View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression

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.

Leveraging family-based assets for Black men who have sex with men in House Ball Communities: Protocol for a cluster randomized controlled trial

Black men who have sex with men (MSM) continue to have the highest incidence of new human immunodeficiency virus (HIV) diagnoses in the United States but are least likely to be engaged in care or to be virally suppressed. Many Black MSM face multiple stigmas, but some have found refuge in the House Ball Community (HBC)-a national network of Black lesbian, gay, bisexual, and transgender kinship commitments that provide care-giving, affirmation, and survival skills-building for its members. We propose to modify a skills-building and HIV prevention best-evidence, group-level intervention for HIV- negative Black MSM (Many Men Many Voices) into a family-based intervention to focus on asset-building for both HIV-negative and HIV-positive Black MSM within HBC families. The adapted intervention will be re-branded as Our Family Our Voices (OFOV). We proposed a mixed-methods study to test the feasibility and preliminary efficacy of OFOV adapted for HIV status-neutral use with HBC families. First, we will develop the intervention protocol using the ADAPT-ITT model for modifying behavioral interventions. Then, we will conduct a cluster randomized controlled trial with six HBC families in New York City. Families will be randomized to the OFOV intervention or waitlist control arm. Primary outcomes will be HIV testing, HIV pre-exposure prophylaxis use, currently in HIV care and on HIV treatment. Secondary outcomes will be the number of family-based assets, resilience, number of sexual partners, and relative frequency of condomless anal intercourse. The results of the formative research, including the pilot trial, will contribute to the evidence-base regarding the development of HIV status-neutral interventions that respond to the diversity and complexities of HBC families and that recognize the importance of asset-building for facilitating HBC resilience to stigma as a part of the United States' domestic policy objective of ending the HIV epidemic by 2030.

Frequency of Private Prayer Predicts Survival Over 6 Years in a Nationwide U.S. Sample of Individuals with a Chronic Illness

Prayer is central to religious/spiritual life, and there are many claims for its effectiveness. However, few studies have examined whether frequency of prayer predicts survival in people with a chronic illness. This study follows a nationwide United States sample of people with a chronic illness (N = 1931) from 2014 to 2020. Those who prayed on a daily basis or more were significantly more likely to survive over 6 years (Hazard Ratio = 1.48; 95% Confidence Intervals: 1.08-2.03) compared with those who prayed less often, after controlling for biomedical variables (age, medical symptoms), sociodemographics (sex, race, and education), psychosocial variables (depression, social support), and health behaviors (alcohol use, smoking, exercise, and body mass index/weight).

Improving the quality of life of people living with HIV/AIDS: A cross-sectional study of the role of religion

Background

Previous studies have found religion as a useful tool in coping with chronic medical conditions including HIV/AIDS. Aim: This study assessed how religiosity and religious coping are associated with quality of life (QOL) among people living with HIV/AIDS (PLWHA).

Patients and Methods

This was a cross-sectional study of 140 HIV clinic attendees of a Nigerian tertiary health facility. Religiosity, religious coping and QOL were measured with religious orientation scale-revised (ROS-R), Brief Religious Coping (Brief RCOPE) and World Health Organization Quality of Life-Bref (WHOQOL-BREF), respectively. Correlation analysis assessed the relationship between ROS-R, Brief RCOPE and WHOQOL-BREF.

Results

: Intrinsic religiosity (IR) scores had a moderate positive correlation with psychological health domain of QOL (r = 0.4, N = 140, and P 0.001), and a weak positive correlation with physical health domain of QOL (r = 0.2, N = 140, and P 0.05). Extrinsic religiosity (ER) scores moderately correlated positively with the psychological health domain of QOL (r = 0.03, N = 140, and P 0.002), but weakly correlated positively with the physical health domain (r = 0.2, N = 140, and P 0.02). Positive religious coping (PRC) scores moderately correlated positively with the psychological health domain (r = 0.03, N = 140, and P 0.05) and weakly correlated positively with physical health domain of QOL (r = 0.2, N = 140, and P 0.02). Extrinsic religiosity social (ERS) scores had a moderate positive correlation with the social relationships domain (r = 0.4, N = 140, P 0.001).

Conclusion

Increased ER, IR orientations and Positive Religious Coping appear to improve the psychological and physical health domains ofQOL QOL Therefore, religiosity should be encouraged among PLWHA to improve QOL.

Coping with Mental Health Problems and Medication Adherence Challenges Among Persons Receiving Antiretroviral Therapy

Although several studies have investigated common mental disorders among persons living with HIV, few have explored how they cope with both a mental health condition and treatment adherence requirements. We conducted qualitative interviews with 20 South African antiretroviral treatment (ART) users living with a mental health condition, a sub-sample from a larger study, at a community clinic and a secondary hospital in the Western Cape of South Africa. The interviews were transcribed and analysed thematically. We found that participants used a range of coping methods to manage stressors pertaining to HIV, their mental health condition, and their environments. Participants used religion more frequently than any other way of coping. Both public and self-stigma challenged individuals and impacted HIV disclosure and social support seeking behaviour. Participants reported misconceptions held by themselves and others concerning mental health problems and HIV.

Praying for People You Know Predicts Survival over 17 Years Among People Living with HIV in the U.S

Most studies predicting the effects of prayer on health have examined intercessory prayer (prayers by others who often don't know you), yet most people pray for their own health and the health of others who they know. Our study, conducted in Miami, USA, differentiated praying for self, known others, and unknown others in people living with HIV, a virus with clearly defined biological markers of progression, enabling control for initial CD4-count and viral load. Only praying for known others predicted greater survival. People with HIV who prayed for known others were twice as likely to survive over 17 years compared to those who did not.

