The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients

Correlation between symptom status, health perception, and spiritual well-being in heart failure patients: A structural equation modeling approach

AIM

To explore predictors of spiritual well-being behaviors among heart failure patients based on Wilson and Cleary's conceptual model of health-related quality of life and to clarify the interrelationships among these variables.

DESIGN

A descriptive and correlational study design was used.

METHODS

This study included 202 heart failure patients treated between October 2020 and July 2021. Data were collected using the Symptom Status Questionnaire-Heart Failure, Perception of Health Scale, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale. Descriptive analysis, correlation, and structural equation modeling were performed.

RESULTS

Characteristic factors positively affected spiritual well-being both directly (β = 0.19, p = 0.007) and indirectly (β = 0.19; CI (0.106; 0.311)). The direct relationship between health perception and spiritual well-being was significant (β = 0.83, p < 0.05). Symptom status acted as an essential mediator between model variables and spiritual well-being (β = -0.28; CI (-0.449; -0.133)). Comorbidity and symptom status also influence spiritual well-being through health perceptions. These variables explain 77% of the variance in spiritual well-being.

CONCLUSION

The modified structural equation modeling based on Wilson and Cleary's conceptual model fits well in predicting spiritual well-being in patients with heart failure. Spiritual well-being was reported to be poor, and changes in spiritual well-being were predicted by age, educational level, marital status, comorbidity, symptom status, and health perception. The results can be applied to patients with heart failure and may serve as a guide for assessment and interventions for improving spiritual well-being.

CLINICAL RELEVANCE

This study mainly concludes that symptom status and perceived health status affect spiritual well-being in heart failure patients. Symptom relief and improvement in perceived health status interventions may help enhance spiritual well-being in this population. Future studies are needed to investigate the different predictor's effects on spiritual well-being and examine whether symptom management and health status-enhancing interventions result in improved spiritual well-being in the heart failure population.

REPORTING METHOD

This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Longitudinal Study of Adherence among Cystic Fibrosis Patients: Associations with Gratitude Over the Course of One Year

BACKGROUND

Daily airway clearance therapy (ACT) is a critical aspect of treatment in cystic fibrosis (CF), but poor adherence is a prominent concern. Identifying factors that might enhance or diminish adherence is a priority for treatment centers. Gratitude, a generalized tendency to notice and appreciate positive facets of experience, is a psychosocial resource that has commanded growing research interest. This longitudinal study examined whether gratitude at baseline was associated with ongoing or persistent ACT adherence over the course of a year.

METHODS

Trait gratitude was evaluated at baseline using a validated measure, among adults receiving care at a regional CF treatment center. Self-reported adherence to ACT was assessed at baseline, 6 months, and 12 months using the Cystic Fibrosis Treatment Questionnaire. Average age of participants was 27.2 years, 45.5% were women, and 19.7% had severe disease.

RESULTS

In multivariable logistic regression models that accounted for disease severity (Forced Expiratory Volume1% predicted) and other clinical and demographic variables, individuals with higher baseline gratitude were significantly more likely to demonstrate persistent adherence over the course of the year. Gratitude remained predictive after additionally adjusting for other well-known psychosocial resource variables (social support and emotional well-being).

CONCLUSION

This is among the first demonstrations that gratitude is associated with persistent self-reported adherence to treatment over time. Findings suggest that gratitude may be important psychosocial resource for adults with CF, as they contend with complex, highly burdensome treatment regimens. Further research is warranted to examine these relationships and their impact on downstream health outcomes.

The Groundswell Community Surf Therapy Intervention for At-Risk Women and Changes in Body Acceptance, Resilience, and Emotional Regulation

Background

Surf therapy combines physical activity with social support to provide a healing environment.

Objective

This exploratory pre-to post-intervention study examined the effects of a novel surf therapy program for women who experienced abuse, trauma, and/or mental illness on emotional regulation, resilience, body acceptance, and gratitude.

Methods

Twenty-seven women (ages 25 to 54; mean 36.32 + SD 7.79) participated in an 8-week Groundswell Surf Therapy Program held in four different coastal cities in California. Standardized self-report questionnaires were administered prior to and following the therapy program, including the Body Acceptance Scale, the Connor-Davidson Resilience Scale (CD-RISC), the Affective Style Questionnaire, and the Gratitude Questionnaire-Six-Item Form (GQ-6) in a pre-post study design. Data were analyzed by repeated measures analysis of variance (ANOVA).

Results

Body acceptance [P < 0.001; partial Eta squared = 0.472] and resilience were increased [P = 0.005; partial Eta squared = 0.319] following the surf therapy intervention. Emotional regulation was examined according to three subscales, with the adjust [P < 0.001; partial Eta squared = 0.397] and tolerate [P < 0.001; partial Eta squared = 0.299] subscales increasing following the intervention, and the conceal subscale [P = 0.459; partial Eta squared = 0.031] remaining unchanged. Gratitude scores were unchanged [P = 0.425; partial Eta squared = 0.026].

