The experiences of living with a suicidal family member, and the impact on daily life: A systematic review and meta-aggregation

INTRODUCTION

Because of the pivotal role that family members play in caring for their suicidal relative, insight into their experiences is necessary to develop good support for them.

AIM

This systematic review aimed to aggregate qualitative research examining the experiences of family members living with their suicidal relative, and their impact on daily life.

METHODS

Systematic searches, covering the period 2000-2022, were conducted in Medline, Embase, PsycINFO, Ovid Nursing database and CINAHL. The JBI-QARI meta-aggregation approach and the PRISMA guidelines were followed.

RESULTS

Eleven studies met the inclusion criteria. Six themes were identified: The hard job of managing the risk of suicide; contributing to the relative's survival; struggling with professional care; being in a lonely position; pressure on relationships; and disruption of well-being.

DISCUSSION

The constant worry of losing their relative and ever-present vigilance dominates their lives in such a way that their well-being may be decreased. Professionals often overlook family members, which leads to feelings of powerlessness and loneliness.

IMPLICATIONS FOR PRACTICE

Collaborating with families in treatment, allowing them to share information and supporting them in the care at home may lead to better outcomes for both the family and their suicidal relative.

The Experience Sampling Method: A New Way of Assessing Variability of the Emotional Dimensions of Religiosity and Spirituality in a Dutch Psychiatric Population

Religiosity and spirituality (R/S) are often regarded as being relatively stable over time. The present exploratory experience sampling method (ESM) study aims to assess the variability of three R/S parameters concerning affective representations of God and spiritual experiences in a psychiatric population. Depressed in- and outpatients self-identifying as being spiritual or religious participated, from two Dutch mental health care institutions. The twenty-eight participants rated momentary affective R/S-variables up to 10 times per day over a 6-day period when prompted by a mobile application. All three examined R/S parameters varied significantly within the day. ESM examination of R/S showed good compliance and little reactivity. This indicates that ESM offers a feasible, usable, and valid way to explore R/S in a psychiatric population.

Varieties of Religious and Spiritual Struggles by Type of Mental Disorder: A Qualitative Approach

INTRODUCTION

Little is known about types of religious/spiritual (R/S) struggles with regard to various diagnostic groups in mental health care. The current qualitative study aims to give an impression of R/S struggles as observed in six diagnostic groups in clinical mental health care.

METHODS

Inductive thematic content analysis was applied to 34 semi-structured interviews. The interviews were performed among (day) clinical mental health care patients in two institutions.

RESULTS

Among patients with depression, a lack of positive R/S experiences, isolation, and feelings of guilt and shame were present. Those with cluster C and anxiety disorders reported uncertainty toward God and faith and R/S reticence. Psychotic disorders were accompanied by impressive R/S experiences, reticence to share these, and mistrust toward health professionals. Patients with bipolar disorder struggled with the interpretation of their R/S experiences and with both attraction and distance toward R/S. Cluster B patients showed ambivalence and anger toward God and others, and some reported existential tiredness. Patients with autism mentioned doubts and troubles with religious beliefs. In all groups, many patients had questions like "why?" or "where is God?"

CONCLUSION

R/S struggles to some extent may be the language of the illness. Mental health professionals are recommended to take this into account, taking heed of the content of individual R/S struggles and considering using R/S interventions.

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.

Coping, Meaning Making and Resilience Within the Dutch Reformed Pietist Community During the COVID-19 Outbreak: An Exploratory Qualitative Study

In this qualitative study, we examined how community members of the Dutch reformed pietist community coped with the COVID-19 pandemic, and which religious sources of meaning making and resilience they used during this time of crisis. Based on seven in-depth interviews, we found that the representation of God being 'above all things' was prominent in times of close encounter with the coronavirus. In actively interpreting the pandemic, community members tended to stay away from concrete eschatological or ecological interpretations. Rather, the general theme of 'malleability' was used and linked to notions of calling and punishment. Furthermore, we identified the importance of community and scepticism towards the government as sources of resilience, whereas thinking about the future of the church was a source of fear and concern.

