Impact of religiosity/spirituality on biological and preclinical markers related to cardiovascular disease. Results from the SPILI III study

Spiritual Health in Iranian Patients With Cardiovascular Diseases: A Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to evaluate the spiritual health status of Iranian patients with cardiovascular diseases. A literature search was conducted in national (MagIran and Scientific Information Database) and international (Scopus, PubMed, and Web of Science/ISI) databases from inception to December 2021. A random-effects model was used to estimate the pooled score of spiritual health. Based on the eligibility criteria, 22 articles were selected for the final analysis. The pooled score of spiritual health in Iranian patients with cardiovascular diseases was 61% (95% confidence interval: 54%-68%). In subgroup analysis, the pooled score in patients with heart failure was higher than other patients (67% vs. 58%). Publication bias was not significant (p = 0.554). Results indicated that the spiritual health of Iranian patients with cardiovascular diseases was moderate. Therefore, it is recommended that proper training be provided to these patients to enhance their adaptation to the complications of cardiovascular diseases.

The Association Between Spirituality, Self-Esteem, Anxiety and Depression: A Comparative Exploratory Study Between People with a Spinal Cord Injury and Healthy Subjects in Greece

The purpose of this study was to evaluate spirituality, religiosity, self-esteem, depression, and stress in people with spinal cord injuries. The Royal Free Questionnaire for Spiritual and Religious Beliefs, the Rosenberg Self-Esteem Scale, the Center for Epidemiologic Studies Depression Scale, and the Spielberger State-Trait Anxiety Scale were all designed for the current study to collect demographic and injury-related information. In the study, 88 patients with traumatic SCI and 88 healthy subjects were included. Half of the participants and healthy subjects were women, while the mean age of the healthy subjects was 42.8 years and that of the subjects was 42.4 years. The majority of participants were Greek (97.2%), while 44.1% were married or with a partner and 43.2% were single. The mean depression and stress score was higher in patients than in healthy subjects, and the mean score of self-esteem was lower in patients than healthy subjects. Multivariable linear regression model showed that patients who believed more that a spiritual force or power outside of ourselves can influence what happens in everyday life had less depression and stress. People with spinal cord injuries experience extreme stress, anxiety, and depression. Spirituality and religiosity can play a significant role in their recuperation, rehabilitation, and adaptation.

A 10-Year Cardiovascular Risk in Adults with Different Levels of Spiritual Health: Tehran Lipid and Glucose Study

Background

Previous studies have shown that spiritual experience may reduce cardiovascular disease (CVDs). However, little is known about the relationship between spiritual health and the gender-specific risk of CVDs in communities with different cultures.

Methods

A total of 3249 individuals (53.7% female, 75.0% middle-aged) participated in the Tehran Lipid and Glucose Study (TLGS) from 2015 to 2017 were included. Based on the ACC/AHA pooled cohort equation, CVD risk over ten years was examined. Spiritual health was measured using a developed tool for measuring spiritual health in Muslim populations (SHIMA-48). Linear regression models were used to assess the association between spiritual health and ACC/AHA risk scores. The natural logarithm scale was calculated to consider the normal distribution hypothesis of the regression model.

Results

The current results suggest a slight but significant increase in the mean of spiritual health in women compared to men in both cognitive/emotional and behavioral dimensions (P < 0.001). In both sexes, a higher prevalence of smoking was observed in participants with lower levels of spiritual health (P < 0.004). In men, compared to those with a low level of spiritual health (the first tertile), the logarithm of the ACC-AHA risk score was reduced by 0.11 (P = 0.004) and 0.18 (P < 0.001) for those in the second and third tertiles of spiritual health, respectively. This result may be attributed to higher cigarette smoking among the latter group. Similar results were not observed in women.

Conclusions

Current results indicate a gender-specific association between spiritual health and cardiovascular disease risk. Our findings imply that promoting spiritual health can be considered an effective strategy in future preventive interventions, primarily by controlling the desire to smoke in men.