Conclusion

A surf therapy program rooted in somatic and trauma-informed models was associated with improved resilience, emotional regulation, and body acceptance in at-risk women.

The Gratitude Campaign: A Multihospital Evidence-Based Practice Project

Nurse well-being and optimism were tested in the midst of COVID-19 patient surges and staffing challenges. Using the American Nurses Foundation Gratitude Toolkit, a health system implemented monthly gratitude practices at 4 hospitals. Validated survey measures indicated that nurses' scores of self-perceived gratitude, flourishing behaviors, and mindfulness were maintained during this challenging time but did not statistically increase. Although statistical significance increases were not demonstrated, the gratitude campaign offered clinical significance through positive feedback and was sustained through the distribution of a toolkit disseminated across the health system.

Development and Validation of Hindu Gratitude Scale (HGS-15): A Rnas Perspective

Researchers have proposed culture- and religion-based variations in experience and expression of gratitude. Accordingly, the present study developed and validated a Hindu Gratitude Scale (HGS) based on Hindu notion of rnas. The rnas are sacred obligations (duties) that every Hindu is supposed to fulfil during their lifetime. These pious obligations are practised to acknowledge, honour, and appreciate others' contribution in one's life. These five holy duties are Pitṛ-yajna, Bhūta-yajna, Manuṣya-yajna, Deva-yajna, and Brahma-yajna. The study started with rnas-based conceptualisation of gratitude followed by item generation using both inductive and deductive approaches. These statements were subjected to content validity and pretesting, which resulted in nineteen items. The psychometric properties of proposed HGS (with nineteen items) were analysed with the help of three studies. The first study evaluated factorial validity of the proposed HGS using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) using a sample of 1032 respondents. Poor factor loading in EFA suggested removal of three statements. The EFA recommended five dimensions of the HGS-appreciation for family, ancestors, and cultural values (AFF), appreciation for family, ancestors, and cultural values (AFF), appreciation for God, appreciation for knowledge, skills, and talents, and appreciation for ecosystem. Further, CFA also suggested removal of one statement. Lastly, the EFA and CFA result suggested adequate factorial validity of a fifteen-itemed five-factored HGS. The second study examined the reliability and validity of the HGS derived from CFA with the help of a sample of 644 participants. And, in the third study, the test-retest reliability was investigated by collecting the data twice. The results revealed significant positive correlations in two sets of data, thereby concluding test-retest reliability of the HGS. The study offered a novel fifteen-item Hindu Gratitude Scale, which could be used in future studies to explore gratitude level of Hindus.

The impact of gratitude interventions on patients with cardiovascular disease: a systematic review

Positive psychological factors play a pivotal role in improving cardiovascular outcomes. Gratitude interventions are among the most effective positive psychological interventions, with potential clinical applications in cardiology practice. To better understand the potential clinical effects of gratitude interventions in cardiovascular disease, four databases (Web of Science, Scopus, PubMed, and PsycArticles) were searched from 2005 to 2023 for relevant studies. Randomized controlled trials of gratitude interventions as the intervention and that reported physiological or psychosocial outcomes were eligible for inclusion. In total, 19 studies were identified, reporting results from 2951 participants from 19 to 71 years old from both healthy populations and those with clinical diagnoses. The studies showed that gratitude not only promotes mental health and adherence to healthy behaviors but also improves cardiovascular outcomes. Gratitude may have a positive impact on biomarkers of cardiovascular disease risk, especially asymptomatic heart failure, cardiovascular function, and autonomic nervous system activity.

Religion/Spirituality and Prevalent Hypertension among Ethnic Cohorts in the Study on Stress, Spirituality, and Health

BACKGROUND

Hypertension is a significant public health issue, particularly for Blacks, Hispanics/Latinos, and South Asians who are at greater risk than whites. Religion and spirituality (R/S) have been shown to be protective, but this has been identified primarily in whites with limited R/S measures examined (i.e., religious service attendance).

PURPOSE

To assess hypertension prevalence (HP) in four racial/ethnic groups while incorporating an array of R/S variables, including individual prayer, group prayer, nontheistic daily spiritual experiences, yoga, gratitude, positive religious coping, and negative religious coping.

METHODS

Data were drawn from the Study on Stress, Spirituality, and Health, a consortium of ethnically diverse U.S. cohorts. The sample included 994 Black women, 838 Hispanic/Latino men and women, 879 South Asian men and women, and 3681 white women. Using a cross-sectional design, prevalence ratios for R/S and hypertension were reported for each cohort, in addition to pooled analyses. Given differences in R/S among men and women, all models were stratified by gender.

