Theory in religion, aging, and health: an overview

Nothingness, Oneness, and Infinity: Transcendent Experience as a Promising Frontier for Religion and Health Research

This paper advocates for a renewed focus into the experiential domain of religious and spiritual expression in research on physical and mental health. Most studies, up to now, have investigated risk or protection associated with behavioral measures of religiousness, whether public behaviors such as religious attendance or private behaviors such as personal prayer. Religious attitudes, beliefs, and identity have been studied, as well, as have religious self-rating scales of various types, but, relatively less emphasized have been subjective experiences, such as feelings of transcendence or unitive connection with the divine. There is good reason to believe that such experiences may impact on well-being, based both on previous studies and on theory and clinical observation. This paper suggests that although researching the domain of such seemingly ineffable experiences may present certain conceptual and methodological challenges, these would be worth facing in order to gain deeper insight into the human spiritual dimension and into connections among body, mind, and spirit.

Measuring Spiritual Needs in a Secular Society: Validation and Clinimetric Properties of the Danish 20-Item Spiritual Needs Questionnaire

In secular cultures, such as Denmark, tools to measure spiritual needs are warranted to guide existential and spiritual care. We examined the clinimetric properties of the Danish version of the Spiritual Needs Questionnaire (DA-SpNQ-20) based on a digital survey in a test-retest setup. A convenience sample was reached via social media and student platforms. A total of 325 (148 for retest) respondents were included in the analysis. The sample was randomly split into two groups (A and B) and used for exploratory (EFA) and confirmatory factor analysis (CFA) by structural equation modeling, respectively. SpNQ dimensions had an internal consistency with Cronbach's alpha between 0.73 and 0.93. The four factors of the SpNQ were supported by both EFA and CFA as follows: religious needs, existential needs, inner peace needs, and generativity needs. The instrument showed good internal consistency, good test-retest reliability, and acceptable structural validity in the sample of relatively young and healthy persons.

Meanings of "the existential" in a Secular Country: A Survey Study

"The existential" is a concept that many people use albeit associated with different meanings. In order to increase research-based insight into the meaning of "the existential," we conducted a questionnaire study in Denmark in 2018 in which we asked 1.106 Danes of various age, gender, educational and geographical background about personal associations linked to "the existential." Factor analysis of the answers resulted in three different groups of meaning: (1) essential meanings of life, (2) spirituality/religiosity and (3) existential thinking. The findings show that "the existential" serves well as an overarching construct potentially including secular, spiritual and religious meaning domains, at least within the European context.

Protocol for EXICODE: the EXIstential health COhort DEnmark-a register and survey study of adult Danes

INTRODUCTION

We established the EXIstential health COhort DEnmark (EXICODE) to examine how existential and spiritual needs, practices and orientations in a secular culture are linked to health outcomes, illness trajectory and overall cost of care in patients. Substantial literature demonstrates that existential and spiritual well-being has positive effects on health. While people turn to existential and spiritual orientations and practices during ageing, struggle with illness and approaching death, patients with severe illnesses like, for example, cancer similarly experience existential and spiritual needs. These needs are often unmet in secular societies leading to spiritual pain, unnecessary suffering, worse quality of life and higher medical costs of care.

METHODS AND ANALYSIS

EXICODE is a national cohort comprising a 10% random sample of the adult Danish population with individual-level register and survey data. Specific patient subgroups are oversampled to ensure diseased respondents. The questionnaire used in the survey consists of a collection of validated instruments on existential and spiritual constructs suited for secular culture as well as some ad hoc questions compiled in the comprehensive EXICODE Questionnaire.

ETHICS AND DISSEMINATION

The project is registered for legal and GDPR concerns by the University of Southern Denmark, journal number: 10.367. Ethical approval was not required by Danish law since EXICODE collects only interview, survey and register data, but due to institutional best-practice policy an ethical evaluation and approval were nevertheless obtained from the University of Southern Denmark Research Ethics Committee (institutional review board), journal number: 20/39546. The project follows The Danish Code of Conduct for Research Integrity and is carried out in accordance with the Helsinki Declaration. Results will be disseminated widely through publications in peer-reviewed scientific journals, international conferences, patient societies as well as mass and social media.

