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AIM: Most prediction models for coronary artery disease (CAD) compile biomedical and behavioural risk factors, using linear multivariate models. This study explored the potential of integrating positive psychosocial factors (PPFs), including happiness, satisfaction with life, and social support, into conventional and machine learning-based CAD prediction models. METHODS: We included UK Biobank participants without CAD at baseline. First, we estimated associations of individual PPFs with subsequent acute myocardial infarction (AMI) and chronic ischaemic heart disease (CIHD) using logistic regression. Then, we compared the performances of logistic regression and eXtreme Gradient Boosting (XGBoost) prediction models when adding PPFs as predictors to the Framingham Risk Score (FRS). RESULTS: Based on a sample size between 160,226 and 441,419 of UK Biobank participants, happiness, satisfaction with health and life, and participation in social activities were linked to lower AMI and CIHD risk (all p-for-trend ≤ 0.04), while social support was not. In a validation sample, adding PPFs to the FRS using logistic regression and XGBoost prediction models improved neither AMI (AUC change: 0.02% and 0.90%, respectively) nor CIHD (AUC change: -1.10% and -0.88%, respectively) prediction. CONCLUSIONS: PPFs were individually linked to CAD risk, in line with previous studies, and as reflected by the new European Society of Cardiology guidelines on cardiovascular disease prevention. However, including available PPFs in CAD-prediction models did not improve prediction compared to the FRS alone. Future studies should explore whether PPFs may act as CAD-risk modifiers, especially if the individual's risk is close to a decision threshold.
Positive psychosocial factors like happiness, satisfaction with health and life, social support and social activities can aid in successfully managing life's challenges, stress and disease. Consequently, they may help lower the risk and progression of cardiovascular disease. The study confirmed that positive psychosocial factors were associated with lower risks of myocardial infarction and chronic ischaemic heart disease. These findings underscore the role of positive psychosocial factors as risk modifiers for coronary artery disease, as recom-mended by the 2021 ESC Guidelines on cardiovascular disease prevention. This means that the individual risk of getting a coronary artery disease can be shifted to the next lower risk category by higher levels of happiness, satisfaction with health and life, and social support.
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Background: Gratitude and religiousness/spirituality are increasingly recognized resources that have potential influence on psychological states such as depression. However, only few studies have investigated this relationship in psychiatric patients. Objective: The present study examined gratitude in psychiatric inpatients with depression, exploring its relevance, course, and interaction with psychopathological and religious measures. Both general and religious gratitude will be evaluated. Methods: A total of 212 inpatients with depression completed a questionnaire both at the beginning and the end of treatment. Gratitude was measured with a general gratitude scale using the Gratitude Questionnaire and a religion-specific measure assessing gratitude to God as part of the Structure of Religiosity Test. The Beck Depression Inventory was used to evaluate depressive symptoms. General religiosity was assessed using the Centrality of Religiosity Scale. Results: Scores on the general and religious gratitude measures were in the upper range of these scales at baseline and demonstrated a significant increase during the hospital stay. Negative associations were found between general gratitude and depressive symptoms both on admission and at discharge (r = -0.505 and r = -0.478, respectively). General as well as religious gratitude was associated with the centrality of religiosity (r = 0.384 and r = 0.546, respectively). Religiosity accounted for approximately 10% of the variance in general gratitude on admission. Conclusions: Gratitude is highly prevalent in psychiatric patients with depression, and that may serve as a resource for these individuals. Both general and religious gratitude are associated with religiosity, which may also serve as a resource to these patients.
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OBJECTIVE: The aim of this study was to evaluate the impact of social support and religiosity/spirituality (R/S) on the recovery from an acute cardiac event or cardiac surgery during cardiac rehabilitation (CR). METHODS: In this prospective study, a convenience sample of 159 patients participating in a CR program were enrolled. Religiosity/spirituality, social support, anxiety, depression, health related quality of life (QoL), and exercise capacity (6-min walk test, cycle ergometer test) were assessed. RESULTS: Social support was significantly associated with less anxiety (p < .01), less depression (p < .01), and better QoL (p < .05) on admission. After adjustment for age, gender, education level, and morbidity, social support remained significantly associated with less depression (p < .001). Religiosity/spirituality was significantly associated with less depression (p < .05), better QoL (p < .05), and better exercise capacity (p < .05) at admission. After adjustment for covariates, however, significance was lost. There were no significant impact of either social support or R/S on the course of CR measured by change in QoL or exercise capacity. CONCLUSION: Social support may be a protective factor against depression in the recovery from cardiac events or surgery. Neither social support nor R/S had a significant impact on the course of the 3-week CR program.