Fear of Punishment in Another World: a Follow-Up Examination of the Religious Beliefs About HIV/AIDS-A Decade of Progress?

This study compared 2000 and 2010 data on the religious beliefs about HIV/AIDS among those with HIV in a Deep South state. The percentage agreeing that HIV/AIDS is a punishment from God had not decreased in that decade. The literature on interventions to reduce religious stigma and increase church involvement in HIV/AIDS prevention was presented. The study concluded with a set of recommendations for future research.

Considering religion and spirituality in precision medicine

The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.

Mortality, Health, and Substance Abuse by Religious Attendance Among HIV Infected Patients from the Veterans Aging Cohort Study

Religion and spirituality have been associated with higher survival and improved biological markers among people living with HIV/AIDS (PLWH). Prior results have largely been among small cohort studies. We examined the association using a larger sample and longitudinal data from the Veterans Aging Cohort Study (VACS) years 2002-2012 (n = 3,685). Attending services at least monthly was associated with higher social support (80% vs 75%, p = 0.002), less unhealthy alcohol use (35% vs 39%, p = 0.006), less marijuana use in the past year (23% vs 32%, p < 0.001), less overall drug use within the past year (27% vs 31%, p = 0.01), and lower depression (20% vs 24%, p = 0.004). Attending services monthly was associated with a reduced mortality risk adjusting for age, race, gender, education, MSM, HCV, VL, CD4, and adherence to ARV (adjusted HazardRatio [aHR] = 0.89, 0.80-0.99). However, after controlling for smoking status, this association of mortality and religious attendance became non-significant (aHR = 0.93, 0.84-1.04).

What Do Adults With HIV Want? End-of-Life Care Goals, Values and Beliefs by Gender, Race, Sexual Orientation

OBJECTIVE

We examined factors influencing end-of-life care preferences among persons living with HIV (PLWH).

METHODS

223 PLWH were enrolled from 5 hospital-based clinics in Washington, DC. They completed an end-of-life care survey at baseline of the FACE™-HIV Advance Care Planning clinical trial.

FINDINGS

The average age of patients was 51 years. 56% were male, 66% heterosexual, and 86% African American. Two distinct groups of patients were identified with respect to end-of-life care preferences: (1) a Relational class (75%) who prioritized family and friends, comfort from church services, and comfort from persons at the end-of-life; and (2) a Transactional/Self-Determination class (25%) who prioritized honest answers from their doctors, and advance care plans over relationships. African Americans had 3x the odds of being in the Relational class versus the Transactional/Self-determination class, Odds ratio = 3.30 (95% CI, 1.09, 10.03), p = 0.035. Males were significantly less likely to be in the relational latent class, Odds ratio = 0.38 (CI, 0.15, 0.98), p = 0.045. Compared to non-African-Americans, African-American PLWH rated the following as important: only taking pain medicines when pain is severe, p = 0.0113; saving larger doses for worse pain, p = 0.0067; and dying in the hospital, p = 0.0285. PLWH who were sexual minorities were more afraid of dying alone, p = 0.0397, and less likely to only take pain medicines when pain is severe, p = 0.0091.

CONCLUSION

Integrating culturally-sensitive palliative care services as a component of the HIV care continuum may improve health equity and person-centered care.

Childhood Trauma and Experience in Close Relationships Are Associated with the God Image: Does Religiosity Make a Difference?

Religiosity and spirituality (R/S) and some of their specific aspects are associated with health. A negatively perceived relationship with God, which has adverse health outcomes, can be formed by human attachment both in childhood and adulthood. The aim of this study was to assess the associations of childhood trauma (CT) and experience in close relationships (ECR) with the God image in a secular environment by religiosity. A national representative sample of Czech adults (n = 1800, 51.1 ± 17.2 years; 43.5% men) participated in a survey. We measured CT (Childhood Trauma Questionnaire), ECR (Experiences in Close Relationships-Revised Questionnaire), image of God (questions from the 2005 Baylor Survey) and religiosity. Our results showed associations of CT and ECR with God images. Respondents who experienced CT were less likely to describe God as loving, always present and forgiving. Religious respondents were less likely to report positive God images with odds ratios (ORs) from 0.78 (0.66-0.94) to 0.95 (0.91-0.99), nonreligious respondents reported negative God images with ORs from 1.03 (1.00-1.06) to 1.22 (1.08-1.37). We found CT and problems in close relationships in adulthood are associated with a less positive God image, especially in nonreligious people. Understanding these associations may help prevent detrimental health outcomes.

Maintaining Health and Well-Being by Putting Faith into Action During the COVID-19 Pandemic

Anxiety and fear adversely affect the physiological systems that protect individuals from infection. This article comments on the role that religious faith and practice can play in helping individuals remain free from infection by the coronavirus and in helping to moderate the effects of infection if that should occur. The author provides six recommendations to help individuals maintain spiritual, mental, and physical resilience during these anxious times of the COVID-19 pandemic.

