Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke.
Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke.
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DOI：
10.1161/jaha.122.027959
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发表时间：
2023-03-07
影响因子：
5.4
通讯作者：
Schneider, Andrea L. C.
中科院分区：
文献类型：
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作者：
Sloane, Kelly L.;Kasner, Scott E.;Favilla, Christopher G.;Rothstein, Aaron;Witsch, Jens;Hamilton, Roy H.;Schneider, Andrea L. C.
心理健康是心血管疾病后康复的重要因素，但乐观和抑郁在中风康复中的作用尚未得到很好的描述。纳入了2005年至2006年在服务不足人群中中风恢复的879名参与者，年龄为≥50 岁，有中风事件入院康复机构。乐观程度由以下问题来评估：“你对未来乐观吗？”抑郁的定义由美国流行病学研究中心抑郁量表评分16。参与者被分为4组：乐观/无抑郁(n=581)、乐观/伴抑郁(n=197)、不乐观/无抑郁(n=36)、不乐观/伴抑郁(n=65)。在出院时、出院后3个月和出院后1年使用功能独立性测量评分来评估卒中结果，并使用调整后的线性混合模型来估计评分轨迹。参与者的平均年龄为68 岁(SD，13 岁)，其中52%是女性，74%是白人。乐观/无抑郁组在前3个 月的总功能独立性评分恢复最多，为24.0(95%CI，22.5-25.4)，随后9个月无变化，−为0.3(95%CI，−2.3~1.7)，与乐观/抑郁组相似，在0~3个 月内迅速恢复，21.1(95%CI，18.6~23.6)，然后在3~12个 月内变化最小，0.7(95%CI，−为2.8%至4.1%)。在整个12个月期间，非乐观组表现出缓慢但持续的恢复，总体变化，非乐观/无抑郁组为25.4(95%CI，17.6-33.2)，非乐观/抑郁组为17.6(95%CI，12.0-23.1)。乐观与抑郁之间存在显著的效应修正(P交互作用&t；0.001)。在这个纵向队列中，乐观和抑郁与中风后的功能恢复存在协同关系。衡量乐观状态可能有助于识别中风后恢复较差的风险。
Psychological health is as an important contributor to recovery after cardiovascular disease, but the roles of both optimism and depression in stroke recovery are not well characterized. A total of 879 participants in the SRUP (Stroke Recovery in Underserved Populations) 2005 to 2006 Study, aged ≥50 years, with incident stroke admitted to a rehabilitation facility were included. Optimism was assessed by the question: “Are you optimistic about the future?” Depression was defined by Center for Epidemiologic Studies Depression scale score >16. Participants were categorized into 4 groups: optimistic/without depression (n=581), optimistic/with depression (n=197), nonoptimistic/without depression (n=36), and nonoptimistic/with depression (n=65). Functional Independence Measure scores were used to assess stroke outcomes at discharge, 3 months after discharge, and 1 year after discharge with adjusted linear mixed models to estimate score trajectories. Participants were a mean age of 68 years (SD, 13 years), 52% were women, and 74% were White race. The optimistic/without depression group experienced the most recovery of total Functional Independence Measure scores in the first 3 months, 24.0 (95% CI, 22.5–25.4), followed by no change in the following 9 months, −0.3 (95% CI, −2.3 to 1.7), similar to the optimistic/with depression group with rapid recovery in 0 to 3 months, 21.1 (95% CI, 18.6–23.6) followed by minimal change in 3 to 12 months, 0.7 (95% CI, −2.8 to 4.1). The nonoptimistic groups demonstrated slow but continued recovery throughout the 12‐month period, with overall change, 25.4 (95% CI, 17.6–33.2) in the nonoptimistic/without depression group and 17.6 (95% CI, 12.0–23.1) in the nonoptimistic/with depression group. There was robust effect modification between optimism and depression (P interaction<0.001). In this longitudinal cohort, optimism and depression are synergistically associated with functional recovery after stroke. Measuring optimism status may help identify individuals at risk for worse poststroke recovery.