Experience of gratitude, awe and beauty in life among patients with multiple sclerosis and psychiatric disorders

Effects of Ayahuasca on Gratitude and Relationships with Nature: A Prospective, Naturalistic Study

Qualitative studies and anecdotal reports suggest that experiences with ayahuasca, a psychedelic brew found in Central and South America, may be followed by individuals enduringly feeling more grateful and connected to nature. Yet, to date, these changes have been understudied. Here, participants (N = 54) completed validated surveys related to gratitude, nature relatedness, and nature appreciation one-week before, one-week after, and one-month after attending an ayahuasca retreat center. Compared to baseline, there was a significant increase in gratitude, nature relatedness, and nature appreciation at the one-week and one-month follow-ups. Ratings of mystical-type experiences and awe, but not ego dissolution, during participants' ayahuasca sessions were weakly-to-moderately correlated with these increases. The number of ayahuasca ceremonies attended at the retreat was not related to change in outcomes, underscoring the importance of the quality rather than the quantity of the experiences in post-acute change. Lastly, participant age was negatively related to the occurrence of mystical-type experiences and awe, supporting literature indicating blunted psychedelic effects with increased age. In the context of study limitations, the results suggest that mystical-type experiences and awe occasioned by ayahuasca may be linked to prosocial changes in gratitude and relationships with nature that may be beneficial to mental health.

The 12-Step Pathway to Spiritual Growth and Gratitude and Its Relationship With Well-Being Among the Members of Sexaholics Anonymous in Poland

Despite the well-established role of mutual-aid groups in addiction treatment, no research has yet explored the role of the 12-step pathway in spiritual growth and gratitude, or its direct and indirect relationships with well-being among individuals with compulsive sexual behavior disorders (CSBD). The purpose of the current study was to examine the number of 12 steps completed as an antecedent of spiritual growth and gratitude and its relationship with well-being among members of Sexaholics Anonymous (SA). The sample consisted of 80 individuals (72 men and 8 women) attending SA meetings in Poland. The study variables were measured using the Daily Spiritual Experiences Scale, Gratitude Questionnaire, Satisfaction with Life Scale, Positive and Negative Affect Schedule, and a single question regarding the number of 12 steps completed. A path analysis showed that the number of 12 steps completed was negatively and directly related to negative affect. Moreover, the number of 12 steps completed was related to higher spiritual growth, which was directly related to higher levels of life satisfaction and lower levels of negative affect, and indirectly, through gratitude, to higher levels of life satisfaction and positive affect. The results suggest that spiritual growth, rooted in the 12-step program, and its ability to increase gratitude, may promote recovery from CSBD.

The Roles Between Gratitude, Perceived Stress, and Quality of Life Among Patients with Multiple Sclerosis

Dispositional gratitude has been negatively associated with perceived stress (PS) and positively associated with higher well-being in both general and chronically ill people. Attempts to understand the relationship between gratitude and aspects of quality of life (QOL) have been documented; however, there is limited research on determining the potential mediating effect of PS on gratitude and QOL factors in individuals with Multiple Sclerosis (MS). In this cross-sectional study, participant demographics, dispositional gratitude, PS, and QOL factors were collected online via self-report measures from a sample of 68 participants diagnosed with MS. Results indicated that both dispositional gratitude and PS were associated with aspects of QOL and that PS was found to partially and indirectly account for the relationship between gratitude and improved QOL. Findings are consistent with existing research conducted with non-chronically ill samples. Clarifying relationships between PS and dispositional factors in MS is necessary to inform future interventions aimed at maintaining and enhancing an individual's QOL.

Let’s color: An online coloring game improves subjective well-being and reduces anxiety during the COVID-19 pandemic (Preprint)

Background

COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown.

Objective

The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic.

Methods

An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed.

Results

In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01).

Conclusions

These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind.

Religious Coping and Life Satisfaction during the COVID-19 Pandemic among Polish Catholics. The Mediating Effect of Coronavirus Anxiety

Recent data have indicated that people may have experienced fear during the COVID-19 pandemic. This study aims to deepen our understanding of the relationship between religious coping and life satisfaction by analysing the indirect effects of fear of COVID-19.

METHODS

This study included 365 people (75% women) aged 18-78 years. The procedure consisted of completing questionnaires to measure religious coping, COVID-19 anxiety, satisfaction with life, and satisfaction with social support.

RESULTS

Structural equation modelling showed that positive religious coping was related to greater life satisfaction and greater satisfaction with social support during the pandemic. Moreover, fear of COVID-19 mediated the relationship between negative religious coping and life satisfaction and social support satisfaction.

