Transcending differences to study the transcendent: an exploratory study of researchers' and chaplains' reflections on interdisciplinary spiritual care research collaboration.

BACKGROUND: Despite recognition of the centrality of professional board-certified chaplains (BCC) in palliative care, the discipline has little research to guide its practices. To help address this limitation, HealthCare Chaplaincy Network funded six proposals in which BCCs worked collaboratively with established researchers. Recognizing the importance of interdisciplinary collaboration in the development of a new field, this paper reports on an exploratory study of project members' reflections over time on the benefits and challenges of conducting inter-disciplinary spiritual care research. METHODS: Data collection occurred in two stages. Stage 1 entailed two independent, self-reflective focus groups, organized by professional discipline, mid-way through the site projects. Stage 2 entailed end-of-project site reports and a conference questionnaire. RESULTS: Eighteen professionals participated in the group discussions. Stage 1: researchers perceived chaplains as eager workers passionately committed to their patients and to research, and identified challenges faced by chaplains in learning to conduct research. Chaplains perceived researchers as passionate about their work, were concerned research might uncover negative findings for their profession, and sensed they used a dissimilar paradigm from their research colleagues regarding the 'ways of relating' to knowledge and understanding. Stage 2: researchers and chaplains noted important changes they ascribed to the interdisciplinary collaboration that were classified into six domains of cultural and philosophical understanding: respect; learning; discovery; creativity; fruitful partnerships; and learning needs. CONCLUSIONS: Chaplains and researchers initially expressed divergent perspectives on the research collaborations. During the projects' lifespans, these differences were acknowledged and addressed. Mutual appreciation for each discipline's strengths and contributions to inter-professional dialogue emerged.

Understanding recent changes in suicide rates among the middle-aged: period or cohort effects?

OBJECTIVE: We examined trends in suicide rates for U.S. residents aged 40 to 59 years from 1979 to 2005 and explored alternative explanations for the notable increase in such deaths from 1999 to 2005. METHODS: We obtained information on suicide deaths from the National Center for Health Statistics and population data from the U.S. Census Bureau. Age- and gender-specific suicide rates were computed and trends therein analyzed using linear regression techniques. RESULTS: Following a period of stability or decline, suicide rates have climbed since 1988 for males aged 40-49 years, and since 1999 for females aged 40-59 years and males aged 50-59 years. A crossover in rates for 40- to 49-year-old vs. 50- to 59-year-old males and females occurred in the early 1990s, and the younger groups now have higher suicide rates. The post-1999 increase has been particularly dramatic for those who are unmarried and those without a college degree. CONCLUSIONS: The timing of the post-1999 increase coincides with the complete replacement of the U.S. population's middle-age strata by the postwar baby boom cohorts, whose youngest members turned 40 years of age by 2005. These cohorts, born between 1945 and 1964, also had notably high suicide rates during their adolescent years. Cohort replacement may explain the crossover in rates among the younger and older middle-aged groups. However, there is evidence for a period effect operating between 1999 and 2005, one that was apparently specific to less-protected members of the baby boom cohort.

Psychosocial factors in heart surgery: presurgical vulnerability and postsurgical recovery.

OBJECTIVE: Distress and low perceived social support were examined as indicators of psychosocial vulnerability in patients about to undergo heart surgery. DESIGN: A total of 550 study patients underwent heart surgeries, including bypass grafting and valve procedures. Psychosocial interviews were conducted about five days before surgery, and biomedical data were obtained from hospital records. MAIN OUTCOME MEASURES: Sociodemographic, personality, religious, and biomedical factors were evaluated as predictors of psychosocial vulnerability, and all five sets of variables were evaluated as contributors to hospital length of stay (LOS). RESULTS: Patients scoring higher on one or more indicator of presurgical psychosocial vulnerability were younger, more likely to be female, less likely to be married, less well educated, lower in dispositional optimism, higher in trait anger, and lower in religiousness. Older age, depression, low support, and low trait anger each showed an independent, prospective association with greater LOS, and several other predictors had prospective relationships with LOS that were statistically mediated by depression or perceived support. CONCLUSION: Evidence that multiple psychosocial factors may influence adaptation to heart surgery has implications for understanding and ameliorating presurgical distress and for improving postsurgical recovery.

Course of depressive symptoms in patients undergoing heart surgery: confirmatory analysis of the factor pattern and latent mean structure of the Center for Epidemiologic Studies Depression Scale.

OBJECTIVE: The purpose of this study was to examine the dimensionality, stability, and course of depressive symptoms over the 12-month period beginning approximately 1 week before heart surgery. METHODS: The Center for Epidemiological Studies Depression Scale (CES-D) was administered to 570 patients before heart surgery and 1, 3.5, 6.5, and 12.5 months later. RESULTS: Confirmatory factor analysis rejected a four-factor model as a result of small variances for two interpersonal items. With their elimination, a three-factor solution (negative affect, low positive affect, somatic/vegetative symptoms) showed good psychometric properties. Except for the somatic/vegetative factor at the 1-month follow up, there was a high degree of stability in the factor pattern over a 12-month period beginning approximately 1 week before heart surgery. Latent mean structure analysis indicated that, apart from elevations in several somatic/vegetative symptoms during the month after surgery, means for all three depressive symptoms declined over time. The recovery of positive affect showed a steeper trajectory toward the end of the follow-up period by comparison with the rates of decline for depressed affect and somatic/vegetative symptoms. CONCLUSIONS: These findings support using 18 CES-D items to measure three depressive symptom dimensions in heart patients and may reflect a normative pattern of adjustment to heart surgery.

