Clinical Relevance

1

• Clinical Relevance
• Illness Prevention
• Coping With Illness
• Recovery From Surgery
• Improving Treatment Outcomes

2
Illness PreventionReligion and Social Support

• Study sample 9,000 residents living in 86 small
  towns in Iowa.
• Study results
• Participating in church helps people feel more
  attached to their community.
• Participating in church-related groups has the
  greatest impact on (increasing) non
  church-related activities including increasing
  ones network of friends.
• Liu QA, et al. The influence of local church
  participation
• on rural community attachment. Rural Sociology
• 199863(3)432-450.

3
Illness PreventionReligion and Social Support

• Study results
• Researchers noted...
• Surprisingly, most recent studies on community
  attachment have neglected the study of religion.
• Liu QA, et al. The influence of local church
  participation on rural community attachment.
  Rural Sociology 199863(3)432-450.

4
Illness PreventionReligion as Social Support
for Clergy?

• Study sample national survey of more than 3,000
  ministers, elders and church members
  (Presbyterian Church USA)
• Study results
• Ministers received 55 more negative feedback
  than church members.
• Negative feedback can come as demands, criticism
  or disagreement.
• Krause N, et al. Church-based emotional support,
  negative interaction, and psychological
  well-being findings from a national sample of
  Presbyterians. J Scientific Study of Religion
  199837(4)725-41.

5
Illness PreventionReligion as Social Support
for Clergy?

• Study results
• Affairs of religion dont always go smoothly,
  when they dont, those in leadership can be a
  flashpoint for the expression of dissatisfaction
  and criticism.
• Krause N, et al. Church-based emotional support,
  negative interaction, and psychological
  well-being findings from a national sample of
  Presbyterians. J Scientific Study of Religion
  199837(4)725-41.

6
Illness PreventionSpirituality and Life
Satisfaction

• Study sample reviewing findings from three
  national surveys totaling more than 5,600 older
  Americans
• Study results Attending religious services was
  linked with improved physical health or personal
  well-being.
• Other studies 12 other studies published since
  1980 found persons in organized religious
  activity had higher levels of life satisfaction.
• Levin JS, Chatters LM. Religion, health, and
  psychological well-being in older adults
  findings from three national surveys. J Aging
  Health 199810(4)504-531.

7
Illness PreventionSpirituality and Well-Being

• Study sample national sample of 2,100 African
  Americans followed up 12 years after initial
  interview
• Study results Show the strong and significant
  association between every combination of
  religious and well-being variable. These
  results confirm similar findings in nearly 75
  studies published between 1980 and 1998 on
  well-being and religion.
• Levin JS, et al. Panel analyses of religious
  involvement and well-being in African Americans
  contemporaneous vs. longitudinal effects. J
  Scientific Study of Religion 199837(4)695-709.

8
Illness PreventionWisdom and Life Satisfaction

• Study sample survey of 121 men and women
  followed in a 40 year longitudinal study
• Study factors assessed
• job and neighborhood
• work and leisure
• home and family relationships
• Ardelt M. Wisdom and life satisfaction in old
  age. J of Gerontol, Psychological Sciences
  199752(1)15-27.

9
Illness PreventionWisdom and Life Satisfaction

• Study findings
• wisdom, far more than either life environments or
  living conditions, explained most of these
  subjects views of life satisfaction
• wisdom much more important than health or having
  financial security
• Ardelt M. Wisdom and life satisfaction in old
  age. J of Gerontol, Psychological Sciences
  199752(1)15-27.

10
Education and Religion

• Study sample of more than 700 students aged
  15-16 from schools throughout England
• Two other studies totaling more than 9,000
  children ages 9-11 found similar results.
• Francis LJ. School influence and pupil attitude
  towards religion. British Journal of Educational
  Psychology 197949107-23.
• Francis LJ. Denominational schools and pupil
  attitude towards Christianity. British
  Educational Research Journal 198649145-52.

11
Education and Religion

• Study sample more than 700 students aged 15-16
  from schools throughout England
• M. Argyle had asserted in 1958 that intelligent
  students are much less likely to accept orthodox
  beliefs, and rather less likely to have
  pro-religious attitudes. This study showed
  there is no significant relationship between
  intelligence and attitudes toward religion.
• Francis LJ. The relationship between intelligence
  and religiosity among 15-16-year-olds. Mental
  Health, Religion and Culture 19981(2)185-96.