RESULTS

Different patterns of associations were found between women and men. Among women: 1) religious attendance was associated with lower HP among Black and white women; 2) gratitude was linked to lower HP among Hispanic/Latino, South Asian, and white women; 3) individual prayer was associated with higher HP among Hispanic/Latino and white women; 4) yoga was associated with higher HP among South Asian women, and 5) negative religious coping was linked to higher HP among Black women. Among men: significant results were only found among Hispanic/Latino men. Religious attendance and individual prayer were associated with higher HP, while group prayer and negative religious coping were associated with lower HP.

CONCLUSION

Religion/spirituality is a multifaceted construct that manifests differently by race/ethnicity and gender. Medical practitioners should avoid a one-size-fits-all approach to this topic when evaluating prevalent hypertension in diverse communities.

Exploring the relationship between gratitude and depression among older adults with chronic low back pain: a sequential mediation analysis

Introduction

Gratitude has been identified as a key factor in a number of positive health-related outcomes; however, the mechanisms whereby gratitude is associated with well-being among older adults with chronic pain are poorly understood. Using the Positive Psychological Well-Being Model as a theoretical framework, the objective of the present study was to examine the serial mediating effects of social support, stress, sleep, and tumor necrosis factor-alpha (TNF-α) on the relationship between gratitude and depressive symptoms.

Methods

A total sample of 60 community-dwelling older adults with chronic low back pain (cLBP) provided blood samples for high-sensitivity TNF-α and completed the Gratitude Questionnaire, Perceived Stress Scale, and the PROMIS Emotional Support, Sleep Disturbance, and Depression forms. Descriptive statistics, correlation analyses, and serial mediation analyses were performed.

Results

Gratitude was negatively associated with perceived stress, sleep disturbance, and depression, and was positively associated with social support. No significant association was observed between gratitude and TNF-α. After controlling for age and marital status, analyses revealed that perceived stress and sleep disturbance sequentially mediated the association between gratitude and depressive symptoms.

Conclusion

Perceived stress and sleep disturbance may be potential mechanistic pathways by which gratitude impacts negative well-being. Targeting gratitude as a protective resource may be a potential therapeutic tool to improve psychological and behavioral outcomes in older adults with cLBP.

Positive religious coping acts through perception of nature and silence in its association with well-being and life satisfaction among Polish Catholics

Previous studies indicate that perceptions of nature and thought-provoking silence can have positive consequences for individual functioning. The purpose of the present study was to assess the relationships between religious coping (assessed with the Brief RCOPE), perceptions of nature and silence (a subscale of the Perception of Change Questionnaire), well-being (the World Health Organization's five-item Well-Being Index) and life satisfaction (the Brief Multidimensional Life Satisfaction Scale). An online questionnaire was completed between 2021-2022 by 1,010 Polish Catholics ages 18 to 73, 61% of whom were women. Structural equation modeling showed that positive religious coping was positively related to well-being (β = 0.08, p = 0.011) and life satisfaction (β = 0.22, p < 0.001). In contrast, negative religious coping was related to reduced well-being (β = -0.07, p = 0.040) and life satisfaction (β = -0.25). In addition, more frequent perceptions of nature and reflective times of silence partially mediated the associations of positive religious coping with well-being (β = 0.04, p = 0.011) and life satisfaction (β = 0.04, p = 0.008). The data might suggest that interventions that help people develop an ability or awareness for nature as an exceptional encounter and may help to strengthen the ways they can utilize their religiosity as a resource and thus contribute to well-being and life satisfaction among Catholics.

Spiritual Well-being in Patients with Chronic Diseases: A Systematic Review and Meta-analysis

As a significant health challenge, chronic disease can have critical spiritual consequences for patients. Therefore, the study of spiritual well-being as an aspect of health is essential but has been less considered with regard to chronic diseases. Thus, this systematic review and meta-analysis were conducted to investigate spiritual well-being in patients with chronic diseases. For this purpose, in the initial search that was performed of valid databases, a total of 615 descriptive studies published between 2000 and 2018 were found. After carefully assessing these, only 24 studies were included in the review. Overall, the spiritual well-being of 3289 patients with chronic disease was investigated. This study showed that the total mean score of the spiritual well-being of patients with chronic diseases was 86.65 (P < 0.001, 95%, CI: 80.34-92.96), indicating a moderate level of spiritual well-being in these patients. Thus, patients with chronic diseases are recommended to consider spiritual consultation programs.

