Religion, spirituality, and medicine

Quantitative and Qualitative Research in the Field of 'Spirituality and Health': An Introductory How-to-Guide from a Brazilian Perspective

The present article aims to describe the different steps on how to design, develop and conduct quantitative and qualitative Spirituality and Health (S/H) studies from a Brazilian perspective, discussing definitions and instruments, and proposing a "how-to guide" for those interested in this field of research. A narrative review of the literature has been conducted by experts in the field of S/H aiming to develop a "how-to-guide". Spirituality is a very complex concept that has several challenges in the current scientific literature, including the lack of consensus in the definitions, the numerous dimensions assessed, the diverse instruments for measurement, the criticisms from other scholars, the great diversity of religious and cultural traditions and the growing number of "spiritual but not religious" individuals. This review supports that S/H studies may follow the high scientific standards, using consolidated research procedures and solid methods for both qualitative and quantitative research. Some peculiarities of the research methods for this field are discussed. S/H research is still under development, and there are several future directions for S/H studies, aiming to minimize previous criticisms and generating stronger evidence.

Training Researchers in the Field of Religion, Spirituality, and Health: Experiences from a Workshop in the United States and Recommendations for Future Workshop Curricula

Although a substantial amount of research has been conducted in the field of religion, spirituality, and health, much still needs to be done. Training of researchers to conduct studies in the field of religion, spirituality, and health is essential for continued academic and methodological rigor. Such training should be globally oriented to ensure both representation and evidence from non-western cultures which is currently lacking. While little attention is given to this area in mainstream contemporary academic curricula, some researchers in the field have provided exceptional leadership in designing programs to train future researchers. In this commentary, the authors who participated in one such training program at Duke University, offer their insights based on a qualitative descriptive analysis of survey responses from a sample of participants. These insights relate to participants' perceptions of the most valuable experiences from a workshop on religion, spirituality, and health, and include recommendations for future content in training programs in this field. The multicultural aspect of the program with researchers, clinicians, and other professionals from 17 different countries was the most enriching aspect of the workshop. One of the key recommendations for future training efforts is to dedicate workshop time for participants to work collaboratively in the design and plan for international and interdisciplinary research projects with guidance from faculty.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Tobias Anker] Last name [Stripp]. Also, kindly confirm the details in the metadata are correct.They are correct.

Are religious patients less afraid of surgery? A cross-sectional study on the relationship between dimensions of religiousness and surgical fear

INTRODUCTION

Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental health, particularly anxiety.

OBJECTIVE

This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia.

DESIGN

Cross-sectional study among elective surgery patients at different departments of a single hospital.

SETTING

University Hospital Sveti Duh, a tertiary health care facility in Croatia.

MEASUREMENTS

Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses.

RESULTS

178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R2 = 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear.

LIMITATIONS

The study was single-center and cross-sectional and did not assess patients' specific religious identity.

CONCLUSIONS

This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.

Spiritual needs in Denmark: a population-based cross-sectional survey linked to Danish national registers

Background

Spiritual aspects of the human condition may give rise to spiritual pain and suffering, especially in the face of illness or difficult life situations. A growing volume of research documents the effects of religiosity, spirituality, meaning, and purpose on health. In supposedly secular societies, however, spiritual matters are rarely addressed in healthcare. This is the first large scale study to examine spiritual needs in Danish culture, and the largest study on spiritual needs to date.

Methods

A population-based sample of 104,137 adult (≥18 yrs) Danes were surveyed cross-sectionally (the EXICODE study) and responses were linked to data from Danish national registers. The primary outcome was spiritual needs in four dimensions: religious, existential, generativity, and inner peace. Logistic regression models were fitted to examine the relationship between participant characteristics and spiritual needs.

Findings

A total of 26,678 participants responded to the survey (25.6%). Of included participants 19,507 (81.9%) reported at least one strong or very strong spiritual need in the past month. The Danes scored highest on inner peace needs, followed by generativity, then existential, and lastly, religious needs. Affiliating as religious or spiritual, regularly meditating or praying, or reporting low health, low life satisfaction, or low well-being increased the odds of having spiritual needs.

Interpretation

This study demonstrated that spiritual needs are common among Danes. These findings have important implications for public health policies and clinical care. Care for the spiritual dimension of health is warranted as part of holistic, person-centered care in what we term 'post-secular' societies. Future research should inform how spiritual needs might be addressed in healthy and diseased populations in Denmark and other European countries and the clinical effectiveness of such interventions.

Funding

The paper was supported by the Danish Cancer Society (R247-A14755), The Jascha Foundation (ID 3610), The Danish Lung Foundation, AgeCare, and the University of Southern Denmark.

