Measuring spirituality in South Africa: Validation of instruments developed in the USA

Abstract

Spirituality is receiving increased attention in the context of the workplace. Research consistently shows that spirituality is significantly correlated with mental health and well-being. Most of the research on spirituality, particularly in the context of the workplace, is conducted with instruments developed in the USA. However, the inter-cultural measurement of constructs remains a concern, because instruments developed in one culture are not necessarily transferable to another culture. In the current study, the transferability of two spiritual measures developed in the USA, namely the Human Spirituality Scale (HSS) and the Organizational Spirituality Values Scale (OSVS) are considered for a sample from South Africa. The results confirm the construct validity of the HSS and the OSVS, but indicate that the factor structures of the HSS and the OSVS should be analysed and reconfirmed when used, particularly in a South African sample. The study provides evidence that the HSS and the OSVS cannot be transferred indiscriminately to a South African sample. This insight contributes to the quality of future research studies in South Africa, not only on the important aspect of spirituality, but also when applying instruments developed elsewhere in the world.     

Daily spiritual experiences in a biracial,community-based population of older adults

Objectives: The objectives of this study were to describe the levels of daily spiritual experiences (DSEs) in community-dwelling older adults, to compare the levels of spiritual experiences with the levels of prayer and religious service attendance, and to examine the demographic and psychosocial correlates of spiritual experiences. The data came from 6534 participants in the Chicago Health and Aging Project, an ongoing population-based, biracial (65% African American) study of the risk factors for incident Alzheimer's disease among older adults. A 5-item version of the Daily Spiritual Experiences Scale (DSES) was used in the study. Multivariable linear regression models were used to examine the relationship between sociodemographic and psychosocial factors and DSES scores.

Results: The majority of the participants reported having spiritual experiences at least daily. In the bivariate analyses, African Americans and women had higher DSES scores than Whites and men, respectively (p's < 0.001). Prayer and worship were moderately associated with DSES scores. In the multivariable analyses, African American race, older age, female gender, better self-rated health, and greater social networks were associated with higher DSES scores, while higher levels of education and depressive symptoms were associated with lower DSES scores.

Conclusion: We observed high levels of spiritual experiences and found that the DSES is related to, but distinct from the traditional measures of religiosity. We found associations between DSES, demographic, and psychosocial factors that are consistent with the findings for other religiosity and spirituality (R/S) measures. Future research should test whether DSES contributes to our understanding of the relationship between R/S and health in older adults.     

A randomized trial on the treatment of the first epileptic seizure scientific background, rationale, study design and protocol

