Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions

Negative religious coping versus spiritual struggles: Moderator or main effect?

OBJECTIVE

While previous research indicates that negative religious coping relates with distress, it is unclear if this represents generalized spiritual struggles or a specific vulnerability activated by negative events. Moreover, past research treats coping as a stable phenomenon, although it likely fluctuates. This research simultaneously tested both models longitudinally and examined the relationship between coping and distress.

METHODS

The current study is a secondary analysis of longitudinal data collected online over 3 years from 397 participants. Life events, negative religious coping, and depressive symptoms were assessed on six occasions, and linear mixed-effect models were used to analyze data.

RESULTS

Negative religious coping was largely stable with increases at times of stress. Participants with higher mean negative coping reported more depressive symptoms regardless of life circumstances (i.e., main effect), likely reflecting generalized spiritual struggles. In addition, those with higher mean coping or with particularly high levels at a given time reported even higher levels of symptoms when they experienced more negative life events (i.e., moderation effect).

CONCLUSION

Results suggest that previous research merges two distinct phenomena-spiritual struggles and negative coping. This has important theoretical and research implications and suggests that integrating spirituality and religion into treatment can be warranted.

Religious/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence

This prospective study examined the primary, secondary and complex conceptual models of religious/spiritual struggles with 18 indicators of whole person functioning across five domains: psychological well-being, psychological distress, social well-being, physical well-being and character. We used three waves of longitudinal data (Wave 1: August/September 2021, Wave 2: October/November 2021, Wave 3: February 2022) from Colombian university students (N = 2878, Mage = 20.88 ± 4.05 years). Adjusting for covariates assessed in Wave 1, our primary analysis applied the analytic templates for outcome-wide and lagged exposure-wide designs to estimate two sets of lagged linear regression models. Religious/spiritual struggles in Wave 2 were associated with a small-to-medium-sized decline in subsequent functioning on 17/18 indicators in Wave 3, and worse functioning on 16/18 indicators in Wave 2 was associated with very small-to-medium-sized increases in subsequent religious/spiritual struggles in Wave 3. The results provided evidence in favour of the complex conceptual model for 16/18 indicators of whole person functioning. Our findings extend existing evidence on the reciprocal association between religious/spiritual struggles and individual functioning to a wide range of indicators, reinforcing the need for practitioners to consider the dynamic interplay between religious/spiritual struggles and individual functioning as they work with younger populations.

Divine struggles and whole person functioning: a 9-year longitudinal study of middle-aged U.S. adults

OBJECTIVE

This longitudinal study examined the associations of divine struggles with 25 psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior outcomes assessed approximately nine years later.

METHODS

We used three waves of data from the National Survey of Midlife Development in the United States (N = 4041): M1 (1995-1996), M2 (2004-2006), and M3 (2013-2014). Following the analytic template for outcome-wide longitudinal designs, our primary analysis employed a series of regression models to estimate the associations between a continuous measure of divine struggles assessed at M2 with each outcome assessed at M3. All models adjusted for a rich set of covariates, including prior values of all outcomes.

RESULTS

There was modest evidence suggesting that divine struggles were associated with worse subsequent functioning on one or more outcomes for each domain except health behaviors (effect sizes were generally very small).

CONCLUSIONS

Divine struggles have the potential to degrade long-term functioning across multiple domains of life. Practitioners should attend to and address divine struggles in their clinical work.

Do Religious Struggles Mediate the Association Between Neighborhood Disorder and Health in the United States?

Over the past two decades, numerous studies have linked the subjective experience of neighborhood disorder (perceptions of crime, dilapidation and ambient strains) with poorer health. We test whether religious struggles (religious doubts and feeling abandoned or punished by God) mediate this association. Our counterfactual mediation analyses of data from the 2021 Crime, Health, and Politics Survey (CHAPS) (n = 1741) revealed consistent indirect effects of neighborhood disorder through religious struggles for anger, psychological distress, sleep disturbance, poorer self-rated health, and shorter subjective life expectancy. This study contributes to previous work by integrating the study of neighborhood context and religion.

Coping Resources among Forced Migrants in South Africa: Exploring the Role of Character Strengths in Coping, Adjustment, and Flourishing

This phenomenological qualitative study explored how forced migrants in South Africa cope with violent, traumatic experiences and precarious resettlement conditions. Data came from a larger empirical project examining migration, psychological distress, and coping. In-depth interviews were conducted with 14 refugees and asylum seekers (Mage = 30.27, SDage = 9.27; male = 71.43%) who migrated from five African countries to Durban, South Africa. Despite overwhelming stressors, participants described pathways to transcend victimhood and hardship through engaging character strengths in ways that promote post-traumatic growth. Qualitative analysis revealed five overarching domains: spirituality and religiousness, love and kindness, hope and optimism, persistence and fortitude, and gratitude and thankfulness. Findings are framed within positive existential psychology and dual-factor understandings of mental health, which attend to both human suffering and flourishing. Limitations, future research directions, and clinical and community implications are discussed, with attention to the role of character strengths in adaptive coping and psychological well-being. The intergenerational transmission of strengths is explored as one potential means of buffering intergenerational trauma impacts and promoting family post-traumatic growth.