The Mediating Effect of Religiousness in the Relationship Between Psychological Resilience and Fear of COVID-19 in Turkey

The purpose of this study was to examine if religiousness has a mediation influence on the link between psychological resilience and fear of COVID-19. Data were collected from 372 participants by using the convenience sampling method. There is a positive significant relationship between psychological resilience and religiousness, a negative significant relationship between religiousness and fear of COVID-19, a negative significant relationship between psychological resilience and a fear of COVID-19. This study was tested with structural equation modeling and bootstrapping was applied. Significant relationships were found between psychological resilience, fear of COVID-19 and religiousness. In addition, it was found that religiousness had a mediating effect on the relationship between psychological resilience and fear of COVID-19. These results suggest that the inverse relationship between psychological resilience and fear of COVID-19 is at least partly explained by level of religiousness.

Latent Profile Analysis to Survey Positive Mental Health and Well-Being: A Pilot Investigation Insight Tunisian Facebook Users

BACKGROUND

To examine mental health during COVID-19 peaks, lockdown, and times of curfew, many studies have used the LPA/LCA person-centered approach to uncover and explore unobserved groups. However, the majority of research has focused only on negative psychological concepts to explain mental health. In this paper, we take another perspective to explore mental health. In addition, the study focuses on a period of peak decline in the COVID-19 pandemic.

OBJECTIVE

The present paper aim (a) empirically identifies different profiles among a cohort of Facebook users in Tunisia based on positive factors of mental health using a person-centered approach, (b) outline identified profiles across sociodemographic, internet use, and physical activity, and (c) establish predictors of these profiles.

METHODS

Cross-sectional data were collected through an online survey among 950 Facebook users were female (n = 499; 52.53%) and male (n = 451; 47.47) with an average age =31.30 ± 9.42. Subjects filled Arabic version of Satisfaction with Life Scale, Scale of Happiness (SWLS), Gratitude Questionnaire (GQ-6), International Physical Activity Questionnaire (IPAQ), and the Spirituel Well-Being Scale (SWBS).

RESULTS

The LPA results revealed three clusters. The first cluster (n = 489, 51,47%) contains individuals who have low scores on the positive psychology scales. The second cluster (n = 357, 37,58%) contained individuals with moderate positive psychology scores. However, a third cluster (n = 104, 10,95%) had high positive psychology scores. The selected variables in the model were put to a comparison test to ensure that the classification solution was adequate. Subsequently, the clusters were compared for the variables of socio-demographics, use of the internet for entertainment and physical activity, the results showed significant differences for gender (low mental well-being for the female gender), socio-economic level (low for the low-income class), and physical activity (low mental well-being for the non-exerciser). However, no significant differences were found for the variables age, location, and use of the Internet for entertainment.

CONCLUSION

Our results complement person-centered studies (LPA/LCA) related to the COVID-19 pandemic and can serve researchers and mental health practitioners in both diagnostic and intervention phases for the public. In addition, the GQ6 scale is a valid and reliable tool that can be administered to measure gratitude for culturally similar populations.

Religious Service Attendance and Mortality among Adults in the United States with Chronic Kidney Disease

Religion and related institutions have resources to help individuals cope with chronic conditions, such as chronic kidney disease (CKD). The purpose of this investigation is to examine the association between religious service attendance and mortality for adults with CKD. Data were drawn from NHANES III linked to the 2015 public use Mortality File to analyze a sample of adults (n = 3558) who had CKD as defined by a single value of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and/or albumin-to-creatinine ratio ≥17 mg/g for males or ≥25 for females. All-cause mortality was the primary outcome and religious service attendance was the primary independent variable. Cox proportional hazards models were estimated to determine the association between religious service attendance and mortality. The mortality risks for participants who attended a service at least once per week were 21% lower than their peers with CKD who did not attend a religious service at all (HR 0.79; CI 0.64–0.98). The association between religious service attendance and mortality in adults with CKD suggest that prospective studies are needed to examine the influence of faith-related behaviors on clinical outcomes in patients with CKD.

COVID-19 Amongst the Ultra-Orthodox Population in Israel: An Inside Look into the Causes of the High Morbidity Rates

The current paper focuses on the circumstances that have led to the high COVID-19 infection rates amongst the ultra-Orthodox population in Israel. The current study utilizes a qualitative design and is based on in-depth interviews, email correspondence and online records of 25 ultra-Orthodox individuals who either tested positive for COVID-19 or had contact with a verified COVID-19 patient. The data were analyzed through identification of main themes and an interpretation of their meanings. The findings showed that a wide range of causes led to the high infection rate, including aspects that derive from a structural element, a religious element and a social-ideological element—all of which are directly or indirectly connected to religion. These findings demonstrate the central role of religion in health outcomes among the ultra-Orthodox community in general and during pandemics in particular, and they shed light on the central role of religion in health outcomes among closed-religious communities. The findings further reveal the importance of cooperation between the state authorities and the religious ones, and of providing culturally adapted health service solutions in the fight against COVID-19 and promoting health more generally. Study limitations are discussed and recommendations for future research are provided.