Observational studies suggest that the sooner treatment is started after the onset of seizures the better is the outcome of the disease. However, when to start antiepileptic treatment is still debated and this may explain the different behaviour of practising physicians. For these reasons, a multicenter randomized controlled trial comparing the treatment of the first seizure and the treatment of the recurrences (the two most common strategies in clinical practice) has been started in Italy. The scientific background, the study rationale and design, and the general characteristics of the study population (498 patients) are presented here. Members:G. Bogliun, Ospedale “San Gerardo”, Monza;P. Aloisi, G. Cerone, C. Porto, Ospedale “Santa Maria di Collemaggio”, L'Aquila;P. Bassi, C. Francesconi, P. Gambaro, Ospedale “Luigi Sacco”, Milano;P. Basso, Centro Regionale per l'Epilessia, Gallarate;R. Freschi, S. Meregalli, Ospedale di Legnano;E. Boati, A. Mamoli, B. Galavotti, M. Camerlingo, M.R. Rottoli, Ospedali Riuniti, Bergamo;E. Bottacchi, L. Carenini, M. Leone, L. Sironi, Ospedale Regionale, Aosta;G.L. Casara, G. Matticchio, Ospedale Policlinico, Padova;E. Covezzi, G. Tortorici, Ospedale Civile, Pordenone;E. Franzoni, V. Marchiani, Ospedale “Sant'Orsola”, Bologna;G. Giuliani, S. Polonara, S. Terziani (Clinica Neurologica),A. Quattrini, A. Ortenzi, A. Paggi (Centro per l'Epilessia), Ospedale Generale Regionale “Torrette” and Ospedale “Umberto I”, Ancona;R. Daniele, G. Mattioli, G. Saladino, Ospedzale “Monaldi”, Napoli;F. Iemolo, G. D'Asta, Ospedale Civile, Vittoria;C. Geda, G.F. Ferrari, M.A. Binetti, A. Martini, M.T. Perenchio, Ospedale Civile Ivrea;R. Lisi, Ospedale di Fidenza;C. Lona, Ospedale Regionale, Bolzano;A. Bianchi, S. Severi, L.P. Zolo, Ospedale Civile, Arezzo;V. Montano, F. Fassio, M. Novellone, Ospedale Civile, Asti;L. Vignolo, (Clinica Neurologica),L. Antonini, M.P. Pasolini (Divisione Neurofisiopatologia, Centro Regionale per l'Epilessia), Ospedale Civile, Brescia;G. Rossi, Ospedale Civile, Rovereto;S. Feller, S. Sbrascini, Ospedale Civile, Garbagnate;P.G. Zagnoni, Ospedale “Santa Croce”, Cuneo;D. Zerbi, D. Clerici, Ospedale Civile, Saronno;A. Romeo, M.P. Gulotta, Centro Regionale di Epilettologia Infantile, Milano;B. Lucci, Ospedale di Udine;E. Russo, S. Mazza, Università Cattolica, Roma;M. De Mattei, R. Cremo, Ospedale “Molinette”, Torino;S. Gentile, N. Lovera, D. Piazza, Ospedale “Giovanni Bosco”, Torino.Clinical Monitors:I. Currado, A. Solari, Istituto di Tecnologie Biomediche Avanzate, CNR, Milano,A. Ciccone, Istituto di Ricerche Farmacologiche “M. Negri”, Milano.     

Religion and Spirituality: How Clinicians in Quebec and Geneva Cope with the Issue When Faced with Patients Suffering from Chronic Psychosis

Spirituality and religion have been found to be important in the lives of many people suffering from severe mental disorders, but it has been claimed that clinicians “neglect” their patients’ religious issues. In Geneva, Switzerland and Trois-Rivières, Quebec, 221 outpatients and their 57 clinicians were selected for an assessment of religion and spirituality. A majority of the patients reported that religion was an important aspect of their lives. Many clinicians were unaware of their patients’ religious involvement, even if they reported feeling comfortable with the issue. Both areas displayed strikingly similar results, which supports their generalization.     

Has there been a delay in the age of regular smoking onset among African Americans?

Background: It is not clear whether the decline in African American adolescent smoking in the 1980s reflected a delay in age of onset of regular smoking initiation rather than success in preventing initiation completely.Purpose: The purpose of this study is to identify whether the marked reductions in African American adolescent smoking in the 1980s were offset by increased initiation in young adults.Methods: We combined data from the Tobacco Use Supplements of the 1992–1993, 1995–1996, and 1998–1999 Current Population Surveys (n = 512,258), and reconstructed year of smoking initiation and calculated age-specific incidence of initiation from 1970 to 1992. We then compared detailed age-specific rates of initiation for two 5-year periods selected to be before and after the documented large declines in African American adolescent smoking.Results: In the time period after marked declines in African American adolescent smoking (1987–1991), the incidence of initiation of regular smoking decreased for African Americans ages 14 to 16 and increased for ages 18 to 20. Such a delay was not as evident among non-Hispanic Whites. The delay that was slight in regular smoking initiation among African Americans relative to non-Hispanic Whites in 1975–79 had increased substantially by 1987–91.Conclusions: Reductions in African American adolescent smoking in the 1980s were offset by increased initiation among young adults ages 18 to 20 during this time period and suggest that the window for uptake of regular smoking shifted to older ages for African Americans more so than non-Hispanic Whites. Efforts to combat smoking should remain aggressive into young adulthood, when the tobacco industry’s efforts to gain new smokers intensify. This research was supported by Grant 9RT-0036 from the University of California Tobacco Related Diseases Research Program.     