Polish Validation of a 14-Item Version of the Religious and Spiritual Struggles Scale (RSS-14): Factorial Structure, Psychometric Properties, and Clinical Correlates

Religious and spiritual (R/S) struggles are defined as the occurrence of tension, conflict, or strain that focus on matters of ultimate significance perceived by people as sacred. The widespread prevalence of R/S struggles and the growing demand for research in this area created the need for a brief tool. Recently, the 14-item form of the Religious and Spiritual Struggles Scale was developed and validated (Exline et al. in Psychology of Religion and Spirituality, 2022a). Given the significance of the empirical research on R/S struggles, we implemented the project of structure verification, internal consistency confirmation, reliability, and nomological validation of the Polish variant of the RSS-14 through three separate studies. With respect to the internal structure of the RSS-14, the CFA from three studies confirmed the good fit of the six-factor model, very similar to the one obtained in the original version of the tool. Moreover, both the total score and the subscales had high reliability and acceptable stability over the three studies. With respect to the nomological analyses, R/S struggles were related negatively to life satisfaction, presence of meaning in life, self-esteem, social desirability, religious centrality, and positively with search for meaning, God's disengagement, poorer health indicators, sleep problems, stress, and cognitive schemas (this category was the new element of our research). Polish 14-item version of the Religious and Spiritual Struggles Scale seems a valuable tool to assess religious strains.

Tragedy or transformation? Online survey of nurse spirituality during the COVID pandemic

AIM

To describe positive and negative spiritual responses to providing COVID-related nursing care among nurses working in hospitals.

BACKGROUND

The COVID pandemic has intensified and publicised the threats to nurse well-being. Absent from the recommendations for promoting nurse well-being is recognition of how nurses' spirituality and/or religiosity is affected by the strain of COVID caring or how it may be affecting their well-being.

DESIGN

Cross-sectional, descriptive observational, mixed methods study.

METHODS

Data were collected from 523 registered nurses employed in three Southern California hospitals during March-May, 2022 when these hospitals' COVID case counts were <15%. Using Online survey methods, data were obtained using the Religious/Spiritual Struggles Scale-Short Form, Moral Injury Symptom Scale-Healthcare Professionals, Post-traumatic Growth Inventory and demographic and work-related items. STROBE guidelines for cross-sectional observational studies were observed.

RESULTS

The mean for religious/spiritual struggles was 1.98 (range of 1-5, comparable to a little bit). Although roughly half of the sample reported the struggles were not experienced/did not apply, 23%-36.5% reported experiencing these struggles at least somewhat. The most frequent struggle was to find ultimate meaning. The mean observed for moral injury was 6.5 (range of 1-10); applying established criteria indicated it was troubling for at least 50%. The mean for post-traumatic growth was 4 (on a scale of 0-6); using established criteria, 41% experienced PTG. Quantitative findings were illustrated by the qualitative responses that occasionally expressed spiritual tragedy and transformation concurrently.

CONCLUSION

The professional work of nursing impacts nurses in invisible, spiritual ways that can be tragic and/or transformative.

RELEVANCE TO CLINICAL PRACTICE

Interventions to address nurses' mental health challenges must include attention to these invisible struggles. Nurses' mental health challenges must be met in part by addressing how they can surmount spiritual tragedy-and allow spiritual transformation.

Varieties of Religious and Spiritual Struggles by Type of Mental Disorder: A Qualitative Approach

INTRODUCTION

Little is known about types of religious/spiritual (R/S) struggles with regard to various diagnostic groups in mental health care. The current qualitative study aims to give an impression of R/S struggles as observed in six diagnostic groups in clinical mental health care.

METHODS

Inductive thematic content analysis was applied to 34 semi-structured interviews. The interviews were performed among (day) clinical mental health care patients in two institutions.

RESULTS

Among patients with depression, a lack of positive R/S experiences, isolation, and feelings of guilt and shame were present. Those with cluster C and anxiety disorders reported uncertainty toward God and faith and R/S reticence. Psychotic disorders were accompanied by impressive R/S experiences, reticence to share these, and mistrust toward health professionals. Patients with bipolar disorder struggled with the interpretation of their R/S experiences and with both attraction and distance toward R/S. Cluster B patients showed ambivalence and anger toward God and others, and some reported existential tiredness. Patients with autism mentioned doubts and troubles with religious beliefs. In all groups, many patients had questions like "why?" or "where is God?"