12
Illness Prevention Mothers Religion and
Depression in their Children

• Study sample 60 mothers and their 151 children
  who were followed up 10 years later
• Study results If mothers viewed religion as
  highly important
• daughters (not sons) 60 less likely to have had
  major depressive disorder
• mothers themselves 80 less likely to have had
  major depressive episode during 10 year follow-up
• Miller, L., et al. Religiosity and depression
  ten-year follow-up of depressed mothers and
  offspring. J Am Acad Child Adolesc Psychiatry
  199736(10)1416-25.

13
Illness Prevention Mothers Religion and
Depression in their Children

• Study results If mothers viewed religion as
  highly important
• if daughters or sons same denomination as
  mother, 70 (daughters) and 84 (sons) less
  likely to have major depression at 10 year
  follow-up.
• Miller, L., et al. Religiosity and depression
  ten-year follow-up of depressed mothers and
  offspring. J Am Acad Child Adolesc Psychiatry
  199736(10)1416-25.

14
The Impact of Mothers Religiousness on
Mother-Child Relations

• Study sample 860 families from Detroit followed
  from pregnancy until age 23
• Study results If the mother rated her religious
  beliefs as very important to her, both the mother
  and child were more likely to both enjoy their
  relationship as well as have respect and
  understanding for each other.
• Pearce LD, et al. The impact of family religious
  life on the quality of mother-child relations.
  Am Sociol Rev 199863810-28.

15
The Impact of Mothers Religiousness on
Mother-Child Relations

• Study sample 860 families from Detroit followed
  from pregnancy until age 23
• Study results The more integral religion is to
  a mothers identity, the better she and her child
  view their relationship.
• Pearce LD, et al. The impact of family religious
  life on the quality of mother-child relations.
  Am Sociol Rev 199863810-28.

16
Illness PreventionInitial Twin Studies

• Study sample 1,900 female-female twin pairs,
  average age, 30.1 years.
• Study results Found significantly lower rates
  of depressive symptoms, smoking and alcohol abuse
  among those who were more religious.
• Kendler KS, et al. Religion, psychopathology, and
  substance use and abuse a multimeasure,
  genetic-epidemiologic study. Am J Psychiatry
  1997154322-29.

17
Illness PreventionSuicide

• Study Findings
• Frequent church attenders are four times less
  likely to commit suicide than non-church
  attenders.
• Comstock and Partridge (1972).
• Journal of Chronic Disease, 25655-672.

18
Illness PreventionSuicide

• Study Findings
• Lack of church attendance is a stronger predictor
  of suicide than any other risk factor assessed.
• Stack (1983). Journal for the
• Scientific Study of Religion, 22239-252.

19
Illness PreventionSuicide

• Review Findings
• There is a strong protective relationship between
  greater religious commitment and less suicide.
• Gartner et al (1991). Journal of Psychology and
  Theology, 196-25.

20
Illness PreventionSpirituality and Marijuana Use

• Study undertaken by Harvard School of Public
  Health and Michigan Survey Research Center
• Study sample 17,592 representative of student
  sample from 140 U.S. colleges
• Study results
• Those whose religion very important 1/3 less
  likely to use marijuana (after controls
  included).
• Bell R., et al. The correlates of college student
  marijuana use results of a U.S. national survey.
  Addiction 199792(5)571-81.

21
Illness PreventionSpirituality and Marijuana Use

• Other factors predicting greater marijuana use
• 1) students living in sorority/fraternity houses
• 2) students living in co-ed dorms
• 3) students with lower grades
• 4) students with less time studying
• 5) students who hung out more frequently
• Bell R., et al. The correlates of college student
  marijuana use results of a U.S. national survey.
  Addiction 199792(5)571-81.

22
Illness PreventionAlcohol Abuse

• Sample of 1,337 former Johns Hopkins medical
  students entering in 1948 through 1964 (91 male)
  with 1,014 males (85) completing 1986 follow-up
  
• 13 of follow-up subjects met criteria for
  alcohol abuse
• 51 of non-drinking medical students remained
  non-drinkers at follow-up

23

• Illness Prevention Alcohol Abuse
• Key Predictors of Alcohol Abuse
• 1) cigarette use of at least one
• pack cigarettes per day (OR2.6)
• 2) past history of alcohol problems (OR3.1)
• 3) non-Jewish ancestry (OR3.1)
• 4) regular use of alcohol
• in medical school (OR3.6)
• 5) lack of religious affiliation (OR4.1)
• Moore, et al. (1990). American
• Journal of Medicine, 88332-336.

