The relationship between religious involvement and clinical status of patients with bipolar disorder

Cruz M, Pincus HA, Welsh DE, Greenwald D, Lasky E, Kilbourne AM. The relationship between religious involvement and clinical status of patients with bipolar disorder.
Bipolar Disord 2010: 12: 68–76. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S. Objective: Religion and spirituality are important coping strategies in depression but have been rarely studied within the context of bipolar disorder. The present study assessed the association between different forms of religious involvement and the clinical status of individuals treated for bipolar disorder. Methods: A cross‐sectional observation study of follow‐up data from a large cohort study of patients receiving care for bipolar disorder (n = 334) at an urban Veterans Affairs mental health clinic was conducted. Bivariate and multivariate analyses were performed to assess the association between public (frequency of church attendance), private (frequency of prayer/meditation), as well as subjective forms (influence of beliefs on life) of religious involvement and mixed, manic, depressed, and euthymic states when demographic, anxiety, alcohol abuse, and health indicators were controlled. Results: Multivariate analyses found significant associations between higher rates of prayer/meditation and participants in a mixed state [odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.10–1.52, chi square = 9.42, df = 14, p < 0.05], as well as lower rates of prayer/meditation and participants who were euthymic (OR = 0.84; 95% CI = 0.72–0.99, chi square = 4.60, df = 14, p < 0.05). Depression and mania were not associated with religious involvement. Conclusions: Compared to patients with bipolar disorder in depressed, manic, or euthymic states, patients in mixed states have more active private religious lives. Providers should assess the religious activities of individuals with bipolar disorder in mixed states and how they may complement/deter ongoing treatment. Future longitudinal studies linking bipolar states, religious activities, and treatment‐seeking behaviors are needed.     

The association between spiritual and religious involvement and depressive symptoms in a Canadian population

Data from a large epidemiologic survey were examined to determine the relationship of religious practice (worship service attendance), spiritual and religious self-perception, and importance (salience) to depressive symptoms. Data were obtained from 70,884 respondents older than 15 years from the Canadian National Population Health Survey (Wave II, 1996-1997). Logistic regression was used to examine the relationship of the religious/spiritual variables to depressive symptoms while controlling for demographic, social, and health variables. More frequent worship service attendees had significantly fewer depressive symptoms. In contrast, those who stated spiritual values or faith were important or perceived themselves to be spiritual/religious had higher levels of depressive symptoms, even after controlling for potential mediating and confounding factors. It is evident that spirituality/religion has an important effect on depressive symptoms, but this study underscores the complexity of this relationship. Longitudinal studies are needed to help elucidate mechanisms and the order and direction of effects.     

Attendance at religious services and subsequent mental health in midlife women

OBJECTIVE: Spiritual and religious factors may influence mental health in midlife women. The purpose of this study was to explore whether strength of religious beliefs or attendance at religious services helps to mitigate the stresses of life in mid-life women. METHODS: Data are from a sub-sample of 265 women, ages 40-70, who were participants in the REACH study, a longitudinal study investigating health parameters in a representative sample of households from rural communities in eastern North Carolina. Using t-tests and linear regression analyses, we analyzed the relationship between frequency of attendance at religious services and strength of religious beliefs in 1997 and subsequent mental health in 2003 as measured by the mental health component score (MCS) of the SF-12. RESULTS: The mean MCS in 2003 was significantly higher (better mental health) in women who reported attending religious services > or =1/week compared to those who reported attending <1/week (53.9 vs. 51.7; p < 0.05). In the linear regression model controlling for self-reported health status, baseline attendance at organized religious services remained a significant predictor of the MCS at six-year follow-up (standardized beta = -0.123, p < 0.05). CONCLUSIONS: Attendance at religious services is positively related to subsequent mental health in middle-aged women. The findings support the notion that religious commitment may help mitigate the stress of the midlife period. More research is needed to translate these findings into clinical interventions that can decrease the burden of anxiety and depression on midlife women.     

