University of Michigan Medical School, Department of Epidemiology, Cardiovascular Center, Room 3194, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5855, USA.
Stroke. 2011 Dec;42(12):3518-23. doi: 10.1161/STROKEAHA.111.625491. Epub 2011 Sep 22.
We sought to describe the association of spirituality, optimism, fatalism, and depressive symptoms with initial stroke severity, stroke recurrence, and poststroke mortality.
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.
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.
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.
我们旨在描述灵性、乐观、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之间的关系。
在德克萨斯州纽西斯县，我们确定了 2004 年 6 月至 2008 年 12 月期间的卒中病例。无失语症的患者在卒中前使用经过验证的量表回忆抑郁症状、宿命论、乐观和非组织性灵性。使用对数转化的国立卫生研究院卒中量表的多线性回归和复发和死亡率的 Cox 比例风险回归来研究量表与卒中结果之间的关系。
669 名患者参与了研究；48.7%为女性。在完全调整的模型中，宿命论从第一到第三四分位数的增加与全因死亡率相关（风险比，1.41；95%置信区间，1.06-1.88），且与复发风险呈边缘相关（风险比，1.35；95%置信区间，0.97-1.88），但与卒中严重程度无关。同样，抑郁症状的增加与死亡率的增加相关（风险比，1.32；95%置信区间，1.02-1.72），与卒中复发呈边缘相关（HR，1.22；95%置信区间，0.93-1.62），并使卒中严重程度增加 9.0%（95%置信区间，0.01-18.0）。抑郁症状改变了宿命论与死亡率之间的关系，以至于对没有抑郁症状的患者来说，宿命论与死亡率之间的关系更加显著。灵性和乐观都没有对卒中严重程度、复发或死亡率产生显著影响。
在已经发生卒中的患者中，自我描述的卒中前抑郁症状和宿命论，但不是乐观或灵性，与卒中复发和死亡率增加相关。非常规危险因素可能解释了人群中观察到的卒中结局的一些变异性，并且可能是新的干预目标。