Designing a Measurement Scale for Spiritual Health of the Elderly in Tehran/Iran (2019)

Background: Spiritual health is one of the important dimensions of health that causes the coherence and harmony of other dimensions of health in human beings. Due to the increasing number of elderly, considering the status of their health is important. Objectives: The present study was an attempt to design and evaluate a measurement instrument for spiritual health in the Iranian elderly, which is appropriate for the Iranian society. Methods: This mixed methods study used a sequential exploratory strategy. In the first phase, spiritual health items were extracted based on a review of the previous studies and interviews with experts and the elderly using direct content analysis. In the second phase, the standardized questionnaire was assessed by performing validity and reliability tests on 400 elderly residents of Tehran. The participants were selected based on the purposive sampling method from the elderly referring to nursing homes. To analyze the collected data, qualitative content analysis was employed. In the first phase, 45 items of the questionnaire were extracted based on the interviews. After quantitatively determining the face and content validity, six items were removed, and the questionnaire items were reduced to 39 items. Results: Exploratory factor analysis on this questionnaire identified five factors that explained a total of 52.2% of the total variance of the test. The Cronbach's alpha coefficient obtained confirmed the high internal consistency of the questionnaire (0.925). Also, a high correlation was reported between the test and retest with a 10-day interval (r = 0.997). In addition, a high and significant correlation was reported in the simultaneous implementation of the designed instrument with Paloutzin and Ellison’s spiritual health instrument (r = 0.76). Conclusions: In general, based on the present study's findings, the designed questionnaire has an acceptable level of validity and reliability and is usable for the elderly.

Gratitude, self-efficacy, and health-related quality of life in individuals with Parkinson's Disease

Parkinson's Disease (PD) is a chronic disease that can affect the physical, psychological, and social functioning of an individual. Minimal research has examined the relationship among positive psychological variables such as gratitude and self-efficacy and their relationship with health-related quality of life (HRQOL) in this population. Gender analyses have also been limited. The aim of this exploratory, cross-sectional study was to examine the relationship among gratitude, self-efficacy, and HRQOL by gender in individuals with Parkinson's Disease (PD). Participants included 102 individuals with PD (55 women; 42 men; 5 did not report gender) who completed questionnaires on gratitude (Gratitude Questionnaire-6), self-efficacy (General Self-Efficacy Scale), and HRQOL problems (Parkinson's Disease Questionnaire-39). Although there were no gender differences between gratitude, self-efficacy, or health-related quality of life problems, there were key gender differences in how those variables were related. Gratitude was associated with more HRQOL problems for women than men, whereas self-efficacy was associated with more HRQOL problems for men than women. In addition, self-efficacy emerged as a more important predictor of HRQOL problems for women and men than gratitude. This research could lead to targeted interventions by gender aimed at improving HRQOL in individuals with PD, particularly in building self-efficacy.

Gratitude Questionnaire (GQ-6)-Exploring Psychometric Properties in India

Due to culture-based differences in conceptualization, expression, and gratitude experience, the GQ-6 scale has been validated in different countries. The present study examines the adaptability of the Gratitude Questionnaire (GQ-6) scale in India. Two studies are conducted to evaluate the psychometric properties of GQ-6 for Indian college students. The first study explores factorial validity, reliability, and measurement invariance of the scale. Appropriate factor loading in exploratory factor analysis and model fit indices in confirmatory factor analysis (CFA) provides empirical evidence of the scale's factorial validity. The second study investigates the convergent and criterion validity of the scale. A positive correlation with positive affect (PANAS scale) and life satisfaction (Wheel of Life Scale) and a negative association with negative affect (PANAS scale) establish criterion validity of GQ-6. The results conclude adequate suitability of the GQ-6 scale for Indian college students.

Self-Compassion and Social Connectedness as Predictors of “Peace and Meaning” during Spain’s Initial COVID-19 Lockdown

The COVID-19 lockdown has had a massive psychological impact on mental health in the general population, with increases in anxiety, depression, and post-traumatic stress disorder. Spiritual well-being, specifically peace and meaning, has already been identified as one of the main protective factors for these disorders in the COVID-19 context. The aim of the present study is to identify facilitating elements for peace and meaning during the COVID-19 lockdown in Spain. Online surveys were used to obtain data from a sample of 3480 Spanish people. Self-compassion and social support were positively related with peace and meaning, while loneliness and perceived discrimination were negatively related. The model for peace and meaning was statistically significant, explaining 47% of the variance. The significant variables were self-kindness, family support, mindfulness, and sense of belonging having a positive association and loneliness a negative one.

Do People Become More or Less Materialistic during Disasters? The Mediating Roles of Mortality Salience and Gratitude

Studies have yielded inconclusive findings regarding the relationship between disaster experience and materialism. Whereas some have found a positive relationship, others have reported a negative relationship. To clarify the mechanisms underlying these mixed findings, we proposed and examined two mechanisms, namely mortality salience and gratitude. A total of 214 participants (M_age = 42.05 years, SD = 16.49 years) were randomly assigned into either an experimental condition to experience a disaster or a control condition. Participants in the experimental condition reported a lower level of materialism than the scores of their counterparts in the control condition. Such effects were mediated by both mortality salience and gratitude. Participants in the experimental condition reported higher levels of both mortality salience and gratitude simultaneously. Mortality salience strengthened materialism, but gratitude weakened materialism. These findings highlighted the duel-existing mechanisms underlying the relationship between disaster experience and materialism.