Spirituality in psychiatry residency training programs

Spirituality has been receiving increased attention in health care in recent years. Surveys have identified that patients want their spiritual beliefs addressed in the clinical setting. Data suggests that spirituality may be helpful to people as they cope with serious illness and life events. Medical educators are recognizing spirituality as a core patient need. Courses in medical schools and in psychiatric residency programs are being developed to address this important issue.The Accreditation Council for Graduate Medical Education (ACGME) guidelines underscore the importance of addressing religious/spiritual issues in psychiatric training. The John Templeton Spirituality and Medicine Award Program administered by GeorgeWashington University recognizes psychiatric residency programs that address spirituality and health. This award has stimulated the development of relevant, novel curricula in this area. In addition, a consensus group of psychiatrists has developed a model curriculum that addresses key concepts of a psychiatric residency training programs in spirituality and medicine.     

Older adults' preferences for religion/spirituality in treatment for anxiety and depression

Objectives: To examine patient preferences for incorporating religion and/or spirituality into therapy for anxiety or depression and examine the relations between patient preferences and religious and spiritual coping styles, beliefs and behaviors.

Method: Participants (66 adults, 55 years or older, from earlier studies of cognitive-behavioral therapy for late-life anxiety and/or depression in primary care) completed these measures by telephone or in-person: Geriatric Anxiety Inventory, Client Attitudes Toward Spirituality in Therapy, Patient Interview, Brief Religious Coping, Religious Problem Solving Scale, Santa Clara Strength of Religious Faith, and Brief Multidimensional Measure of Religiousness and Spirituality. Spearman's rank-order correlations and ordinal logistic regression examined religious/spiritual variables as predictors of preferences for inclusion of religion or spirituality into counseling.

Results: Most participants (77–83%) preferred including religion and/or spirituality in therapy for anxiety and depression. Participants who thought it was important to include religion or spirituality in therapy reported more positive religious-based coping, greater strength of religious faith, and greater collaborative and less self-directed problem-solving styles than participants who did not think it was important.

Conclusion: For individuals like most participants in this study (Christians), incorporating spirituality/religion into counseling for anxiety and depression was desirable.     

Spirituality in children and adolescents: research findings and implications for clinicians and researchers

Spirituality is a powerful force in the lives of children. Although spirituality has only recently begun to be a focus for psychiatric research, initial qualitative data suggest that children experience themselves as spiritual beings and that understanding and connecting with them around their spiritual lives can be an important adjunct to treatment. Clinicians should feel free to ask about a child's spiritual life and to work with the family using their spiritual resources if they are perceived to be beneficial in helping the child and family cope with their current situation. Because the work with children's spirituality is in its preliminary stages, qualitative methodology is still the recommended research method for investigating questions in this research area.     

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting

Background In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. Objectives To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. Method Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. Results The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that “it is Satan's work” (35.8 %) and “it is a natural illness“ (23.2 %). Other factors were “genetic” (9.5 %), “witchcraft” (10.5 %) and “curse by enemies” (10.5 %). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were “genetic” (41.5 %) and “natural” (21.5 %). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. Conclusions These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support. Accepted: 10 July 2001     

Mental health screening of African American adolescents and facilitated access to care

This study retrospectively reviews de-identified records from school-based mental health screening in a predominantly African American community. We compare participation rates, screening results, referrals to services and access to care of white and African American adolescents. Among those offered screening, 20.1% of white students (n = 297), and 28.8% of African American students (n = 499) were screened (χ² = 32.47, df = 1, P < .001). African American students (45.1%) were significantly more likely than white students (33.0%), (AOR = 1.59; P = .003) to be identified as being at risk. In both racial groups, most youth accessed the school-based services (89.02%, 95% CI 82.25–95.79) and community services (86.57%, 95% CI 78.41–94.73) to which they were referred. The groups did not differ in the odds of accessing community-based services (AOR = .58; P = .49). African American students were, however, more likely than white students to access school-based services (AOR = 10.08; P = .022). The findings support the effectiveness of screening in school settings in predominantly African American communities.     