The Use of Prayer During Life-Threatening Illness: A Connectedness to God, Inner-Self, and Others

To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.

Dimensions of Religious Involvement Represent Positive Pathways in Cognitive Aging

Older Black and Hispanic adults report more religious involvement, and religious involvement has been linked to better cognition. This study examined which aspects of religious involvement are associated with better longitudinal episodic memory and whether religious involvement offsets racial and ethnic inequalities in episodic memory. Using Health and Retirement Study data (N = 16,069), latent growth curves estimated independent indirect pathways between race and ethnicity and 6-year memory trajectories through religious attendance, private prayer, and religious belief, controlling for nonreligious social participation, depressive symptoms, chronic health diseases, age, education, and wealth. Negative direct effects of Black race and Hispanic ethnicity on memory were partially offset by positive indirect pathways through more private prayer and religious attendance. While results were significant for memory intercept and not subsequent memory change, religious attendance and private prayer were independently associated with better cognitive health among diverse older adults. Findings may inform culturally relevant intervention development to promote successful aging and reduce older adults' cognitive morbidity.

Religiosity and health: A global comparative study

The objective of this paper is to understand global connections between indicators of religiosity and health and how these differ cross-nationally. Data are from World Values Surveys (93 countries, N=121,770). Health is based on a self-assessed question about overall health. First, country-specific regressions are examined to determine the association separately in each country. Next, country-level variables and cross-level interactions are added to multilevel models to assess whether and how context affects health and religiosity slopes. Results indicate enormous variation in associations between religiosity and health across countries and religiosity indicators. Significant positive associations between all religiosity measures and health exist in only three countries (Georgia, South Africa, and USA); negative associations in only two (Slovenia and Tunisia). Macro-level variables explain some of this divergence. Greater participation in religious activity relates to better health in countries characterized as being religiously diverse. The importance in god and pondering life's meaning is more likely associated with better health in countries with low levels of the Human Development Index. Pondering life's meaning more likely associates with better health in countries that place more stringent restrictions on religious practice. Religiosity is less likely to be related to good health in communist and former communist countries of Asia and Eastern Europe. In conclusion, the association between religiosity and health is complex, being partly shaped by geopolitical and macro psychosocial contexts.

The discourse on faith and medicine: a tale of two literatures

Research and writing at the intersection of faith and medicine by now include thousands of published studies, review articles, books, chapters, and essays. Yet this emerging field has been described, from within, as disheveled on account of imprecision and lack of careful attention to conceptual and theoretical concerns. An important source of confusion is the fact that scholarship in this field constitutes two distinct literatures, or rather meta-literatures, which can be termed (a) faith as a problematic for medicine and (b) medicine as a problematic for faith. These categories represent distinct theoretical lenses for viewing the intersection of faith and medicine. Observations about these two approaches are offered, along with insights about why the discourse on faith and medicine should become better integrated into discussions of religion and science.

Psychometric Evaluation of the Filipino Versions of the Duke University Religion Index and the Spiritual Coping Strategies Scale in Filipino Hemodialysis Patients

This study evaluated the psychometric properties of the Filipino versions of the Duke University Religion Index (DUREL-F) and the Spiritual Coping Strategies scale (SCS-F) for hemodialysis (HD) patients in the Philippines. A convenient sample of 162 HD patients was included in this descriptive, cross-sectional study. The DUREL-F and SCS-F exhibited acceptable internal consistency and stability reliability, as well as excellent content and construct validity. The findings confirmed the soundness of the psychometric properties of the two scales. Thus, they can be used for timely and accurate assessment of religiosity and spiritual coping utilization among Filipino patients receiving HD.

Positive ageing perceptions among migrant Turkish and native Dutch older people: a matter of culture or resources?

Background

This study examined ethnic differences in ageing perceptions of migrant Turkish and native Dutch elders residing in Rotterdam, and explored whether such differences could be attributed to culture or resources (personal, physical, economic and/or social).