Spiritual Well-Being in Older Adults: A Concept Analysis

This concept analysis of spiritual well-being (SWB) in the older adult seeks to improve nurses' integration of spiritual care. Using Walker and Avant's method, the author identified five defining attributes of SWB: personal faith, religious practices, spiritual contentment, productive engagement, and healthy interpersonal relationships. Antecedents to SWB include awareness of one's spiritual needs and seeking to live a meaningful and purposeful life. Model, borderline, and contrary cases are presented to illustrate the defining attributes of SWB. Nursing implications for practice are discussed.

Gratitude, social support and cardiovascular reactivity to acute psychological stress

The pathways linking gratitude to cardiovascular reactivity (CVR) to acute stress are not fully understood. We examine whether this association is mediated by social support. Healthy adults (N = 178) completed measures of trait gratitude and perceived social support and participated in a standardised mental arithmetic and speech stress testing protocol. Their CVR (i.e., systolic and diastolic blood pressure [SBP, DBP], heart rate [HR], cardiac output [CO] and total peripheral resistance [TPR]) were monitored throughout. Gratitude was positively associated with SBP, DBP and TPR reactivity, with those reporting higher gratitude showing higher CVR. Social support was positively associated with TPR to the maths task. The association between gratitude and TPR was mediated by social support but this was only evident in response to the maths task and not the speech task. These novel findings suggest that CVR may be a potential mechanism underlying the gratitude-physical health link.

Religiosity and Spirituality in the Stages of Recovery From Persistent Mental Disorders

ABSTRACT

The impact of religiosity and spirituality (R/S) on mental health and the importance of incorporating R/S in mental health treatment have been previously explored. However, clarification is needed regarding the effects of R/S in the process of recovery from persistent mental disorders (PMDs). This study identifies how different R/S factors correlate with the stages of recovery, while considering individual psychological well-being and perceived social support. Seventy-five individuals who use Madrid's public services for people with PMD completed questionnaires assessing those factors. We found that during the recovery process, R/S correlated with psychological well-being and perceived social support, and that these variables were associated with the five stages of recovery differently. We further identified the importance of gratitude, compassion, inner peace, and connection with life in the recovery process. Overall, our findings highlight the importance of these R/S variables in particular recovery stages for individuals with PMD.

The Emerging Science of Virtue

Numerous scholars have claimed that positive ethical traits such as virtues are important in human psychology and behavior. Psychologists have begun to test these claims. The scores of studies on virtue do not yet constitute a mature science of virtue because of unresolved theoretical and methods challenges. In this article, we addressed those challenges by clarifying how virtue research relates to prosocial behavior, positive psychology, and personality psychology and does not run afoul of the fact-value distinction. The STRIVE-4 (Scalar Traits that are Role sensitive, include Situation × Trait Interactions, and are related to important Values that help to constitute Eudaimonia) model of virtue is proposed to help resolve the theoretical and methods problems and encourage a mature science of virtue. The model depicts virtues as empirically verifiable, acquired scalar traits that are role sensitive, involve Situation × Trait interactions, and relate to important values that partly constitute eudaimonia (human flourishing). The model also holds that virtue traits have four major components: knowledge, behavior, emotion/motivation, and disposition. Heuristically, the STRIVE-4 model suggests 26 hypotheses, which are discussed in light of extant research to indicate which aspects of the model have been assessed and which have not. Research on virtues has included survey, intensive longitudinal, informant-based, experimental, and neuroscientific methods. This discussion illustrates how the STRIVE-4 framework can unify extant research and fruitfully guide future research.

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.

A systematic review of gratitude interventions: Effects on physical health and health behaviors

OBJECTIVE

Gratitude interventions are easy-to-deliver, offering promise for use in clinical-care. Although gratitude interventions have consistently shown benefits to psychological wellbeing, the effects on physical health outcomes are mixed. This systematic review aims to synthesize gratitude intervention studies which assessed physical health and health behavior outcomes, as well as evaluate study quality, comment on their efficacy, and provide directions for future research.

METHODS

Relevant studies were identified through searches conducted in PsycINFO, MedLine, Embase and Cochrane Library databases, up until August 2019. Only studies that evaluated a gratitude intervention, randomly assigned participants to gratitude and control conditions, and assessed objective and subjective measures of physical health and health behaviors were included. The Revised Cochrane risk-of-bias (RoB2) tool was used to assess risk of bias.

