Always Look on the Bright Side: Associations of Optimism With Functional Outcomes After Stroke

BACKGROUND: 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. METHODS AND RESULTS: 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). CONCLUSIONS: 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.