Psychosis and transformation: A phenomenological inquiry

Conventional views towards psychosis typically portray psychosis as an illness of the brain with a generally poor prognosis, even if treated with antipsychotics. However, there is a growing body of literature which presents an alternative view of psychosis, whereby people are not only able to recover from psychosis, but can also experience transformative and/or spiritual growth through psychosis. To learn more about the transformative potential of psychotic experiences, a phenomenological approach was used to research the experiences of six people who self-identified as having benefited from psychosis in a spiritual and/or transformative manner. Keys themes emerging from interviews with these six individuals included in the pre-psychosis phase “childhood foreshadowing” and “negative childhood events,” and in the psychosis phase, “sudden psychosis,” “psychic/intuitiveness and unusual visual experiences,” “comprised day-to-day functioning,” “experiences of dying,” and “communication with god.” Four themes made up the transformation of psychosis phase including “detachment and mindfulness,” “accepting the dissolution of time into now,” “embracing a spiritual pathway,”“ and ”re-alignment of career path.“ Overall, the results suggest that at least for some individuals, the experience of psychosis can be an important catalyst for spiritual and personally transformative growth.     

Posterior reversible encephalopathy syndrome on computed tomography perfusion in a patient on “triple H” therapy

Introduction: This article reports a case of posterior reversible encephalopathy syndrome on compyted tomography (CT) perfusion in a patient on “Triple H” (hypertension, hypervolemia, and hemodilution) therapy following aneurysmal rupture repair. Case Report: “Triple H” therapy is used in the postoperative course for treatment of vasospasm to prevent stroke and hemorrhage by maintaining cerebral perfusion pressure. Discussion: A potential complication includes vasogenic edema from dysfunction of cerebral blood vessel autoregulation. CT perfusion can detect alterations in cerebral blood flow and volume caused by these hemodynamic changes.     

The “Army” Incident: The Psychology of Uniforms and Their Abolition on an Adolescent Ward†

Abstract

The phenomenology of mystical experiences has been described throughout all the ages and in all religions. All mystical traditions identify some sense of union with the absolute as the ultimate spiritual goal. I assume that the pathway to both theistic and secular spirituality and our readiness to seek a solution in a psychological merger with something beyond the self evolves out of our human experience. Spirituality is one of man's strategies for dealing with the limitations of the life cycle, separation and loss, biological fragility, transience, and non—existence. Spirituality may serve as the affective component to a belief system or myth that is not rooted in scientific evidence but is lived as if it is true. Spirituality may take many forms, but I will suggest that in some instances it may serve as a reparative process in which one creates in the external world, through symbolic form, a nuance or facet of an internalized mental representation which has become lost or is no longer available to the self; or it may represent the continuity of the self-representation after death through a self—object merger. Lastly I will illustrate from the writings of two of our greatest poets, Dante Alighieri and William Wordsworth, how their poetry became interwoven with a profound spirituality. In Dante we will see the elaboration of a religious spirituality, while in the writings of Wordsworth a secular spirituality emerges interwoven with nature and belatedly his identification with “tragic man” as his mythos.     