Increasing Opportunities for Spiritual and Religious Supports to Improve HIV-Related Outcomes for Black Sexual Minority Men

Given the importance of spirituality and religion in the lives of many Black gay, bisexual, and other Black sexual minority men (SMM) and the need for additional resources to improve HIV outcomes within this population, research on how spiritual and religious support can promote HIV prevention and treatment among Black SMM is greatly needed. We conducted nine focus groups with 52 spiritual and religious Black SMM in Baltimore, Maryland, to explore opportunities for HIV-related programming that incorporates spiritual and/or religious supports. Thematic analysis of the focus group transcripts was conducted using an iterative constant comparison coding process. Participants expressed a desire for more spiritual/religious support in non-church-based settings and identified the use of peer supports, inclusion of prayer and gospel music, and messaging related to the ideas that God is love, the Bible says to treat yourself preciously, and taking care of your health can strengthen your relationship with God as ways in which this could be incorporated into HIV-related programming. Participants living with HIV identified the message of "keeping the faith" as important for maintaining their HIV treatment plans. Participants also expressed a need for parental supports to improve HIV-related outcomes for Black SMM and potentially expand opportunities for spiritual and religious support to Black SMM within the church. Spirituality and religion can influence HIV outcomes for Black SMM, and the strategies identified by Black SMM in this study could aid in designing culturally congruent HIV prevention and treatment programs situated in the community.

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.

Religiosity and Mental Health: A Contribution to Understanding the Heterogeneity of Research Findings

Most studies report positive associations between religiosity and spirituality and aspects of mental health, while a small proportion report mixed or fully negative associations. The aim of this study was to assess the associations of religiosity measured more specifically, with mental health in a secular environment, using a nationally representative sample of Czech adults (n = 1795). We measured religious affiliation, conversion experience, non-religious attitudes and the stability of these attitudes, mental health problems, and anxiety levels. Compared to stable non-religious respondents, unstable non-religious and converted respondents who perceived God as distant were more likely to experience anxiety in close relationships, and had higher risks of worse mental health. Our findings support the idea that the heterogeneity of findings in associations between religiosity/spirituality and mental health could be due to measurement problems and variation in the degree of secularity. A shift towards religiosity could be expected to be seen in a substantial part of non-religious respondents in problematic times.

Religiousness, Spirituality, and Salivary Cortisol in Breast Cancer Survivorship: A Pilot Study

BACKGROUND

Psychoneuroimmunological theory suggests a physiological relationship exists between stress, psychosocial-behavioral factors, and neuroendocrine-immune outcomes; however, evidence has been limited.

OBJECTIVE

The primary aim of this pilot study was to determine feasibility and acceptability of a salivary cortisol self-collection protocol with a mail-back option for breast cancer survivors. A secondary aim was to examine relationships between religiousness/spirituality (R/S), perceptions of health, and diurnal salivary cortisol (DSC) as a proxy measure for neuroendocrine activity.

METHODS

This was an observational, cross-sectional study. Participants completed measures of R/S, perceptions of health, demographics, and DSC.

RESULTS

The sample was composed of female breast cancer survivors (n = 41). Self-collection of DSC using a mail-back option was feasible; validity of mailed salivary cortisol biospecimens was established. Positive spiritual beliefs were the only R/S variable associated with the peak cortisol awakening response (rs = 0.34, P = .03). Poorer physical health was inversely associated with positive spiritual experiences and private religious practices. Poorer mental health was inversely associated with spiritual coping and negative spiritual experiences.

CONCLUSIONS

Feasibility, validity, and acceptability of self-collected SDC biospecimens with an optional mail-back protocol (at moderate temperatures) were demonstrated. Positive spiritual beliefs were associated with neuroendocrine-mediated peak cortisol awakening response activity; however, additional research is recommended.

IMPLICATIONS FOR PRACTICE

Objective measures of DSC sampling that include enough collection time points to assess DSC parameters would increase the rigor of future DSC measurement. Breast cancer survivors may benefit from nursing care that includes spiritual assessment and therapeutic conversations that support positive spiritual beliefs.

Imams’ Experience With and Response to Mosque-Goers With OCD Scrupulosity

The experience of obsessive-compulsive disorder (OCD) symptoms that have a religious theme is common. Recent research has found that religious participants with religious OCD symptoms frequently turn to religious advisors, such as imams or clergy, for help to understand and alleviate their symptoms. As such, the advice provided by imams or clergy may have an important impact on the response of the person seeking help. This study examined the attitudes, beliefs and experiences of 64 Muslim imams with mosque-goers who had religious OCD symptoms, particularly scrupulosity. This study also examined imams’ familiarity with first-line psychological treatments for OCD such as Exposure and Response Prevention (ERP). Sunni imams from Australia and Shia imams from Iran completed an online survey based on the research of Deacon, Vincent, and Zhang (2012), which was conducted with Christian clergy in the United States. Results showed that the majority of imams were unfamiliar with scrupulosity as a possible symptom of a mental health problem, such as OCD, and with ERP as a recognised treatment for OCD. While 37% of participants reported having been approached by mosque-goers for help with scrupulosity, only 9% referred mosque-goers to mental health professionals, and only one imam reported having referred a mosque-goer for ERP. Sunni imams located in Australia were more likely to provide advice inconsistent with the ERP approach and were also significantly less likely than Shia imams located in Iran to recommend referral to a mental health professional who was not affiliated with their own religious denomination. Finally, Sunni imams had significantly higher scores than Shia imams on Thought Action Fusion (TAF) subscales. Results of multiple regression analysis revealed that TAF explained a considerable amount of the variance related to ERP-inconsistent advice. Research implications and limitations are discussed.

Advance Care Planning and HIV Symptoms in Adolescence

OBJECTIVES

To determine the effect of family-centered pediatric advance care planning (FACE pACP) on HIV-specific symptoms.

