Journal of Religion and Health

, Volume 51, Issue 4, pp 1293–1305 | Cite as

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

  • Lesli E. Skolarus
  • Lynda D. Lisabeth
  • Brisa N. Sánchez
  • Melinda A. Smith
  • Nelda M. Garcia
  • Jan M. H. Risser
  • Lewis B. Morgenstern
Original Paper


To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher’s exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.


Spirituality Mexican Americans Stroke 



This study was funded by the NIH (National Institute on Neurological Disorders and Stroke, R01 NS38916). Dr. Skolarus is funded by the American Academy of Neurology Clinical Research Training Fellowship.


  1. Berges, I. M., Kuo, Y. F., Markides, K. S., & Ottenbacher, K. (2007). Attendance at religious services and physical functioning after stroke among older Mexican Americans. Experimental Aging Research, 33(1), 1–11.PubMedCrossRefGoogle Scholar
  2. Blane, D. (1995). Social determinants of health–socioeconomic status, social class, and ethnicity. American Journal of Public Health, 85(7), 903–905.PubMedCrossRefGoogle Scholar
  3. Blas, E., Gilson, L., Kelly, M. P., Labonte, R., Lapitan, J., Muntaner, C., et al. (2008). Addressing social determinants of health inequities: What can the state and civil society do? Lancet, 372(9650), 1684–1689.PubMedCrossRefGoogle Scholar
  4. Blumenthal, J. A., Babyak, M. A., Ironson, G., Thoresen, C., Powell, L., Czajkowski, S., et al. (2007). Spirituality, religion, and clinical outcomes in patients recovering from an acute myocardial infarction. Psychosomatic Medicine, 69(6), 501–508.PubMedCrossRefGoogle Scholar
  5. Bowley, D. M., Butler, M., Shaw, S., & Kingsnorth, A. N. (2003). Dispositional pessimism predicts delayed return to normal activities after inguinal hernia operation. Surgery, 133(2), 141–146.PubMedCrossRefGoogle Scholar
  6. Campbell, M. K., Demark-Wahnefried, W., Symons, M., Kalsbeek, W. D., Dodds, J., Cowan, A., et al. (1999). Fruit and vegetable consumption and prevention of cancer: The Black Churches United for Better Health project. American Journal of Public Health, 89(9), 1390–1396.PubMedCrossRefGoogle Scholar
  7. Campbell, M. K., Hudson, M. A., Resnicow, K., Blakeney, N., Paxton, A., & Baskin, M. (2007). Church-based health promotion interventions: Evidence and lessons learned. Annual Review of Public Health, 28, 213–234.PubMedCrossRefGoogle Scholar
  8. DeHaven, M. J., Hunter, I. B., Wilder, L., Walton, J. W., & Berry, J. (2004). Health programs in faith-based organizations: Are they effective? American Journal of Public Health, 94(6), 1030–1036.PubMedCrossRefGoogle Scholar
  9. Diez-Quevedo, C., Rangil, T., Sanchez-Planell, L., Kroenke, K., & Spitzer, R. L. (2001). Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosomatic Medicine, 63(4), 679–686.PubMedGoogle Scholar
  10. Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M., & Chang, R. W. (2003). Racial/ethnic differences in rates of depression among preretirement adults. American Journal of Public Health, 93(11), 1945–1952.PubMedCrossRefGoogle Scholar
  11. Everson, S. A., Roberts, R. E., Goldberg, D. E., & Kaplan, G. A. (1998). Depressive symptoms and increased risk of stroke mortality over a 29-year period. Archives of Internal Medicine, 158(10), 1133–1138.PubMedCrossRefGoogle Scholar
  12. George, L. K., Ellison, C. G., & Larson, D. B. (2002). Explaining the relationships between religious involvement and health. Psychological Inquiry, 13(3), 190–200.CrossRefGoogle Scholar
  13. Giltay, E. J., Geleijnse, J. M., Zitman, F. G., Hoekstra, T., & Schouten, E. G. (2004). Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Archives of General Psychiatry, 61(11), 1126–1135.PubMedCrossRefGoogle Scholar
  14. Gump, B. B., Matthews, K. A., Eberly, L. E., & Chang, Y. F. (2005). Depressive symptoms and mortality in men: Results from the multiple risk factor intervention trial. Stroke, 36(1), 98–102.PubMedCrossRefGoogle Scholar
  15. Hall, D. E. (2006). Religious attendance: More cost-effective than lipitor? Journal of the American Board of Family Medicine, 19(2), 103–109.PubMedCrossRefGoogle Scholar