Religious Experience and Clinical-EEG Aspects in Adult People with Epilepsy

Spirituality and religiosity are complex cognitive phenomena; however, the relationship between spiritual experiences and epilepsy continues to be debated. Methods. Data from the daily spiritual experience scale (DSES) were related to EEG data and clinical variables of 100 adult people with epilepsy (PWEs). DSES scores were compared to 51 normal individuals (control group [CG]), with a significance level of P < .05. Results. The total score in the DSES was 36.1 ± 14 and 37.6 ± 13.2, respectively, in the PWEs and in the CG. In the PWEs, there was a correlation between DSES and age (Pearson's correlation; -0.22; P = .027) and educational level (0.207; P = .039). PWEs with ≥one seizure/month have a lower frequency of daily spiritual experiences than those with better controlled seizures (T-test; 39.2 ± 16.2 vs 31.7 ± 7.6; P = .038). EEG epileptiform activity (EA) in the right hemisphere was associated with a higher frequency of spiritual experiences than those with left-hemisphere EA (29.8 ± 9.0 vs 38.5 ± 17.5; P = .010). Conclusion. Demographic aspects, EA in the right hemisphere, and lower seizure frequency are associated with daily spiritual experiences in epilepsy, suggesting an association between aspects of spirituality, epilepsy, and neurobiological correlates.

Toward a translational epidemiology of religion: challenges and applications

This paper explores the concept of translational epidemiology in the context of epidemiologic studies of religious determinants of morbidity and mortality. Despite a research literature of, by now, thousands of published studies, many in top-tier medical and public health journals, some resistance remains to full acceptance of this work. A principal reason may be the failure of investigators to make the case for real-world applications of epidemiologic findings on religious risk or protection for subsequent personal or population health, in keeping with the definition of translational epidemiology. To remedy this, a case is made for a translational epidemiology of religion. Three types of translation are proposed. The first two recall the standard definition of translational medicine as "from bench to bedside," in this instance two types of bedside encounters, pastoral and clinical. The third application is to public health practice, involving multiple public health professions and specialties. As with other substantive topics within psychosocial epidemiology, research on population-health outcomes of religious exposures provides information that can be applied to development of health promotion and disease prevention programs and formulation of health policy. But this can happen only if investigators give more attention to enumerating potential uses of their findings.

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.

A Buddhist Biography Project: Story-Telling, Spiritual Connection, and Intergenerational Exchange

This descriptive article discusses the development, delivery, and impact of the “Biography Project”. The project is a research and teaching initiative focused on both enhancing the quality of life of older persons, and providing university students across diverse degree programs the opportunity to learn about and engage first-hand with the challenges that confront older adults living in residential aged care. In accounting for the project and its objectives, the article explores the Buddhist values that underpin the project’s approach to teaching, and the important role of spirituality in training students to engage older people in telling the stories of their lives.

The Influence of Religiosity and Spirituality on Health in Canada: A Systematic Literature Review

The association between religion and health has been the subject of growing interest in academia. However, limited reviews of such studies in Canada exist. The paper systematically reviews and synthesizes existing literature on the relationship between spirituality and health in Canada. Available general databases such as: Medline; Web of Science, PubMed, Sociological abstract, Social Service Abstracts, Google scholar, Humanities International Index, JSTOR, CPI.Q Canadian Periodicals, and American Theological Library Association were searched for the period between 2000 and April 2019 inclusive. Collected data were then systematically analysed for common themes about spirituality and health in Canada. In total, 151 articles were found, but only 128 had relevance with the study objectives. Overall, the analysis showed that religion and spirituality do influence health behaviours, and well-being. However, more gender-based studies need to be conducted to tease out the differences in religion/spirituality and health across different genders, and ethnic groups in Canada.

Invited Commentary: Religious Service Attendance and Implications for Clinical Care, Community Participation, and Public Health

In this commentary, we review the evidence concerning associations between religious service attendance and subsequent health and wellbeing outcomes. The evidence base for a link between religious service attendance and health has increased substantially over the past 2 decades. The interpretation and implications of this research require careful consideration (Am J Epidemiol. 2022;191(1):20-30). It would be inappropriate to universally promote service attendance solely on the grounds of the associations with health. Nevertheless, a more nuanced approach, within both clinical care and public health, may be possible-one that encouraged participation in religious community for those who already positively self-identified with a religious or spiritual tradition and encouraged other forms of community participation for those who did not. Discussion is given to potential future research directions and the challenges and opportunities for promotion efforts by the public health community.

Addressing Religion in Secular Healthcare: Existential Communication and the Post-Secular Negotiation

This article aims to understand why religion has proven difficult to address in secular healthcare, although existential communication is important for patients’ health and wellbeing. Two qualitative data samples exploring existential communication in secular healthcare were analyzed following Interpretative Phenomenological Analysis, leading to the development of the analytical constructs of ‘the secular’ and ‘the non-secular’. The differentiation of the secular and the non-secular as different spheres for the individual to be situated in offers a nuanced understanding of the physician–patient meeting, with implications for existential communication. We conceptualize the post-secular negotiation as the attempt to address the non-secular through secular activities in healthcare. Employment of the post-secular negotiation enables an approach to existential communication where the non-secular, including religion, can be addressed as part of the patients’ life without compromising the professional grounding in secular healthcare. The post-secular negotiation presents potential for further research, clinical practice, and for the benefit of patients.

