A spirituality teaching program for depression: a randomized controlled trial

Influence of Optimism, Social Support, and Spirituality on COVID-19 Stress in Christian Church Community

OBJECTIVE

Optimism, social support, and spirituality can be important factors related to coronavirus disease-2019 (COVID-19) stress. However, studies investigating the influence and interplay of optimism, social support, and spirituality on COVID-19 simultaneously are still few. This study is aimed to explore the influence of optimism, social support, and spirituality on COVID-19 stress in the Christian church community.

METHODS

A total 350 participants were included in this study. This study was cross-sectionally conducted by using an online survey on optimism, social support, spirituality, and COVID-19 stress that were measured by the Life Orientation Test-Revised (LOT-R), Multidimensional Scale of Perceived Social Support Scale (MSPSS), Spiritual Well-Being Scale (SWBS), and COVID-19 Stress Scale for Korean People (CSSK). The prediction models for COVID-19 stress were analyzed by using univariate and multiple linear regression.

RESULTS

Based on the results of univariate linear regression, subjective feelings on income (p<0.001) and health status (p<0.001), LOTR (p<0.001), MSPSS (p=0.025), and SWBS (p<0.001) scores were significantly associated with COVID-19 stress. The multiple linear regression model with subjective feelings on income and health status and SWSB score was significant (p<0.001) and explained 17.7% of the variance (R2=0.177).

CONCLUSION

This study showed that subjective feeling on low income, those who had poor health status, lower optimism, lower perceived social support, and lower spirituality were significantly affected with COVID-19 stress. Especially, the model with subjective feelings on income and health status, and spirituality showed highly significant effects, despite the interaction with associated factors. To cope with unpredictable stressful situations like the COVID-19 pandemic, integrated interventions on psycho-socio-spiritual aspect are warranted.

Use of Spirituality in the Treatment of Depression: Systematic Literature Review

Spirituality has been gaining recognition as a potential treatment modality. Our paper aimed to provide a systematic overview of existing research examining the use of spirituality as a treatment method for depression. All articles published between 2000 and 2018 that scientifically evaluated therapeutic interventions with elements of spirituality were included in the review. Ten studies met the inclusion criteria. Their analysis showed that there were elements of spirituality-based treatments that were repeatedly mentioned, including gratitude, forgiveness, self-acceptance, and compassion. Most often, spirituality was used together with psychotherapy. The review also noted the emergence of digital interventions.

What is the short-term remission rate for people with untreated depression? A systematic review and meta-analysis

BACKGROUND

Depression is one of the prevalent mental illnesses and leading cause of global disease burden. However, most people with depression do not access treatment. Remission without treatment may occur in some cases of depression. This study aimed to estimate the short-term remission (natural recovery) from untreated depression.

METHODS

A systematic review and meta-analysis was registered on PROSPERO and conducted following PRISMA guidelines. EMBASE, PsycINFO, and PubMed were searched, supplemented with an additional hand search to identify studies reporting natural recovery from untreated depression. Study selection and screening were carried out by three independent reviewers. Methodological quality assessment of the included studies was conducted. Remission was defined as no longer meeting the diagnostic criteria or scoring below the cut off points of the validated tools as reported by the included studies. The data were synthesized using narrative summary and random-effects meta-analysis.

RESULTS

Sixteen waitlist-controlled trial studies were included in the systematic review and meta-analysis. The duration of follow-up ranged from 4 to 12 weeks with a median duration of 8 weeks. The overall pooled remission from untreated depression was 12.5%, 95% confidence interval (7.8, 18.0%). Due to lack of published data, we were unable to determine if the severity of depression symptoms was associated with remission rates.

CONCLUSIONS

Short-term remission from depression without treatment is uncommon. Across studies, 8 - 18% of people remitted without treatment within 12 weeks. Waitlist control groups may not represent all persons with depression.