RESULTS

Of the 1433 articles found, 19 were included in the review. Subjective sleep quality was improved in 5/8 studies. Improvements in blood pressure, glycemic control, asthma control and eating behavior were understudied yet demonstrated improvements (all 1/1). Other outcome categories remain understudied and mixed, such as inflammation markers (1/2) and self-reported physical symptoms (2/8). The majority of studies showed some risk of bias concerns.

CONCLUSIONS

Although it was suggested gratitude interventions may improve subjective sleep quality, more research is still needed to make firm conclusions on the efficacy of gratitude interventions on improving health outcomes. Further research focusing on gratitude's link with sleep and causal mechanisms is needed, especially in patient populations where more 'clinically-usable' psychosocial interventions are urgently needed.

A Structural Equation Model of Gratitude, Self-efficacy, and Medication Adherence in Patients With Stage B Heart Failure

BACKGROUND

Consistent self-care slows the progression of heart failure (HF). Gratitude, the practice of appreciating the positive aspects of life, may influence self-efficacy, which in turn is known to improve self-care. However, little is known about the relationships among gratitude, self-efficacy, and medication adherence in HF.

OBJECTIVE

The aim of this study was to test a model to determine if self-efficacy mediates the relationship between gratitude and medication adherence in asymptomatic patients with HF.

METHOD

This is a secondary analysis of data from a prospective observational study. Data were analyzed using a structural equation model to examine associations between gratitude, cardiac-specific self-efficacy, and medication adherence in 153 patients with HF. Gratitude, self-efficacy, and medication adherence were assessed using the Gratitude Questionnaire-6, Cardiac Self-efficacy Scale-Maintain Function Subscale, and the Morisky Medication Adherence Scale, respectively.

RESULTS

Patient mean (SD) age was 66 (11) years, and 95% of the participants were men. Patients were primarily white (79%), black (12%), or Asian (6%). Gratitude exerted an indirect effect on medication adherence through self-efficacy (b = 0.16; P < .05). Gratitude was positively related to self-efficacy (b = 0.50; P < .05), and self-efficacy was positively related to medication adherence (b = 0.31; P < .05). The model fit was acceptable (comparative fit index = 0.92, Tucker-Lewis index = 0.90, root-mean-square error of approximation = 0.08).

CONCLUSION

In this study, we found evidence that self-efficacy was a mechanism through which gratitude was associated with medication adherence in asymptomatic patients with HF, suggesting a way to improve self-care nonpharmacologically. Future work will examine whether gratitude intervention results in improved self-care.

The Relationship Between Spiritual Health and Quality of Life of Heart Transplant Candidates

The heart transplantation is a stressful event, and its waiting time is often associated with worsening of clinical conditions and deterioration of the patient's quality of life. Spirituality plays an important role in mental health, so the present study was conducted to investigate the relationship between spiritual health and quality of life of patients undergoing cardiac transplantation. The present descriptive study was performed on 48 patients undergoing cardiac transplantation at the Shahid Rajaee Cardiovascular Center in Tehran during the first half of 2016. The data were collected by Ellisan-Palutzian Spiritual Well-Being Scale, Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Iranian Heart Failure Quality of Life Questionnaire (IHF-QOL). We used the SPSS v.20 software to analyze the data via descriptive statistics, parametric and non-parametric correlation and regression tests. The majority of patients (60.4%) had high spiritual health with a median score of 105, and its religious dimension was reported better (P < 0.001 and r = 0.591). With a mean of 63.23 ± 23.25, the quality of life of the majority of patients (75%) was at a poor level based on the Minnesota questionnaire. According to the IHF-QOL, the median total score was 39.50. There was a significant relationship between spiritual health score and quality of life in both questionnaires (MLHFQ: P = 0.006 and r = - 394; IHF-QOL: P = 0.022 and r = 0.329). Considering the positive relationship between spiritual health and quality of life of patients in this study, it is recommended to implement spiritual care and provide fulfillment for various needs of patients along with other medical care services.

Is Belonging to a Religious Organization Enough? Differences in Religious Affiliation Versus Self-ratings of Spirituality on Behavioral and Psychological Variables in Individuals with Heart Failure

In the United States, heart failure (HF) affects approximately 6.5 million adults. While studies show that individuals with HF often suffer from adverse symptoms such as depression and anxiety, studies also show that these symptoms can be at least partially offset by the presence of spiritual wellbeing. In a sample of 327 men and women with AHA/ACC classification Stage B HF, we found that more spirituality in patients was associated with better clinically-related symptoms such as depressed mood and anxiety, emotional variables (affect, anger), well-being (optimism, satisfaction with life), and physical health-related outcomes (fatigue, sleep quality). These patients also showed better self-efficacy to maintain cardiac function. Simply belonging to a religious organization independent of spiritualty, however, was not a reliable predictor of health-related benefits. In fact, we observed instances of belonging to a religious organization unaccompanied by parallel spiritual ratings, which appeared counterproductive.