Altruism and "love of neighbor" offer neuroanatomical protection against depression

We prospectively investigate protective benefits against depression of cortical thickness across nine regions of a Ventral Frontotemporal Network (VFTN), previously associated with spiritual experience. Seventy-two participants at high and low risk for depression (Mean age 41 years; 22-63 years; 40 high risk, 32 low risk) were drawn from a three-generation, thirty-eight year study. FreeSurfer estimated cortical thickness over anatomical MRIs of the brain (Year 30) for each of the nine ROIs. Depression (MDD with SAD-L; symptoms with PHQ; Years 30 and 38) and spirituality (self-report on five phenotypes; Year 35), respectively, were associated with the weighted average of nine regions of interest. VFTN thickness was: 1) positively associated (p<0.01) with two of five spiritual phenotypes, altruism and love of neighbor, interconnectedness at a trend level, but neither commitment nor practice, 2) inversely associated with a diagnosis of MDD (SADS-L Year 30, for any MDD in the past ten years), and 3) prospectively neuroanatomically protective against depressive symptoms (PHQ-9 Year 38) for those at high familial risk.

Coronavirus pandemic and spirituality in southwest Nigeria: A sociological analysis

Introduction

The coronavirus pandemic outbreak is wreaking much havoc across the globe, with many nations shutting down their economy and social life with the hope of flattening the curve while health practitioners are also gearing efforts in providing a cure for it. Part of the coronavirus challenges is the various spiritual undertones attributed to it in many quarters. Hence, this study seeks to understand the various spiritual undertones attributed to the coronavirus incidence in southwest Nigeria.

Methodology

This paper examined the coronavirus pandemic and spirituality sociologically in southwest Nigeria, using secondary and primary data. Secondary data includes a review of literature, social media comments, official records, and newspaper reports. Primary data entails using google form (questionnaire) circulated via social media with 221 responses retrieved and analyzed using the frequency distribution tables and bar charts. Also, a one-sample t-test was used for further statistical analysis.

Results

Findings show that rather than attributing coronavirus incidence to spirituality alone, most of the respondents also see it as a public health concern, and precautionary measures should adhere. They see the government ban on social gathering, which affected the religious houses as the right thing to do and not solely targeted as religious houses. However, most believe that religious houses provide 'essential' emotional and spiritual support to the people. Respondents also believe they can get their healing from their place of worship even if infected with the coronavirus.

Conclusion

Based on the findings it was recommended that religious organizations should source valid data so that policy-makers can make informed decisions. Also, there is a need to have an accurate record of the number of infected persons and death rates to know the right time to ease lockdown and lift the social gathering measures. There should also be a place for easy and free testing for people. This will help the government ascertain the number of infected persons, reduce the associated fear with the pandemic, and lessen the people's economic, social, and religious effects.

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).

Relationship between religiosity and smoking among undergraduate health sciences students

INTRODUCTION

The university period is often characterized as a critical period of vulnerability for smoking habit initiation.

OBJECTIVE

The purpose of this cross-sectional study was to assess the relationship between religiosity and smoking among undergraduate students on health sciences courses.

METHODS

A total of 336 students on four health sciences courses (occupational therapy, speech therapy, nutrition, and physiotherapy) completed a cigarette smoking questionnaire along with the Duke University Religion Index.

RESULTS

Smoking prevalence was 8.3% among females and 12.7% among males. Prevalence among students who do not have a religion, but do believe in God, was higher than among those who do have a religion (16.3 and 6.3%, respectively). Organizational religious activity has a significant effect on smoking status.

CONCLUSION

The students have health habits that are not only motivated by the technical knowledge acquired on their undergraduate courses, since there was a possible influence of social norms stimulated by religious institutions on their attitudes, knowledge and practices in health.

The Effect of Religious Beliefs on the Attitude of Aesthetic Surgery Operation in Islam