Religious or spiritual coping, religious service attendance, and type 2 diabetes: A prospective study of women in the United States

PURPOSE

To investigate religion and spirituality (R/S) as psychosocial factors in type 2 diabetes risk.

METHODS

Using the Nurses' Health Study II, we conducted a 14-year prospective analysis of 46,713 women with self-reported use of religion or spiritual beliefs to cope with stressful situations, and 42,825 women with self-reported religious service attendance, with respect to type 2 diabetes. Cox regression was used to assess the associations.

RESULTS

Compared with not using religious or spiritual coping at all, the fully-adjusted hazard ratios (HR) were minimally different across all categories: a little bit (HR=1.01; 95% CI:0.85, 1.19), a medium amount (HR=0.96; 95% CI:0.80, 1.14), a lot (HR=0.93; 95% CI: 0.77, 1.11) (Ptrend=0.24). Similarly, compared with participants who never or almost never attend religious meetings or services, there were minimal differences with participants attending less than once/month (HR=1.06; 95% CI:0.92, 1.22), 1-3 times/month (HR=1.00; 95% CI:0.85, 1.17), once/week (HR=0.98; 95% CI:0.85, 1.14), more than once/week (HR=1.20; 95% CI:1.01, 1.43) (Ptrend=0.29). Perceived stress did not modify these associations. Our hypothesis of mediated effects through lifestyle factors and social integration was not supported.

CONCLUSIONS

R/S was not significantly associated with type 2 diabetes, but its role in other chronic conditions may be important.

Emotional Discomfort Scale: Instrument Development and Association With General Self-Efficacy and Data From an Urban Primary Care Setting

Introduction: Sense of discomfort, which is experienced in daily encounters, can develop into stress, coexist with stress, or interplay with self-efficacy. This study presents two objectives, namely, to develop and test a new instrument called the Emotional Discomfort (EmoD) Scale and to compare the EmoD with the General Self-Efficacy (GSE) Scale.

Methods: The study was conducted in an urban primary healthcare center in Greece over a three-week period in 2020. Out of 314 individuals invited to participate, 263 accepted and completed the questionnaire. The EmoD is a five-point Likert-type eight-item scale for assessing individual reaction and sense of discomfort in daily life situations.

Results: Cronbach’s α for the new scale reached 0.730 (acceptable reliability). Participants who used psychotropic drugs scored higher in the EmoD scale compared with nonusers. GSE scores showed reverse associations with EmoD scores. Multiple linear regression analysis indicated that an increase in self-efficacy, as measured using the GSE scale, was associated with a reduction in sense of discomfort, as measured by the EmoD scale.

Conclusions: The use of the EmoD scale can aid health or social care providers in detecting levels of emotional discomfort, a finding that is demonstrated to interplay with self-efficacy. Future studies employing the use of this new instrument could examine emotional discomfort in relation to stress coping and social isolation.

Spirituality, religiousness, and mental health: A review of the current scientific evidence

Research in the field of “Spirituality and Health” has been growing, with spirituality/religiousness (S/R) being consistently related to both physical and mental health. The objective of this article is to provide an updated review of the current scientific evidence on the relationship between S/R and mental health, highlighting the most important studies. As a secondary objective, the mechanisms that explain this relationship and the interventions that utilize this information in treating mental disorders will be discussed. The findings reveal a large body of evidence across numerous psychiatric disorders. Although solid evidence is now available for depression, suicidality, and substance use, other diagnosis, such as post-traumatic stress disorder, psychosis, and anxiety, have also shown promising results. The effects of S/R on mental health are likely bidirectional, and the manner in which religious beliefs are used to cope with distress (i.e. negative and positive), may affect mental health outcomes. Despite these findings, the mechanisms that explain these associations and the role of S/R interventions need further study. Concerning clinical practice, mental health providers should ask patients about S/R that are important in their lives to provide holistic and patient-centered care.

