The Association Between Spirituality and Depression in an Urban Clinic

OBJECTIVE: To investigate the correlation between spiritual beliefs and depression in an urban population. METHOD: A convenience sample of adult patients of an urban primary care clinic completed a self-administered questionnaire consisting of the Zung Depression Scale and the Spiritual Involvement and Beliefs Scale (SIBS). RESULTS: Among 122 respondents, 99 (81%) reported that they consider themselves religious. Responses from the Zung Depression Scale found that 76 (62%) of the patients were depressed and 46 (38%) were not. The Pearson correlation coefficient between the Zung Depression Scale and the SIBS was -0.36 (p <.0001). Backward stepwise regression analysis revealed that SIBS score and physical health predicted the Zung Depression Scale score. Age, gender, ethnicity, religious affiliation, and income showed no significant association with depression. Analysis of individual SIBS items revealed that high spirituality scores on items in the domain of intrinsic beliefs, such as belief in a higher power (p <.01), the importance of prayer (p <.0001), and finding meaning in times of hardship (p <.05), were associated negatively with depression. Attendance of religious services had no significant association with depression. CONCLUSION: Appropriate encouragement of a patient's spiritual beliefs may be a helpful adjunct to treating depression.     

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.     

Religiosity,Spirituality, and Socioemotional Functioning in Mothers of Children with Autism Spectrum Disorder

Religious beliefs, religious activities, and spirituality are coping resources used by many mothers of children with autism spectrum disorder (ASD). This study examined whether and how these resources were related to maternal socioemotional functioning. Mothers of children with ASD completed questionnaires assessing religiosity, spirituality, and a wide range of outcome variables, including stress, depression, self-esteem, life satisfaction, positive affect, and sense of control. Analyses revealed that religious beliefs and spirituality were associated with better positive outcomes and, to a lesser extent, lower levels of negative outcomes. Of the two predictors, spirituality accounted for more unique variance in positive outcomes. In contrast, religious activities were related to more negative outcomes and lower levels of positive outcomes.     

The assessment of spirituality and religiousness in schizophrenia

To assess religious coping in schizophrenia, we developed and tested a clinical grid, as no validated questionnaire exists for this population. One hundred fifteen outpatients were interviewed. Results obtained by 2 clinicians were compared. Religion was central in the lives of 45% of patients, 60% used religion extensively to cope with their illness. Religion is a multifaceted construct. Principal component analysis elicited 4 factors: subjective dimension, collective dimension, synergy with psychiatric treatment, and ease of talking about religion with psychiatrist. Different associations were found between these factors and psychopathology, substance abuse, and psychosocial adaptation. The high prevalence of spirituality and religious coping clearly indicates the necessity of addressing spirituality in patient care. Our clinical grid is suitable for this purpose. It proved its applicability to a broad diversity of religious beliefs, even pathological ones. Interjudge reliability and construct validity were high and specific training is not required.     

Protective factors against suicidal behavior in depressed adults reporting childhood abuse

Most previous studies compared suicidal behavior in subjects with and without a history of childhood abuse, whereas less attention was paid to the comparison of suicide attempters and nonattempters among subjects reporting childhood abuse. To identify risk and protective factors against suicidal behavior, we compared suicide attempters with nonattempters among the sample of 119 depressed inpatients who reported childhood abuse. Compared with nonattempters, suicide attempters were younger, had more self-rated depression severity and suicidal ideation, higher trait aggression and more cluster B personality disorder comorbidity, less coping potential, and fewer moral objections to suicide (MOS)/religious beliefs. Logistic regression showed that more severe suicidal ideation and fewer MOS/religious beliefs were associated with suicidal acts in subjects with reported childhood abuse. Furthermore, suicidal ideation and MOS/religious beliefs were significantly inversely correlated. The results of this clinical study add support to previous reports that religious/spiritual coping could serve as an additional resource in prevention of suicidal behavior for subjects with reported childhood abuse.     

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.     