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Depressão , Qualidade de Vida , Apoio Social , Espiritualidade , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Idoso , Estudos Prospectivos , Suíça , Depressão/psicologia , Ansiedade/psicologia , Procedimentos Cirúrgicos Cardíacos/psicologia , Procedimentos Cirúrgicos Cardíacos/reabilitação , Reabilitação Cardíaca/psicologiaRESUMO
Modern healthcare research has only in recent years investigated the impact of health care workers' religious and other values on medical practice, interaction with patients, and ethically complex decision making. So far, only limited international data exist on the way such values vary across different countries. We therefore established the NERSH International Collaboration on Values in Medicine with datasets on physician religious characteristics and values based on the same questionnaire. The present article provides (a) an overview of the development of the original and optimized questionnaire, (b) an overview of the content of the NERSH data pool at this stage and (c) a brief review of insights gained from articles published with the questionnaire. The pool at this stage consists of data from 17 studies from research units in 12 different countries representing six continents with responses from more than 6000 health professionals. The joint data pool suggests that there are large differences in religious and other moral values across nations and cultures, and that these values contribute to the observed differences in health professionals' clinical practices-across nations and cultures!
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Princípios Morais , Médicos , Atitude do Pessoal de Saúde , Pessoal de Saúde , Humanos , Espiritualidade , Inquéritos e QuestionáriosRESUMO
Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had "some" influence on their patients' health (CI95%) (81.8%-84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%-95.5%). Across all samples 649 (16%; 14.9%-17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%-25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.
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Médicos , Espiritualidade , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Religião , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association. METHODS: Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists. RESULTS: We found 11 eligible surveys from 8 countries (nâ=â3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48-0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists. CONCLUSIONS: We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine.
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Médicos/psicologia , Religião , Espiritualidade , Humanos , Religião e MedicinaRESUMO
Background: Chronic pain is a complex, multidimensional experience. Spirituality is hypothesized to impact pain experience in various ways. Nevertheless, the role that spirituality plays in multimodal pain therapy remains controversial and, to date, quantitative data on whether and for which patients spiritual aspects should be considered in the treatment of chronic pain is lacking. The aim of this study was thus to investigate the proportion and characteristics of patients with chronic pain who wish spiritual aspects to be integrated in their treatment. Methods: Two hundred nine patients with chronic pain were recruited from five inpatient departments and outpatient clinics in the German-speaking part of Switzerland. Patients filled out validated questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Resilience Scale (RS-11), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), and the 12-item Spiritual Well-Being Scale (FACIT-Sp-12). Results: More than 60% (CI95%: 55.5-67.9%) of the patients wanted to address spiritual aspects in their treatment. These patients were significantly younger, had higher levels of education, and suffered from more frequent and more severe pain than patients who did not wish to address spiritual aspects. Furthermore, there were high correlations with existing spiritual resources and higher scores of spirituality. Conclusions: These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.
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CONTEXT: Valid instruments for assessing spiritual resources and distress in pain therapy are scarce. The Spiritual Distress and Resources Questionnaire (SDRQ) was developed to fill this gap. GOALS: The objective of this study was to investigate the SDRQ's psychometric properties. METHODS: We presented the SDRQ to 219 patients with chronic pain conditions and examined its measurement properties, namely reliability and structural, convergent and discriminant validity. To investigate test-retest reliability, the SDRQ was presented a second time to a subsample of 58 randomly selected participants. RESULTS: Factor analysis required a grouping of the 22 SDRQ items into four subscales: spiritual distress, spiritual coping, immanence and transcendence, the latter two representing spiritual resources. Cronbach's alpha was high for spiritual distress (0.93), transcendence (0.85), and immanence (0.81) while it was somewhat lower but still satisfactory for spiritual coping (0.70). The construct validity of the SDRQ was shown by correlations with established measures in the field. Higher levels of spiritual distress were associated with signs of more severe illness, such as emotional distress and pain intensity. CONCLUSION: The results from this study suggest that the SDRQ is an easy-to-use, reliable and valid screening instrument for assessing spiritual distress, spiritual resources and spiritual coping in patients with chronic pain. The SDRQ has the potential to be used with patients suffering from other chronic diseases and to disseminate the palliative approach to pain treatment to other areas of medicine.