24
Illness PreventionDrug Use

• "Whenever religion is used in a (study)
  analysis, it predicts those who have not used an
  illicit drug regardless of whether the religious
  variable is defined in terms of membership,
  active participation, religious upbringing, or
  the meaningfulness of religion."
• Gorsuch and Butler (1976).
• Psychological Bulletin 3120-137.

25
Illness PreventionSubstance Abuse

• Individuals suffering from these (alcohol or
  drug abuse) problems are found to have a low
  level of religious involvement . . . spiritual
  re(engagement) appears to be correlated with
  recovery.
• Miller WR. Researching the spiritual dimensions
  of alcohol and other drug problems. Addiction
  199893(7)979-90.

26
Illness PreventionSubstance Abuse

• The link between spiritual or religious
  involvement and lower risk is one of the more
  consistent (although seldom taught) findings of
  the addiction field.
• Miller WR. Researching the spiritual dimensions
  of alcohol and other drug problems. Addiction
  199893(7)979-90.

27
Illness PreventionSpirituality and Smoking

• Study sample Duke Central Carolina sample of
  nearly 400 adults over age 65
• Study results
• Older adults who both attended religious services
  and prayed (or read the Bible) were nine times
  less likely to smoke.
• Frequently attending services -- strongest
  predictor of not smoking (much stronger than
  prayer/Bible reading).
• Koenig HG, et al. The relationship between
  religious activities and cigarette smoking in
  older adults. J Gerontol Medical Sciences
  199853A(6)M1-M9.
• Bell R., et al. The correlates of college student
  marijuana use results of a U.S. national survey.
  Addiction 199792(5)571-81.

28
Illness PreventionSpirituality and Smoking

• Study sample Duke Central Carolina sample of
  nearly 400 adults over age 65
• Study results
• Watching religious TV -- no research relationship
  with smoking.
• Koenig HG, et al. The relationship between
  religious activities and cigarette smoking in
  older adults. J Gerontol Medical Sciences
  199853A(6)M1-M9.

29
Illness PreventionWorship Attendance and Smoking

• Study sample 400 Lumbee Indians from
  tobacco-laden North Carolina
• Study results
• 1. Smokers who had not attended religious
  services in past year smoked significantly more
  per day than those currently attending more
  often.
• Spangler JG, et al. Church-related correlates of
  tobacco use among Lumbee Indians in North
  Carolina. Ethn Dis 1998873-80.

30
Illness PreventionWorship Attendance and Smoking

• Study results
• 2. Among those who had ever smoked, infrequent
  attenders 79 less likely to quit smoking.
• 3. Regular attenders were 73 less likely to be
  current smokers.
• Spangler JG, et al. Church-related correlates of
  tobacco use among Lumbee Indians in North
  Carolina. Ethn Dis 1998873-80.

31
Illness PreventionSpirituality and Teen Health
Risk

• Study sample 5,000 high school seniors
• 
  Religion important
• Study Results regular
  attenders
• Substance abuse (drugs, alcohol smoking)
  Lowest Rates
• Carry weapons, get into fights Lowest
  Rates
• Wallace J, Forman T. Religions role in promoting
  health and reducing risk among American youth.
  Health Education Behavior 199825(6)721-741.

32
Illness PreventionSpirituality and Teen Health
Risk

• Study sample 5,000 high school seniors
• 
  Religion important
• Study Results regular
  attenders
• Attempt Suicide Lowest Rates
• Wear Seatbelts Highest Rates
• Wallace J, Forman T. Religions role in promoting
  health and reducing risk among American youth.
  Health Education Behavior 199825(6)721-741.

33
Illness PreventionSpirituality and Teen Health
Risk

• Young people for whom religion is very important
  and who attend religious services regularly are
  significantly more likely than their
  non-religious peers to eat in a healthy fashion,
  to exercise regularly and to get adequate sleep.
• Wallace J, Forman T. Religions role in promoting
  health and reducing risk among American
  youth. Health Education Behavior
  199825(6)721-741.