Spirituality and religious practices among outpatients with schizophrenia and their clinicians

OBJECTIVES: Religious issues may be neglected by clinicians who are treating psychotic patients, even when religion constitutes an important means of coping. This study examined the spirituality and religious practices of outpatients with schizophrenia compared with their clinicians. Clinicians' knowledge of patients' religious involvement and spirituality was investigated. METHODS: The study sample included 100 patients of public psychiatric outpatient facilities in Geneva, Switzerland, with a diagnosis of nonaffective psychosis. Audiotaped interviews were conducted with use of a semistructured interview about spirituality and religious coping. The patients' clinicians (N=34) were asked about their own beliefs and religious activities as well as their patients' religious and clinical characteristics. RESULTS: Sixteen patients (16 percent) had positive psychotic symptoms reflecting aspects of their religious beliefs. A majority of the patients reported that religion was an important aspect of their lives, but only 36 percent of them had raised this issue with their clinicians. Fewer clinicians were religiously involved, and, in half the cases, their perceptions of patients' religious involvement were inaccurate. A few patients considered religious practice to be incompatible with treatment, and clinicians were seldom aware of such a conflict. CONCLUSIONS: Religion is an important issue for patients with schizophrenia, and it is often not related to the content of their delusions. Clinicians were commonly not aware of their patients' religious involvement, even if they reported feeling comfortable with such an issue.     

Religion,spirituality, and chaplains in the biomedical literature: 1965-2000

In recent years, several prominent medical journals have published articles addressing the relationship between religion/spirituality and medicine, and recognizing the importance of religion in the lives of most Americans, especially in times of illness. We hypothesized that the publication of these articles reflected a trend in the biomedical literature in which greater attention is being given to the role of religion and spirituality in health-care. A correlational design was used, based on an electronic survey of all articles in MEDLINE for the years 1965 through 2000. The search terms used were: 1) religion or religious; 2) spiritual; and 3) chaplain. The number of articles per 100,000 that mentioned religion (religion or religious), spirituality, or chaplains each year was determined. Statistically significant upward trends across years were found for the rates of articles addressing religion (r = .59, p < .001) and spirituality (r = .89, p < .001) and a non-significant trend was found for chaplains (r = .31). The rising rates of articles on religion and spirituality in biomedical journals suggest a growing recognition of the need to address spiritual and religious issues in health-care.     

Influence of Optimism,Social Support,and Spirituality on COVID-19 Stress in Christian Church Community

ObjectiveOptimism, social support, and spirituality can be important factors related to coronavirus disease-2019 (COVID-19) stress. However, studies investigating the influence and interplay of optimism, social support, and spirituality on COVID-19 simultaneously are still few. This study is aimed to explore the influence of optimism, social support, and spirituality on COVID-19 stress in the Christian church community. MethodsA total 350 participants were included in this study. This study was cross-sectionally conducted by using an online survey on optimism, social support, spirituality, and COVID-19 stress that were measured by the Life Orientation Test-Revised (LOT-R), Multidimensional Scale of Perceived Social Support Scale (MSPSS), Spiritual Well-Being Scale (SWBS), and COVID-19 Stress Scale for Korean People (CSSK). The prediction models for COVID-19 stress were analyzed by using univariate and multiple linear regression. ResultsBased on the results of univariate linear regression, subjective feelings on income (p<0.001) and health status (p<0.001), LOTR (p<0.001), MSPSS (p=0.025), and SWBS (p<0.001) scores were significantly associated with COVID-19 stress. The multiple linear regression model with subjective feelings on income and health status and SWSB score was significant (p<0.001) and explained 17.7% of the variance (R²=0.177). ConclusionThis study showed that subjective feeling on low income, those who had poor health status, lower optimism, lower perceived social support, and lower spirituality were significantly affected with COVID-19 stress. Especially, the model with subjective feelings on income and health status, and spirituality showed highly significant effects, despite the interaction with associated factors. To cope with unpredictable stressful situations like the COVID-19 pandemic, integrated interventions on psycho-socio-spiritual aspect are warranted.     

A brief measure of core religious beliefs for use in psychiatric settings

Results from several national studies in the United States suggests that: (1) religious beliefs and practices are highly prevalent; (2) spirituality and religion are statistically and clinically relevant to mental health and symptoms; and (3) many patients have a preference for spiritually integrated care. However, existing protocols that assess for salient religious themes in psychiatric settings are time-consuming to administer, relevant only to specific populations (e.g., Christians), and have poor psychometric properties. Further, evidence suggests that religious beliefs can take on a positive and negative valence, and both of these dimensions are worthy of assessment. We, therefore, developed a brief (six-item) self-report measure of positive and negative core beliefs about God which is uniquely suited for use with a broad range of religious patients. Across three studies, we evaluated its psychometric properties and ability to predict symptoms of anxiety and depression. Results provide support for the validity and reliability of our measure and further highlight the salience of both positive and negative religious beliefs to psychiatric symptoms. It is hoped that this measure will help to decrease the burden of spiritual assessment in psychiatric and medical settings, and further have research utility for this area of study.     