METHODS

In this single-blinded, randomized controlled trial conducted at 6 US hospital-based HIV clinics, 105 adolescent-family dyads, randomly assigned from July 2011 to June 2014, received 3 weekly sessions in either the FACE pACP arm ([1] pediatric advance care planning survey, [2] Respecting Choices interview, and [3] 5 Wishes directive) or the control arm ([1] developmental history, [2] safety tips, and [3] nutrition and exercise tips). The General Health Assessment for Children measured patient-reported HIV-specific symptoms. Latent class analyses clustered individual patients based on symptom patterns. Path analysis examined the mediating role of dyadic treatment congruence with respect to the intervention effect on symptom patterns.

RESULTS

Patients were a mean age of 17.8 years old, 54% male, and 93% African American. Latent class analysis identified 2 latent HIV-symptom classes at 12 months: higher symptoms and suffering (27%) and lower symptoms and suffering (73%). FACE pACP had a positive effect on dyadic treatment congruence (β = .65; 95% CI: 0.04 to 1.28), and higher treatment congruence had a negative effect on symptoms and suffering (β = -1.14; 95% CI: -2.55 to -0.24). Therefore, FACE pACP decreased the likelihood of symptoms and suffering through better dyadic treatment congruence (β = -.69; 95% CI: -2.14 to -0.006). Higher religiousness (β = 2.19; 95% CI: 0.22 to 4.70) predicted symptoms and suffering.

CONCLUSIONS

FACE pACP increased and maintained agreement about goals of care longitudinally, which lowered adolescents' physical symptoms and suffering, suggesting that early pACP is worthwhile.

HIV and religion in HIV-infected Asians and their families: A qualitative study

AIM

This paper examines HIV-infected Asian Americans' experiences with religion throughout the course of their illness and their family relationships.

BACKGROUND

As the number of Asians in the United States continues to grow, health professionals are beginning notice obvious gaps of knowledge in caring for this population, including HIV-infected individuals. Little is known about the impact of religion and faith on Asian Americans with HIV and their families. The study focuses on the participants' reported experiences to understand the variety of roles religion can play in the progression of a highly stigmatized chronic disease.

METHODS

An in-depth interview was conducted in San Francisco and New York City with 30 HIV-infected Asians. Narrative samples and summarized responses was used to highlight themes that emerged from the participants' anecdotes. Interpretive content analysis was employed.

RESULTS

These groups were categorized as (a) those who did not adhere to any religion, (b) those of tenuous religious faith with conflicted feelings, and (c) those of strong religious faith with congruent beliefs. Within these three groups, various themes were synthesized from the members' perceptions and past experiences with religion. Within each group, participants displayed various stages of reconciliation with their current faith-related beliefs and escape the family stress from their religion practices. Each participant's story shown the vast range of human understanding and faith experiences including self-actualization, acculturation, and depression.

CONCLUSIONS

This research provides new insight on the challenge of managing HIV-infected patients in a culturally and religiously appropriate manner.

Religion, Spirituality, and HIV Clinical Outcomes: A Systematic Review of the Literature

This systematic review evaluates the association between religion, spirituality and clinical outcomes in HIV-infected individuals. A systematic literature review was conducted for all English language articles published between 1980 and 2016 in relevant databases. Six hundred fourteen studies were evaluated. 15 met inclusion criteria. Ten (67%) studies reported a positive association between religion or spirituality and a clinical HIV outcome. Two (13%) studies failed to detect such an association; and two (13%) demonstrated a negative association. One study (7%) identified features of religiosity and spirituality that had both negative and positive associations with HIV clinical outcomes. Recognizing the religious or spiritual commitments of patients may serve as an important component of patient care. Further longitudinal studies and interventions might be required to further clarify the potential impact of religion and spirituality on HIV clinical outcomes.

Assessing the Relationships Among Forgiveness by God, God Images, and Death Anxiety

Previous research suggests that people who feel forgiven by God may experience lower levels of death anxiety. The purpose of the current study is to contribute to this work by assessing whether the relationship between forgiveness by God and death anxiety varies according to how people view God. Three images of God are assessed: a pantheistic view of God, a theistic view of God, and a deistic view of God. Data from nationwide survey that was conducted in 2014 (N = 2,650) suggest that the relationship between forgiveness by God and death anxiety is strongest among people with a theistic view of God, significantly weaker among people with a pantheistic view of God, and not significant among individuals with a deistic view of God. The findings point to the importance of taking views of God into account when assessing the relationship between forgiveness by God and death anxiety.

Does religiosity predict attrition from a culturally-informed family treatment for schizophrenia that targets religious coping?

OBJECTIVE

People dealing with serious mental illness frequently report turning to religion to help cope with the disorder. However, little is known about how religion impacts commitment to psychotherapy programs for people with schizophrenia and their caregivers.

METHOD

In a sample of 64 families enrolled in a culturally informed family treatment for schizophrenia that targets religiosity, we hypothesized that patients and caregivers who use high levels of adaptive religious coping and low levels of maladaptive religious coping, would be less likely to drop out of treatment than their counterparts.

RESULTS

In line with hypotheses, results demonstrated that greater maladaptive religious coping was associated with fewer family therapy sessions attended. Contrary to expectations, greater adaptive religious coping was also associated with attending fewer family therapy sessions.

