Elsevier

Mayo Clinic Proceedings

Volume 76, Issue 12, December 2001, Pages 1225-1235
Mayo Clinic Proceedings

Review
Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice

https://doi.org/10.4065/76.12.1225Get rights and content

Surveys suggest that 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. 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, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (eg, chaplains) are available to clinicians to address the spiritual needs of patients.

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

REFERENCES (146)

  • JA McNeill et al.

    Assessing clinical outcomes: patient satisfaction with pain management

    J Pain Symptom Manage

    (1998)
  • JA Kotarba

    Perceptions of death, belief systems and the process of coping with chronic pain

    Soc Sci Med

    (1983)
  • D Barnard et al.

    Toward a person-centered medicine: religious studies in the medical curriculum

    Acad Med

    (1995)
  • PB Gove et al.

    Webster's Third New International Dictionary of the English Language, Unabridged

    (1961)
  • JC Holland et al.

    A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness

    Psychooncology

    (1998)
  • RD Fallot

    The place of spirituality and religion in mental health services

    New Dir Ment Health Serv

    (1998)
  • G Gallup

    Religion in America: 1990. Princeton, NJ: Princeton Religious Research Center; 1990. Cited by Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status: a review of the research and implications for family medicine

    Arch Fam Med

    (1998)
  • DE King et al.

    Beliefs and attitudes of hospital inpatients about faith healing and prayer

    J Fam Pract

    (1994)
  • TA Maugans et al.

    Religion and family medicine: a survey of physicians and patients

    J Fam Pract

    (1991)
  • JW Ehman et al.

    Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?

    Arch Intern Med

    (1999)
  • TP Daaleman et al.

    Patient attitudes regarding physician inquiry into spiritual and religious issues

    J Fam Pract

    (1994)
  • MR Ellis et al.

    Addressing spiritual concerns of patients: family physicians’ attitudes and practices

    J Fam Pract

    (1999)
  • G Fitchett et al.

    The religious needs and resources of psychiatric inpatients

    J Nerv Ment Dis

    (1997)
  • L Gundersen

    Faith and healing

    Ann Intern Med

    (2000)
  • DB Larson et al.

    Systematic analysis of research on religious variables in four major psychiatric journals, 1978–1982

    Am J Psychiatry

    (1986)
  • AJ Weaver et al.

    A systematic review of research on religion in four major psychiatric journals: 1991–1995

    J Nerv Ment Dis

    (1998)
  • FC Craigie et al.

    A systematic analysis of religious variables in the Journal of Family Practice, 1976-1986

    J Fam Pract

    (1988)
  • RD Orr et al.

    Religious variables are infrequently reported in clinical research

    Fam Med

    (1992)
  • AJ Weaver et al.

    Research on religious variables in five major adolescent research journals: 1992 to 1996

    J Nerv Ment Dis

    (2000)
  • AJ Weaver et al.

    An analysis of research on religious and spiritual variables in three major mental health nursing journals, 1991–1995

    Issues Ment Health Nurs

    (1998)
  • GL Engel

    The clinical application of the biopsychosocial model

    Am J Psychiatry

    (1980)
  • HG Koenig

    Religion, spirituality, and medicine: application to clinical practice

    JAMA

    (2000)
  • GW Comstock

    Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic characteristics

    Am J Epidemiol

    (1971)
  • GW Comstock et al.

    Education and mortality in Washington County, Maryland

    J Health Soc Behav

    (1977)
  • LF Berkman et al.

    Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents

    Am J Epidemiol

    (1979)
  • JS House et al.

    The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study

    Am J Epidemiol

    (1982)
  • DL Wingard

    The sex differential in mortality rates: demographic and behavioral factors

    Am J Epidemiol

    (1982)
  • DM Zuckerman et al.

    Psychosocial predictors of mortality among the elderly poor: the role of religion, well-being, and social contacts

    Am J Epidemiol

    (1984)
  • VJ Schoenbach et al.

    Social ties and mortality in Evans County, Georgia

    Am J Epidemiol

    (1986)
  • TE Seeman et al.

    Social network ties and mortality among the elderly in the Alameda County Study

    Am J Epidemiol

    (1987)
  • S Bryant et al.

    Predictors of mortality among elderly African-Americans

    Res Aging

    (1992)
  • JD Kark et al.

    Does religious observance promote health? mortality in secular vs religious kubbutzim in Israel

    Am J Public Health

    (1996)
  • WJ Strawbridge et al.

    Frequent attendance at religious services and mortality over 28 years

    Am J Public Health

    (1997)
  • D Oman et al.

    Religion and mortality among the community-dwelling elderly

    Am J Public Health

    (1998)
  • TA Glass et al.

    Population based study of social and productive activities as predictors of survival among elderly Americans

    BMJ

    (1999)
  • RA Hummer et al.

    Religious involvement and U.S. adult mortality

    Demography

    (1999)
  • HG Koenig et al.

    Does religious attendance prolong survival? a six-year follow-up study of 3,968 older adults

    J Gerontol A Biol Sci Med Sci

    (1999)
  • KM Clark et al.

    A longitudinal study of religiosity and mortality risk

    J Health Psychol

    (1999)
  • HG Koenig et al.

    Religion and the survival of 1010 hospitalized veterans

    J Religion Health

    (1998)
  • HG Koenig et al.

    Religion, spirituality, and medicine: a rebuttal to skeptics

    Int J Psychiatry Med

    (1999)
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