This study aims to investigate the relationship between individuals' attitudes about acceptance of aesthetic surgery (e.g. rhinoplasty, autoplasty, blepharoplasty, and mammaplasty) and some of the worship practices in Islamic religion such as performing prayer, fasting, and going to pilgrimage. Although many people think that aesthetic surgery is inappropriate in Islamic religion, no studies in the literature were found to have investigated this issue. This study collected data through a questionnaire administered to 96 patients who applied to our Plastic Surgery Clinic and underwent various surgical operations and 96 patients who were recommended plastic surgery but rejected to have one; the questionnaire aimed to identify the participants' frequency of religious worship practices and appropriateness of aesthetic surgery to their beliefs. The participants responded on the frequency of religious worship levels according to the options in the questionnaire. The "Acceptance of Cosmetic Surgery Scale" was utilized in order to identify their attitudes towards aesthetic surgery. Levels of performing prayers, fasting, and going to pilgrimage in the groups that accepted surgery and in the groups that rejected surgery were significantly different (p < 0.001, p = 0.008, p < 0.001). In two different groups, the Acceptance of Aesthetic Surgery Scale scores were significantly different within the prayer groups and fasting groups (p < 0.001, p < 0.001, p = 0.001, p < 0.001). While the group that accepted surgery indicated no significant differences between those who thought about going to pilgrimage and who did not (p = 0.650), there was a significant difference in the group that rejected surgery (p < 0.001). While 14.6% of the participants in the group that accepted surgery considered aesthetic surgery a sin, this proportion was 56.3% in the group that rejected surgery, and this difference was significant (p < 0.001). In both surgery groups, there were differences in the scale scores of those who considered aesthetic surgery a sin and those who did not (p < 0.001, p < 0.001). There was a significant relationship between worship practices, one of the biggest indicators of the level of belief in Islamic religion, and aesthetic surgery attitudes. However, despite the fact that belief levels affect the decision of having an operation in plastic surgery, in case of serious health problems, the decision of having an operation becomes more important religious beliefs.

Religion, spirituality and depression in prospective studies: A systematic review

BACKGROUND

Many empirical studies have shown inverse associations between measures of religiousness and spirituality (R/S) and depression. Although the majority of these studies is cross-sectional, a considerable number of prospective studies have also appeared.

METHODS

The current systematic review offers an overview of the major pattern of associations between the measures of R/S and depression / depressive symptoms in 152 prospective studies (until 2017).

RESULTS

With on average two R/S measures per study (excluding measures of religious struggle, treated separately), 49% reported at least one significant association between R/S and better course of depression, 41% showed a non-significant association, and 10% indicated an association with more depression or mixed results. The estimated strength of these associations was modest (d = -0.18). Of the studies that included religious struggle, 59% reported a significant association with more depression (d = +0.30). Especially among persons identified with psychiatric symptoms, R/S was significantly more often protective (d = -0.37). In younger samples and in samples of patients with medical illness, R/S was less often protective. Studies with more extensive adjustment for confounding variables showed significantly more often associations with less depression. Geographical differences in the findings were not present.

LIMITATIONS

Given the huge heterogeneity of studies (samples size, duration of follow-up), the current synthesis of evidence is only exploratory.

CONCLUSION

In about half of studies, R/S predicted a significant but modest decrease in depression over time. Further inquiry into bi-directional associations between religious struggle and (clinical) depression over time seems warranted.

The Evolution of Spirituality, Religion and Health Publications: Yesterday, Today and Tomorrow

This research aims to present a bibliometric analysis of the published documents on spirituality, religion and health. Despite the increasing number of publications spirituality, religion and health research in recent years, there is still little information about the effects of these publications in the literature. "Religion," "spirituality," "spiritual," "health" and "medicine" keywords were used to search the Web of Science (WoS) database. Bibliometric analysis was conducted on the articles published between 1975 and 2017. The analysis was presented with network and density maps. The analysis also included the regression analysis to predict a number of publications in 2018. A total number of 1674 publications were found: 818 of these publications were articles. Of the 818 articles, 210 were religion, 198 were Public Environmental Occupational Health, 139 were Psychology, and 77 were performed in the field of Psychiatry. The most productive journal with 107 articles and 1129 citations was the Journal of Religion and Health. The USA (495; 60.5%) was the most productive country on spirituality, religion and health publications. The author who had the highest number of publications and citations was Koenig HG (33 publications; 4.03% and 1617 citations), the document who had the highest number of citations was Ellison CG and Levin JS (633 citations), and the author who had the highest number of citations in the references was Koenig HG, 2001, (126 citations). Duke Univ was the top institution in the number of publication (50 Article). This study will lead the researchers especially in terms of the important journals, active countries, authors, top-cited articles and current topics in spirituality, religion and health research.

Intensive Care Clinicians' Views on the Role of Chaplains

There is evidence that addressing the religious and spiritual needs of patients has positive effects on patient satisfaction and health care utilization. However, in the intensive care unit (ICU), chaplains are often consulted only at the very end of life, thereby leaving patients' spiritual needs unmet. This study looked at the views of 219 ICU clinicians on the role of chaplains. We found that all clinicians find chaplains helpful when a patient is dying or when the chaplain brings up religious or spiritual topics. Physicians find chaplains less helpful in other clinical scenarios such as challenging family meetings or when patients are recovering. Nurses are more likely to consult chaplains for a difficult family meeting or when patients are recovering from critical illness. Communication between clinicians and chaplains, both directly and indirectly through electronic health record notes, remains infrequent, highlighting the need for interventions aimed at improving multidisciplinary spiritual care.