CONCLUSIONS

The data suggest a need for practitioners to focus on interventions that enhance positive religious coping to improve life satisfaction during the spread of infectious diseases.

Wondering Awe as a Perceptive Aspect of Spirituality and Its Relation to Indicators of Wellbeing: Frequency of Perception and Underlying Triggers

Background: Spirituality is a multidimensional construct which includes religious, existentialistic, and relational issues and has different layers such as faith as the core, related attitudes and conviction, and subsequent behaviors and practices. The perceptive aspects of spirituality such as wondering awe are of relevance for both, religious and non-religious persons. These perceptions were related to perceiving the Sacred in life, mindful awareness of nature, others and self, to compassion, meaning in life, and emotional wellbeing. As awe perceptions are foremost a matter of state, it was the aim (1) to empirically analyze the frequency of wondering awe perceptions (i.e., with respect to gender, age cohorts, religious or non-religious persons) and (2) to qualitatively analyze a range of triggers of awe perceptions.

Methods: Data from 7,928 participants were analyzed with respect to the frequency of Awe/Gratitude perceptions (GrAw-7 scale), while for the second part of the study responses of a heterogeneous group of 82 persons what caused them to perceive moments of wondering awe were analyzed with qualitative content analysis techniques.

Results: Persons who experience Awe/Gratitude to a low extend were the youngest and had lowest wellbeing and lowest meditation/praying engagement, while those with high GrAw-7 scores were the oldest, had the highest wellbeing, and were more often meditating or praying (p<0.001). Gender had a significant effect on these perceptions, too (Cohen’s d=0.32). In the qualitative part, the triggers can be attributed to four main categories, Nature, Persons, Unique Moments, and Aesthetics, Beauty, and Devotion. Some of these triggers and related perceptions might be more a matter of admiration than wondering awe, while other perceptions could have more profound effects and may thus result in changes of a person’s attitudes and behaviors.

Conclusion: Emotionally touching experiences of wondering awe may result in feelings of interconnectedness, prosocial behavior, mindful awareness, and contribute to a person’s meaning in life and wellbeing and can also be a health-relevant resource. These perceptions can be seen as a perceptive aspect of spirituality, which is not exclusively experienced by religious people but also by non-religious persons.

The Relationships between Character Strengths and Subjective Wellbeing: Evidence from Greece under Lockdown during COVID-19 Pandemic

COVID-19 was first identified in December 2019. As long as this type of coronavirus was new, the main way for governments to avoid the spread of the infection was enforced quarantine. Besides public health protection, quarantine can have a psychological impact on the residents, with main symptoms being angst, anxiety, depressive, and PTSD symptoms. As it has been found that character strengths can promote subjective wellbeing, the purpose of the study was to examine this relationship under the new situation of quarantine in the Greek population in adults who were in quarantine for at least two weeks. The total sample consisted of 354 participants who were aged 18–72-years-old. A total of 263 participants were women (74.3%), 91 were men (25.7%), and 94.6% of them were highly educated. The sample was a convenience sample. The tools used were PANAS, PERMA and finally VIA-114GR. The data analysis was completed using SPSS software version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY, USA: IBM Corp) and EQS 6.1 (Multivariate Software Inc.: Encino, CA, USA, 2006). The results showed that love, curiosity, persistence, hope, and zest are strongly associated with subjective wellbeing, even in conditions such as quarantine, and can support specific aspects of it.

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.

Awe/Gratitude as an Experiential Aspect of Spirituality and Its Association to Perceived Positive Changes During the COVID-19 Pandemic

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be "spellbound at the moment" and to become "quiet and devout," indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor. Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020. Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a "stronghold in difficult times" (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R ² = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = -0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of β = 0.15 (p < 0.001) and an indirect effect of β = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is β = 0.18 (p < 0.001), and the indirect effect is β = 0.11 (p < 0.001). Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply "touch" a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being.

Perceived changes of specific attitudes, perceptions and behaviors during the Corona pandemic and their relation to wellbeing

Background

During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected ‘extra time’ there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic.

Methods

An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ).

Results

Within the number of respondents (n = 1277), women were predominating (67.5%). Participants’ mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: (1) Nature/Silence/Contemplation (Cronbach’s alpha = .87), (2) Spirituality (Cronbach’s alpha = .83), (3) Relationships (Cronbach’s alpha = .80), (4) Reflection on life (Cronbach’s alpha = .74), (5) Digital media usage (Cronbach’s alpha = .74). Strongest changes were observed for Relationships and Nature/Silence/Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person’s perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants’ wellbeing was explained best by low perceived burden and high life satisfaction (R² = .46). Awe/gratitude, perceived changes in terms of Nature/Silence/Contemplation and low Reflections of live are further variables that would predict a person’s wellbeing among the COVID-19 pandemic.