  16. Hall, D. E., Meador, K. G., & Koenig, H. G. (2008). Measuring religiousness in health research: Review and critique. Journal of Religion and Health, 47(2), 134–163.PubMedCrossRefGoogle Scholar
  17. Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: Results from the National epidemiologic survey on alcoholism and related conditions. Archives of General Psychiatry, 62(10), 1097–1106.PubMedCrossRefGoogle Scholar
  18. Herrmann, N., Black, S. E., Lawrence, J., Szekely, C., & Szalai, J. P. (1998). The Sunnybrook stroke study: A prospective study of depressive symptoms and functional outcome. Stroke, 29(3), 618–624.PubMedCrossRefGoogle Scholar
  19. Hill, T. D., Angel, J. L., Ellison, C. G., & Angel, R. J. (2005). Religious attendance and mortality: An 8-year follow-up of older Mexican Americans. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 60(2), S102–S109.CrossRefGoogle Scholar
  20. House, A., Knapp, P., Bamford, J., & Vail, A. (2001). Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke, 32(3), 696–701.PubMedCrossRefGoogle Scholar
  21. Howard, G., Anderson, R. T., Russell, G., Howard, V. J., & Burke, G. L. (2000). Race, socioeconomic status, and cause-specific mortality. Annals of Epidemiology, 10(4), 214–223.PubMedCrossRefGoogle Scholar
  22. Hummer, R. A., Powers, D. A., Pullum, S. G., Gossman, G. L., & Frisbie, W. P. (2007). Paradox found (again): Infant mortality among the Mexican-origin population in the United States. Demography, 44(3), 441–457.PubMedCrossRefGoogle Scholar
  23. Hunt, K. J., Resendez, R. G., Williams, K., Haffner, S. M., Stern, M. P., & Hazuda, H. P. (2003). All-cause and cardiovascular mortality among Mexican-American and non-hispanic white older participants in the San Antonio heart study” evidence against the Hispanic Paradox”. American Journal of Epidemiology, 158(11), 1048–1057.PubMedCrossRefGoogle Scholar
  24. Levin, J. S., Markides, K. S., & Ray, L. A. (1996). Religious attendance and psychological well-being in Mexican Americans: A panel analysis of three-generations data. Gerontologist, 36(4), 454–463.PubMedCrossRefGoogle Scholar
  25. Lewis, S. C., Dennis, M. S., O’Rourke, S. J., & Sharpe, M. (2001). Negative attitudes among short-term stroke survivors predict worse long-term survival. Stroke, 32(7), 1640–1645.PubMedCrossRefGoogle Scholar
  26. Lisabeth, L. D., Risser, J. M., Brown, D. L., Al-Senani, F., Uchino, K., Smith, M. A., et al. (2006a). Stroke burden in Mexican Americans: The impact of mortality following stroke. Annals of Epidemiology, 16(1), 33–40.PubMedCrossRefGoogle Scholar
  27. Lisabeth, L. D., Smith, M. A., Brown, D. L., Moye, L. A., Risser, J. M., Morgenstern, L. B., et al. (2006b). Ethnic differences in stroke recurrence. Annals of Neurology, 60(4), 469–475.PubMedCrossRefGoogle Scholar
  28. Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the southwestern United States: An epidemiologic paradox. Public Health Reports, 101(3), 253–265.PubMedGoogle Scholar
  29. Marmot, M. G., & Bell, R. (2009). Action on health disparities in the United States: Commission on social determinants of health. The Journal of the American Medical Association, 301(11), 1169–1171.CrossRefGoogle Scholar
  30. Marmot, M., Friel, S., Bell, R., Houweling, T. A., & Taylor, S. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet, 372(9650), 1661–1669.PubMedCrossRefGoogle Scholar
  31. McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19(3), 211–222.PubMedCrossRefGoogle Scholar
  32. Morgenstern, L. B., Smith, M. A., Lisabeth, L. D., Risser, J. M., Uchino, K., Garcia, N., et al. (2004). Excess stroke in Mexican Americans compared with non-Hispanic Whites: The Brain Attack Surveillance in Corpus Christi Project. American Journal of Epidemiology, 160(4), 376–383.PubMedCrossRefGoogle Scholar
  33. Nabi, H., Koskenvuo, M., Singh-Manoux, A., Korkeila, J., Suominen, S., Korkeila, K., et al. (2010). Low Pessimism protects against stroke. The health and social support (HeSSup) prospective cohort study. Stroke, 41(1), 187–190.PubMedCrossRefGoogle Scholar
