Negative attitudes among short-term stroke survivors predict worse long-term survival

Background and Purpose - Patients respond to serious illness in different w ays. We wished to determine whether different attitudes toward illness are associated with survival after stroke. Methods - Three hundred seventy-two stroke patients were identified and med ically assessed as part of a randomized trial to evaluate a stroke family c are: worker. They had all survived 6 months from randomization. A research psychologist visited each patient and administered the Mental Adjustment to Stroke Scale (a self-rated attitude scale based on the Mental Adjustment t o Cancer Scale). Disability and dependence (Barthel Index, modified Rankin Scale) and mood (Hospital Anxiety and Depression Scale, General Health Ques tionnaire 30) were also assessed. Patients were followed up in 1998 (3 to 5 years after the initial. stroke) to establish their survival. We modeled t he relationship between Mental Adjustment to Stroke scores and survival, ad justing for other factors associated with:stroke survival. Results-Eighty-two patients (22%) died within 3 years. After adjustment for other significant factors, fatalism and helplessness/hopelessness were bot h associated with decreased survival (P=0.03 and 0.04, respectively), but f ighting spirit, anxious preoccupation, and denial/avoidance were not. Mood was not associated with survival Conclusions Patients' attitudes-toward their illness seem to be associated with survival after stroke. Patients-who feel that there is nothing they ca n do to help themselves 6 months after a stroke have a shorter survival. Th ese findings need to be confirmed and any causal relationship between attit ude and survival further explored in a randomized controlled trial to "impr ove" the attitude of stroke patients toward their illness.