Religious Beliefs and Their Relevance for Treatment Adherence in Mental Illness: A Review

Religion and mental health seeking behaviors in war-tone zones of the Democratic Republic of the Congo

OBJECTIVE

Although religious leaders play an important role in providing informal mental health care to individuals struggling to seek religious and spiritual care, existing studies have not explored the magnitude of psychiatric symptoms and motivators to seek mental health services from religious leaders in religious listening centers and mental hospitals. This paper presents preliminary data from a survey aimed at assessing psychiatric symptoms and factors associated with access to spiritual services among 151 individuals at a religious listening center, as well as to determine the pathways of care among 150 patients attending a mental health clinic in conflict zones of the Eastern Democratic Republic of the Congo.

METHOD

Three hundred and one participants were screened for psychiatric symptoms and factors motivating access to religious leaders using a semi-structured questionnaire. Descriptive analyses were performed to determine information on psychiatric symptoms and factors affecting access to spiritual and mental health services.

RESULTS

Nearly 6 in 10 individuals seeking spiritual help in the religious center had psychiatric symptoms. Furthermore, 7 in 10 patients seek help for mental health needs from religious leaders and healers before seeking conventional mental health services; among such individuals, there was a high prevalence of bipolar disorder and schizophrenia spectrum disorder, recurrent admissions, and poor adherence to psychotropic medication.

CONCLUSION

These results highlight the need for greater integration of mental health services with care provided by religious organizations within conflict zones such as the Congo. They also emphasize the need for greater promotion of person-centered care that considers and integrates patients' religious beliefs in their treatment.

Religious hallucinations in Lebanese patients with schizophrenia and their association with religious coping

PURPOSE

to evaluate the relationship between religious hallucinations and religious coping among Lebanese patients with schizophrenia.

METHODS

We have studied the prevalence of religious hallucinations (RH) among 148 hospitalized Lebanese patients suffering from schizophrenia or schizoaffective disorder in November 2021 exhibiting religious delusions (RD), and their relationship with religious coping using the brief Religious Coping Scale (RCOPE). The PANSS scale was used to evaluate psychotic symptoms.

RESULTS

After adjustment over all variables, more psychotic symptoms (higher total PANSS scores) (aOR = 1.02) and more religious negative coping (aOR = 1.11) were significantly associated with higher odds of having religious hallucinations, whereas watching religious programs (aOR = 0.34) was significantly associated with lower odds of having religious hallucinations.

CONCLUSION

This paper highlights the important role of religiosity that has to play in the formation of religious hallucinations in schizophrenia. Significant association was found between negative religious coping and the emergence of religious hallucinations.

Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients

BACKGROUND

Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance.

AIMS

To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period.

METHOD

201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling.

RESULTS

R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p < .001), and unmet R/S care needs with lower WAI score (β = -.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (β = -.13; p < .05).

CONCLUSIONS

Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

The effect of mindfulness on medication adherence in individuals diagnosed with Schizophrenia: A cross-sectional study

OBJECTIVE

The aim of this study is to determine the effect of mindfulness on medication adherence in individuals diagnosed with schizophrenia.

MATERIALS AND METHODS

This cross-sectional study was conducted with 147 individuals diagnosed with schizophrenia. The data were collected using the Descriptive Characteristics Form, Morisky Medication Adherence Scale, and Mindful Attention Awareness Scale.

RESULTS

A strong positive correlation was determined between the mindfulness level and medication adherence of the individuals diagnosed with schizophrenia. Furthermore, mindfulness of the individuals diagnosed with schizophrenia was statistically significant in explaining medication adherence (p < 0.05) and mindfulness predicted medication adherence by 64%.

CONCLUSION

It was observed that the individuals' mindfulness level was low and half of the participants had low medication adherence. Moreover, as their mindfulness level increased, so did their medication adherence.