Religious landscape in Brazil: Comparing different representative nationwide approaches to obtain sensitive information in healthcare research

Although the basis of religious studies start with demographics, nation-wide data are often extracted from face-to-face interviews (leading to a social-desirability bias) and in studies not originally designed to assess religion. This study aims to understand the religious landscape in Brazil and to investigate the feasibility of carrying out a representative nation-wide survey without interviewers, comparing it with other representative face-to-face surveys. We conducted a nationwide online survey representing all regions in Brazil. These results were compared with five other Brazilian representative surveys. A total of 1169 individuals completed the online questionnaires. The percentage of participants according to the gender and in relation to the Brazilian region was quite similar for all surveys. However, the online survey had the higher level of education among all surveys. In relation to the religious characteristics, the percentage of each variable varied from survey to survey. Those surveys originally designed to assess religion tended to yield more religious affiliations and less ceiling effects. The online survey was able to identify more diverse religious affiliations and more balanced responses in the religious attendance and importance of religion in life. The present study found that, even in nation-wide representative surveys, there are important differences in the results obtained while investigating religion. These differences could be associated with the type of data collection (face-to-face and online), the design of the study (originally designed to investigate religion or not) and options and the type of the questions used.

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Self-administered questionnaires avoid social desirability bias.

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This study found important differences while investigating religion among nationwide surveys.

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Online survey identifies more religious affiliations and more balanced responses in variables.

The Coping Mechanisms and Strategies of Hypertension Patients in Ghana: The Role of Religious Faith, Beliefs and Practices

This qualitative study explored the role of religious faith, belief and practice systems in the coping mechanisms and strategies of essential hypertension patients in Accra, Ghana. Six participants were recruited for participation, of which five were Christians and one was a Muslim. Interviews were conducted and interpretative phenomenological analysis was used to analyze the data. Results showed that participants used their religious faith, beliefs and practices as coping resources. Participants used a deferring-collaborative style of religious coping, which seemed to have provided them with an avoidance strategy that protected the participants from conscious confrontation with their illness. Religious faith and beliefs also afforded the participants a sense of coherence that enabled the participants to manage their stress, reflect on their external and internal resources to promote effective coping and adaptive functioning in a health promoting manner. Implications of a deferring-collaborative style of religious coping and religious re-appraisal are discussed.

Addressing religion and spirituality in the intensive care unit: A survey of clinicians

OBJECTIVE

Studies have shown that when religious and spiritual concerns are addressed by the medical team, patients are more satisfied with their care and have lower healthcare costs. However, little is known about how intensive care unit (ICU) clinicians address these concerns. The objective of this study was to determine how ICU clinicians address the religious and spiritual needs of patients and families.

METHOD

We performed a cross-sectional survey study of ICU physicians, nurses, and advance practice providers (APPs) to understand their attitudes and beliefs about addressing the religious and spiritual needs of ICU patients and families. Each question was designed on a 4- to 5-point Likert scale. A total of 219 surveys were collected over a 4-month period.

RESULT

A majority of clinicians agreed that it is their responsibility to address the religious/spiritual needs of patients. A total of 79% of attendings, 74% of fellows, 89% of nurses, and 83% of APPs agreed with this statement. ICU clinicians also feel comfortable talking to patients about their religious/spiritual concerns. In practice, few clinicians frequently address religious/spiritual concerns. Only 14% of attendings, 3% of fellows, 26% of nurses, and 17% of APPs say they frequently ask patients about their religious/spiritual needs.

SIGNIFICANCE OF RESULTS

This study shows that ICU clinicians see it as their role to address the religious and spiritual needs of their patients, and report feeling comfortable talking about these issues. Despite this, a minority of clinicians regularly address religious and spiritual needs in clinical practice. This highlights a potential deficit in comprehensive critical care as outlined by many national guidelines.

Religion and spirituality in clinical practice

Spirituality and religion have assumed importance in psychiatric practice in recent years because of both a growing evidence base and the desire of patients that such matters should be better addressed as an aspect of their care. However, there has been controversy regarding interpretation of the evidence base and issues of good practice, notably about defining appropriate professional boundaries. A sensitive and patient-focused clinical enquiry is therefore needed to discover whether and how spiritual/religious concerns are important to patients and, if they are, how they might most appropriately be addressed in treatment. Many of the concerns of patients and professionals regarding spirituality overlap with the recovery agenda and so are easily addressed implicitly and without need to impose the language of spirituality or religion. However, for some patients, transcendent concerns that are not a part of this agenda are easily overlooked.

Spiritual care and psychiatric treatment: an introduction

The Patron of the Royal College of Psychiatrists has pointed out the irony involved in recording patients' religion, without seeking to discover that all this means to them in terms of understanding and coping with their illness (HRH The Prince of Wales, 1991). One College past-President (Sims, 1994) firmly recommends evaluating the religious and spiritual experiences of our patients in assessing aetiology, diagnosis, prognosis and planning treatment. Across the water, an American Journal of Psychiatry editorial (Andreasen, 1996) has it that, ‘We must practice and preach the fact that psychiatrists are physicians to the soul as well as the body.’

Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials

OBJECTIVE

To examine whether religious and spiritual interventions (RSIs) can promote physical health and quality of life in individuals.

METHODS

The following databases were used to conduct a systematic review: PubMed, Scopus, Web of Science, EMBASE, PsycINFO, Cochrane, and Scielo. Randomized controlled trials that evaluated RSIs regarding physical health outcomes and/or quality of life in English, Spanish or Portuguese were included. RSI protocols performed at a distance (i.e. intercessory prayer) or for psychiatric disorders were excluded. This study consisted of two phases: (a) reading titles and abstracts, and (b) assessing the full articles and their methodological quality using the Cochrane Back Review Group scale.

RESULTS

In total, 7,070 articles were identified in the search, but 6884 were excluded in phase 1 because they were off topic or repeated in databases. Among the 186 articles included in phase 2, 140 were excluded because they did not fit the inclusion criteria and 16 did not have adequate randomization process. Thus, a final selection of 30 articles remained. The participants of the selected studies were classified in three groups: chronic patients (e.g., cancer, obesity, pain), healthy individuals and healthcare professionals. The outcomes assessed included quality of life, physical activity, pain, cardiac outcomes, promotion of health behaviors, clinical practice of healthcare professionals and satisfaction with protocols. The divergence concerning scales and protocols proposed did not allow a meta-analysis. RSIs as a psychotherapy approach were performed in 40% of the studies, and the control group was more likely to use an educational intervention (56.7%). The results revealed small effect sizes favoring RSIs in quality of life and pain outcomes and very small effects sizes in physical activity, promotion of health behaviors and clinical practice of health professionals compared with other complementary strategies. Other outcomes, such as cardiac measures and satisfaction with the protocols, revealed no evidence for RSIs. Regarding the quality of the selected articles according to the Cochrane Back Review Group Scale, the average score was 6.83 (SD = 9.08) on a scale of 11, demonstrating robustness in the studies.

CONCLUSION

Clinical trials on RSIs demonstrated that they had small benefits compared with other complementary health therapies by reducing pain and weight, improving quality of life and promoting health behaviors. The lack of clinical trials that included biological outcomes and the diversity of approaches indicate a need for more studies to understand the possible mechanisms of action of RSIs and their roles in health care.

The Relationship Between Trust-in-God, Positive and Negative Affect, and Hope

We aimed to test the relationships between Trust-in-God, positive and negative affect, and feelings of hope. A sample of university students (N = 282, 50 % female) completed the Positive and Negative Affect Schedule, the Adult Dispositional Hope Scale, and a Persian measure of Trust-in-God for Muslims. The results of a series of hierarchical regression analyses indicated that Trust-in-God was positively associated with participants' scores for hope and positive affect but was negatively associated with their scores for negative affect. The results support the relationship between Trust-in-God and indices of mental health.

Attendance at Religious Services, Prayer, Religious Coping, and Religious/Spiritual Identity as Predictors of All-Cause Mortality in the Black Women's Health Study

Previous longitudinal studies have consistently shown an association between attendance at religious services and lower all-cause mortality, but the literature on associations between other measures of religion and spirituality (R/S) and mortality is limited. We followed 36,613 respondents from the Black Women's Health Study from 2005 through December 31, 2013 to assess the associations between R/S and incident all-cause mortality using proportional hazards models. After control for numerous demographic and health covariates, together with other R/S variables, attending religious services several times per week was associated with a substantially lower mortality rate ratio (mortality rate ratio = 0.64, 95% confidence interval: 0.51, 0.80) relative to never attending services. Engaging in prayer several times per day was not associated with mortality after control for demographic and health covariates, but the association trended towards a higher mortality rate ratio when control was made for other R/S variables (for >2 times/day vs. weekly or less, mortality rate ratio = 1.28, 95% confidence interval: 0.99, 1.67; P-trend < 0.01). Religious coping and self-identification as a very religious/spiritual person were associated with lower mortality when adjustment was made only for age, but the association was attenuated when control was made for demographic and health covariates and was almost entirely eliminated when control was made for other R/S variables. The results indicate that service attendance was the strongest R/S predictor of mortality in this cohort.

"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.

Characteristics of Spirituality and Religion Among Suicide Attempters

Spirituality and religiousness are associated with a lower risk of suicide. A detailed assessment of spirituality among 88 suicide attempters hospitalized after a suicide attempt was performed. Factors associated with the recurrence of suicide attempts over 18 months were looked into. Spirituality was low among most suicide attempters in comparison with the general population. Two groups were identified: those with a high score of depression who featured "low" in spirituality and those with a more heterogeneous profile, for example, involving personality disorders, characterized by a "high" spirituality. At the follow-up, the "meaning in life" score appeared to correlate with recurrence of suicide. Clinical implications are discussed herein.