Conclusions

During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons’ wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples’ life.

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 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.

Ehrfurcht/Dankbarkeit als säkulare Form der Spiritualität bei jungen Erwachsenen und Ordens-Christen

Wenn das Interesse an der institutionalisierten Religiosität scheinbar abnimmt, hat dann Ehrfurcht/Dankbarkeit als eher säkulare und individuelle Form einer wahrnehmenden anstatt kognitiv geprägten Spiritualität eine Bedeutung auch für junge Erwachsene? Wie ist dieser Aspekt von Spiritualität bei jungen Erwachsenen und Ordens-Christen (als Kontrast-Gruppe) ausgeprägt? Um diesen Fragen nachzugehen, wurden 1.622 Personen (60 % Frauen, 40 % Männer) aus unterschiedlichen Alters- und Rekrutierungsgruppen mit dem standardisierten Fragebogen zur Erfassung von Ehrfurcht/Dankbarkeit (GrAw-7) untersucht. Es zeigte sich, dass Gefühle staunender Ehrfurcht und daraus resultierende Dankbarkeit von allen hier untersuchten Personen- und Altersgruppen erlebt werden, jedoch in divergenter Ausprägung, wobei die älteren Ordens-Christen die höchsten Scores hatten und die jungen Erwachsenen die niedrigsten. Auch von Personen ohne Religionszugehörigkeit (bzw. solchen, die gemäß Selbsteinschätzung weder religiös noch spirituell sind) wurde Ehrfurcht/Dankbarkeit empfunden, jedoch signifikant geringer als von Personen mit Religionszugehörigkeit (bzw. mit einer Selbsteinschätzung, spirituell und/oder religiös zu sein). Diese perzeptive Form der Spiritualität kann als Achtsamkeit dem Augenblick gegenüber aufgefasst werden, für die sensibilisiert werden kann. Sie bedarf keiner spezifischen religiösen Ausrichtung oder Weltanschauung und könnte eine gesellschaftlich und individuell relevante Ressource gerade in säkular geprägten Gesellschaften darstellen.

Openness to Experience, Extraversion, and Subjective Well-Being Among Chinese College Students: The Mediating Role of Dispositional Awe

Awe is the emotion experienced when people confront stimuli so vast and novel that they require accommodation. Dispositional awe, in contrast, captures individual differences in the tendency to experience awe. Previous research has found that state awe could predict life satisfaction; however, no study has focused on the indirect effects of dispositional awe on the relationship between personality traits and subjective well-being. Previous studies have found that both openness to experience and extraversion were significant predictors of subjective well-being. Both openness to experience and awe involve cognitive flexibility. Awe can also arise from engaging in social events. Previous research has found that those who are higher in dispositional awe tend to be more extraverted and open to experience. Therefore, the main purpose of this study is to test the mediating role of dispositional awe among openness to experience, extraversion, and subjective well-being. To test this hypothesis, a total of 332 Chinese college students were invited to complete an anonymous survey using a cross-sectional design. The results of structural equation modeling showed that openness to experience and extraversion predicted higher levels of dispositional awe, while dispositional awe predicted higher levels of subjective well-being. Moreover, dispositional awe mediated the effects of openness to experience and extraversion on subjective well-being. The findings of this study suggest that openness to experience and extraversion may invite more experiences of awe and thus promote subjective well-being.

Trait Appreciation of Beauty: A Story of Love, Transcendence, and Inquiry

This review of the trait of appreciation of beauty (AoB) draws from the literature in personality psychology, philosophy, religion, neuroscience, neuro-aesthetics, evolutionary psychology, and the psychology of morality. We demonstrate that AoB can be mapped onto a definition of appreciation that includes perceptual, cognitive, emotional, trait, virtue, and valuing elements. A classic component of defining beauty, unity-in-diversity, is described based on the works of a variety of major philosophers. We next describe that there are at least four channels of appreciation of beauty: natural beauty, artistic beauty, moral beauty, and beautiful ideas. Examining the neuro-aesthetics research indicates that many networks of the brain are involved in mental acts of appreciating beauty, but the medial orbital front cortex (mOFC) is implicated across all four channels of beauty. We then explain how the trait of AoB is a member of three different families of traits: traits of love, traits of transcendence, and traits of inquiry. Next we briefly explain why Kant may have been more correct than Hegel concerning beauty and the good soul. We then present evidence that women may appreciate beauty somewhat more than men. Data from many cultures and nations consistently indicate this. After that we claim AoB leads to individual and collective flourishing. We examine and summarize studies that indicate appreciation of natural beauty leads to a wide variety of positive outcomes; we focus on the importance of open-mindedness that accompanies engagement with artistic beauty; and we summarize studies regarding the moral emotion of elevation and appreciation of moral beauty. Suggested future directions for research are embedded in each subsection of the paper.