Religiosity, anxiety, and depression among a sample of Iranian medical students

OBJECTIVE: There are many studies of religion and mental health in a Christian context, but studies in Islamic countries are few. Most previous studies used only a single question for measuring religion, and several of them showed negative associations between religion and indexes of anxiety or depression among older people. This study preliminary assesses the associations between religious variables, anxiety, and depression in a sample of Muslim students. METHOD: This cross-sectional study examines a sample of medical students (N = 285) for association(s) between religiosity, anxiety, and depression. The subjects completed a Muslim religiosity questionnaire including religious beliefs, emotions, and behaviors subscales and the Beck anxiety and depression inventories during their psychiatry rotation at Roozbeh psychiatric hospital, Tehran, Iran. RESULTS: all the three religious subscales were negatively associated with and negatively predicted depression and anxiety; but only prediction of anxiety by the religious beliefs score was statistically significant. CONCLUSIONS: These findings provide further evidence for a protective role of religion against anxiety and depression but more studies are required.     

Suicidality, depression, and substance abuse in adolescence

The authors assessed the occurrence of suicidal ideation, suicide attempts, major depression, and substance abuse in a sample of 424 apparently healthy college students 16-19 years old. Major depression and substance abuse were independent and interactive risk factors for suicidal ideation and for suicide attempts; substance abuse had a particularly deleterious effect on men. A prolonged desire to be dead was a more specific risk factor for a suicide attempt than was a thought of suicide. The authors conclude that suicidal ideation in the presence of major depression and/or substance abuse in older adolescents should call forth greater concern for lethality.     

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.     

Risk factors for completed suicide among adolescents with a lifetime history of substance abuse: a case-control study

The risk factors for suicide in adolescents with substance abuse were assessed by comparing 23 adolescent suicide victims and 12 community controls with a lifetime history of definite or probable DSM-III substance abuse. Suicide victims were more likely than controls to show the following risk factors: active substance abuse, comorbid major depression, suicidal ideation within the past week, family history of depression and substance abuse, legal problems and presence of a handgun in the home. Recommendations for the identification and prevention of suicide among substance-abusing youth on the basis of these findings are presented.     

The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis

BackgroundDespite the large amount of literature assessing how spiritual and religious beliefs have an impact on mental health and suicide risk in various groups of patients, few studies have investigated patients with chronic kidney disease (CKD). The purpose of this study is to investigate whether spirituality and religiousness (S/R) are associated with the presence of suicide risk as well as whether those beliefs are also associated with the presence of mental health problems in patients undergoing hemodialysis.MethodsCross-sectional study carried out in three Brazilian dialysis units involving hemodialysis patients. The study assessed religiousness (Duke Religion Index); spiritual well-being (FACIT-Sp 12); mental health - depression and anxiety (Mini International Neuropsychiatric Interview–MINI); and risk of suicide (MINI). For analysis, adjusted logistic regression models were applied.ResultsA total of 264 (80.7%) patients were included, 17.8% presented suicide risk, 14.0% presented current major depressive episode, and 14.7% presented generalized anxiety disorder. Concerning spiritual well-being (FACIT-Sp 12), the subscale of “Meaning” was associated with lower risk of suicide, depression, and anxiety. The subscale “Peace” was associated with lower depression and anxiety, whereas the subscale “Faith” was associated with lower suicide risk and depression. Religiousness measures were not associated with the study outcomes.ConclusionSpiritual beliefs were associated with lower suicide risk and better mental health among hemodialysis patients. Factors related to spiritual well-being, such as “meaning”, “peace” and “faith” were more associated with the outcomes studied than religious involvement. Further studies are needed to replicate our findings in different cultural and religious settings.     

Exploring the Relationships between Spirituality and Personality Disorder Traits among a Sample of In-Patients in Treatment for Substance Use Disorder

Personality disorders (PD) complicate the treatment of individuals with substance use disorders. Spirituality has been shown to be a protective factor in the treatment of addiction but very little research has explored how spirituality may differ among individuals in treatment for substance use issues who present with clinical and non-clinical levels of PD traits. This study examined the relationship between spirituality and PD traits among 305 clients recruited from a residential substance abuse treatment center. Results indicated that the existential well-being dimension of spirituality was a statistically significant predictor of most PD trait levels. In addition, the religious well-being dimension was a statistically significant predictor of Narcissistic traits. However, the clinical significance of these results may be limited due to the relatively low amount of variance in PD trait levels explained by the spirituality dimensions. Clinical implications for the treatment of individuals experiencing comorbid PDs and substance use disorders were discussed highlighting the potential benefit of focusing on therapeutic techniques that would help these clients develop existential well-being in their lives rather than a relationship with a Higher Power.     