34

• Illness Prevention
• Spirituality and Adolescent Health

• Religious communities give members a sense of
  certainty and purpose in living and meaningful
  and guided experience. The moral constraints of
  religious communities regulate and constrain
  behavior in ways that facilitate good physical
  health, positive family and interpersonal
  relations, ethical work conduct and financial
  dealings and inhibits stress including lifestyle
  choices.
• Bjornson, Durkheimian Framework of adolescent
  anomie.
• J Scientific Study of Religion 199937742-754.

35
Illness Prevention Domestic Violence

• Men who regularly attend religious services are
  one-third as likely to abuse.
• Abuse by men or women is reduced for regular
  attenders even when controlling for unemployment
  or educational differences.
• Ellison CG, et al. Are there religious
  variations in domestic violence? J Fam Issues
  1999 20(1)87-113.

36
Illness Prevention Domestic Violence

• Theologically conservative men married to more
  liberal women twice as likely to abuse than if
  married to conservative spouses.
• Study highlighted Violence research seldom
  includes religious variables.
• Ellison CG, et al. Are there religious
  variations in domestic violence? J Fam Issues
  1999 20(1)87-113.

37
Illness PreventionChild Abuse and Adult
Spirituality

• Study sample 1,207 male veterans admitted to
  Belford, VA Medical Center Substance Abuse
  Treatment Program
• Study results 44 of the sample had experienced
  physical, sexual or emotional abuse as children.
• Impact on spirituality
• 1) Potential for alienation from religion and
  God.
• Lawson R, Drebing, C, et al. The long term impact
  of child abuse on religious behavior and
  spirituality in men. Child Abuse and Neglect
  199822(1)369-79.

38
Illness PreventionChild Abuse and Adult
Spirituality

• Impact on spirituality
• 2) Lower stability of religious belief and
  behavior.
• 3) Higher frequency of prayer.
• 4) Higher frequency of spiritual emptiness.
• 5) As well as higher frequency of positive
  spiritual experiences.
• Lawson R, Drebing, C, et al. The long term impact
  of child abuse on religious behavior and
  spirituality in men. Child Abuse and Neglect
  199822(1)369-79.

39
Bottom Line of PreventionLiving Longer

• Respect for God is the beginning of wisdom and
  the knowledge of the sacred is understanding.
• By wisdom your days will be MULTIPLIED and the
  years of your life will be INCREASED.
• Proverbs 910-11

40
Religion and MortalitySeriously Ill Men

• Study sample 9 year follow-up of more than 1,000
  acutely ill hospitalized men
• Study results
• 1. 67 drew on their religious faith for
  strength or comfort to a great degree
• 2. Those who relied most on their faith to cope
  had
• --lower rates of depression
• --wider network of supportive friends
• --same mortality rates as the less religious
• Koenig HG, et al. Religion and the survival of
  1010 hospitalized veterans. J Religion and
  Health 199937(1)15-29.

41
Illness PreventionSurvival and Mortality

• 30-year follow-up of nearly 7,000 persons living
  in Alameda County, CA initially seen in 1965
  comparing frequent church attenders to infrequent
  attenders
• I. Frequent attenders had lower mortality rates
  (Relative Hazard0.65)
• Strawbridge et al. (1997). American
• Journal of Public Health, 87957-961.

42
Illness PreventionSurvival and Mortality

• II. During follow-up frequent attenders were
• a. more likely to stop smoking
• b. more likely to increase exercising
• c. more likely to increase social contacts
• d. more likely to stay married
• III. Adjusting for the 4 health practices did not
• change frequent attenders mortality rates.
• Strawbridge et al. (1997). American
• Journal of Public Health, 87957-961.

43
Illness PreventionMortality Findings

• Mortality data from Alameda County, California,
  1980-1987
• 3 Lifestyle practices smoking exercise 7-8
  hours of sleep
• Attend Church
• 3 Practices Weekly/3 Practices
• SMR for all
• cancer mortality 51 13
• Frequent attenders
• vs. all others 0.71
• Enstrom (1989). Journal of the
• National Cancer Institute, 811807-1814.

44
Illness Prevention Living Longer

• Study sample national sample of 21,000 U.S.
  adults with 10-year follow-up. 1987 National
  Health Interview Survey with 1997 NCHS Multiple
  Cause of Death File
• Study results
• Life expectancy gap between those who attend
  more than once a week and those who never attend
  is over 7 years.
• For Blacks, the life expectancy gap is 14 years.
• Hummer RA, et al. Religious involvement and U.S.
  adult mortality. Demography 199936(2)273-85.

