Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions.

OBJECTIVE: This study tested three conceptual explanatory models that have been theorized to account for the linkages between religious/spiritual (R/S) struggles and psychological distress: the primary model (i.e., R/S struggles lead to psychological distress), the secondary model (i.e., psychological distress leads to R/S struggles), and the complex model (i.e., R/S struggles and psychological distress reciprocally exacerbate each other). METHODS: Using prospective data from a sample of US adults living with chronic health conditions (n = 302), we performed a cross-lagged panel analysis with three timepoints to test for evidence of potential causal relations between R/S struggles and psychological distress. RESULTS: Consistent with the complex conceptual model of R/S struggles, we found evidence of positive reciprocal associations between R/S struggles and psychological distress. CONCLUSION: The findings highlight the importance of attending to the dynamic interplay between R/S struggles and psychological distress when working with adults who have chronic health conditions.

R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health.

OBJECTIVE: Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014. DESIGN: An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018. RESULTS: Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data). CONCLUSIONS: R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.

The Relevance of Religion and Spirituality to Mental Health: A National Survey of Current Clients' Views.

Despite a growing interest in the relationship between religion and spirituality (RS) and mental health across helping professions, less is known about clients' perceived relevance of these areas. This article describes the development and validation of the Relevance of Religion and Spirituality to Mental Health (RRSMH) scale, and responses to the first national survey of clients' perceived relevance of RS to mental health. Specifically, a sample of 989 U.S. adults who saw a mental health care provider in the last month responded to an online survey that included 27 new items to measure clients' perceptions of the relevance of RS to mental health, both positive and negative. A confirmatory factor analysis revealed that the sample's data had an adequate fit to the final 12-item model, and the instrument's overall reliability was very good (α = .96). Descriptive analyses indicated that clients view RS as both supportive and relevant to their mental health. The RRSMH scale may be used in mental health research and practice settings. Authors recommend that RS be assessed and included in treatment planning, where appropriate, and addressed in training for mental health professionals.

Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health.

Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.

Spiritual intimacy, spiritual one-upmanship, and marital conflict across the transition to parenthood.

Dyadic discussions that directly tap into spouses' views on spirituality and religiousness (S/R) represent an understudied but important facet of marital functioning that may be tied, for better or worse, to marital conflict and resolution processes. This study used longitudinal data gathered from 164 married couples across the transition to parenthood (TtP) to address this possibility. Specifically, during late pregnancy and when their infant was 3, 6, and 12 months old, husbands and wives completed measures about both spouses' spiritual intimacy (i.e., self-disclosure and support of partner's disclosures about spirituality) and spiritual one-upmanship (i.e., relying on spiritual and religious [dis]beliefs and opinions to assert superiority in conflicts). Criterion variables were the frequency of marital conflict and both partners' use of collaborative, hostile, and stalemating communication strategies during marital conflicts. Using fixed-effects regression models with both predictors entered, we found that greater spiritual intimacy by wives and husbands predicted less frequent conflict (p < .01), more collaborative communication by husbands (p < .01) and less stalemating (p < .01) by both spouses. Wives' spiritual intimacy also predicted more collaboration and less verbal hostility by wives (p < .01). By contrast, greater spiritual one-upmanship by both spouses predicted greater stalemating by both spouses (p < .05) and verbal hostility by husbands (p < .05). The findings indicate that 2 contrasting types of S/R dialogues are differentially linked to disagreements and conflict-resolution skills after accounting for stable aspects of the couples across the TtP (e.g., personality traits). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Decoding of the Human Spirit: A Synergy of Spirituality and Character Strengths Toward Wholeness.