CONCLUSION

Results suggest that any type of religious coping may be associated with higher levels of attrition from family therapy. Perhaps spiritual/religious people are already getting support and guidance from their beliefs and practices that aid them in coping with mental illness. Results may also suggest that there is a "religiosity gap" in which religious individuals perceive a disconnect between their beliefs and the beliefs of their mental health providers. It is important to point out that in this study, of those who dropped out prematurely, nearly all did so before the religiosity segment of treatment even began. Modifying how family treatments are introduced early on in therapy to ensure they appear congruent with the beliefs and values of religious families may help to reduce attrition. (PsycINFO Database Record

Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature

Much attention has been given to the relationship between religion/spirituality (R/S) and HIV in recent years, but comparatively little has been explored in regard to R/S and HIV testing, retention in care, and adherence to medication. Religious views concerning HIV risk behavior pose challenges to communication and education about sexual health in religious communities and may serve as barriers to HIV treatment and care. Conversely, religious coping and spiritual well-being, as well as social support could serve as facilitators to HIV treatment and care. This study aims to fill a gap in the literature by addressing the following questions: (1) what dimensions of R/S have been found to be factors associated with HIV outcomes?; (2) which R/S factors function as barriers or facilitators to care among people living with HIV (PLWH)?; and (3) which R/S factors, if any, vary across socio-demographic groups? Thirty-three empirical articles were identified for systematic review. Of the 33 empirical studies included, 24 studies found that at least one measure of R/S was associated with better adherence and clinical health outcomes. Twelve studies found at least one measure of R/S to be associated with poorer adherence and clinical health outcomes. Seven of the studies found at least one R/S measure to have no significant association with outcomes. Though all of the studies included in this review focused on R/S experiences of PLWH, there was very little consistency in regard to measurement of R/S. Studies in this review included a wide range of R/S measures, including beliefs, religious/spiritual practices, R/S coping, organizational religion, and many more. Of the 33 studies reviewed, only 9 focused on unique populations such as women, people with histories of substance abuse, immigrants, etc. Findings from this review highlight opportunities for more studies in various populations using standardized R/S measures.

The Daily Lives of People With HIV Infection: A Qualitative Study of the Control Group in an Expressive Writing Intervention

Emotional disclosure is an expressive writing technique used in psychotherapy to process traumatic and stressful life experiences. While emotional disclosure interventions frequently use control groups, there are few qualitative analyses of these control groups. Our study's purpose was to analyze the control essays written by HIV-infected informants about their daily activities in an augmented written emotional disclosure intervention. Latent and manifest qualitative content analyses revealed prevalent contextual themes within the data. The emergent themes were socioeconomic status (SES), self-care, religiosity/spirituality, and social support. Emotional disclosure control subjects contributed substantial findings in terms of SES, self-care, resiliency, religiosity/spirituality, and social support and altruism.

Spirituality and Religiousness are Associated With Fewer Depressive Symptoms in Individuals With Medical Conditions

BACKGROUND

The increased prevalence of depressive symptoms among adults diagnosed with chronic health issues has been largely documented.

OBJECTIVES

Research is needed to clarify the effect of religiousness/spirituality in relation to chronic health conditions and depression, to establish whether these variables can serve as protective factors.

METHODS

Self-report data from a nationwide study of spirituality and health were used. Individuals with at least 1 chronic illness (N = 1696) formed the subsample for this study. Religiousness/spirituality variables included frequency of church attendance, prayer, religious meaning, religious hope, general meaning, general hope, peace, and view of God. Other variables included depressive symptoms and demographics (age, gender, ethnicity, and education).

RESULTS

A series of hierarchical regression analyses revealed that chronic conditions were consistently associated with more depressive symptoms. Greater religiousness/spirituality was significantly associated with fewer depressive symptoms, contributing 16% of the variance above demographics and the number of chronic illnesses. The religiousness/spirituality variables conferring the greatest protection against depression were psychospiritual variables (general meaning and general hope, followed by peace). Also significant but making a smaller contribution to less depression were church attendance, religious meaning, religious hope, and positive view of God. Only prayer did not relate significantly to less depression.

CONCLUSION

Maintaining a sense of spirituality or religiousness can benefit well-being of individuals diagnosed with a chronic health condition, especially having meaning, maintaining hope, and having a sense of peace. Patients could potentially benefit from being offered the resources that support their spiritual/religious practices and beliefs as they cope with chronic illness.

Parochial prosocial religions: Historical and contemporary evidence for a cultural evolutionary process

In our response to the 27 commentaries, we refine the theoretical claims, clarify several misconceptions of our framework, and explore substantial disagreements. In doing so, we (1) show that our framework accommodates multiple historical scenarios; (2) debate the historical evidence, particularly about "pre-Axial" religions; (3) offer important details about cultural evolutionary theory; (4) clarify the term prosociality; and (4) discuss proximal mechanisms. We review many interesting extensions, amplifications, and qualifications of our approach made by the commentators.

Childhood Exposure to Religions With High Prevalence of Members Who Discourage Homosexuality Is Associated With Adult HIV Risk Behaviors and HIV Infection in Black Men Who Have Sex With Men

Exposure to childhood religious affiliations where the majority of members discourage homosexuality may have negative psychological impacts for Black men who have sex with men. This study tested the hypothesis that exposures to these environments during childhood were associated with adulthood human immunodeficiency virus (HIV)/sexually transmitted infection (STI) behavioral risk and HIV infection, because these exposures influenced HIV/STI risk by undermining race/sexual identity congruence and increasing internalized homophobia and interpersonal anxiety. Structural equation modeling as well as logistic and Poisson regressions were performed using baseline data from HIV Prevention Trials Network 061 ( N = 1,553). Childhood religion affiliations that were more discouraging of homosexuality were associated with increased likelihood of HIV infection; however, the association was no longer significant after adjusting for age, income, and education. Having a childhood religion affiliation with high prevalence of beliefs discouraging homosexuality was associated with increased numbers of sexual partners (adjusted odds ratio = 4.31; 95% confidence interval [3.76, 4.94], p < .01). The hypothesized path model was largely supported and accounted for 37% of the variance in HIV infection; however, interpersonal anxiety was not associated with HIV/STI risk behaviors. Structural interventions are needed that focus on developing affirming theologies in religious institutions with Black men who have sex with men congregants.