Religion, spirituality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women

Background

Religion and spirituality (R/S) are important resources for coping with stress and are hypothesized to influence health outcomes via modulation of the hypothalamic-pituitary-adrenal (HPA) axis, though this has not been evaluated extensively. In this study, we examined associations between several measures of religiosity or spirituality (R/S) and three HPA axis biomarkers: cortisol, dehydroepiandrosterone (DHEA), and cortisol:DHEA ratio.

Methods

Sample included 216 female postmenopausal Nurses’ Health Study II participants who provided up to five timed saliva samples: immediately upon awakening, 45 min, 4 h, and 10 h after waking, and prior to going to sleep during a single day in 2013. Multivariable-adjusted linear mixed models with piecewise cubic spline functions and adjustment for potential covariates were used to estimate the cross-sectional associations of eight R/S measures with diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio.

Results

There was little evidence of association between the eight R/S measures analyzed and diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio. Women who reported that R/S was very involved in understanding or dealing with stressful situations had slower night rise in cortisol than those who did not. Greater levels of religious struggles were associated with higher cortisol levels throughout the day. Higher non-theistic daily spiritual experiences scores were associated with slower DHEA night rise, and a higher cortisol/DHEA ratio upon waking and at night. However, these associations were significantly attenuated when we excluded women reporting bedtimes at least 30 min later than usual.

Conclusion

Observed associations were driven by those with late sleep schedules, and given the number of comparisons made, could be due to chance. Future research using larger, more diverse samples of individuals is needed to better understand the relationship between R/S and HPA axis biomarkers.

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We examined the influence of religion and spirituality on HPA-axis diurnal rhythms of cortisol, DHEA, and their ratio.

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Religious coping, religious struggles, and non-theistic DSES were associated with modest alterations in HPA axis rhythms.

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Observed associations were driven by those with late sleep schedules.

Introduce a New Intervention Model Based on Islamic Lifestyle for Decreasing the Risk of Cardiovascular Disease in People at Risk: A Comparative Study

The main purpose of the present study was designing and assessing the common lifestyle and Islamic lifestyle interventions and comparison of them. Sample of the study was thirty-nine subjects participated in a healthy lifestyle program. The Islamic group were received the Islamic healthy lifestyle program. In comparison with common, in the Islamic group the CVD risk was significantly lower; the psychological well-being was increased significantly; the psychological distress was decreased significantly; and the spiritual well-being was increased significantly. The most powerful element of Islamic lifestyle was to strengthen the spirituality that can positively affect the life.

The Effect of Spirituality on Mental Health Among Hypertensive Elderly People: A Cross-sectional Community-based Study

Introduction:

Elderly suffering from hypertension may also experience other psychological disorders in their daily life, such as depression and anxiety. Moreover, they use spiritual practices to relieve symptoms or comorbidities of hypertension. All these practices produce a calming effect on them.

Aim:

This study aims at investigating the relation between spirituality and mental health among older adults with hypertension and their sociodemographic characteristics.

Methods:

A descriptive, cross-sectional study was conducted in Greece. A questionnaire consisting of the sociodemographic characteristics, the FACIT-Sp-12 scale and the General Health Questionnaire-28 (GHQ-28) was completed by a total of 134 hypertensive elderly (≥65 years of age) persons. Descriptive and inferential statistical methods were used.

Results:

The sample consisted of 42,5% males and 57,5% females, aged 65 to 95 years, with a mean age of 78,38 years (SD= 6,68). A statistically significant correlation was found between FACIT-Sp-12 total score and the “physical discomfort (r=-0,562 p<0.001), “anxiety” (r=-0,735 p<0.001), “social disfunctioning” (r=-0,650 p<0.001), “depression” (r=-0,735 p<0.001) and the total score of GHQ-28 (r=-0,735 p<0.001). Specifically, the higher the total score of spirituality among older hypertensive adults the lower the rates of psychosomatic disorders and the total burden of mental health (and vice versa).

