJ;Smith,MelindaA;Zahuranec,DarinB;Lisabeth,LyndaD
背景和目的我们试图描述精神性、乐观主义、宿命论和抑郁症状与初始卒中严重程度、卒中复发和卒中后死亡率的关系。非失语症患者在中风前使用有效的量表询问他们对抑郁症状、宿命论、乐观主义和非组织性精神的回忆。使用对数转换的美国国立卫生研究院卒中量表和COX比例风险回归对复发和死亡率进行多元线性回归，研究量表和卒中结局之间的关系。结果669名患者参与其中，其中48.7%是女性。在完全调整的模型中，从第一到第三四分位数的死亡增加与全原因死亡率(风险比，1.41；95%可信区间，1.06-1.88)相关，与复发风险(风险比，1.35；95%可信区间，0.97-1.88)略有关联，但与中风严重程度无关。同样，抑郁症状的增加与死亡率(风险比，1.32；95%CI，1.02-1.72)有关，与中风复发(HR，1.22；95%CI，0.93-1.62)关系不大，与中风严重性增加9.0%(95%CI，0.01-18.0)相关。抑郁症状改变了宿命论与死亡率的联系，因此，对于没有抑郁症状的患者，宿命论和死亡率之间的联系更加明显。精神性和乐观性对卒中的严重程度、复发或死亡率均无显著影响。结论在已有卒中的患者中，自述的卒中前抑郁症状和宿命论，而不是乐观主义或灵性，与卒中复发和死亡的风险增加有关。非常规危险因素可能解释了在人群中观察到的卒中结果的一些变异性，并可能成为干预的新靶点。
Background and PurposeWe sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality.MethodsStroke 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.ResultsSix 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.ConclusionsAmong 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.