Proactive coping and spirituality among patients who left or remained in antiretroviral treatment in St Petersburg, Russian Federation

Positive Psychology, the study of "positive" factors or strengths and evidence-based interventions to increase them, is a rapidly developing field that is beginning to be applied to HIV care. Proactive coping and spirituality are two positive characteristics that have been examined in multiple chronic serious health conditions. In the present study, lost-to-care (LTCs; did not attend treatment for ≥12 months; n = 120) and engaged-in-care HIV clinic patients (EICs; attended treatment for ≥12 months and adherent with antiretrovirals; n = 120) in Leningrad Oblast, Russian Federation were compared on the Proactive Coping Inventory and View of God Scale. EICs had higher scores in proactive coping [t(229) = 3.69; p = .001] and instrumental [t(232) = 2.17; p = .03] and emotional [t(233) = 2.33; p = .02] support, indicating that they engage in autonomous goal setting and self-regulate their thoughts and behaviors; obtain advice and support from their social network; and cope with emotional distress by turning to others. LTCs had higher scores in avoidance coping [t(236) = -2.31; p = .02]. More EICs were spiritual, religious, or both [ χ(2)(1, N = 239) = 7.49, p = .006]. EICs were more likely to believe in God/Higher Power [χ(2)(1, N = 239 = 8.89, p = .002] and an afterlife [ χ(2)(1, N = 236) = 5.11, p = .024]; have a relationship with God/Higher Power [ χ(2)(1, N = 237) = 12.76, p = .000]; and call on God/Higher Power for help, healing, or protection [ χ(2)(1, N = 239) = 9.61]. EICs had more positive [t(238) = 2.78; p = .006] and less negative [t(236) = -2.38; p = .002] views of God. Similar proportions, but slightly more EICs than LTCs were members of a faith community; members of a12-step group; or attended religious or spiritual services, meetings, or activities. More EICs than LTCs engaged in private spiritual or religious activities, such as prayer or meditation [ χ(2)(1, N = 239) = 9.226, p = .002].

Benevolent Images of God, Gratitude, and Physical Health Status

This study has two goals. The first is to assess whether a benevolent image of God is associated with better physical health. The second goal is to examine the aspects of congregational life that is associated with a benevolent image of God. Data from a new nationwide survey (N = 1774) are used to test the following core hypotheses: (1) people who attend worship services more often and individuals who receive more spiritual support from fellow church members (i.e., informal assistance that is intended to increase the religious beliefs and behaviors of the recipient) will have more benevolent images of God, (2) individuals who believe that God is benevolent will feel more grateful to God, (3) study participants who are more grateful to God will be more hopeful about the future, and (4) greater hope will be associated with better health. The data provide support for each of these relationships.

FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

Perspectives of the Breast Cancer Survivorship Continuum: Diagnosis through 30 Months Post-Treatment

This study explored breast cancer survivors' perspectives regarding their experiences of the survivorship continuum from diagnosis through 30 months post-treatment. The sample included women (N = 379) with newly-diagnosed breast cancer undergoing treatment at a Midwestern university-affiliated cancer center. Semi-structured interviews were conducted using the Lymphedema and Breast Cancer Questionnaire at time of diagnosis, post-operatively, quarterly during the first year, and then semi-annually thereafter through 30 months post-treatment. A mixed-methodology was used to analyze participants' comments. Themes central to long-term survivorship experiences included social support, positive worldviews, breast cancer and lymphedema health literacy, religious/spiritual beliefs, self-empowerment, and recovery expectations. These themes were consistent with a psychoneuroimmunological model of health in which psychosocial variables mediate stress and influence health outcomes. Qualitative data showed that social support and positive worldviews were the two themes with the most significant impact on long-term breast cancer survivorship experiences. Survivors expressed a need to advance their health care literacy in order to share ownership of breast cancer and lymphedema treatment decisions. Since breast cancer is an immune-mediated disease, long-term survivorship planning should address psychosocial factors that influence the long-term psychological distress associated with immune dysfunction.

In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits? Insights from a Multiple Case Analysis

This study sought to understand the context in which Psycho-Spiritual Integrative Therapy (PSIT), a group intervention, promotes varying degrees of spiritual growth and quality of life change in breast cancer survivors. A secondary aim was to explore the relationship between spiritual well-being (SWB) and Quality of Life (QL) in PSIT participants. A qualitative, multiple case analysis was undertaken to examine the experiences of two participants with the highest change scores on the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale-Expanded Version (FACIT-Sp-Ex) and two participants with among the lowest change scores on this measure. The participant factors thought to contribute to SWB and QL changes included utilization of metacognitive psychological skills and spiritual/religious frameworks, while PSIT factors included application of PSIT core intervention components, cognitive restructuring, group dynamics, and the role of the facilitator. The nature and extent of participant use of spiritual practices appeared to shape the relationship between SWB and OL. The findings suggest directions for future research to investigate potential moderators and mediators of treatment efficacy of PSIT specifically, as well as other psycho-spiritual interventions for cancer survivors more generally.