Conclusion:

Results showed that younger elderly, living in urban areas and not experiencing any other chronic health conditions, have higher levels of spirituality compared to older. Also, a negative correlation was found between spirituality and mental health.

Religiosity, Well-Being and 'Slowing Down' Ageing Damage: A Literature Review

Telomere length (TL) represents an important marker of cellular aging. Its shortening affects human health and longevity by inducing senescence, apoptosis, and oncogenesis. Advanced ageing and negative behavioral and lifestyle factors decrease TL. The relationship between positive psycho-social factors and longer telomeres has given rise to a growing number of research efforts. Among these, religiosity poses a particular interest since it is associated with a wide range of favorable health outcomes. In this direction, recent literature reports, suggest a positive link between religiosity and TL. Underlying mechanisms for this association are not yet clarified.

In this review, we would like to summarize the current knowledge on the link between religiosity and TL. Taking this opportunity, we recall findings from a cohort study in rural Crete, Greece that adds evidence on the discussion of potential psycho-social mediators which some may prevent shortening of TL.

Religiosity/Spirituality and Physiological Markers of Health

The long-standing interest in the effects of religiosity and spirituality (R/S) on health outcomes has given rise to a large and diverse literature. We conducted a meta-analysis on research involving R/S and physiological markers of health to elucidate both the scope and mechanism(s) of this phenomenon. A combined analysis found a significant, but small, beneficial effect. Subgroup analyses found that some measures of both extrinsic and intrinsic religiosity were significantly associated with health. Several outcome measures, including blood pressure, C-reactive protein, and cardiovascular health markers, were significantly associated with R/S. Our findings suggest that R/S benefits health, perhaps through minimizing the disruptive effects of stress/depression on inflammation. We hope that researchers can use these results to guide efforts aimed at elucidating the true mechanism(s) linking religious/spiritual beliefs and physical health.

[The influence of religiosity on depressive disorders and suicidal behavior]

This review of the literature is focused on the positive influence of religiosity on recovery after depression and on the protective role of religiosity against suicidal activity. Despite the inconsistent results on the role of religiosity in treatment of mental diseases, to date there is a sufficiently large body of literature showing the beneficial effect of religiosity and describing specific therapeutic approaches and suicide prevention programs.

Spirituality and satisfaction with physicians among hospitalized patients

We examined the relationship between a patient's spirituality and satisfaction with physicians during hospitalization. Data were collected using the Daily Spiritual Experience Scale (DSES), the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) and a five-question, internally-developed, patient satisfaction questionnaire (5QS). Scores were rescaled from 0 to 100 for easy comparison. Results showed a statistically significant increase in patient satisfaction with increasing spirituality. In the unadjusted model, each 1% increase in DSES score (or 1% decrease in spirituality) was associated with 0.21% (p < 0.001) and 0.14% (p = 0.002) decrease in patient satisfaction with physicians as measured by 5QS and TAISCH respectively. The results were consistent after adjustment for the patient's age, gender, and race. With the increasing influence, patient satisfaction scores have on the health care system, the results from this study help us better understand how these scores are influenced.

Sex differences in the association of psychosocial resources with prevalent type 2 diabetes among African Americans: The Jackson Heart Study

AIM

To examine the association of psychosocial resources with prevalent type 2 diabetes (T2D) in 5104 African American men and women.

METHODS

Using data from the Jackson Heart Study (JHS), we evaluated the cross-sectional associations of four psychosocial resources (social support, optimism, religiosity, and social networks) with T2D [fasting glucose ≥126 mg/dL, or HbA1c ≥ 6.5%, or use of diabetic medication]. Multivariable Poisson regression estimated prevalence ratios (PR, 95% confidence interval-CI) of T2D by each psychosocial measure, adjusting for demographics, SES, waist circumference, health behaviors, and depressive symptoms.