45
Illness PreventionLiving Longer

• Study results
• Assessed for potential confounders and mediating
  factors (stronger social ties and better health
  behaviors) did explain some of the mortality
  link.
• Hummer RA, et al. Religious involvement and U.S.
  adult mortality. Demography 199936(2)273-85.

46
Illness PreventionLiving Longer

• Study sample 5-year follow-up of 2,025
  residents of Marin County who were 55 years and
  older.
• Study results
• For each sex, weekly attendees with the lowest
  mortality and non-attendees had the highest
  mortality.
• Other social support activities (e.g. Rotary Club
  or hospital auxiliaries) not with same mortality
  benefit.
• Oman D, Reed D. Religion and mortality among the
  community-dwelling elderly. Am J Public Health
  1998 88(10)1469-1475.

47
Illness PreventionLiving Longer

• Study results
• People who engaged in volunteer activities and
  attended religious services had additive
  mortality effects.
• Controlling for six classes of potential
  confounding and intervening variables did not
  explain the protective effects of religious
  attendance on mortality.
• Oman D, Reed D. Religion and mortality among the
  community-dwelling elderly. Am J Public Health
  1998 88(10)1469-1475.

48
Illness PreventionImmune Functioning

• Study sample 1700 community adults from central
  North Carolina
• Study results Link between low religious
  attendance and high levels Interleukin 6 (IL-6).
• Study controls
• Increased levels of depression negative life
  events.
• Koenig HG et al. Attendance at religious
  services, interleukin-6, and other biological
  parameters of immune function in older adults.
  Int J Psychiatry Med. 199727(3)233-50.

49
Illness PreventionImmune Functioning

• Study sample 1700 community adults from central
  North Carolina
• Study implications
• Increased levels of stress can be associated with
  release of substances such as cortisol and IL-6.
• Koenig HG et al. Attendance at religious
  services, interleukin-6, and other biological
  parameters of immune function in older adults.
  Int J Psychiatry Med. 199727(3)233-50.

50
Illness PreventionHypertension

• Study sample 400 community residents age 65 and
  older.
• Study results Risk of diastolic hypertension
  reduced up to 40 for
• --regular attenders who also
• --prayed or read bible daily
• Koenig HG, et al. The relationship between
  religious activities and blood pressure in older
  adults. Int J Psychiatry Med 1998
  28(2)189-213.

51
Illness PreventionHypertension

• Study sample 400 community residents age 65 and
  older.
• Study findings
• -- Stronger for Blacks than for Whites
• -- Stronger for 65-75 over those 75 years old and
  older
• Koenig HG, et al. The relationship between
  religious activities and blood pressure in older
  adults. Int J Psychiatry Med 1998
  28(2)189-213.

52

• Clinical Relevance
• Illness Prevention
• Recovery From Surgery
• Coping With Illness
• Improving Treatment Outcomes

53
Coping With IllnessElderly Inpatients

• In a study of elderly inpatients, more than 50
  percent of the patients rated their religious
  beliefs as very important means of effectively
  coping with their illness.
• Koenig HG, et al. American Journal
• of Psychiatry 1992 149(12)1693-1700.

54
Coping With IllnessDepression

• A religious perspective can have a beneficial
  impact on coping with and recovering from
  depression.
• Andreasen, NJ (1972). Journal of Religion
• and Health, 11153-166.

55
Coping with StressLiving in Poverty

• Study sample national sample of more than 500
  elderly assessed twice over four years to
  evaluate changes in health
• 1. Those elderly living in deteriorating
  neighborhoods showed a greater decline in health
  than those living in better neighborhoods.
• Krause N. Neighborhood deterioration, religious
  coping, and changes in health during late life.
  Gerontologist 199938(6)653-64.

56
Coping with StressLiving in Poverty

• 2. Those elderly who turned to religion to cope
  showed much less decline in self-rated health.
• 3. Religious coping may foster a sense of
  self- worth not based on economic resources.
• 4. Feeling the presence of God and believing
  that one is not alone during adverse times may
  have a beneficial effect.
• Krause N. Neighborhood deterioration, religious
  coping, and changes in health during late life.
  Gerontologist 199938(6)653-64.

57
Coping with StressThe Harm and Benefit of
Religion

• Study results (similar across 3 populations)
• Negative coping strategies (e.g. seeing the
  crisis as Gods punishment or questioning Gods
  love or power) linked to more depression and
  lowered quality of life and greater callousness
  to others.
• Pargament KI, et al. Patterns of positive and
  negative religious coping with major life
  stressors. J Scientific Study of Religion 1998
  37(4)710-724.