Spiritual and religious involvement relate to end-of-life decision-making in patients undergoing coronary bypass graft surgery

Settling one's end-of-life affairs in the face of coronary artery bypass graft surgery (CABG) can be both distressing and beneficial for individuals who are facing imminent threat of death. Religious thoughts, common in this context, may offer some comfort and support for facing this process. However, few empirical studies have addressed the role of religious or spiritual involvement in the settling of one's end-of-life affairs in cardiac patients. This prospective study investigated the effect of religious and spiritual factors on whether decisions regarding end-of-life had been made in a sample of middle-aged and older patients undergoing CABG. In particular, we expected faith factors of an intrinsic nature would promote this decision. Two weeks pre-operatively, patients (mean age = 65 years) were recruited for interviews. One hundred seventy-seven CABG patients completed the pre-operative and post-operative follow-up one month after surgery, while 96 offered information regarding their engagement in settling end-of-life affairs. Cardiac indicators were obtained from the computerized Society of Thoracic Surgeons' Adult Cardiac Database (STS). Multiple regression analyses revealed that private religiousness increased the likelihood of having engaged in end-of-life decision planning by nearly half again (OR = .1.47, 95% CI = 1.10, 1.96, p < .05) and that experiencing reverence in secular contexts nearly doubled the likelihood (OR = .1.99, 95% CI = 1.16, 3.44, p < .05). The reduced likelihood of having made plans was observed among those who scored higher on experiencing reverence in religious contexts (OR = .44, 95% CI = .23, .87, p < .05) and among patients using petitionary prayer (OR = .21, 95% CI = .04, .98,p < .05). These effects manifested after controlling for age, impacted functioning, and number of diseased arteries. Therefore, faith factors appear to have independent but complex effects on end-of-life decision making in middle-aged and older cardiac patients.     

Gender differences in associations between religious attendance and mental health in Finland

We investigated in a nationwide sample of the Finnish general population (869 women and 773 men) whether there were gender-differences in associations between religious attendance and mental well-being. Respondents were asked during telephone interviews about sociodemographic variables, frequency of religious attendance and social contacts, and perceived social and family support. Mental health was screened by means of the 12-item General Health Questionnaire (GHQ-12). More women than men (62% vs. 50%) attended religious events, and there was a corresponding difference in percentages relating to regular religious attendance (17% vs. 10%). Regular religious attendance was most common among those over 65 years of age. In women, minor mental disorder (GHQ-12 score > or = 3) was more common among those who never attended religious events than among the others (25% vs. 16%). In men there was no difference. In women, religious attendance associated positively with social contacts, in men with happy family life. In multivariate analyses an independent positive association between religious attendance and absence of minor mental disorder was found in women (adjusted OR 1.58, 95% CI 1.12 to 2.24) but not in men. These results suggest that there may be gender-differences in associations between religious attendance, social and family life, and mental health.     

Parental involvement and mental health among Thai adolescents

The objective of this analysis was to examine the associations between parental involvement and mental health in Thai middle school students. Data from the 2671 school-going adolescents aged 12–15 y who participated in the nationally representative Global School-based Student Health Survey in Thailand in 2008 were analysed. About 16.5% of students reported symptoms of depression, and about 8.6% reported having seriously considered suicide in the past year. High levels of parental involvement – homework checks, monitoring of free time and seeking to understand children's problems – were associated with significantly lower odds of symptoms of depression and suicidal thoughts for both boys and girls. Skipping school without permission was associated with significantly increased odds of poor mental health, including loneliness and anxiety. Active parenting and effective communication between schools and parents about truancy may contribute to the promotion of adolescent mental health and early detection of psychological problems.     

LGBTQ adolescents and young adults raised within a Christian religious context: Positive and negative outcomes

Religious contexts have traditionally been understood as protective for a variety of psychosocial health outcomes. However, the generalizability of these findings to youth who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) is questioned due to denominational teachings on same-sex attractions and sexual behavior. Eight adolescents (15–17 years) and 11 young adults (19–24 years) who identify as LGBTQ raised in Christian religious affiliations (16 participants raised in the Church of Jesus Christ of Latter Day Saints, 2 participants raised Catholic and 1 participant raised Presbyterian) participated in individual in-depth interviews, journal writings, and focus groups to provide greater insight into the lived experiences of LGBTQ individuals raised within a Christian religious environment. Findings suggest the religious context is related to both positive and negative outcomes. Eight themes are explored using participant's own words and experiences. Directions for future research and implications are discussed.     

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery–Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.     

The role of religious involvement on depression, risky behavior, and academic performance among Korean American adolescents

Structural equation modeling was used to test a theoretical path model of church engagement, personal spirituality, and mentoring relationships on depressive symptoms, involvement in risky behaviors, and self-reported grades among Korean American adolescents. It was hypothesized that personal spirituality and mentoring relationship quality would mediate the relation between church engagement and adolescent outcomes. Data were obtained through a self-report survey from 248 Korean American adolescents in grades 7 through 12. High levels of church engagement, as characterized by years of attendance, choice to attend, and participation in activities, predicted deeper personal spirituality and better mentoring relationships. Personal spirituality, as measured by one’s daily religious experiences, beliefs, and private spiritual practices, was a mediator of the relationship between church engagement and adolescent outcomes. Specifically, higher levels of church engagement was linked to stronger personal spirituality, which in turn predicted less depressive symptoms for girls and higher grades for boys.     