Methods

This study was based on combined data from two research projects focusing on the health and well-being of community-dwelling elderly people in Rotterdam. The first dataset contained data from 994 native Dutch elders aged 70–99 years. The Rotterdam municipal register was used to randomly sample respondents, stratified by age group (70–74, 75–79, 80–84, and ≥85 years) and neighbourhood. Of the 2593 eligible respondents, 1075 returned filled-in questionnaires (41% response rate). Of these 1075 respondents a total of 994 were natives which is the sample we selected for the current study. The second dataset contained data from 680 Turkish migrants aged 65–90 years. All Turkish people aged ≥65 years were identified using the Rotterdam municipal register and invited to participate. In total, 680 Turkish respondents returned filled-in questionnaires (32% response rate; out of 2350).

Ageing perceptions were measured using the 21-item Ageing Perceptions Questionnaire–Short (APQ-S). Respondents were additionally asked about their current general health, income, education, marital status, age and gender.

Results

The results of this study clearly reveal the importance of culture for all ageing perceptions among Turkish and Dutch elders. We found that age, health, and education were also important factors. For Turkish elders, health and education were the most important resources; for Dutch elders, age and health were most important in relation to ageing perceptions. Ageing perceptions were generally more negative among Turkish than among Dutch elders. Turkish elders reported more negative awareness of ageing, felt less in control of their ageing processes, and had more negative emotional reactions to ageing. They also believed more firmly that their ageing processes would have both negative and positive effects on their lives. Results revealed poorer health, lower income and educational levels among Turkish than among Dutch elders. In addition, many more Dutch than Turkish elders were single/widowed/divorced.

Conclusion

Physical and personal resources, in addition to culture, are most important for positive ageing perceptions among native Dutch and migrant Turkish elders residing in Rotterdam, the Netherlands. These resources are health and education for Turkish elders, and health and age for Dutch elders. Overall, ethnicity remained a significant predictor of ageing perceptions when other resources were taken into account.

Faith Moves Mountains-Mountains Move Faith: Two Opposite Epidemiological Forces in Research on Religion and Health

Research suggests opposite epidemiological forces in religion and health: (1). Faith seems to move mountains in the sense that religion is associated with positive health outcomes. (2). Mountains of bad health seem to move faith. We reflected on these forces in a population of 3000 young Danish twins in which all religiosity measures were associated with severe disease. We believe the reason for this novel finding is that the sample presents as a particularly secular population-based study and that the second epidemiological force has gained the upper hand in this sample. We suggest that all cross-sectional research on religion and health should be interpreted in light of such opposite epidemiological forces potentially diluting each other.

"For They Knew Not What It Was": Rethinking the Tacit Narrative History of Religion and Health Research

Over the past couple of decades, research on religion and health has grown into a thriving field. Misperceptions about the history and scope of this field, however, continue to exist, especially among new investigators and commentators on this research. Contrary to the tacit narrative, published research and writing date to the nineteenth century, programmatic research to the 1950s, and NIH funding to 1990; elite medical journals have embraced this topic for over 100 years; study populations are religiously and sociodemographically diverse; and published findings are mostly positive, consistent with psychosocial theories of health and confirmed by comprehensive reviews and expert panels.

Differences in Religiousness in Opposite-Sex and Same-Sex Twins in a Secular Society

Sex differences in religion are well known, with females generally being more religious than males, and shared environmental factors have been suggested to have a large influence on religiousness. Twins from opposite-sex (OS) and same-sex (SS) pairs may differ because of a dissimilar psycho-social rearing environment and/or because of different exposures to hormones in utero. We hypothesized that OS females may display more masculine patterns of religiousness and, vice versa, that OS males may display more feminine patterns. We used a web-based survey conducted in Denmark, which is a secular society. The survey included 2,997 twins aged 20-40 years, identified through the population-based Danish Twin Registry. We applied la Cour and Hvidt's adaptation of Fishman's three conceptual dimensions of meaning: Cognition, Practice, and Importance, and we used Pargament's measure of religious coping (RCOPE) for the assessment of positive and negative religious coping patterns. Differences between OS and SS twins were investigated using logistic regression for each sex. The analyses were adjusted for dependence within twin pairs. No significant differences in religiousness and religious coping were found for OS and SS twins except that more OS than SS females were members of the Danish National Evangelical Lutheran Church and fewer OS than SS females were Catholic, Muslim, or belonged to other religious denominations. Moreover, OS males at age 12 had higher rates of church attendance than did SS males. This study did not provide evidence for masculinization of female twins with male co-twins with regard to religiousness. Nor did it show any significant differences between OS and SS males except from higher rates of church attendance in childhood among males with female co-twins.