Spirituality, Religious Attendance and Health Complaints in Czech Adolescents

Research in some religious countries shows that religiosity and spirituality positively affect adolescent health. We studied whether religiosity and spirituality also have positive associations with adolescent health in a secular country. We tested the associations between religious attendance and spirituality and self-reported health and health complaints using a representative sample of Czech adolescents (n = 4182, 14.4 ± 1.1 years, 48.6% boys) from the 2014 health behavior in school-aged children (HBSC) study. We used religious attendance, the adjusted shortened version of the spiritual well-being scale (SWBS), and its two components—religious well-being (RWB) and existential well-being (EWB)—as independent variables and the eight item “HBSC symptom checklist” and self-reported overall health as dependent variables. A higher level of spirituality was associated with lower chances of health complaints and self-reported health, ranging from a 9% to 30% decrease in odd ratios (OR). Religious attendance was not associated with any of the observed variables. The EWB showed a negative association with all of the observed variables, with associations ranging from a 19% to 47% decrease. The RWB was associated with a higher risk of nervousness (OR = 1.12), while other associations were not significant. Non-spiritual but attending respondents were more likely to report a higher occurrence of stomachache (OR = 2.20) and had significantly worse overall health (OR = 2.38). In a largely secular country, we found that spirituality and the EWB (unlike religious attendance and the RWB) could have a significant influence on adolescent health.

Gender Differences in Psycho-Social-Spiritual Healing

Background: Many individuals exhibit significant distress in response to serious and/or life-limiting illness. However, there are others who make life-transforming changes, which involve healing experiences in the psychological, social, and spiritual domains of life regardless of illness outcome. The aim of the present study is to determine if there are any differences in psycho-social-spiritual healing between genders.

Materials and Methods: The NIH Healing Experiences in All Life Stressors (NIH-HEALS), a 35-item measure of psycho-social-spiritual healing, is composed of three factors: Connection, Reflection & Introspection, and Trust & Acceptance. NIH-HEALS and a demographic questionnaire were administered to 193 patients with serious and/or life-limiting illness at the National Institutes of Health Clinical Center.

Results: In response to NIH-HEALS, men and women significantly differed on the Reflection & Introspection factor. Women reported increased enjoyment of mind–body practices (p < 0.001), compassion (p = 0.005), gratitude (p = 0.014), and a desire to be more positive (p = 0.044) compared to men. Men rated their pain levels (p = 0.035) and severity of illness (p = 0.016) higher and their overall level of health (p = 0.010) poorer compared to women. Women's responses to items regarding compassion (r_s = 0.37, p < 0.001) and gratitude (r_s = 0.24, p = 0.015) correlated positively with better overall health ratings.

Conclusion: Men and women show some differences in their self-reported psycho-social-spiritual healing, which may have implications when designing interventions aimed at promoting a healing experience in the context of serious and life-limiting illness.

Testing Motivational Theories in Music Education: The Role of Effort and Gratitude

Acquiring musical skills requires sustained effort over long periods of time. This work aims to explore the variables involved in sustaining motivation in music students, including perceptions about one's own skills, satisfaction with achievements, effort, the importance of music in one's life, and perception of the sacrifice made. Two models were developed in which the variable of gratitude was included to integrate positive psychology into the motivational area of music education. The first predicts effort, while the second predicts gratitude. The models were tested using a sample of 84 music students. Both models were fitted using Bayesian analysis techniques to examine the relationship between variables and showed adequate goodness of fit. These models emphasize the role of cognition and motivation in music education and, more precisely, the relationship between effort and gratitude.

Longitudinal associations between gratitude and depression 1 year later among adult cystic fibrosis patients

Individuals with cystic fibrosis (CF) are confronted by a range of difficult physical and psychosocial sequelae. Gratitude has drawn growing attention as a psychosocial resource, but it has yet to be examined among adults with CF. The current investigation evaluated longitudinal associations between trait gratitude and subsequent outcomes from depression screening 12 months later, adjusting for disease severity (FEV₁% predicted) and other significant clinical or demographic covariates. Participants were 69 adult CF patients recruited from a regional adult treatment center. They completed a validated measure of gratitude (Gratitude Questionnaire-6) at baseline and a screening measure of depression (Hospital Anxiety and Depression Scale) at 12-month follow-up. In a logistic regression analysis controlling for disease severity, higher levels of baseline gratitude were associated with reduced likelihood of depression caseness at 12 months (OR .83, 95% CI .73-.91, p = .001). Gratitude remained predictive after adjusting for other psychosocial resource variables (i.e., perceived social support and positive reframing coping). Findings offer an initial indication of the potential salutary role of dispositional gratitude in an understudied clinical population.