Protocol for an RCT on cognitive bias modification for alcohol use disorders in a religion-based rehabilitation program

INTRODUCTION

Alcohol-related cues trigger relapse in patients with alcohol use disorders (AUDs). These cues may automatically activate motivational approach tendencies. Through computerised cognitive bias modification (CBM), the tendencies of patients with AUD to approach alcohol can be reduced. The present protocol describes a training intervention with approach bias modification (ApBM) incorporating religion-related stimuli as an alternative to alcohol to improve the effectiveness of CBM in a religion-based rehabilitation centre. AUD is often related to patients' religious attitudes in this treatment context. The religion-adapted ApBM, therefore, combines training in avoidance of alcohol-related motivational cues and an approach to religion-based motivational cues. This combination's effectiveness will be compared with a standard ApBM and to a sham ApBM.

METHODS AND ANALYSIS

Using a double-blind multiarm parallel randomised controlled trial procedure (ratio 1:1:1), 120 patients with AUD will be randomised into 1 of 3 conditions (religion-adapted ApBM, standard ApBM or sham ApBM) with personalised stimuli. The interventions are delivered over 4 consecutive days during an inpatient detoxification programme in addition to treatment as usual. Assessments occur before the start of the training and after the fourth training session, with follow-up assessments after 1 and 4 months. A multivariate analysis of variance will be used with the primary outcomes, the percentage of days abstinent and meaning in life 4-month follow-up. Secondary outcomes include differences in reported training satisfaction and symptoms of AUD.

ETHICS AND DISSEMINATION

This study has been reviewed and approved by the Medical Research Ethics Committee Academic Medical Center Amsterdam (Reference number: 2020_251). Further, study results will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

NL75499.018.20.

Without Your Therapist: Contemplative Prayer During Treatment as a Religious Exposure Intervention to Reduce Religious Struggle and Anxious God Representation

This case study focuses on the treatment of a 44-year-old Dutch man presenting with an anxious God representation and religious struggles according to DSM-5 criteria. Having received prior treatment for a panic disorder and alcohol use disorder, the patient was given a 60-day treatment in which the Jesus Prayer intervention was used to address his religious and spiritual problems. To our knowledge, this is the first case study involving the Jesus Prayer in the treatment of a patient. The intervention had positive effects on the patient’s religious and spiritual problems concerning an anxious God representation, religious struggles, stress levels and surrender to God. The intervention may also play a supporting role in decreasing symptoms of depression and anxiety and in promoting global mental health, as reliable change index analyses revealed symptom reduction between baseline levels and at post-assessment levels for all measured symptoms, with a semi-gradual decrease over the course of treatment. These improvements were continued in a 3-month follow-up assessment, suggesting promise for the Jesus Prayer as an effective treatment method for religious and spiritual problems. Recommendations regarding the importance of assessing the religious life of patients and implementing spiritual interventions are discussed, as well as the relevance of the therapist’s own assumptions when treating a religious or spiritual problem.

[The association between religious coping styles and psychopathological symptomatology within a Christian population]

BACKGROUND

Religious coping can be seen as a method which applies religious resources, including prayer, and trust and appeals to God, in order to deal with stressful situations.

AIM

To gain insight into the associations between religious coping styles and mental health and to investigate whether the use of the coping styles differs between mental health care clients and non-mental health care clients with a Christian background.

METHOD

The sample consisted of 655 Dutch participants with a Christian worldview, aged 18 to 79 years (M = 42.6, SD = 14.2). 60.9% were female and 49.5% higher educated. Intra- and extramural clients in mental health care were involved. A cross-sectional, online survey was used, combined with an available client database.

RESULTS

More use of the collaborative coping style was associated with less psychological complaints. More use of the (passive-)deferring and selfdirecting coping styles was associated with more psychological complaints. Christian mental health care clients used the collaborative and the deferring coping styles less often compared to Christian non-clients.

CONCLUSION

The collaborative religious coping style is positively associated with mental health. Mental health care clients amongst them use this style less often compared to non-clients. Awareness of religious coping styles and appropriate support are indicated.