Canadian psychiatric inpatient religious commitment: an association with mental health.

BACKGROUND: Research indicates that religion may have a positive effect on coping and possibly enhance clinical outcomes. This study aims to determine the level of religious interest of psychiatric inpatients and to assess whether religious commitment has an impact on selected outcome variables. METHODS: There were 88 consecutive adult patients (50% men) who were admitted to a Canadian tertiary care psychiatry inpatient unit and were interviewed about their religious beliefs and practices. Patients with a Beck Depression score of 12 or more were included for outcome analysis. RESULTS: A total of 59% believed in a God who rewards and punishes, 27% had a high frequency of worship attendance, and 35% prayed once or more daily. More frequent worship attenders had less severe depressive symptoms, shorter current length of stay, higher satisfaction with life, and lower rates of current and lifetime alcohol abuse (P < 0.05), when compared with those with less frequent or no worship attendance. In contrast, private spirituality was associated with lower depressive symptoms and current alcohol use only (P < 0.05), and prayer frequency had no significant associations. DISCUSSION: This study indicates that certain religious practices may protect against severity of symptoms, hospital use, and enhance life satisfaction among psychiatric inpatients. This is the first known Canadian study that examines religious commitment among psychiatric inpatients.     

Impact of coworker involvement with supported employees on wage and integration outcomes

This report is the fourth in a series on positive relations of typical employment features and coworker involvement with higher wage and integration outcomes for persons in supported employment. Imbedded in the discussion about natural supports in recent years has been the extent and value of coworker participation in the work life of employees with disabilities. Previous studies have illustrated the connection between natural supports and meaningful and satisfying employment outcomes. We investigated specific details associated with coworker training and support and their relation to social and economic outcomes that enable persons with disabilities to succeed economically and socially in inclusive employment.     

The impact of religious practice and religious coping on geriatric depression

OBJECTIVE: Both religiousness and social support have been shown to influence depression outcome, yet some researchers have theorized that religiousness largely reflects social support. We set out to determine the relationship of religiousness with depression outcome after considering clinical factors. METHODS: Elderly patients (n=114) in the MHCRC for the Study of Depression in Late Life while undergoing treatment using a standardized algorithm were examined. Patients completed measures of public and religious practice, a modified version of Pargament's RCOPE to measure religious coping, and subjective and instrument social support measures. A geriatric psychiatrist completed the Montgomery-Asberg Depression Rating Scale (MADRS) at baseline and six months. RESULTS: Both positive and negative religious coping were related to MADRS scores in treated individuals, and positive coping was related to MADRS six months later, independent of social support measures, demographic, and clinical measures (e.g. use of electro-convulsive therapy, number of depressed episodes). Public religious practice, but not private religious practice was independently related to MADRS scores at the time of completion of the religiousness measures. Religious coping was related to social support, but was independently related to depression outcome. CONCLUSIONS: Clinicians caring for older depressives should consider inquiring about spirituality and religious coping as a way of improving depressive outcomes.     

The role of religious identity in the mental health of older working and retired adults

This study investigates whether religious identity explains unique variance of the self esteem and depressive symptoms of older working and retired adults. Data were collected from a larger, five-year project begun in 1992 that compared the well-being of older workers and with that of new retirees living in the Raleigh-Durham-Chapel Hill, North Carolina metropolitan area. Data are from the third and final wave, collected between March and June, 1997, during which 242 of the eligible 255 people participated. Net of religious attendance, religiosity, and various control variables, religious identity predicted both mental health outcomes. As predicted, self esteem increased and depressive symptoms decreased as religious identity increased (i.e., viewing oneself as more competent, confident, and sociable as a religious person). Though there was a trend towards religious identity being more strongly predictive of mental health among retirees than among the working adults, these interactions did not reach statistical significance.     

Public and private religious involvement and initiation of alcohol,cigarette, and marijuana use in Black and White adolescent girls

Social Psychiatry and Psychiatric Epidemiology - This longitudinal study aimed to identify variation by race in the associations between religious involvement and initiation of alcohol, cigarette,...