ReviewReligious Involvement, Spirituality, and Medicine: Implications for Clinical Practice
Section snippets
METHODS
We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life (HRQOL), and other outcomes. Studies selected used validated measures of religious involvement (eg, attendance at religious services) and spirituality (eg, scales of spiritual well-being) and statistical testing for significance. In addition, we reviewed articles that
USE OF RELIGIOUS AND SPIRITUAL VARIABLES IN MEDICAL RESEARCH
Religious and spiritual variables are not widely used in medical research. For example, a review15 of 2348 studies published in 4 major psychiatry journals between 1978 and 1982 revealed that only 59 (2.5%) used a religious or spiritual variable. A later review16 of the same journals for 1991 to 1995 revealed that only 1.2% of studies used such a variable. Similar reviews have shown that only 3.5% of family practice studies,17 1.1% of internal medicine studies,18 11.8% of adolescent health
RELIGIOUS INVOLVEMENT, SPIRITUALITY, AND PHYSICAL HEALTH
A majority of the nearly 350 studies of physical health and 850 studies of mental health that have used religious and spiritual variables have found that religious involvement and spirituality are associated with better health outcomes.23
RELIGIOUS INVOLVEMENT AND SPIRITUALITY IN TERMINALLY ILL PATIENTS
The World Health Organization definition of palliative medicine emphasizes the psychosocial and spiritual aspects of care.57 End-of-life care addresses not only physical symptoms but also psychosocial and spiritual concerns. Terminally ill patients derive strength and hope from spiritual and religious beliefs.58, 59 Indeed, terminally ill adults report significantly greater religiousness60 and depth of spiritual perspective61 compared with healthy adults. Greater depth of spiritual perspective
Depression
Depression is a common illness; 6% to 10% of the population experience notable depression during their life-time.66 Recent longitudinal studies have examined the relationship between religious involvement and spirituality and depression. One study67 examined the effects of self-reported religious salience on the incidence and course of depression in a community-based sample of 177 persons (age, 55–89 years) in 1 year. Religious salience was associated not only with less risk of depression but
RELIGIOUS INVOLVEMENT, SPIRITUALITY, AND COPING WITH ILLNESS
Illnesses may interrupt routines, drain finances, separate families, create situations of dependency, and lead to existential and spiritual concerns.57 Not only do many people rely on their religious beliefs and spirituality to cope with illness, but these people may also cope with illness more effectively than persons without such beliefs.75 Religious and spiritual coping are common among persons with asthma,92 human immunodeficiency virus (HIV) disease,93 chronic pain,94, 95 coronary artery
RELIGIOUS INVOLVEMENT, SPIRITUALITY, AND HRQOL
The terms quality of life and more specifically healthrelated quality of life refer to the distinct physical, psychological, social, and spiritual domains of health that are influenced by a person's experiences, beliefs, expectations, and perceptions.117 Studies have shown that religious involvement and spiritual well-being are associated with high levels of HRQOL in persons with cancer,65, 118, 119, 120, 121 HIV disease,118, 121 heart disease,65 limb amputation,119 and spinal cord injury.119
POSSIBLE BENEFICIAL MEDIATORS ASSOCIATED WITH RELIGIOUS INVOLVEMENT AND SPIRITUALITY
Like other factors that promote health (eg, exercise), religious involvement and spirituality likely enhance resistance to disease through the interaction of multiple beneficial mediators. As noted previously, religiously involved persons are more likely to embrace health-promoting behaviors such as eating a proper diet, eschewing risky behaviors such as smoking, seeking preventive services, and being compliant with treatments. Members of a religious group may have a shared genetic ancestry
NEGATIVE EFFECTS OF RELIGIOUS INVOLVEMENT AND SPIRITUALITY
Few systematic population-based studies have shown that religious involvement and spirituality are associated with negative physical and mental health outcomes. However, like any factor that may affect health (eg, lifestyle choices), religious involvement and spirituality may adversely affect an individual. For example, religious beliefs may adversely affect a person's health by encouraging avoidance or discontinuance of traditional treatments, failure to seek timely medical care, avoidance of
WHAT CONCLUSIONS CAN BE DRAWN FROM THE RESEARCH?
According to Levin,127 to verify a causal relationship between a variable (eg, religious involvement) and a health outcome (eg, mortality), 3 questions must be answered. Is there an association? If so, is the relationship valid? If so, is it causal? Regarding the first question, a majority of nearly 850 studies of mental health and 350 studies of physical health have found a direct relationship between religious involvement and spirituality and better health outcomes.23
The association between
IMPLICATIONS OF RELIGIOUS INVOLVEMENT AND SPIRITUALITY FOR CLINICAL PRACTICE Practical Aspects
The results of the surveys and the studies we reviewed suggest that acknowledging and supporting patient spirituality may enhance patient care. Indeed, William Osler128 called faith “an unfailing stream of energy,” whereas William Mayo129 said, “[T]here is a spiritual as well as a material quality in the care of sick people, and too great efficiency in material details may hamper progress.” Today, the US Joint Commission on the Accreditation of Healthcare Organizations80 recommends and requires
CONCLUSIONS
Most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. Surveys suggest, however, that these needs are not met.
A large and growing number of studies have shown a direct relationship between religious involvement and spirituality and positive health outcomes, including mortality, physical illnesses, mental illness, HRQOL, and coping with illness (including terminal
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