God Representation Types Are Associated With Levels of Personality Organization and Christian Religious Orthodox Culture

ABSTRACT

This exploratory study shows that God representation types are associated with levels of personality organization. Among two Dutch samples of psychiatric patients (n = 136) and nonpatients (n = 161), we found associations between the psychotic, borderline, and neurotic personality organizations, and passive-unemotional, negative-authoritarian, and positive-authoritative God representation types, respectively. Both patients and nonpatients reported positive God representations, but only nonpatients and higher-level functioning patients reported an integrated God-object relation. For persons with personality pathology, the relationship with God can be a struggle and might have a defensive and/or compensating function. In addition to personality organization, Christian religious orthodox culture is a statistical predictor of God representations, but not of anger toward God. We offer suggestions for how psychotherapeutic work with God representations might differ for patients with different levels of personality organization.

Religious/spiritual care needs and treatment alliance among clinical mental health patients

WHAT IS KNOWN ON THE SUBJECT?: The relationship between patient and professional is one of the cornerstones of successful treatment in mental health care. For part of the mental health patients, a similar outlook on life with their caregiver(s) is important. Attention to religion/spirituality (R/S) in mental health care is likely to influence the relationship between a patient and mental health professional, for patients preferring so. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Patients, who appreciate and experience personalized attention to R/S in conversations with practitioners and nurses, are likely to receive the highest therapeutic benefit from their relationship with their mental health professionals Patients who welcome personalized attention to R/S in conversations but find themselves unsupported in this regard experience significantly lower levels of treatment alliance than do those whose needs are met or those who do not express such needs For religious and nonreligious patients attaching importance to a similar outlook on life with practitioner or nurse, this experience was also related to a better relationship, compared with patients preferring so but experiencing a different outlook on life. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Personalized attention to R/S in conversations is recommended, both for practitioners and nurses. In case of a different outlook on life between a patient and mental health professional, addressing R/S with an open and respectful attitude may prevent negative effects on a patient's treatment experience. ABSTRACT: Introduction Attention to religion and spirituality (R/S) in mental health care has increased and may benefit treatment alliance. Aim To describe the association of (un)met R/S care needs with treatment alliance and compliance among mental health patients. Methods Patients in a Christian and a secular mental health clinic (n = 201) filled in a questionnaire. Scales of met and unmet R/S care needs (range 0-14) were regressed on the Working Alliance Inventory (WAI), Service Engagement Scale and Medication Adherence Report Scale. Ancova analyses were performed for the fourteen R/S care needs separately. Results In the Christian clinic, met R/S care needs were associated with a higher WAI score (p = .001) and unmet R/S care needs, with a lower WAI score (p = .000). For the Secular clinic, the same trends were observed, but insignificant. Items with the strongest associations were conversations about religious distress with a nurse (p = .000) and a similar outlook on life with practitioner (p = .001) or nurse (p = .005). (Un)met R/S care needs were not associated with treatment compliance. Discussion and implications for practice We recommend personalized attention to R/S in conversations. A (perceived) similar outlook on life with mental health professionals may be beneficial for religious and nonreligious patients.

Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed, Religiously Affiliated Patients

There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in- and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive-supportive God representation is negatively correlated with suicide ideation. A passive-distressing God representation has a positive correlation with suicide ideation. High MOS and a positive-supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.

[Reformed pietists: higher risk for suicide? A retrospective cohort study on the incidence of suicides in a christian institute for mental health care]

In scientific literature, active commitment to a religious community is considered to be a protective factor against suicidal behavior. However, it is assumed that this protective effect does not apply to 'reformed pietists' or strict Calvinists, an orthodox-protestant group in the Netherlands.<br/> AIM: To explore whether the incidence of suicide is higher among reformed pietists than among other Christian patients of Eleos, a Dutch christian institute for mental health care.<br/> METHOD: A retrospective cohort study was conducted over the period 2000-2017. All evaluating reports, which were written after a suicide, were analyzed.<br/> RESULTS: In the period 2000-2017 28 evident suicides were committed. The number of suicides among reformed pietistic patients was about 10 times lower than among other Christian patients.<br/> CONCLUSION: The assumption that reformed pietists run a relatively high risk for suicide does not have adequate grounds. In case of risk assessment, reformed pietistic affiliation might be considered to be more a protecting than a risk-increasing factor for suicide.