The Mediating Role of Spirituality on Depression, Alcohol Use Disorder, and Problem Gambling Among Korean College Students: A Multiple-Mediation Analysis

ABSTRACT

Excessive alcohol use and gambling problems among Korean college students in Korea have been recognized as significant public health issues. The purpose of this study was to identify the direct, indirect, and total influence of depression on alcohol use disorder and problem gambling to determine relative magnitudes of the specific mediating effects of spirituality. A cross-sectional correlational survey was conducted in South Korea with 239 college students. Study variables included the Center for Epidemiological Studies Depression Scale, a Spirituality Scale for Koreans, the Alcohol Consumption Questions, and the Korean version of the Canadian Problem Gambling Severity Index. Multiple-mediation analyses were performed. The results found that depression has a negative effect on each of the six subgroups of spirituality. In terms of the effects of spirituality on alcohol use disorder and problem gambling, spirituality was found to have a positive effect only on alcohol use disorder. The relationship between depression and those two addictive behaviors was significantly mediated by spirituality. Bootstrapping revealed that transcendence and connectedness were significantly mediating the relationship between depression and alcohol use disorder. For problem gambling, compassion and connectedness were found to be mediators affecting the relationship between depression and problem gambling. The finding suggests that spirituality's subscales affect two specific addiction problems in different ways. College students' excessive drinking and problem gambling can be prevented by developing and applying an intervention program that strengthens the connectedness of spirituality's subscales.

Is spirituality a component of wisdom? Study of 1,786 adults using expanded San Diego Wisdom Scale (Jeste-Thomas Wisdom Index)

OBJECTIVE

Wisdom has gained increasing interest among researchers as a personality trait relevant to well-being and mental health. We previously reported development of a new 24-item San Diego Wisdom Scale (SD-WISE), with good to excellent psychometric properties, comprised of six subscales: pro-social behaviors, emotional regulation, self-reflection (insight), tolerance for divergent values (acceptance of uncertainty), decisiveness, and social advising. There is controversy about whether spirituality is a marker of wisdom. The present cross-sectional study sought to address that question by developing a new SD-WISE subscale of spirituality and examining its associations with various relevant measures.

METHODS

Data were collected from a national-level sample of 1,786 community-dwelling adults age 20-82 years, as part of an Amazon M-Turk cohort. Participants completed the 24-item SD-WISE along with several subscales of a commonly used Brief Multidimensional Measure of Religiousness/Spirituality, along with validated scales for well-being, resilience, happiness, depression, anxiety, loneliness, and social network.

RESULTS

Using latent variable models, we developed a Spirituality subscale, which demonstrated acceptable psychometric properties including a unidimensional factor structure and good reliability. Spirituality correlated positively with age and was higher in women than in men. The expanded 28-item, 7-subscale SD-WISE total score (called the Jeste-Thomas Wisdom Index or JTWI) demonstrated acceptable psychometric properties. The Spirituality subscale was positively correlated with good mental health and well-being, and negatively correlated with poor mental health. However, compared to other components of wisdom, the Spirituality factor showed weaker (i.e., small-to-medium vs. medium-to-large) association with the SD-WISE higher-order Wisdom factor (JTWI).

CONCLUSION

Similar to other components as well as overall wisdom, spirituality is significantly associated with better mental health and well-being, and may add to the predictive utility of the total wisdom score. Spirituality is, however, a weaker contributor to overall wisdom than components like pro-social behaviors and emotional regulation. Longitudinal studies of larger and more diverse samples are needed to explore mediation effects of these constructs on well-being and health.

A Spirituality Mind-Body Wellness Center in a University Setting; A Pilot Service Assessment Study

Increasing rates of mental illness among college students over the past 10 years suggest a collective deficit in meaning and purpose unattended to by many university campuses. Psychopathology among young adult college students is associated with developmental tasks such as spiritual individuation, suggesting that interventions aimed at spiritual wellbeing may support the stated need for comprehensive mental health services. The aim of this pilot service assessment study is to investigate the feasibility, acceptability, and helpfulness of spiritually integrated programs at a Spirituality Mind Body (SMB) Wellness Center at a graduate-level academic institution. Wellness Center demographic and attendance data of N = 305 adult graduate students (M = 27.7 years, SD = 6.05) were used to assess acceptability and feasibility. To evaluate helpfulness, measures assessing symptoms of depression, anxiety, post-traumatic stress (PTS), spirituality, mindfulness, and psychological inflexibility were completed before and after eight-week programs on a subset of participants (n = 141). SMB users completed a total of 64% of sessions and reported significant pre/post gains in spirituality and mindfulness and decreases in psychological inflexibility, symptoms of depression and PTS. The preliminary findings of this open-trial are encouraging but inherently limited by the design; foremost, the results offer support for future research, which might draw on a larger sample and a study design involving a comparison group.

