title: Fatalism, optimism, spirituality, depressive symptoms, and stroke outcome: a population-based analysis.
abstract: OBJECTIVE
  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.affiliation: University of Michigan Medical School, Department of Epidemiology, Cardiovascular Center, Room 3194, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5855, USA. Lmorgens@umich.edu
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.forename: Nelda
authors.initials: N
authors.lastname: Garcia
authors.forename: Jan M H
authors.initials: JM
authors.lastname: Risser
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Smith
authors.forename: Darin B
authors.initials: DB
authors.lastname: Zahuranec
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications / Q000401:mortality / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality / Q000502:physiology*; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D029181:Spirituality; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000523:psychology*; D015996:Survival Rate