Religious Affiliation, Religious Service Attendance, and Mortality

Very few studies have examined the effects of both religious affiliation and religiosity on mortality at the same time, and studies employing multiple dimensions of religiosity other than religious attendance are rare. Using the newly created General Social Survey-National Death Index data, our report contributes to the religion and mortality literature by examining religious affiliation and religiosity at the same time. Compared to Mainline Protestants, Catholics, Jews, and other religious groups have lower risk of death, but Black Protestants, Evangelical Protestants, and even those with no religious affiliation are not different from Mainline Protestants. While our study is consistent with previous findings that religious attendance leads to a reduction in mortality, we did not find other religious measures, such as strength of religious affiliation, frequency of praying, belief in an afterlife, and belief in God to be associated with mortality. We also find interaction effects between religious affiliation and attendance. The lowest mortality of Jews and other religious groups is more apparent for those with lower religious attendance. Thus, our result may emphasize the need for other research to focus on the effects of religious group and religious attendance on mortality at the same time.

Rethinking gender and mental health: a critical analysis of three propositions

In this paper, we critically examine three propositions that are widely (but not universally) accepted in the gender and mental health literature. First, women and men have similar or equal rates of overall psychopathology. Second, affective disorders like anxiety and depression, which are more common among women, and behavioral disorders like substance abuse and antisocial personality, which are more common among men, are functionally equivalent indicators of misery. Finally, women are more likely to respond to stressful conditions with affective disorders while men are more likely to respond to stressful conditions with behavioral disorders. Our review of previous research shows little to no consistent empirical support for any of these propositions. Results from national studies of overall psychopathology or "any disorder" are, at best, mixed and limited to a narrow range of mental health conditions. A comprehensive test of gender differences in overall psychopathology would require a systematic and exhaustive examination of gender differences across the known universe of mental health conditions, but this may be impossible to achieve due to a lack of consensus on the universe, the proliferation of diagnostic categories, and the tendency to pathologize the mental health of women. There is no empirical evidence to suggest that women substitute affective disorders for behavioral disorders or that men substitute behavioral disorders for affective disorders. There is no theory to suggest that affective and behavioral disorders should be treated as comparable indicators of misery. Some studies support the idea that women and men respond to stress in different ways, but most do not. Numerous studies show that women and men respond to stressors with higher levels of emotional distress, substance abuse, and antisocial behavior. We conclude with seven recommendations to advance theory and research and several general reflections on the sociological study of gender and mental health.

Why gerontologists should care about empirical research on religion and health: transdisciplinary perspectives

A large volume of empirical research has accumulated on the relationship between religion/spirituality (R/S) and health since the year 2000, much of it involving older adults. The purpose of this article is to discuss how this body of existing research findings has important messages or important new insights for gerontologists; clinicians in medicine, psychiatry, and psychology; sociologists; and theologians. In other words, what contributions do the research findings on R/S and health make to these disciplines? In this article, experts from each of the aforementioned disciplines discuss what contributions this research can make to their own area of study and expertise. Besides emphasizing the broad relevance of research on R/S and health to many clinical and academic audiences in gerontology (i.e., addressing the "so what" question), this discussion provides clues about where R/S research might focus on in the future.

Direct and indirect effects of religiosity on valuation of life through forgiveness and social provisions among older incarcerated males

PURPOSE OF THE STUDY

Few studies have investigated the influence of religiosity (REL), forgiveness, and social resources on incarcerated individuals' attachment to their lives, or valuation of life (VOL). We tested a model linking REL to VOL through 3 subscales of the Heartland Forgiveness Scale (Self, Others, and Situations) and social provisions (SPS).

DESIGN AND METHODS

Cross-sectional data were collected from 261 male prison inmates, aged 45-82, incarcerated in 8 state-managed correctional facilities. Participants were sampled from the prison census database (Oklahoma Department of Corrections or DOC). Exclusion criteria, per the Oklahoma DOC, were those housed in medical or psychiatric units, currently in solitary confinement, or sentenced to death row.

RESULTS

To account for possible violations of multivariate normality, we used the Satorra-Bentler chi-square statistic. The final model fit the data well, explaining 57% of the variance in VOL: χ(2) (N = 261; df = 3) = 7.40; p = .06; Comparative Fit Index = .99; root mean squared error of approximation = .08; standardized root mean squared residual = .02. Significant indirect effects of REL on VOL were present through Forgiveness of Others and SPS, and of REL on SPS through Forgiveness of Others. Analyses controlled for age, race, education, perceived physical health, and depressive symptoms.

IMPLICATIONS

Implications of the findings for those involved with prisoner care are discussed, particularly therapeutic interventions including process models of forgiveness.