RSAS-3: validation of a very brief measure of Religious Commitment for use in health research

Religious Commitment is a construct known to be predictive of various health-related factors of importance to researchers. However, data collection efficiency and instrument brevity in healthcare settings are priorities regardless of the construct being measured. Brief, valid instruments are particularly valuable in health research and will be vital for testing mechanisms by which health may be improved or maintained. This series of studies aims to demonstrate that Religious Commitment can be validly measured with a very brief instrument, the Religious Surrender & Attendance Scale-3 (RSAS-3), which combines a 2-item measure of Surrender, a specific type of religious coping, with a 1-item measure of Attendance at religious services. Three studies are reported, two utilizing undergraduate university students (Ns = 964 and 466) and one utilizing a clinical-based pregnant population (N = 320), all in southern Appalachia. The original 12-item Surrender Scale, a 2-item subset of Surrender items, and Attendance were found to be highly positively correlated with each other and with Intrinsic Religiosity, an additional measure of Religious Commitment employed to demonstrate concurrent validity. Religiosity variables were found to be strongly negatively correlated with Anxiety and stress, which were the health outcomes of interest. Hierarchical multiple regression analysis was used to confirm the similarity of Anxiety and stress prediction using the 12-item and 2-item Surrender measures and to confirm the superior stress prediction of the 3-item instrument RSAS-3. The RSAS-3 is recommended as a measure of Religious Commitment in future health research.

Spiritual coping predicts CD4-cell preservation and undetectable viral load over four years

In this study of 177 people living with HIV, we examined if spiritual coping leads to slower HIV disease progression (CD4 cells, viral load [VL]), and more positive health behaviors (adherence, safer sex, less substance use). Prior research suggests that physicians' assessment of spiritual coping can be an interventional aid in promoting positive spiritual coping. Longitudinal spiritual coping was rated using qualitative content analysis of six-monthly interviews/essays. Positive spiritual coping (65%) was predominant over negative (7%), whereas 28% did not make significant use of spirituality as a means to cope. Spiritual coping was associated with less substance use disorder but not with less sexual risk behavior. Hierarchical linear modeling demonstrated that spiritual coping predicted sustained undetectable VL and CD4-cell preservation over four years, independent of sociodemographics, baseline disease status, and substance use disorder. Achieving undetectable VL significantly increased over time in participants with positive spiritual coping but decreased among those with negative spiritual coping. For every participant with positive spiritual coping achieving undetectable VL, four with negative spiritual coping reported with detectable/transmittable HIV. Notably, even when controlling for the effect of VL suppression, CD4-cell decline was 2.25 times faster among those engaged in negative versus positive spiritual coping. In conclusion, spiritual coping is associated with positive health behaviors, such as maintaining long-term VL suppression and less onset/relapse of substance use disorder over time. Among those who are sexually active, positive spiritual coping reduces the risk of HIV transmission via VL suppression but may not prevent the transmission of other STDs because spiritual coping is not related to safer sexual behavior. Notably, the association between spiritual coping and immune preservation was direct (i.e., not explained by VL suppression), suggesting potential psychoneuroimmunological pathways. Thus, assessment of spiritual coping may be an important area of intervention to achieve undetectable VL, reduce HIV disease progression, and prevent substance use onset/relapse.

Spirituality and optimism: a holistic approach to component-based, self-management treatment for HIV

For people living with HIV (PLWH), spirituality and optimism have a positive influence on their health, can slow HIV disease progression, and can improve quality of life. Our aim was to describe longitudinal changes in spirituality and optimism after participation in the SystemCHANGE™-HIV intervention. Upon completion of the intervention, participants experienced an 11.5 point increase in overall spiritual well-being (p = 0.036), a 6.3 point increase in religious well-being (p = 0.030), a 4.8 point increase in existential well-being (p = 0.125), and a 0.8 point increase in total optimism (p = 0.268) relative to controls. Our data suggest a group-based self-management intervention increases spiritual well-being in PLWH.

Spirituality and religion among HIV-infected individuals

Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon, which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of-the-art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention.

Spiritual well-being among HIV-infected adolescents and their families

Congruence in spirituality between HIV+ adolescent (n = 40)/family (n = 40) dyads and psychological adjustment and quality of life were assessed, using the Spiritual Well-Being Scale of the Functional Assessment of Chronic Illness Therapy, Beck Depression Inventory-II, Beck Anxiety Inventory and Pediatric Quality of Life Inventory at baseline and 3-month post-intervention. Adolescents were 60 % female and 92 % African American. Congruence in spirituality between adolescent/surrogate dyads remained unchanged at 3 months. High congruence existed for "having a reason for living"; rejection of "life lacks meaning/purpose" and "HIV is a punishment from God." Adolescents were less likely to forgive the harm others caused them than their families.

Spiritual struggle and affective symptoms among geriatric mood disordered patients

OBJECTIVES

We explored relationships between general religiousness, positive religious coping, negative religious coping (spiritual struggle), and affective symptoms among geriatric mood disordered outpatients, in the northeastern USA.

METHODS

We assessed for general religiousness (religious affiliation, belief in God, and private and public religious activity) and positive/negative religious coping, alongside interview and self-report measures of affective functioning in a diagnostically heterogeneous sample of n = 34 geriatric mood disordered outpatients (n = 16 bipolar and n = 18 major depressive) at a psychiatric hospital in eastern Massachusetts.

RESULTS

Except for a modest correlation between private prayer and lower Geriatric Depression Scale scores, general religious factors (belief in God, public religious activity, and religious affiliation) as well as positive religious coping were unrelated to affective symptoms after correcting for multiple comparisons and controlling for significant covariates. However, a large effect of spiritual struggle was observed on greater symptom levels (up to 19.4% shared variance). Further, mean levels of spiritual struggle and its observed effects on symptoms were equivalent irrespective of religious affiliation, belief, and private and public religious activity.