  34. Pandey, D. K., Labarthe, D. R., Goff, D. C., Chan, W., & Nichaman, M. Z. (2001). Community-wide coronary heart disease mortality in Mexican Americans equals or exceeds that in non-Hispanic whites: The Corpus Christi heart project. The American Journal of Medicine, 110(2), 81–87.PubMedCrossRefGoogle Scholar
  35. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19(1), 2–21.PubMedCrossRefGoogle Scholar
  36. Peek, M. E., Sayad, J. V., & Markwardt, R. (2008). Fear, fatalism and breast cancer screening in low-income African-American women: The role of clinicians and the health care system. Journal of General Internal Medicine, 23(11), 1847–1853.PubMedCrossRefGoogle Scholar
  37. Perez-Stable, E. J., Sabogal, F., Otero-Sabogal, R., Hiatt, R. A., & McPhee, S. J. (1992). Misconceptions about cancer among Latinos and Anglos. The journal of the American Medical Association, 268(22), 3219–3223.CrossRefGoogle Scholar
  38. Piriyawat, P., Smajsova, M., Smith, M. A., Pallegar, S., Al-Wabil, A., Garcia, N. M., et al. (2002). Comparison of active and passive surveillance for cerebrovascular disease: The Brain Attack Surveillance in Corpus Christi (BASIC) Project. American Journal of Epidemiology, 156(11), 1062–1069.PubMedCrossRefGoogle Scholar
  39. Randolph, W. M., Freeman, D. H., Jr., & Freeman, J. L. (2002). Pap smear use in a population of older Mexican-American women. Women and Health, 36(1), 21–31.CrossRefGoogle Scholar
  40. Resnicow, K., Campbell, M. K., Carr, C., McCarty, F., Wang, T., Periasamy, S., et al. (2004). Body and soul. A dietary intervention conducted through African-American churches. American Journal of Preventive Medicine, 27(2), 97–105.PubMedCrossRefGoogle Scholar
  41. Reyes-Ortiz, C. A., Berges, I. M., Raji, M. A., Koenig, H. G., Kuo, Y. F., & Markides, K. S. (2008). Church attendance mediates the association between depressive symptoms and cognitive functioning among older Mexican Americans. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(5), 480–486.CrossRefGoogle Scholar
  42. Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition examination survey III. American Journal of Public Health, 95(6), 998–1000.PubMedCrossRefGoogle Scholar
  43. Roberts, R. E., Roberts, C. R., & Chen, I. G. (2000). Fatalism and risk of adolescent depression. Psychiatry, 63(3), 239–252.PubMedGoogle Scholar
  44. Sauaia, A., Min, S. J., Lack, D., Apodaca, C., Osuna, D., Stowe, A., et al. (2007). Church-based breast cancer screening education: Impact of two approaches on Latinas enrolled in public and private health insurance plans. Preventing Chronic Disease, 4(4), A99.PubMedGoogle Scholar
  45. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078.PubMedCrossRefGoogle Scholar
  46. Scheier, M. F., Matthews, K. A., Owens, J. F., Magovern, G. J., Sr., Lefebvre, R. C., Abbott, R. A., et al. (1989). Dispositional optimism and recovery from coronary artery bypass surgery: The beneficial effects on physical and psychological well-being. Journal of Personality and Social Psychology, 57(6), 1024–1040.PubMedCrossRefGoogle Scholar
  47. Scheier, M. F., Matthews, K. A., Owens, J. F., Schulz, R., Bridges, M. W., Magovern, G. J., et al. (1999). Optimism and rehospitalization after coronary artery bypass graft surgery. Archives of Internal Medicine, 159(8), 829–835.PubMedCrossRefGoogle Scholar
  48. Schulz, R., Beach, S. R., Ives, D. G., Martire, L. M., Ariyo, A. A., & Kop, W. J. (2000). Association between depression and mortality in older adults: The Cardiovascular health study. Archives of Internal Medicine, 160(12), 1761–1768.PubMedCrossRefGoogle Scholar
  49. Smith, M. A., Risser, J. M., Lisabeth, L. D., Moye, L. A., & Morgenstern, L. B. (2003). Access to care, acculturation, and risk factors for stroke in Mexican Americans: The Brain Attack Surveillance in Corpus Christi (BASIC) project. Stroke, 34(11), 2671–2675.PubMedCrossRefGoogle Scholar
  50. Smith, M. A., Risser, J. M., Moye, L. A., Garcia, N., Akiwumi, O., Uchino, K., et al. (2004). Designing multi-ethnic stroke studies: The brain attack surveillance in corpus Christi (BASIC) project. Ethnicity and Disease, 14(4), 520–526.PubMedGoogle Scholar