Cardiovascular reactivity to mental arithmetic and cold pressor in African Americans,Caribbean Americans,and White Americans

Background: Caribbean Americans and African Americans, two of the largest Black ethnic groups in the United States, differ in cardiovascular-disease-related mortality rates.Purpose: Cardiovascular reactivity to psychological stress may be an important marker or mediator of risk for cardiovascular disease development in Blacks in the United States, yet little attention has been paid to ethnicity among Blacks in reactivity research. This study examined cardiovascular reactivity to psychological stress in African American, Caribbean American, and White American participants.Methods: Forty-five women and 43 men performed mental arithmetic and hand cold pressor (CP) tasks.Results: Caribbean Americans displayed larger decreases in heart period variability during mental arithmetic than White Americans (p = .02). White Americans exhibited a pre-ejection period decrease, whereas African Americans and Caribbean Americans displayed pre-ejection period increases during CP (p = .023). African Americans exhibited greater decreases in interbeat interval during CP than White Americans (p = .013). Caribbean Americans displayed greater decreases in cardiac output than White Americans during CP (p = .009). White Americans exhibited significantly greater increases in systolic blood pressure than Caribbean Americans during CP (p = .014).Conclusions: These findings suggest that differences in reactivity to psychological stress exist among Black ethnic groups in the United States and underscore the need to consider ethnicity as a factor in reactivity research with Black Americans. This study was supported by the National Institute of Mental Health Grant 1 F31 MH12330-01A1 to Carlotta M. Arthur. We thank Stefan Wiens and William Guethlein for programming assistance. We also thank Robert M. Kelsey, Ronald Friend, K. Daniel O’Leary, Richard P. Sloan, Laura D. Kubzansky, Ichiro Kawachi, and Norman B. Anderson for their valuable comments.     

Bewertung des Therapieerfolgs durch Patienten mit Angststörungen nach stationärer Psychotherapie

Zusammenfassung Ziel. Identifikation von Einflussfaktoren auf die subjektive Bewertung des Therapieerfolgs nach station?rer Angstpsychotherapie. Methode. 231 Angstpatienten wurden in einer multizentrischen Studie zu Therapiebeginn und -ende sowie in der 1-Jahres-Katamnese untersucht. Die subjektive Erfolgsbewertung wurde mittels des Helping Alliance Questionnaire erfasst; in diesem Zusammenhang wird der Begriff “Patientenzufriedenheit” diskutiert. Ergebnis. Die Bewertung des Therapieerfolgs korreliert weder mit Alter, Geschlecht oder Bildungsstand noch mit Krankheitsdauer, Symptombelastung bei Therapiebeginn oder Behandlungsdauer. Am h?chsten korreliert die Bewertung des Therapieerfolgs mit dem symptombezogenen Therapieerfolg, wobei das absolute Ausma? der Symptomauspr?gung nach der Therapie (“klinische Signifikanz”) enger mit der subjektiven Erfolgsbewertung zusammenh?ngt als der Betrag der erfolgten Symptomreduktion (“statistische Signifikanz”). Schlussfolgerung. Unabh?ngig von personenbezogenen oder krankheitsbezogenen Variablen nehmen Angstpatienten ihren Therapieerfolg differenziert wahr und bewerten ihn positiv. Unsere Ergebnisse zeigen, dass die aktuelle Diskussion um die Bewertung von Therapieergebnissen nach “statistischer” und “klinischer” Signifikanz auch für die subjektive Perspektive der Patienten von Bedeutung ist.      

Belief in Divine Control, Coping, and Race/Ethnicity among Older Women with Breast Cancer

Background

Belief in divine control is often assumed to be fatalistic. However, the assumption has rarely been investigated in racial/ethnic minorities.

Objectives

This study aims to examine the association between belief in divine control and coping and how the association was moderated by ethnicity/acculturation in a multi-ethnic sample of breast cancer patients.

Methods

Latina, African American, and non-Hispanic White older women with newly diagnosed breast cancer (N?=?257) from a population-based survey completed the scale of Belief in Divine Control and the Brief COPE.

Results

Belief in divine control was positively related to approach coping (i.e., positive reframing, active coping, and planning) in all ethnic groups. Belief in divine control was positively related to acceptance and negatively related to avoidance coping (i.e., denial and behavioral disengagement) among low-acculturated Latinas.