Dispositional Gratitude Moderates the Association between Socioeconomic Status and Interleukin-6

Socioeconomic disparities in health are prevalent and growing in importance as a concern among academics, policymakers, and the general public. However, psychological resources that can narrow such disparities have not been well-examined. The current study examined the moderating role of dispositional gratitude in the relationship between socioeconomic status (SES) and inflammation risk as an index of health. Participants consisted of 1,054 midlife adults from the biomarker project of the Midlife in the United States. Inflammation risk was measured by interleukin-6 biomarker and SES was operationalized by education attainment and income. We found that dispositional gratitude significantly moderated the relationships between SES and interleukin-6. Among individuals with low dispositional gratitude, higher SES was significantly associated with lower levels of interleukin-6. However, the association between SES and interleukin-6 was not significant among individuals with high dispositional gratitude. More importantly, the findings remained robust after controlling for demographic characteristics, health status, health behaviours, and personality traits. Our findings suggest that gratitude may serve as an important psychological resource in attenuating health-related risk from socioeconomic stressors.

Explanatory definition of the concept of spiritual health: a qualitative study in Iran

Scientists and researchers have examined spiritual health from different angles and proposed various definitions, but a comprehensive definition does not exist for the term as of now. The present study aimed to offer the definition, components and indicators of spiritual health from experts' perspective. This qualitative study utilized conventional content analysis and individual in-depth interviews with 22 experts in the area of spiritual health in various fields selected through purposeful sampling. Member check, credibility, reliability, transferability and allocation of adequate time for data collection were measured to increase the validity and reliability of the results. Conventional content analysis was performed in three main phases: preparation, organization and reporting, and the categories, subcategories and codes emerged accordingly. Participants defined spiritual health in three dimensions: religious, individualistic, and material world-oriented. The study revealed four types of connection in spiritual health: human connection with God, himself, others and the nature. The majority of participants stated that spiritual health and spirituality were different, and pointed out the following characteristics for spiritual health: it affects physical, mental, and social health; it dominates other aspects of health; there are religious and existential approaches to spiritual health; it is perceptible in people's behavior; and it can be enhanced and improved. Most experts recognized human connection with God as the most important part of the definition of spiritual health. In conclusion, the connection between humans and themselves, others and the nature was not seen as a component specific to spiritual health.

Spirituality, Spiritual Well-Being, and Spiritual Coping in Advanced Heart Failure: Review of the Literature

Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.

State Gratitude for One's Life and Health after an Acute Coronary Syndrome: Prospective Associations with Physical Activity, Medical Adherence and Re-hospitalizations

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one's health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β=340.9; 95% confidence interval=53.4-628.4; p=.020). Gratitude for one's life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β=.60; 95% confidence interval=.16-1.04; p=.008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.

The Cultivation of Pure Altruism via Gratitude: A Functional MRI Study of Change with Gratitude Practice

Gratitude is an emotion and a trait linked to well-being and better health, and welcoming benefits to oneself is instrumentally valuable. However, theoretical and empirical work highlights that gratitude is more fully understood as an intrinsically valuable moral emotion. To understand the role of neural reward systems in the association between gratitude and altruistic motivations we tested two hypotheses: First, whether self-reported propensity toward gratitude relates to fMRI-derived indicators of "pure altruism," operationalized as the neural valuation of passive, private transfers to a charity versus to oneself. In young adult female participants, self-reported gratitude and altruism were associated with "neural pure altruism" in ventromedial prefrontal cortex (VMPFC) and nucleus accumbens. Second, whether neural pure altruism can be increased through practicing gratitude. In a double-blind study, we randomly assigned participants to either a gratitude-journal or active-neutral control journal group for 3 weeks. Relative to pre-test levels, gratitude journaling increased the neural pure altruism response in the VMPFC. We posit that as a context-dependent value-sensitive cortical region, the VMPFC supports change with gratitude practice, a change that is larger for benefits to others versus oneself.

A Potential Role for mu-Opioids in Mediating the Positive Effects of Gratitude

Gratitude is a complex emotional feeling associated with universally desirable positive effects in personal, social, and physiological domains. Why or how gratitude achieves these functional outcomes is not clear. Toward the goal of identifying its' underlying physiological processes, we recently investigated the neural correlates of gratitude. In our study, participants were exposed to gratitude-inducing stimuli, and rated each according to how much gratitude it provoked. As expected, self-reported gratitude intensity correlated with brain activity in distinct regions of the medial pre-frontal cortex associated with social reward and moral cognition. Here we draw from our data and existing literature to offer a theoretical foundation for the physiological correlates of gratitude. We propose that mu-opioid signaling (1) accompanies the mental experience of gratitude, and (2) may account for the positive effects of gratitude on social relationships, subjective wellbeing, and physiological health.