Medical illness,religion, health control and depression of institutionalized medically ill veterans in long-term care

Utilizing multivariable multivariate regression procedures, we examine the relationships among medical illness, religion, health control beliefs and depression in 97 mostly elderly, institutionalized medically ill veterans in long term-care. Controlling for other domains of indicators, conditional canonical correlations showed that (1) religious motivation alone predicts religious coping, (2) religious coping alone predicts health control beliefs, and (3) both severity of illness/length of stay and health control beliefs predict depression. Result (1) is incompatible with the prediction by the multivariate belief-motivation theory of religiousness (MBMTR) (Schaefer and Gorsuch, 1991) that both religious belief and religious motivation determine religious coping. Results (2) and (3) are consistent with our hypothesis that control beliefs mediate the relationship between religious coping and depression. It is argued that a different operationalization of religious belief may still support the MBMTR. The role of religion in coping with health problems is discussed.     

General and specific childhood risk factors for depression and drug disorders by early adulthood

OBJECTIVE: To identify childhood risk factors that predict depression and drug disorders by early adulthood, distinguishing between general risk factors for both disorders and specific risk factors for each individual disorder. METHOD: Within a longitudinal community study (N = 360), familial and behavioral-emotional characteristics were assessed in early childhood (ages 5, 6, and 9 years). At age 21, the Diagnostic Interview Schedule, version III-revised, provided lifetime diagnoses of major depression and drug abuse/dependence. RESULTS: Sibling substance use disorders predicted depression and drug disorders for both genders. Feelings of anxiety, depression, and peer rejection were general predictors for females. Specific risk factors for depression were parental depression and anxious/depressed behavior in both genders and peer problems for males. Specific risk factors for drug abuse/dependence were larger family size, lower socioeconomic status, hyperactivity, attention problems, and aggression. Parental substance abuse and having younger parents were specific risk factors for drug disorders in males. CONCLUSIONS: Familial and behavioral-emotional risk factors for depression and drug disorders were primarily specific, suggesting separate pathways. The unique perspectives of multiple informants facilitate early identification.     

The Role of Spirituality in the Relationship Between Religiosity and Depression in Prostate Cancer Patients

Purpose

This study aims to develop a theoretical framework of the relationship among religiosity, spirituality, and depression, potentially explaining the often mixed and inconsistent associations between religiosity and depression.

Methods

In this cross-sectional study, 367 men (average age of 66?±?9 years) with prostate cancer completed measures of religiosity (extrinsic/intrinsic), spirituality (Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale), quality of life (FACT-G), and depression (Hospital Anxiety and Depression Scale).

Results

There was a small relationship between intrinsic religiosity and depression (r?=??0.23, p?<?0.05) but a strong association between spirituality and depression (r?=??0.58, p?<?0.01). Using a mediation model, the meaning/peace subscale of the spirituality measure mediated the relationship between intrinsic religiosity and depression. This model controlled for age, marital status, stage of disease, time since diagnosis, hormone therapy, quality of life, and anxiety.

Conclusions

When examining religiosity and spirituality, the main component that may help reduce depression is a sense of meaning and peace. These results highlight the potential importance of developing a patient’s sense of meaning through activities/interventions (not exclusive to religious involvement) to achieve this goal.     

Spiritual belief, social support, physical functioning and depression among older people in Bulgaria and Romania

Objectives: An exploratory investigation is reported into the role of spirituality and religious practice in protecting against depression among older people living in rural villages in Bulgaria and Romania, two neighbouring countries with similar cultural, political and religious histories, but with differing levels of current religiosity.

Methods: In both countries, interviews were conducted with samples of 160 persons of 60 years and over in villages of similar socio-economic status. The Hospital Anxiety and Depression-D scale and the Royal Free Interview for Religious and Spiritual Beliefs were used to assess depression and spiritual belief and practice respectively. In addition social support, physical functioning and the presence of chronic diseases were assessed. One year later, follow-up interviews were conducted with 58 of the original sample in Bulgaria, in which additional measures of depression and of spiritual belief and practice were also included.

Results: The study demonstrates, as expected, significantly lower levels of spiritual belief in the Bulgarian sample (Bulgarian mean 29.7 (SD?=?19.1), Romanian mean 47.6 (SD?=?11.2), t?=?10.2, p?t?=?9.3, p?

Conclusions: Much of Eastern Europe displays high rates of depression among its older population and provides opportunities for investigation of the role of religious belief and practice in preventing and coping with depression. Further research is encouraged in populations of diverse religiosity.