58
Coping with StressThe Harm and Benefit of
Religion

• Study sample
• sample of 300 from Oklahoma City Bombing
• 540 college students who had experienced death of
  friend or serious loss
• 550 older hospitalized patients.
• Study results (similar across 3 populations)
• positive coping strategies linked to positive
  personal growth due to stress
• Pargament KI, et al. Patterns of positive and
  negative religious coping with major life
  stressors. J Scientific Study of Religion
  199837(4)710-724.

59
Coping with IllnessSpirituality and Medically
Ill Hospitalized Patients

• Study sample Nearly 600 severely ill
  hospitalized patients aged 55 and over
• Study results spiritual coping via connection
  with God and receiving religious support
• 1) less depression
• 2) better quality of life
• 3) greater compliance with care
• Koenig, HG, et al. Religious coping and health
  status in medically ill hospitalized older
  adults. J Nerv Ment Dis 1998186(9)513-21.

60
Coping with IllnessSpirituality and Pain

• Study sample more than 460 patients from a
  family medicine clinic
• Study results
• Those with moderate or high intrinsic beliefs
  more likely to experience better health.
• Moderately spiritual patients experienced least
  pain. Highly spiritual, more pain low
  spirituality, the most pain.
• McBride JL et al. The relationship between a
  patients spirituality and health experiences.
  Fam Medicine 199830(2)122-126.

61
Patient NeedSpirituality and Health

• Study results
• Researchers concluded... Family physicians may
  find that considering the spirituality of their
  patients informs, enhances and adds a new
  dimension to clinical practice.
• McBride JL et al. The relationship between a
  patients spirituality and health experiences.
  Fam Medicine 199830(2)122-126.

62
Coping with IllnessPatients on Hemodialysis

• Among patients undergoing hemodialysis
• 1. Over half of the patients saw their religious
  beliefs as an important factor in adjusting to
  their illness.
• 2. Nearly half of the patients re-surveyed three
  years later felt that their religious beliefs had
  become even more important to them in coping with
  their illness.
• O'Brien ME. Journal of Religion and Health
  21(1)68-80, 1982.

63
Coping with IllnessGynecologic Cancer

• 91 -- religion helped them sustain their hopes
• 76 -- religion had a serious place in their
  lives
• 49 -- patients became more religious since
• their diagnoses
• 41 -- religion supported their sense of worth
• None had become less religious since their cancer
  diagnoses
• Roberts JA, et al. Am J Obstetrics and
  Gynecology, 1997176(1)166-172.

64
Coping With IllnessBreast Cancer

• 88 considered religion to be important or
• very important
• 85 felt religion helped them to cope with
• their illness
• 95 very satisfied with clergy home and
• hospital visits
• Johnson and Spilka (1991). Journal
• of Religion and Health, 3021-33.

65
Coping With IllnessBreast Cancer

• Religious Predictors of Clergy Satisfaction
• 1) number of visits
• 2) prayer with clergy
• 3) reading Bible with clergy
• 4) talking about church matters
• Johnson and Spilka (1991). Journal
• of Religion and Health, 3021-33.

66
Coping with IllnessSpirituality and Skin Cancer

• Study sample 2 samples of melanoma patients--
  of 100 or more -- one from New York City and one
  from Jerusalem.
• Definition Active coping style patient accepts
  illness and tries to deal with it in positive,
  meaningful way.
• Study results Those relying more on religious
  or spiritual beliefs more frequently utilized
  active coping style.
• Holland JC, et al. The role of religious and
  spiritual beliefs in coping with malignant
  melanoma. Psycho-Oncology 1999814-26.
• Baider et al. The role of religious and spiritual
  beliefs in coping with malignant melanoma an
  Israeli sample. Psycho-Oncology 1999827-35.

67
Coping with IllnessSpirituality and Skin Cancer

• Study implications
• Reverses past views of religious coping as
  passive, regressive, even avoidant psychological
  phenomenon.
• Shows need for more research in looking at
  spiritual and religious beliefs in coping with
  cancer.
• Holland JC, et al. The role of religious and
  spiritual beliefs in coping with malignant
  melanoma. Psycho-Oncology 1999814-26.
• Baider et al. The role of religious and spiritual
  beliefs in coping with malignant melanoma an
  Israeli sample. Psycho-Oncology 1999827-35.