CONCLUSIONS

Previously observed effects of general religiousness on (less) depression among geriatric mood disordered patients may be less pronounced in less religious areas of the USA. However, spiritual struggle appears to be a common and important risk factor for depressive symptoms, regardless of patients' general level of religiousness. Further research on spiritual struggle is warranted among geriatric mood disordered patients.

Longitudinal spiritual coping with trauma in people with HIV: implications for health care

This 10-year study (N=177) examines how people with HIV use spirituality to cope with life's trauma on top of HIV-related stress (e.g., facing death, stigma, poverty, limited healthcare) usual events. Spirituality, defined as a connection to a higher presence, is independent from religion (institutionalized spirituality). As a dynamic adaptive process, coping requires longitudinal studying. Qualitative content-analysis of interviews/essays yielded a coding of specific aspects and a longitudinal rating of overall spiritual coping. Most participants were rated as spiritual, using spiritual practices, about half experienced comfort, empowerment, growth/transformation, gratitude, less than one-third meaning, community, and positive reframing. Up to one-fifth perceived spiritual conflict, struggle, or anger, triggering post-traumatic stress, which sometimes converted into positive growth/transformation later. Over time, 65% used spiritual coping positively, 7% negatively, and 28% had no significant use. Spirituality was mainly beneficial for women, heterosexuals, and African Americans (p<0.05). Results suggest that spirituality is a major source of positive and occasionally negative coping (e.g., viewing HIV as sin). We discuss how clinicians can recognize and prevent when spirituality is creating distress and barriers to HIV treatment, adding a literature review on ways of effective spiritual assessment. Spirituality may be a beneficial component of coping with trauma, considering socio-cultural contexts.

Religious coping among psychotic patients: relevance to suicidality and treatment outcomes

Religious coping is very common among individuals with psychosis, however its relevance to symptoms and treatment outcomes remains unclear. We conducted a prospective study in a clinical sample of n=47 psychiatric patients with current/past psychosis receiving partial (day) treatment at McLean Hospital. Subjects completed measures of religious involvement, religious coping and suicidality prior to treatment, and we assessed for psychosis, depression, anxiety and psychological well-being over the course of treatment. Negative religious coping (spiritual struggle) was associated with substantially greater frequency and intensity of suicidal ideation, as well as greater depression, anxiety, and less well-being prior to treatment (accounting for 9.0-46.2% of the variance in these variables). Positive religious coping was associated with significantly greater reductions in depression and anxiety, and increases in well-being over the course of treatment (accounting for 13.7-36.0% of the variance in change scores). Effects remained significant after controlling for significant covariates. Negative religious coping appears to be a risk factor for suicidality and affective symptoms among psychotic patients. Positive religious coping is an important resource to this population, and its utilization appears to be associated with better treatment outcomes.

Compassionate Love as a Predictor of Reduced HIV Disease Progression and Transmission Risk

Objectives. This study examined if compassionate love (CL) predicts HIV disease progression and transmission risk. Scientific study of CL emerged with Underwood's working model of other-centered CL, defining five criteria: free choice, cognitive understanding, valuing/empowering, openness/receptivity for spirituality, and response of the heart. Method. This 10-year cohort study collected 6-monthly interviews/essays on coping with HIV and trauma of 177 people with HIV in South Florida. Secondary qualitative content analysis on other-centered CL inductively added the component of CL towards self. Deductively, we coded the presence of the five criteria of CL and rated the benefit of CL for the recipient on a 6-point Likert scale. Growth-curve modeling (reduced to 4 years due to cohort effects) investigated if CL predicts CD4 slope (HIV disease progression) and cumulative viral load detection (transmission risk). Results. Valuing/empowering and cognitive understanding were the essential criteria for CL to confer long-term benefits. CL had a higher benefit for recipients if given out of free choice. High scores of CL towards self were reciprocal with receiving (93%) and giving (77%) other-centered CL. Conversely, those rated low on CL towards self were least likely to score high on receiving (38%) and giving (49%) other-centered CL. Growth-curve modeling showed that CL towards self predicted 4-year cumulative undetectable viral load (independent from sociocultural differences, substance use disorder, baseline CD4 and viral load). Those high versus low on CL self were 2.25 times more likely to have undetectable viral load at baseline and 1.49 times more likely to maintain undetectable viral load over time. CL towards self predicted CD4 preservation after controlling for differences in CL giving. Conclusions. CL towards self is potentially the seed of being expressive and receptive of CL. Health care professionals prepared to walk the extra mile for those who neglect and isolate themselves may break a vicious circle since those lacking CL self were least likely to receive CL from others. Future studies should examine whether any enhancement of CL towards self may translate into slower disease progression and reduction of transmission risk.

How have long-term survivors coped with living with HIV?

With advances in HIV treatment, more individuals have grown older with the disease. Little is known about factors that have helped these survivors manage everyday life with HIV. In this exploratory, qualitative study, we asked, "What has helped survivors cope with challenges of living long term with HIV?" Participants were recruited from a convenience sample of persons living with HIV who obtained treatment at a specialty HIV clinic; 16 long-term survivors of HIV were interviewed. Mean age was 50.13 (SD = 8.30) years; mean time from diagnosis was 16.75 (SD = 5.98) years. Results were broadly dichotomized as coping mechanisms and social supports. Three themes characterized coping mechanisms: disease coping, practical coping, and emotional coping. Social supports included themes of family, friends, professionals, peer groups, and pets. In particular, the power of patient-professional relationships and meanings derived from religion/spirituality were considered by a majority of participants to be influential factors.

Religion, spirituality, and health: the research and clinical implications

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.