CONCLUSION

R/S struggles to some extent may be the language of the illness. Mental health professionals are recommended to take this into account, taking heed of the content of individual R/S struggles and considering using R/S interventions.

The Role of Religiosity and Spirituality in Helping Polish Subjects Adapt to Their Tinnitus

This study aims to assess whether religiosity and spirituality might be significant internal resources that help people with tinnitus to adapt to their condition. The study group comprised 256 Polish patients with tinnitus (123 women and 133 men) who answered the Tinnitus Handicap Inventory and Tinnitus Functional Index (both of which measure tinnitus annoyance) and the Self-Description Questionnaire (which measures: religious attitudes, ethical sensitivity, and harmony). Significant positive correlations between religious attitudes and tinnitus annoyance were found in subjects with tinnitus. The higher the religiosity, the higher tinnitus the annoyance, at least in the two TFI questionnaire dimensions: sense of control and quality of life (although these correlations were statistically significant only for men). Religiosity was found to be a positive predictor of tinnitus annoyance. Also, ethical sensitivity positively predicted tinnitus annoyance, whereas harmony was a negative predictor. We suggest that psychologists and audiologists should, in their diagnostic and therapeutic work with patients with tinnitus, pay attention to the religious and spiritual aspects of their patients' lives.

Development and Initial Validation of the Persevering Hope Scale: Measuring Wait-Power in Four Independent Samples

Hope has been conceptualized as agency and pathways to achieve goals. However, this goal-directed conceptualization does not encapsulate all situations in which hope may be beneficial. To address the dispositional motivation to endure when a desired goal seems unattainable, unlikely, or even impossible (i.e., goal-transcendent hope), we provide initial psychometric evidence for the new Persevering Hope Scale (PHS). We developed and refined the PHS with undergraduates at a public college (Study 1) and replicated our findings in a community adult sample (Study 2). We replicated and extended these findings using longitudinal data with undergraduates at a faith-based college (Study 3) and a community sample of chronically ill adults (Study 4), and examined measurement invariance (Study 5). Scores on the PHS demonstrated robust evidence of estimated internal consistency and of criterion-related, convergent/discriminant, and incremental validity. Estimated temporal stability was modest. Partial scalar invariance was evidenced across samples, and full scalar invariance was evidenced across gender, race/ethnicity, and time. These preliminary findings suggest that the PHS is a psychometrically sound measure of persevering hope. Its use can broaden the current body of literature on trait hope to include goal-transcendent hope and advance research on the nature and benefits of this important construct.

What Aspects of Religion and Spirituality Affect the Physical Health of Cancer Patients? A Systematic Review

In recent years, the literature on the relationship between religion and spirituality (R/S) and the health of cancer patients has been flourishing. Although most studies focus on mental health, many study the physical health of these individuals. In order to summarize the findings of these studies, we reviewed the most recent research on this subject using the PubMed and PsycInfo databases. The objective of this systematic review was to recognize the primary R/S variables studied in research on physical health in cancer contexts. We found that spiritual well-being was the most-researched variable in studies of these characteristics, followed by R/S struggles and other variables such as religious coping; religious commitment or practice; or self-rated R/S. In general, R/S seems to have a positive association with the physical health of cancer patients, although the results are quite heterogeneous, and occasionally there are no relationships or the association is negative. Our results may assist in improving interventions that include spirituality in clinical settings as well as the development of holistic approaches, which may have a positive impact on the quality of life and well-being of cancer patients.

Religiosity, Emotions and Health: The Role of Trust/Mistrust in God in People Affected by Cancer

Trust in God implies the conviction that God looks after a person’s own interests. The first evidence of a relationship between this construct and people’s psychological and emotional health dates back several centuries. However, the literature on this is limited, especially for people with physical health conditions, such as cancer. Therefore, the purpose of this study is to test the relationships between trust/mistrust in God, social support and emotions in people affected by cancer. The sample consisted of 177 women and men in Spain diagnosed with cancer. The instruments used were the Trust/Mistrust in God Scale, the Positive and Negative Affect Schedule and the Multidimensional Scale of Perceived Social Support. Correlation analysis and hierarchical regression analysis were performed to compare several explanatory models for the dependent variables: positive and negative emotions. The results show significant relationships between all variables. It was observed that, when trust/mistrust in God is included in the model, only mistrust in God predicts both types of emotions. In addition, both social support and some sociodemographic variables help to predict the dependent variables. This study shows that valuing the religiosity and spirituality of oncology patients in healthcare settings can have a significant positive impact on the health of these individuals. Moreover, it represents an important approach to the study of trust/mistrust in God in the context of a traditionally Catholic country.