68
Coping with IllnessSpirituality and
HIV-Positive Patients

• Study sample 90 HIV positive patients were
  surveyed about their 1) fear of death 2)
  religious status and
• 3) guilt about HIV infection
• Study results HIV infection challenges the
  deepest beliefs, including
• 32 fear of death
• 44 felt guilty
• 26 saw their illness as some form of
  punishment (17 -- from God)
• Kaldjian LC, et al. End-of-life decisions in
  HIV-positive patients the role of spiritual
  beliefs. AIDS 199812(1)103-07.

69
Coping with IllnessSpirituality and
HIV-Positive Patients

• Study results
• Fear of death more likely in those who felt
  guilty about having HIV or viewed their infection
  as punishment from God.
• Fear of death less likely for those who
• 1) read Bible frequently 2) attended church
  regularly and 3) saw God having a central role
  in their life.
• Those who believed in Gods forgiveness more
  likely to have discussion about resuscitation
  status.
• Kaldjian LC, et al. End-of-life decisions in
  HIV-positive patients the role of spiritual
  beliefs. AIDS 199812(1)103-07.

70
Coping with IllnessSpirituality and
HIV-Positive Patients

• Study results
• Belief in a God who forgives and comforts may
  signify an ability to accept HIV or premature
  death.
• Kaldjian LC, et al. End-of-life decisions in
  HIV-positive patients the role of spiritual
  beliefs. AIDS 199812(1)103-07.

71

• Clinical Relevance
• Illness Prevention
• Coping With Illness
• Recovery From Surgery
• Improving Treatment Outcomes

72
Recovery from SurgeryHip Replacement

• Hip fracture patients with stronger religious
  beliefs and practices were less depressed and
  could walk a greater distance at discharge than
  patients with lower levels of religious
  commitment.
• Pressman P, et al. Am J Psychiatry
  1990147758-760.

73
Recovery From SurgeryHeart Surgery

• 232 patients undergoing elective heart surgery
  were studied to investigate their surgical
  survival and recovery rates.
• Six months following surgery, 21 (9) of the
  original 232 patients had died post-operatively.
• Oxman TE, et al. Psychosomatic
• Medicine 575-15, 1995.

74
Recovery From SurgeryHeart Surgery

• Study Results
• 1. None of the 37 patients who had described
  themselves as "deeply religious" died during the
  6-month time period.
• 2. Only 5of those who attended church at least
  every few months had died.
• 3. 12 of those who rarely (or never) attended
  church died during the six month follow-up
  period.
• Oxman TE, et al. Psychosomatic
• Medicine 575-15, 1995.

75
Recovery From SurgeryHeart Transplant Surgery

• For patients followed during their first year
  post-transplant
• The patients frequently turned to God, prayer,
  and religion for help and delineated specific
  ways in which their faith had provided them
  support, as well as how the transplant experience
  had furthered their religious beliefs.
• Harris, RC, et al. (1995). Journal of
• Religion and Health, 3417-32.

76
Recovery From SurgeryHeart Transplant Surgery

• For patients followed during their first year
  post-transplant
• The study found evidence that recipients with
  strong beliefs who participated in religious
  activities had better physical and emotional
  well-being, fewer health worries, and better
  medical compliance at the time ot the 12-month
  assessment.
• Harris, RC, et al. (1995). Journal of
• Religion and Health, 3417-32.

77
Recovery from SurgeryCoping with Waiting Room
Worries

• Study sample 150 family members of 50 heart
  surgery patients
• Study results Religious coping methods used
• 1. Praying alone to God
• 2. Prayer with others to God
• 3. Reading Scriptures
• 4. Attending religious services
• VandeCreek L, et al. The unique benefits of
  religious
• support during cardiac bypass surgery. J
  Pastoral
• Care 199953(1)19-29.

78
Recovering from SurgeryCoping with Waiting Room
Worries

• Study results
• Religious coping both
• Improved coping outcomes.
• Linked with more symptoms of depression.
• VandeCreek L, et al. The unique benefits of
  religious support during cardiac bypass surgery.
  J Pastoral Care 199953(1)19-29.