Screening the soul: Communication regarding spiritual concerns among primary care physicians and seriously ill patients approaching the end of life

The purpose of this study was to explore the spiritual concerns of seriously ill patients and the spiritual-care practices of primary care physicians (PCPs). Questionnaires were administered to outpatients (n = 65, 90 percent response rate) with end-stage illness and to PCPs (n = 67, 87 percent response rate) in a diverse general medicine practice. Most patients (62 percent) and PCPs (68 percent) considered it important that physicians attend to patients’ spiritual concerns. However, few patients reported receiving such care, and most (62 percent) did not think it was the PCP’s job to talk about spiritual concerns. Although both seriously ill outpatients and PCPs assert the importance of spiritual concerns, PCPs often do not provide spiritual care. Appropriate provision of spiritual care within a diverse population of seriously ill outpatients is complex, necessitating appropriate and attentive screening.

Can You Teach Medical and Nursing Students About Spirituality?

Spirituality is a central principle in complementary and alternative medical prac tice. Important spiritual issues, which are personal to the patient as well as to the practitioner, can be taught and modeled. This article describes a lecture and small group-based curriculum that can be adapted to teach spirituality. Medical and nursing students were jointly taught using this curriculum. They learned to take a spiritual history using one of three models, to reflect on clinical and personal situations involving spirituality, and to present evidence on the clinical relevance of spirituality. Samples from the syllabus including cases and references are presented.

Measuring Multiple Dimensions of Religion and Spirituality for Health Research

Progress in studying the relationship between religion and health has been hampered by the absence of an adequate measure of religiousness and spirituality. This article reports on the conceptual and empirical development of an instrument to measure religiousness and spirituality, intended explicitly for studies of health. It is multidimensional to allow investigation of multiple possible mechanisms of effect, brief enough to be included in clinical or epidemiological surveys, inclusive of both traditional religiousness and noninstitutionally based spirituality, and appropriate for diverse Judeo-Christian populations. The measure may be particularly useful for studies of health in elderly populations in which religious involvement is higher. The measure was tested in the nationally representative 1998 General Social Survey ( N = 1,445). Nine dimensions have indices with moderate-to-good internal consistency, and there are three single-item domains. Analysis by age and sex shows that elderly respondents report higher levels of religiousness in virtually every domain of the measure.

Measuring a Dimension of Spirituality for Health Research

Health-related studies of spirituality are threatened by the lack of conceptual distinctions between religion and spirituality, the use of small, nongeneralizable samples, and by measurement error in many instruments that unreliably and invalidly capture this domain. The authors review the construct and validity evidence for the Spirituality Index of Well-Being (SIWB), an instrument designed to measure a dimension of spirituality linked to subjective well-being in patient populations. The SIWB was developed using qualitative research methods and subsequently conceptualized with two dimensions; self-efficacy and life scheme. Primary psychometric data from three sample populations are reviewed and summarized. A secondary, confirmatory factor analysis, using pooled data from all samples, supports the theoretical two-factor structure. In addition, SIWB scores correlate more strongly with established measures of well-being than the Spiritual Well-Being Scale (SWB) or other recognized religiosity instruments. The SIWB is a valid and reliable instrument that can be used in health-related studies.

Religious Involvement and Mortality Risk among African American Adults

This article examines the effects of religious involvement on mortality risk among African Americans. The authors use a relatively new and innovative nationally representative data set—the National Health Interview Survey matched to the National Center for Health Statistics’ multiple cause of death file—to model this relationship. The results show that, compared with African Americans who attend religious services more than once a week, those who never attend are more than twice as likely to die during the nine-year follow-up period, even net of a large number of confounding and mediating factors. The strong effect of nonattendance on mortality risk is robust, pervasive, and remarkably strong across all subgroups of the population, whereas a moderate level of attendance is associated with higher mortality risk among young adults, men, and Southerners, but not among older adults, women, and non-Southerners. Among African Americans, lack of religious involvement appears to be associated with risk of premature death, whereas frequent religious involvement stands out as a critical protective factor that contributes to lower mortality and longer life.

Religion and Subjective Well-Being: Western and Eastern Religious Groups Achieved Subjective Well-Being in Different Ways

Culture can moderate which variables most influence subjective well-being (SWB). Because religion can be conceptualized as culture, religious differences can be considered cultural differences. However, there have been few studies comparing how different religious groups evaluate SWB at any given time. This study is among the first to investigate this issue. The present study compared Buddhists, Taoists, Christians, and atheists. In addition to demographic items, 451 Chinese adults completed Chinese version of the Socially Oriented Cultural Conception of SWB Scale. Religious belief was distributed as follows: 10 % Christian, 20 % Buddhist, 25 % Taoist, and 43 % atheists. As predicted, the socially oriented cultural conception of SWB was found to be highest among Buddhists, followed in order by Taoists, atheists, and Christians. It was concluded that the various religious groups achieved SWB in different ways.