Patients' Needs of Religion/Spirituality Integration in Two Mental Health Clinics in the Netherlands

INTRODUCTION

In the last decades, the attention for religion/spirituality (R/S) in mental health care (MHC) has considerably increased. However, patients' preferences concerning R/S in treatment have not often been investigated. The aim of this study was to find out how patients in clinical multidisciplinary MHC want R/S to be addressed in their care.

METHODS

Thirty-five semi-structured interviews were carried out between September 2015 and July 2016 among patients in a secular and a Christian MHC in the Netherlands. Qualitative inductive content analysis was performed, using Atlas Ti.

RESULTS

Patients appreciated (1) individual R/S conversations between patients and care team members (mainly nurses), (2) a familiar R/S environment, (3) a special R/S program and (4) contact with their R/S network. Patients varied in their presentation of R/S care needs from (a) explicit, mostly in the Christian MHC, to (b) implicit, predominantly in the secular MHC, or showed (c) hidden R/S care needs. A non-acute stage of the illness and R/S affinity of the mental health professionals, were classified as possible conditions for addressing R/S. Discussion and implications for practice: Nurses are recommended to be aware of the diversity of patients' R/S care needs. Actively addressing R/S may help in recognizing implicit or even hidden R/S care needs. Further considerations on whether and how to respond to patients' R/S care needs would be justified.

Efficacy of home-based non-pharmacological interventions for treating depression: a systematic review and network meta-analysis of randomised controlled trials

OBJECTIVES

To systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression.

DESIGN

Systematic review and network meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016.

ELIGIBILITY CRITERIA

Randomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review.

MAIN OUTCOMES

Depression symptom scores and disease remission rates at the end of treatment.

RESULTS

Seventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were âˆ'0.57 (95% CI âˆ'0.84 to âˆ'0.31), âˆ'1.03 (95% CI âˆ'2.89 to 0.82) and âˆ'0.78 (95% CI âˆ'1.09 to âˆ'0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission.

CONCLUSION

Our study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.

The Effect of Spiritual Intervention on Postmenopausal Depression in Women Referred to Urban Healthcare Centers in Isfahan: A Double-Blind Clinical Trial

Background:

Depression is not only common after menopause, but also affects postmenopausal women more than other women. Some studies show the positive effects of spiritual intervention on postmenopausal women and depressed patients. However, there is inadequate experimental data for supporting the effectiveness of such interventions.

Objectives:

This study investigated the effect of a spiritual intervention on postmenopausal depression in women referred to urban healthcare centers in Isfahan, Iran.

Patients and Methods:

A randomized controlled clinical trial was conducted on postmenopausal women referred to the healthcare centers of Isfahan. Sixty-four women with postmenopausal depression were assigned randomly into an experimental group (n = 32) and a control group (n = 32). The experimental group received eight sessions of spiritual intervention while the control group received two sessions of training on healthy diet for postmenopausal women. All subjects in the experimental group and the control group responded to the Beck’s depression inventory at the start of the study, at the end of the fourth week, and a month after the last educational session. In addition to descriptive statistics, the chi-square test, independent samples t-test and repeated measures analysis of variance were used to analyze the data.

Results:

Before the intervention, the study groups did not differ significantly in terms of mean depression scores (20.76 ± 4.61 vs. 19.58 ± 5.27, P = 0.33). However, immediately after intervention and after one month, the mean depression scores of 11.01 ± 7.85 and 11.21 ± 9.23 in the experimental group were significantly lower than the control group (19.22 ± 4.94 and 19.34 ± 4.92, respectively) (P = 0.001). In repeated measures analysis of variance, Mauchly’s test of sphericity was not significant (P = 0.672), and in the test of within-subjects effects, a significant interaction was found between the spiritual intervention and time.