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.

[The associations between God representations and suicidality among Christian patients with a major depressive disorder]

Depression strongly increases the risk of suicide. Religion is described as a protective factor against suicide. Considering the emotional blunting associated with depression, it is important to investigate the affective dimension of religion. This dimension is conveyed in God representations.<br/> AIM: To describe what types of God representation occur among Christian patients with major depressive disorder and to determine whether there is a relationship between types of God representation and suicide.<br/> METHOD: Clinical and outpatients with a major depressive disorder (n=155) completed the Questionnaire God Representations and the Paykel Suicide Items. A k-means cluster analysis is applied to examine which types of God representations occur among depressed patients. Whether there is a relationship between the different God representations and suicide is examined by applying a linear regression analysis.<br/> RESULTS: Depressed patients uphold two types of God representation: a positive type (n=82) with positive feelings towards God and where God was experienced as supportive, and a negative type (n=73) with anger and anxiety towards God and where God was experienced as passive. Patients with a negative type of God representation scored significantly higher on suicidality. The severity of depression was the main predictor of suicidality, but God representations were also related with a 4% increase in the explained variance.<br/> CONCLUSION: In Christian patients with major depressive disorder a negative and a positive God representation emerged. Patients with a negative God representation mainly seem to feel abandoned by God. The suicidality is significantly increased in patients with a negative God representation, however, the increase in the proportion of the explained variance is small.

[The God image in relation to autistic traits and religious denomination]

BACKGROUND

Estimates of the prevalence of autism spectrum disorders (ASD) range from 0.6 to 1.0 per cent of the general population. Among the characteristic traits of ASD are qualitative impairments in social reciprocity and in abstract imagination. Not surprisingly, these traits can affect the personal religion of ASD patients, in the same manner as religious background does.

AIM

To determine to what extent the religiousness of religious patients is associated with autistic traits and religious background.

METHOD

Dutch adults attending a Protestant mental healthcare institution as outpatients were asked to complete the 'Questionnaire God Image' (QGI) and the 'Autism Quotient' (AQNL). In this cross-sectional study various aspects of the God image were related to autistic traits and religious background.

RESULTS

The more that respondents reported autistic traits, the greater was their fear of God and the less positive were their feelings. Respondents who were strict Calvinists experienced greater fear of God than did other respondents.

CONCLUSION

Treatment of religious patients with asd needs to take into account these patients' greater fear of God and their less positive feelings. Those patients who had had a strict Calvinist upbringing had a more pronounced fear of God.

God image and happiness in chronic pain patients: the mediating role of disease interpretation

OBJECTIVE

The present study explored the role of the emotional experience of God (i.e., positive and negative God images) in the happiness of chronic pain (CP) patients. Framed in the transactional model of stress, we tested a model in which God images would influence happiness partially through its influence on disease interpretation as a mediating mechanism. We expected God images to have both a direct and an indirect (through the interpretation of disease) effect on happiness.

DESIGN

A cross-sectional questionnaire design was adopted in order to measure demographics, pain condition, God images, disease interpretation, and happiness. One hundred thirty-six CP patients, all members of a national patients' association, completed the questionnaires.

RESULTS

Correlational analyses showed meaningful associations among God images, disease interpretation, and happiness. Path analyses from a structural equation modeling approach indicated that positive God images seemed to influence happiness, both directly and indirectly through the pathway of positive interpretation of the disease. Ancillary analyses showed that the negative influence of angry God images on happiness disappeared after controlling for pain severity.

CONCLUSION

The results indicated that one's emotional experience of God has an influence on happiness in CP patients, both directly and indirectly through the pathway of positive disease interpretation. These findings can be framed within the transactional theory of stress and can stimulate further pain research investigating the possible effects of religion in the adaptation to CP.