  51. Sorlie, P. D., Backlund, E., Johnson, N. J., & Rogot, E. (1993). Mortality by Hispanic status in the United States. The journal of the American Medical Association, 270(20), 2464–2468.CrossRefGoogle Scholar
  52. Sorlie, P. D., Backlund, E., & Keller, J. B. (1995). US mortality by economic, demographic, and social characteristics: The National Longitudinal Mortality Study. American Journal of Public Health, 85(7), 949–956.PubMedCrossRefGoogle Scholar
  53. Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87(6), 957–961.PubMedCrossRefGoogle Scholar
  54. Strawbridge, W. J., Shema, S. J., Cohen, R. D., Roberts, R. E., & Kaplan, G. A. (1998). Religiosity buffers effects of some stressors on depression but exacerbates others. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 53(3), S118–S126.CrossRefGoogle Scholar
  55. Teoh, V., Sims, J., & Milgrom, J. (2009). Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: A longitudinal study. Topics in Stroke Rehabilitation, 16(2), 157–166.PubMedCrossRefGoogle Scholar
  56. Tindle, H. A., Chang, Y. F., Kuller, L. H., Manson, J. E., Robinson, J. G., Rosal, M. C., et al. (2009). Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative. Circulation, 120(8), 656–662.PubMedCrossRefGoogle Scholar
  57. Uchino, K., Risser, J. M., Smith, M. A., Moye, L. A., & Morgenstern, L. B. (2004). Ischemic stroke subtypes among Mexican Americans and non-Hispanic whites: The BASIC project. Neurology, 63(3), 574–576.PubMedCrossRefGoogle Scholar
  58. Voorhees, C. C., Stillman, F. A., Swank, R. T., Heagerty, P. J., Levine, D. M., & Becker, D. M. (1996). Heart, body, and soul: Impact of church-based smoking cessation interventions on readiness to quit. Preventive Medicine, 25(3), 277–285.PubMedCrossRefGoogle Scholar
  59. Williams, L. S., Brizendine, E. J., Plue, L., Bakas, T., Tu, W., Hendrie, H., et al. (2005). Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke, 36(3), 635–638.PubMedCrossRefGoogle Scholar
  60. Williams, L. S., Ghose, S. S., & Swindle, R. W. (2004). Depression and other mental health diagnoses increase mortality risk after ischemic stroke. American Journal of Psychiatry, 161(6), 1090–1095.PubMedCrossRefGoogle Scholar
  61. Williams, L. S., Yilmaz, E. Y., & Lopez-Yunez, A. M. (2000). Retrospective assessment of initial stroke severity with the NIH stroke scale. Stroke, 31(4), 858–862.PubMedCrossRefGoogle Scholar
  62. Wong, M. D., Shapiro, M. F., Boscardin, W. J., & Ettner, S. L. (2002). Contribution of major diseases to disparities in mortality. New England Journal of Medicine, 347(20), 1585–1592.PubMedCrossRefGoogle Scholar
  63. Xiao, X., Liang, J., Bennett, J. M., Quiñones, A. R., & Wen, Y. (2010). Ethnic differences in the dynamics of depressive symptoms in middle-aged and older Americans. Journal of Aging and Health, 22(5), 631–652.CrossRefGoogle Scholar
  64. Zahuranec, D. B., Brown, D. L., Lisabeth, L. D., Gonzales, N. R., Longwell, P. J., Eden, S. V., et al. (2006). Differences in intracerebral hemorrhage between Mexican Americans and non-Hispanic whites. Neurology, 66(1), 30–34.PubMedCrossRefGoogle Scholar
  65. Zahuranec, D. B., Morgenstern, L. B., Garcia, N. M., Conley, K. M., Lisabeth, L. D., Rank, G. S., et al. (2008). Stroke health and risk education (SHARE) pilot project: Feasibility and need for church-based stroke health promotion in a bi-ethnic community. Stroke, 39(5), 1583–1585.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Lesli E. Skolarus
    • 1
    • 5
  • Lynda D. Lisabeth
    • 1
    • 2
  • Brisa N. Sánchez
    • 3
  • Melinda A. Smith
    • 1
  • Nelda M. Garcia
    • 1
  • Jan M. H. Risser
    • 4
  • Lewis B. Morgenstern
    • 1
    • 2
  1. 1.Stroke ProgramUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
  3. 3.Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborUSA
  4. 4.Department of EpidemiologyUniversity of Texas at Houston School of Public HealthHoustonUSA
  5. 5.University of Michigan Cardiovascular CenterAnn ArborUSA

Personalised recommendations