Conclusions

Negative presumptions about fatalistic implications of belief in divine control should be critically reappraised, especially when such skepticism is applied to racial/ethnic minority patients.     

Spirituality attenuates the association between depression symptom severity and meaning in life

Objectives: This cross-sectional study examined whether spirituality moderates the association between depression symptom severity and meaning in life among treatment-seeking adults.

Method: Participants were 55 adults (≥60 years of age) newly seeking outpatient mental health treatment for mood, anxiety, or adjustment disorders. Self-report questionnaires measured depression symptom severity (Patient Health Questionnaire-9), spirituality (Spirituality Transcendence Index), and meaning in life (Geriatric Suicide Ideation Scale-Meaning in Life subscale).

Results: Results indicated a significant interaction between spirituality and depression symptom severity on meaning in life scores (β = .26, p = .02). A significant negative association between depression symptom severity and meaning in life was observed at lower but not the highest levels of spirituality.

Conclusion: In the presence of elevated depressive symptomatology, those participants who reported high levels of spirituality reported comparable levels of meaning in life to those without elevated depressive symptomatology. Assessment of older adult patients’ spirituality can reveal ways that spiritual beliefs and practices can be can be incorporated into therapy to enhance meaning in life.     

Spirituality and Autonomic Cardiac Control

Background Spirituality has been suggested to be associated with positive health, but potential biological mediators have not been well characterized. Purpose and Methods The present study examined, in a population-based sample of middle-aged and older adults, the potential relationship between spirituality and patterns of cardiac autonomic control, which may have health significance. Measures of parasympathetic (high-frequency heart rate variability) and sympathetic (pre-ejection period) cardiac control were obtained from a representative sample of 229 participants. Participants completed questionnaires to assess spirituality (closeness to and satisfactory relationship with God). Personality, demographic, anthropometric, health behavior, and health status information was also obtained. A series of hierarchical regression models was used to examine the relations between spirituality, the autonomic measures, and two derived indexes—cardiac autonomic balance (CAB, reflecting parasympathetic to sympathetic balance) and cardiac autonomic regulation (CAR, reflecting total autonomic control). Results Spirituality, net of demographics, or other variables were found to be associated with enhanced parasympathetic as well as sympathetic cardiac control (yielding a higher CAR) but was not associated with CAB. Although the number of cases was small (N = 11), both spirituality and CAR were significant negative predictors of the prior occurrence of a myocardial infarction. Conclusions In a population-based sample, spirituality appears to be associated with a specific pattern of CAR, characterized by a high level of cardiac autonomic control, irrespective of the relative contribution of the two autonomic branches. This pattern of autonomic control may have health significance. Funding was provided by the National Institute of Aging Grant No. PO1 AG18911 and the John Templeton Foundation.     

Internet suicide searches and the incidence of suicide in young people in Japan

Although several case reports have suggested a relationship between accessing Internet suicide sites and the incidence of suicide, the influence of the Internet on the incidence of suicide is not known. Thus, we examined the association between Internet suicide-related searches and the incidence of suicide in 20- and 30-year-old individuals in Japan. The Box–Jenkins transfer function model was applied to monthly time series data from January 2004 to May 2010 (77 months). The terms “hydrogen sulfide,” “hydrogen sulfide suicide,” and “suicide hydrogen sulfide suicide” at (t-11) were related to the incidence of suicide among people aged in their 20 s (P = 0.005, 0.005, and 0.006, respectively) and people aged in their 30 s (P = 0.013, 0.011, and 0.012, respectively). “BBS on suicide” at (t-5) and “suicide by jumping” at (t-6) were related to the incidence of suicide in people aged 30–39 (P = 0.006 and 0.001, respectively). Internet searches for specific suicide-related terms are related to the incidence of suicide among 20- and 30-year-old individuals in Japan. Routine interrogation by a clinician about visiting Internet suicide websites and stricter regulation of these websites may reduce the incidence of suicide among young people.