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Dor , Espiritualidade , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
The purpose of this study was to evaluate the beliefs, opinions, and experiences of medical students from a Catholic confessional university concerning spirituality in medical practice. This is a descriptive and cross-sectional study with a sample of 323 undergraduate students, of which 162 were in their first two years of their studies and 161 in the final two years. A validated questionnaire consisting of 58 questions was applied. Although the spiritual dimension was recognized as important for patient care, 95% of students were not familiar with spiritual and religious issues. Advanced students reported that they had not received adequate training in this area. Therefore, this topic should be included in the medical curriculum, preferably in the first years.
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Espiritualidade , Estudantes de Medicina , Brasil , Estudos Transversais , Humanos , Religião , Inquéritos e QuestionáriosRESUMO
The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.
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Atitude do Pessoal de Saúde , Religião , Espiritualidade , Bases de Dados Factuais , Humanos , Reprodutibilidade dos Testes , Terapias Espirituais , Inquéritos e QuestionáriosRESUMO
This study reports preliminary findings on the hypothesis that worldview can predict cardiovascular and cortisol responses to social stress. Based on theory and previous findings, we assumed that worldview security would provide a basis for stress resilience. Accordingly, religious and atheist individuals were expected to show higher stress resilience than spiritual and agnostic participants. Likewise, dimensional measures of religiosity and atheism were hypothesized to predict decreased, and existential search-indicating worldview insecurity-was hypothesized to predict increased physiological stress responses. Subjects included 50 university students who completed online questionnaires and took part in a standardized social stress test (Trier Social Stress Test). Systolic and diastolic blood pressure (SBP/DBP), heart rate (HR), and salivary cortisol (SC) were assessed at baseline, immediately after stress testing, and during a forty-minute recovery period. Worldview comparisons revealed lower cardiovascular stress responses among religious than among atheist and spiritual participants and particularly high baseline SC among spiritual participants. Across the entire sample, existential search showed substantial positive correlations with SBP, HR, and SC stress parameters. The findings suggest that worldview security might partly explain the health benefits often associated with religion.
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Doenças Cardiovasculares/psicologia , Existencialismo/psicologia , Hidrocortisona , Religião , Saliva/química , Espiritualidade , Estresse Psicológico/psicologia , Adulto , Feminino , Humanos , Masculino , Estresse Psicológico/metabolismoRESUMO
A integração da espiritualidade no cuidado em saúde mental, na psiquiatria e na psicologia ainda é algo controverso, apesar de um crescente corpo de evidências estar mostrando os efeitos benéficos e a real necessidade de tal integração. Na presente revisão, eu resumo pesquisas antigas e recentes, assim como evidências da nossa prática clínica na Suíça. Coping religioso é altamente presente entre pacientes com transtornos psiquiátricos. Pesquisas indicam que 70% a 80% usam de crenças ou práticas religiosas ou espirituais para lidar com dificuldades e frustrações diárias. A religião pode ajudar os pacientes a melhorar o ajustamento emocional e a manter a esperança, os propósitos e o sentido. Os pacientes enfatizam que servir a um propósito além de si mesmos pode tornar possível viver com algo que, de outra maneira, seria insustentável. São descritos e discutidos programas que incorporaram com sucesso a espiritualidade na prática clínica. Estudos indicam que o resultado da psicoterapia em pacientes religiosos pode ser incrementado ao integrar-se elementos religiosos no protocolo terapêutico e que isso pode ser feito com sucesso por terapeutas religiosos ou não.
Integrating spirituality into mental health care, psychiatry and psychotherapy is still controversial, albeit a growing body of evidence is showing beneficial effects and a real need for such integration. In my review I summarize past and recent research as well as evidence from clinical practice at our clinic in Langenthal/Switzerland. Religious coping is highly prevalent among patients with psychiatric disorders. Surveys indicate that 70-80% use religious or spiritual beliefs and activities to cope with daily difficulties and frustrations. Religion helps patients to enhance emotional adjustment and to maintain hope, purpose and meaning. Patients emphasize that serving a purpose beyond one's self can make it possible to live with what might otherwise be unbearable. Programs successfully incorporating spirituality into clinical practice are described and discussed. Studies indicate that the outcome of psychotherapy in religious patients can be enhanced by integrating religious elements into the therapy protocol and that this can be successfully done by religious and non-religious therapists alike.