RESULTS

Women reported greater religiosity and had more social networks than men (p < 0.001). High (vs. low) social support was associated with a lower prevalence of T2D among men after full adjustment (PR 0.74, 95% CI 0.59-0.91). Women with high (vs. low) social networks had a 16% lower prevalence of T2D (PR 0.84, 95% CI 0.73-0.96) after full adjustment. High (vs. low) optimism was associated with a 20% lower prevalence of T2D after adjustment for age (PR 0.80, 95% CI 0.65-0.98). Religiosity was not associated with T2D.

CONCLUSION

Social support and networks should be considered in efforts to prevent T2D among a high-risk group such as African Americans.

Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011-2012

INTRODUCTION

Cardiovascular disease is the leading cause of death in the United States, and mortality rates are higher among African Americans than among people of other races/ethnicities. We aimed to understand how African American adults and adolescents conceptualize cardiovascular health and perceive related barriers and facilitators.

METHODS

This qualitative study was conducted as formative research for a larger study, Heart Healthy Lenoir, which aimed to reduce cardiovascular disease disparities among African Americans in eastern North Carolina, part of the widely-known "stroke belt" that runs through the southeastern United States. Using photovoice, a community-based participatory research method, we conducted eight 90-minute photovoice sessions with 6 adults and 9 adolescents in Lenoir County, North Carolina. Topics for each discussion were selected by participants and reflected themes related to cardiovascular health promotion. All sessions were transcribed and coded using a data-driven, inductive approach.

RESULTS

Participants conceptualized cardiovascular health to have mental, spiritual, and social health dimensions. Given these broad domains, participants acknowledged many ecological barriers to cardiovascular health; however, they also emphasized the importance of personal responsibility. Facilitators for cardiovascular health included using social health (eg, family/community relationships) and spiritual health dimensions (eg, understanding one's body and purpose) to improve health behaviors.

CONCLUSION

The perspectives of African American adults and adolescents elicited through this formative research provided a strong foundation for Heart Healthy Lenoir's ongoing engagement of community members in Lenoir County and development and implementation of its intervention to prevent cardiovascular disease.

Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project

BACKGROUND

Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/spirituality and sense of coherence with depression.

METHODS

A total number of 220 subjects of the SPILI III cohort (1988-2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was performed.

RESULTS

A significant inverse association was found between BDI and RFI-SRB scale (B-coef = -0.6999, p < 0.001), as well as among BDI and SOC scale (B-coef = -0.556, p < 0.001).

CONCLUSIONS

The findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly lower in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality on mental health.

Exploring the association of sense of coherence, and spiritual and religious beliefs in a rural population group on the island of Crete, Greece

OBJECTIVES/AIM

This article reports the results of an observation study, aimed at exploring an association between spirituality, religiousness, and sense of coherence in a population group residing in a rural area of Crete, Greece.

STUDY DESIGN AND METHODS

The study was conducted during the period 2007-2009. Subjects aged 65 years and older (n = 118) living in two remote and rural villages in the Heraklion county (Crete) were eligible. Eighty-nine people (51 women and 38 men) participated. Demographic data were obtained, and all participants were asked to complete the Greek version of the self-reported Royal Free Interview for Spiritual and Religious Beliefs, and the Sense of Coherence Scale.

RESULTS

Most participants reported strong religious beliefs and this was found to be related with increased age. Widowed participants expressed greater religiousness and spirituality (p = 0.029). The total score for Sense of Coherence was negatively correlated with gender (women have lower scores, p < 0.05), marital status (widows presented lower scores, p < 0.001), and increased age. A strong positive correlation of the Sense of Coherence score with the Spiritual Scale as measured by three questions of the Royal Free Interview was also identified (p = 0.039).

CONCLUSIONS

The impact of gender and marital status seem to be emerging determinants in defining sense of coherence among inhabitants of rural Crete. The positive association between religious/spiritual beliefs and sense of coherence deserves further attention to promote a multidimensional approach in its study.