Quality of life following cardiac surgery: impact of the severity and course of depressive symptoms.

OBJECTIVES: The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. METHODS: Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. RESULTS: Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. CONCLUSIONS: Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery.

Why not find out whether religious beliefs predict surgical outcomes? If they do, why not find out why? Reply to Freedland (2004).

In this reply to K. E. Freedland's (see record 2004-13299-002) comments on R. J. Contrada et al. (see record 2004-13299-001), it is shown that the statistical issues he raised, and his preferred interpretation of the findings, were adequately addressed in the original article. It is argued that methodological limitations also were fully characterized and do not differ in kind from those of biomedical studies. Other issues discussed include the merits of focusing on distal versus proximal causation, plausibility of explanatory mechanisms for health effects of religious involvement, and potential practical applications that do not require manipulation of religious involvement. The article is concluded by commenting on subtle aspects of discourse that may unnecessarily polarize discussions of possible physical health effects of religious involvement.

Psychosocial factors in outcomes of heart surgery: the impact of religious involvement and depressive symptoms.

This article reports a prospective study of religiousness and recovery from heart surgery. Religiousness and other psychosocial factors were assessed in 142 patients about a week prior to surgery. Those with stronger religious beliefs subsequently had fewer complications and shorter hospital stays, the former effect mediating the latter. Attendance at religious services was unrelated to complications but predicted longer hospitalizations. Prayer was not related to recovery. Depressive symptoms were associated with longer hospital stays. Dispositional optimism, trait hostility, and social support were unrelated to outcomes. Effects of religious beliefs and attendance were stronger among women than men and were independent of biomedical and other psychosocial predictors. These findings encourage further examination of differential health effects of the various elements of religiousness.

Pathways from religion to advance care planning: beliefs about control over length of life and end-of-life values.

PURPOSE OF THE STUDY: To evaluate the extent to which religious affiliation and self-identified religious importance affect advance care planning (ACP) via beliefs about control over life length and end-of-life values. DESIGN AND METHODS: Three hundred and five adults aged 55 and older from diverse racial and socioeconomic groups seeking outpatient care in New Jersey were surveyed. Measures included discussion of end-of-life preferences; living will (LW) completion; durable power of attorney for healthcare (DPAHC) appointment; religious affiliation; importance of religion; and beliefs about who/what controls life length, end-of-life values, health status, and sociodemographics. RESULTS: Of the sample, 68.9% had an informal discussion and 46.2% both discussed their preferences and did formal ACP (LW and/or DPAHC). Conservative Protestants and those placing great importance on religion/spirituality had a lower likelihood of ACP. These associations were largely accounted for by beliefs about God's controlling life length and values for using all available treatments. IMPLICATIONS: Beliefs and values about control account for relationships between religiosity and ACP. Beliefs and some values differ by religious affiliation. As such, congregations may be one nonclinical setting in which ACP discussions could be held, as individuals with similar attitudes toward the end of life could discuss their treatment preferences with those who share their views.

Mending broken hearts: marriage and survival following cardiac surgery.

Marriage has long been linked to lower risk for adult mortality in population and clinical studies. In a regional sample of patients (n = 569) undergoing cardiac surgery, we compared 5-year hazards of mortality for married persons with those of widowed, separated or divorced, and never married persons using data from medical records and psychosocial interviews. After adjusting for demographics and pre- and postsurgical health, unmarried persons had 1.90 times the hazard of mortality of married persons; the disaggregated widowed, never married, and divorced or separated groups had similar hazards, as did men and women. The adjusted hazard for immediate postsurgical mortality was 3.33; the adjusted hazard for long-term mortality was 1.71, and this was mediated by married persons' lower smoking rates. The findings underscore the role of spouses (both male and female) in caregiving during health crises and the social control of health behaviors.

Religion and the quality of life in the last year of life.

OBJECTIVES: Religious involvement in old age appears to remain quite stable until the very end of life, reflecting patterns established earlier in life. Are there differences in quality of life (QOL) for those who are religiously involved in that last year compared with those who are not? METHODS: We studied 499 elderly persons participating in ongoing annual interviews who died in the 12 months following an interview. We examined public and subjective religious involvement and indicators of health-related and psychosocial QOL, including health status and functional ability, family and friendship networks, depression, and well-being. RESULTS: More deeply religious respondents were more likely to see friends, and they had better self-rated health, fewer depressive feelings, and were observed by the interviewer to find life more exciting compared with the less religious. Respondents receiving strength and comfort from religion reported poorer self-rated health. Those who attended religious services often were most likely to have attended holiday parties, even after adjusting for health status. Significant interactions indicated that the disabled benefited more from both public and subjective religious involvement than the nondisabled. DISCUSSION: Overall, QOL in the last year of life is positively related to religious involvement, particularly its more subjective dimensions.

Looking Inside the Black Box of "Attendance at Services": New Measures for Exploring an Old Dimension in Religion and Health Research.

Research in religion and health has spurred new interest in measuring religiousness. Measurement efforts have focused on subjective facets of religiousness such as spirituality and beliefs, and less attention has been paid to congregate aspects, beyond the single item measuring attendance at services. We evaluate some new measures for religious experiences occurring during congregational worship services. Respondents (N=576) were religiously-diverse community-dwelling adults interviewed prior to cardiac surgery. Exploratory factor analysis of the new items with a pool of standard items yielded a readily interpretable solution, involving seven correlated but distinct factors and one index variable, with high levels of internal consistency. We describe religious affiliation and demographic differences in these measures. Attendance at religious services provides multifaceted physical, emotional, social, and spiritual experiences that may promote physical health through multiple pathways.