Conclusions:

Spiritual intervention effectively could reduce the severity of postmenopausal depression. Considering the high prevalence of depression in postmenopausal women and the effectiveness, simplicity, and affordability of spiritual intervention, using such interventions in postmenopausal women is recommended.

Evaluation of a spirituality informed e-mental health tool as an intervention for major depressive disorder in adolescents and young adults - a randomized controlled pilot trial

Background

Depression in adolescents and young adults is a major mental health condition that requires attention. Research suggests that approaches that include spiritual concepts and are delivered through an online platform are a potentially beneficial approach to treating/managing depression in this population. The purpose of this study was to evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention (the LEAP Project) on depression severity, and secondary outcomes of spiritual well-being and self-concept, in adolescents and young adults with major depressive disorder of mild to moderate severity.

Methods

A parallel group, randomized, waitlist controlled, assessor-blinded clinical pilot trial was conducted in Calgary, Alberta, Canada. The sample of 62 participants with major depressive disorder (DSM-IV-TR) was defined by two age subgroups: adolescents (ages 13 to 18 years; n = 31) and young adults (ages 19 to 24 years; n = 31). Participants in each age subgroup were randomized into the study arm (intervention initiated upon enrolment) or the waitlist control arm (intervention initiated after an 8-week wait period). Comparisons were made between the study and waitlist control arms at week 8 (the point where study arm had completed the intervention and the waitlist control arm had not) and within each arm at four time points over 24-week follow-up period.

Results

At baseline, there was no statistical difference between study and waitlist participants for both age subgroups for all three outcomes of interest. After the intervention, depression severity was significantly reduced; comparison across arms at week 8 and over time within each arm and both age subgroups. Spiritual well-being changes were not significant, with the exception of an improvement over time for the younger participants in the study arm (p = 0.01 at week 16 and p = 0.0305 at week 24). Self-concept improved significantly for younger participants immediately after the intervention (p = 0.045 comparison across arms at week 8; p = 0.0175 in the waitlist control arm) and over time in the study arm (p = 0.0025 at week 16). In the older participants, change was minimal, with the exception of a significant improvement in one of six factors (vulnerability) in study arm over time (p = 0.025 at week 24).

Conclusions

The results of the LEAP Project pilot trial suggest that it is an effective, online intervention for youth ages 13 to 24 with mild to moderate major depressive disorder with various life situations and in a limited way on spiritual well-being and self-concept.

Trial registration

ClinicalTrials.gov NCT00985686. Registered 24 September 2009.

Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials

BACKGROUND

Despite the extensive literature assessing associations between religiosity/spirituality and health, few studies have investigated the clinical applicability of this evidence. The purpose of this paper was to assess the impact of religious/spiritual interventions (RSI) through randomized clinical trials (RCTs).

METHOD

A systematic review was performed in the following databases: PubMed, Scopus, Web of Science, PsycINFO, Cochrane Collaboration, Embase and SciELO. Through the use of a Boolean expression, articles were included if they: (i) investigated mental health outcomes; (ii) had a design consistent with RCTs. We excluded protocols involving intercessory prayer or distance healing. The study was conducted in two phases by reading: (1) title and abstracts; (2) full papers and assessing their methodological quality. Then, a meta-analysis was carried out.

RESULTS

Through this method, 4751 papers were obtained, of which 23 remained included. The meta-analysis showed significant effects of RSI on anxiety general symptoms (p < 0.001) and in subgroups: meditation (p < 0.001); psychotherapy (p = 0.02); 1 month of follow-up (p < 0.001); and comparison groups with interventions (p < 0.001). Two significant differences were found in depressive symptoms: between 1 and 6 months and comparison groups with interventions (p = 0.05). In general, studies have shown that RSI decreased stress, alcoholism and depression.

CONCLUSIONS

RCTs on RSI showed additional benefits including reduction of clinical symptoms (mainly anxiety). The diversity of protocols and outcomes associated with a lack of standardization of interventions point to the need for further studies evaluating the use of religiosity/spirituality as a complementary treatment in health care.