Patients' Perspectives About the Treatment They Receive for Cardiovascular Diseases and Mental Disorders: Web-Based Survey Study

Background

Noncommunicable disease (NCD)–related deaths account for 71% of deaths worldwide. The World Health Organization recently developed a global action plan to address the impact of NCDs, with the goal of reducing the number of premature NCD-related deaths to 25% by the year 2025. Appropriate therapeutic adherence is critical for effective disease management; however, approximately 30%-50% of patients with an NCD do not comply with disease management activities as prescribed. Web-based patient communities can represent platforms from which specific information on patients’ perception of treatment adherence can be gathered outside of a clinical trial setting.

Objective

This study aims to better understand patients’ perspectives regarding therapeutic adherence and iatrogenic risk in 2 major groups of NCDs for which poor disease management can have fatal consequences: cardiovascular diseases and mental disorders. Therapeutic adherence, motivational factors, patients’ awareness and perception of iatrogenesis, and treatment tools used by patients were assessed.

Methods

A web-based survey was performed among patients with cardiovascular diseases or mental disorders or both conditions who were registered on the French Carenity platform, a web-based community in which patients with an NCD can share experiences and receive support and information. The study inclusion criteria were defined as follows: diagnosis of cardiovascular disease or mental disorder or both conditions (self-declared), age ≥18 years, residence in France, registration on the French Carenity platform, and ongoing pharmaceutical treatment for the condition. Patients who met the inclusion criteria were then invited to complete a self-administered web-based questionnaire that included questions addressing therapeutic adherence and iatrogenic risk.

Results

A total of 820 patients were enrolled in the study, including patients with cardiovascular diseases (403/820, 49.2%), patients with mental disorders (292/820, 35.6%), and patients with both cardiovascular diseases and mental disorders (125/820, 15.2%). The mean age of the participants was 55.2 (SD 12.7) years. We found that 82.8% (679/820) of patients experienced adverse effects of medication. Patients tended to perceive themselves to be more adherent than they actually were; a significant number of patients disregarded their prescription and stopped or interrupted medication without consulting with a doctor. Patients with cardiovascular diseases were nearly twice as adherent as patients with a mental disorder (P≤.001). Adherence was significantly associated with gender (P≤.001), age (P≤.001), and treatment complexity (P≤.001). Finally, for each disease type, 3 patient profiles were identified, which provide interesting insight for improving therapeutic adherence and adjustment strategies specifically according to patient behavior.

Conclusions

This study provides insight into the perspectives of patients receiving therapy for cardiovascular diseases or mental disorders or both conditions, which could help improve the management of NCDs and prevent premature death. Our study also shows that web-based patient platforms provide new opportunities to improve disease management by understanding patients’ experiences.

Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review

PURPOSE

For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives.

METHOD

The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions.

RESULTS

Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients.

CONCLUSIONS

S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.

Perceived barriers to providing spiritual care among psychiatric mental health nurses

BACKGROUND

Although nurses typically view spiritual care as important, it is provided infrequently.

OBJECTIVES

This research investigated psychiatric mental health nurses' perceived barriers to providing spiritual care, and how these barriers were associated with frequency of spiritual care and demographic factors.

METHODS

This cross-sectional correlational study of 159 psychiatric mental health nurses used questionnaires to measure frequency of spiritual care and barriers to spiritual care.

RESULTS

The most frequent barriers to providing spiritual care were lack of education and fear of exacerbating psychiatric symptoms. Psychiatric mental health nurses provided spiritual care infrequently.

CONCLUSIONS

Nurses need education about providing spiritual care to those with psychiatric mental health needs.

Influence of Religious and Spiritual Elements on Adherence to Pharmacological Treatment

The objective of this study is to know the influence of religious/spiritual elements on the adherence to pharmacological therapy. The descriptors used for this literature review were "medicine, medication, drug, or treatment," "adherence to treatment," and "religion or spirituality or faith or prayer" in different databases (CINAHL, PsycINFO, PubMed). Finally, 23 articles were selected. Articles available in full text, published between 2010 and 2017, in English or Spanish were included. The results showed that some studies relate positively the R/S and therapeutic adherence, but others determine an opposite or even mixed effect, mainly addressing pathologies such as HIV and other chronic diseases. The influence of religiosity/spirituality on therapeutic adherence requires that health professionals acquire sensitivity and competence to address these issues with their patients.