Spiritual Influences on Ability to Engage in Self-Care Activities among Older African Americans

The influence of spiritual factors on the ability of African-American elders to carry out instrumental activities of daily living (IADL) independent of age, gender, education, and self-rated health is explored using the religion-health explanatory model in a cross-sectional sample of 96 African-American community dwelling adults 62 to 93 years of age. The Reed spiritual perspective (SPS) and self-transcendence (STS) scales are used to study spiritual factors (Reed, 1991). The typical respondent was 75 years of age, female, widowed with 10.4 years of education. Self-rated health and age are strongly related to IADL in models that include the other variables ( R2 = 0.41, p < 0.01). Those who are younger and those who self-report better health have higher IADL scores than those without these characteristics. Spiritual factors are significantly related to IADL in a model that includes an interaction of STS with education ( R2 = 0.50). Among the least educated, STS is associated with higher scores of IADL. Addition of the interaction to the model resulted in a significant positive association of both STS and education with IADL. SPS was unrelated to IADL. Caregivers concerned with functional ability may want to consider interventions based on increasing a sense of self-transcendence, and to consider educational level as a potential moderator of this relationship. Criticism of the religion-health literature has suggested that putative health effects of religion may be exaggerated, because of failure to take confounding variables into account (Sloan, Bagiella, & Powell, 1999). However, this study and a recent survey by Musick, House, and Williams (2004) are evidence that it is just as likely that health benefits of religion would be hidden by confounders as that they would be exaggerated by them.

Spirituality and mood pathology in severe skin conditions: a prospective observational study

Although the association between spirituality and parameters of psychological health and disease has been investigated extensively, little evidence is available for its potential role in dermatology. In a single-centre observational prospective study, 149 outpatients (107 women) with systemic sclerosis (SSc; n = 44), lupus erythematosus (LE; n = 48), or early stage malignant melanoma (MM; n = 57) were investigated using the multidimensional inventory for religious/spiritual well-being together with the Brief Symptom Inventory for psychiatric symptoms (BSI-18). SSc patients reported the highest amount of Somatization in comparison with LE and MM patients (p < 0.05). Furthermore, in line with the previous research, spiritual dimensions, such as Hope for a better future (p < 0.01) or Hope for a better afterlife (p < 0.01), proved to be especially negatively predictive for the global amount of psychiatric symptom burden in these dermatological patient groups. Our findings suggest that greater attention should be given to spiritual issues, such as encouraging patients, imbuing them with optimism, and offering interventions that address spiritual well-being.

Faith Factors and Internal Health Locus of Control in Patients Prior to Open-heart Surgery

This study explored the relationships between faith factors and internal health locus of control (IHLC) beliefs. Based on a review of different relationships of perceived control, spiritual surrender and faith factors in the liberation, we assumed a multivariate association among them. Using data from two sequential interviews and the Society of Thoracic Surgeons’ Adult Cardiac Database, we tested these associations in a final sample of 202 middle-aged and older patients undergoing open-heart surgery. Primary findings from two-step multiple regression analyses supported hierarchical multi-faceted hypotheses. Greater internal control was positively associated with private prayer for coping, an event-specific, ‘vicarious’ control strategy, but negatively related to subjective religiosity, general faith measure controlling for other confounders, especially cardiac-significant ones.

Methodological Pitfalls in the Study of Religiosity and Spirituality

The number of studies demonstrating a relationship between religiosity and spirituality and physical and psychological health have increased rapidly during the past decade. There are significant disputes in the literature regarding the methodological quality of research in this area. Despite nursing scholars’ interest in this area, no thorough review of the methodological critiques is available. The purpose of this study is to review areas of methodological difficulty in the study of religiosity and spirituality by identifying contemporary methodological critiques, critically evaluating the critiques and the underlying issues, and making suggestions for methodological advancement in the field. Three main areas of methodological critique exist: construct measurement, study design, and data analysis. Research in this area should aim for conceptual clarity, deliberate design, and appropriate analysis. Considerations of these critiques are instructive for nursing research done in the area of religiosity and spirituality.

Religious Involvement and 6-Year Course of Depressive Symptoms in Older Dutch Citizens:

Objectives: Expanding on cross-sectional studies, associations are examined between religious involvement and the 6-year course of depressive symptoms in older adults. Methods: Subjects are 1,840 community-dwelling older adults (aged 55 to 85) participating in three measurement cycles of the Longitudinal Aging Study, Amsterdam. Assessments include aspects of religious involvement, depressive symptoms, physical health, self-perceptions, social integration, urbanization, and alcohol use. Results: Church attendance is negatively associated with the course of depressive symptoms, also after adjustment for explanatory variables. Among respondents with functional limitations, lower depression scores are found for those who attend church on a regular basis. For respondents who are bereaved or nonmarried, however, slightly higher depression scores are found for those with high levels of orthodox beliefs. Discussion: There is a consistent negative association over time between church attendance and depressive symptoms in older Dutch citizens. Both stress-buffering as well as depression-evoking effects of religious involvement are found.