79

• Clinical Relevance
• Illness Prevention
• Coping With Illness
• Recovery From Surgery
• Improving Treatment Outcomes

80
Improving Treatment OutcomesSpirituality and
Recovery from Depression

• Study sample 87 patients 60 years old and older
  admitted for physical illness with co-morbid
  depression.
• Study results
• ) Patients with higher intrinsic scores (score
  range 10-50) experienced faster recovery rates.
• ) Every 10 point increase in score associated
  with 70 increase in speed of remission.
• Koenig HG, et al. Religiosity and remission of
  depression in medically ill older adults. Am J
  Psychiatry 1998155(4)536-542.

81
Treatment OutcomesThe Researching of Religious
Psychotherapies

• Study sample all studies (total n111 subjects)
  included the treatment of depression using
  religious psychotherapy compared to a
  non-religious approach.
• Study results At one week, follow-up effects
  for 111 religious subjects receiving religious
  approaches showed slightly more improvement.
• McCullough ME. Research on religion-accommodative
  counseling review and meta-analysis. J
  Counseling Psychology 199946(1)1-7.

82
Treatment OutcomesThe Researching of Religious
Psychotherapies

• Study results
• Few studies assessed for more than one week
  follow-up.
• Future studies need to assess whether adding
  religious components makes a difference for
  anxiety, anger, marital or family problems.
• McCullough ME. Research on religion-accommodative
  counseling review and meta-analysis. J
  Counseling Psychology 199946(1)1-7.

83
Improving Treatment OutcomesPsychotherapy for
Depression

• Among religiously committed patients suffering
  from depression
• Those receiving religiously-oriented therapy had
  better scores on measures of both post-treatment
  depression and clinical adjustment than those
  whose therapy did not integrate religious
  content.
• Propst et al. (1992). Journal of
• Consulting and Psychology, 6094-103.

84
Improving Treatment OutcomesDrug Treatment

• 45 of participants in a religious treatment
  program for opioid addiction were still abstinent
  at one year follow up, compared to 5 of
  participants in a non-religious public health
  service hospital treatment program.
• Desmond, Maddux (1981). American Journal
• of Drug and Alcohol Abuse, 871-83.

85
Improving Treatment OutcomesReducing Hospital
Stays

• Study sample 542 patients 60 or older
  consecutive admissions to Duke University Medical
  Center.
• Study results
• Regular attendees were 43 less likely to have
  been hospitalized during previous year.
• If hospitalized, briefer stays -- non affiliated
  spent 25 days in hospital affiliated spent 11
  days.
• Koenig HG, Larson DB. Use of hospital services,
  religious attendance, and religious affiliation.
  South Med J 199891(10)925-32.

86
Improving Rehabilitation OutcomesReducing
Criminal Recidivism

• 400 prison inmates were followed for one year
  after their release
• 200 At least monthly Bible studies
• 200 No Bible studies
• One year follow-up
• 14 of Bible study participants had returned to
  prison
• 41 of non-participants had returned to prison
• Johnson et al. Justice Quarterly 199714145-166.

87
Treatment OutcomesThe Harmfulness of Faith
Healing

• Study sample 172 children who died (1975-95)
• a) after parents refused medical care
• b) preferred faith healing alone
• Study results 140 (81) died from conditions
  with excellent long-term survival (e.g.
  Dehydration, diabetes, measles, pneumonia,
  appendicitis) with medical care.
• 59 prenatal newborn died, 58 from conditions
  with excellent long-term survival following
  medical care.
• Asser SM, Swan R. Child fatalities from
  religion-motivated medical neglect. Pediatrics
  1998101(4)625-629.

88

• For the more than 70 percent of the population
  for whom religious commitment is a central life
  factor, treatment approaches devoid of spiritual
  sensitivity may provide an alien values
  framework... a majority of the population
  probably prefers an orientation... that is
  sympathetic, or at least sensitive, to a
  spiritual perspective. We need to better
  perceive and respond to this public need.
• Bergin and Jensen . Psychotherapy 1990273-7.

89

• Humor is the experience that the small
  incongruities of life are note serious and faith
  is the commitment to the proposition that the
  large incongruities of life are not ultimate.
• Reunhold Nieburh, in Fackenheim, p. 247.

90
Medicine and Faith Revisited in the 1990s
Quite Measurable

• Nothing in life is more wonderful than faith --
  the one great moving force which (as it turns
  out) we can weigh in the balance and test in the
  crucible . . . not so mysterious, and not so
  indefinable, known by its clinical effects, faith
  pours out an unfailing stream of energy while
  abating little of its potency.