Gratitude across the life span: Age differences and links to subjective well-being

Gratitude has been described as an adaptive evolutionary mechanism that is relevant to healthy psychological and interpersonal outcomes. Questions remain as to whether the presence and benefits of gratitude are consistent from young adulthood to old age; prior research has yielded mixed evidence. We examined the magnitude and direction of age differences in gratitude in three samples (combined N = 31,206). We also examined whether gratitude was associated with greater/lesser well-being at different periods in the life course. We found that the experience of gratitude was greatest in older adults and least in middle aged and younger adults. Further, we found that the associations between gratitude and subjective well-being remained relatively constant across the lifespan. Findings are discussed from a developmental perspective.

Reduced Sense of Coherence Due to Neuroticism: Are Transcendent Beliefs Protective Among Catholic Pastoral Workers?

In this study, we examined a third variable effect on the relationship of personality traits, especially neuroticism and the salutogenetic concept sense of coherence. Specifically, we were interested in the moderating role of religious trust (RT) and transcendence perception operationalized as daily spiritual experiences (DSE) on the aforementioned relationship among religious individuals. We applied a cross-sectional study among a sample of 8594 pastoral workers using standardized questionnaires. Multiple regression and moderator analysis displayed the relationships between big five personality variables and sense of coherence. Neuroticism was identified as a negative predictor to sense of coherence, indicating impairment on this psychological resource. RT and DSE appear to function as moderators that buffer the negative effects of neuroticism on sense of coherence among religious persons. This is an interesting finding because people with expressions of neurotic personality tendencies often struggle to find helpful methods of coping and may find a helpful resource in the concepts studied here.

Risk Factors for Suicidal Ideation in Patients Feeling Severely Affected by Multiple Sclerosis

BACKGROUND

Being severely affected by multiple sclerosis (MS) brings substantial physical and psychological challenges. Contrary to common thinking that MS is not lethal, there is a higher mortality risk in patients also reflected in alarming rates of assisted suicide, and - where possible - euthanasia.

OBJECTIVE

Analyzing independent variables promoting suicidal ideation in severely affected MS patients.

DESIGN

A self-report questionnaire with 25 needs categories including one self-assessment item "prone to suicidal ideation" was applied.

SETTING/SUBJECTS

Included were patients reporting feeling subjectively severely affected by MS. Of 867 patients addressed, 573 (66.1%) completed the questionnaires.

MEASUREMENTS

32 items being potential risk factors for suicidal ideation were tested for statistical significance using a multivariate logistic regression model with stepwise, backward elimination procedure.

RESULTS

22.1% of 573 patients (median age 51, range 20-83) had suicidal ideation. 48.4% suffered from secondary progressive, 24.7% from relapsing-remitting and 21.9% from primary progressive MS. A set of six statistically significant criteria for suicidal ideation were found. Three items were risk factors for suicidal ideation: the extent to which MS affects leisure time (p < 0.001), depression (p < 0.000), and feeling socially excluded (p < 0.002). Three items reduced the odds of suicidal ideation: having a purpose in life (p < 0.000), being productive (p < 0.000), and having comfort in faith and spiritual beliefs (p < 0.024).

CONCLUSION

This study identified potentially modifiable factors that may help preventing suicide in people with MS. Integrating palliative care (PC) with its multidisciplinary approach could be beneficial to reduce patient's burden.

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

Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, p<0.01), less depressed mood (r=-.41, p<0.01), less fatigue (r=-.46, p<0.01), and better self-efficacy to maintain cardiac function (r=.42, p<0.01). Patients expressing more gratitude also had lower levels of inflammatory biomarkers (r=-.17, p<0.05). We further explored relationships among these variables by examining a putative pathway to determine whether spirituality exerts its beneficial effects through gratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, p<.001). Gratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, p<.001), and between spiritual wellbeing and self-efficacy (z=2.91, SE=.04, p=.003). In sum, we report that gratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.