Little attention has been given to the integral relationship between character strengths and spirituality (the search for or communing with the sacred to derive meaning and purpose). The science of character strengths has surged in recent years with hundreds of studies, yet with minimal attention to spirituality or the literature thereof. At the same time, the science of spirituality has steadily unfolded over the last few decades and has offered only occasional attention to select strengths of character (e.g., humility, love, and forgiveness) or the universal typology of the VIA classification of character strengths and virtues. In this exploration, we argue that there is a robust synergy of these sciences and practices revealing that spirituality is vitally concerned with promoting character strengths. At the same time, character strengths can enhance and deepen spiritual practices, rituals, and experiences. We elaborate on how character strengths and spirituality come together in the context of the psycho-spiritual journey toward wholeness. By wholeness, we are referring to a way of being in the world that involves a life-affirming view of oneself and the world, a capacity to see and approach life with breadth and depth and the ability to organize the life journey into a cohesive whole. We further discuss six levels by which spirituality can be integrated within the VIA Classification, including a meta-perspective in which wholeness represents a meta-strength or superordinate virtue. We frame two pathways of integration: the grounding path, in which character strengths offer tangibility and thereby deepen and enhance spirituality, and the sanctification path, in which spirituality elevates character strengths. Finally, we turn to research-based practices and examine how character strengths might facilitate and contribute to spiritual practices and, conversely, how spirituality might enhance character strength practices. Such multifaceted integration offers insight and wisdom to both areas of study and opens up new directions for psycho-spiritual research and practices to deepen and broaden our understanding of what it means to be human.

Religious and spiritual struggles, religiousness, and alcohol problems among undergraduates.

Theoretically, religion/spirituality may protect against alcohol problems or facilitate recovery. However, challenges can arise in religious/spiritual life that may contribute to or complicate alcohol problems. Emerging adults often experience difficult transitions from family environments to independent membership in academic communities straddling the legal drinking age boundary. Among underage undergraduates, we hypothesized that religious/spiritual struggles predict more alcohol problems independently of distress and religiousness, and religiousness independently predicts fewer alcohol problems. Our survey of two U.S. universities (total N = 2525) supported these hypotheses. Structural equation models revealed positive correlations between alcohol problems and all six religious/spiritual struggles (divine, demonic, interpersonal, moral, ultimate meaning, doubt), but only moral struggle predicted alcohol problems moderately and independently of religiousness, distress, gender, and non/white ethnicity. Evidence also emerged for negative correlations between religious/spiritual struggles and drinking as it varies independently of alcohol problems. We recommend that alcoholism counselors address clients' religious/spiritual struggles.

Positive and negative religious coping as predictors of distress among minority older adults.

OBJECTIVES: The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults. METHODS: Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress. RESULTS: Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study. CONCLUSIONS: The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

Reading the Bible, Stressful Life Events, and Hope: Assessing an Overlooked Coping Resource.

Many people rely on religion to deal with the stressors in their lives. The purpose of this study is to examine a religious coping resource that has received relatively little attention-reading the Bible. We evaluated three hypotheses: (1) reading the Bible moderates the relationship between stress and hope; (2) people who read the Bible more often are more likely to rely on benevolent religious reappraisal coping responses; and (3) individuals who rely on benevolent religious reappraisals will be more hopeful about the future. Support was found for all three hypotheses in our analyses.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress.

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized ß = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

Assessing the role of race/ethnicity in the relationships among spiritual struggles, health, and well-being.

A growing body of research suggests that greater exposure to spiritual struggles is associated with more physical and mental health problems. Spiritual struggles involve difficulties that a person may encounter with his or her faith, which may include having a troubled relationship with God, encountering difficulties with religious others, or being unable to find a sense of meaning in life. However, little is known about the way in which spiritual struggles may differ across racial/ethnic groups. The purpose of this study was to assess variations in spiritual struggles, health, and well-being among Whites, Blacks, and Hispanics. We examined two ways in which race/ethnic variations may arise. First, the differential-exposure perspective suggests that some groups may experience more spiritual struggles than others. Findings from a recent nationwide survey suggest that Blacks experience more spiritual struggles than either Whites or Hispanics. Second, the differential-impact perspective suggests that the relationship between spiritual struggles, health, and well-being varies across racial/ethnic groups. Findings from the current study suggest that when spiritual struggles arise, Blacks experience fewer symptoms of physical illness, less anxiety, and they tend to be happier than Whites or Hispanics. The theoretical implication of these findings is discussed. (PsycINFO Database Record

Spiritual Struggles and Problem Drinking: Are Younger Adults at Greater Risk than Older Adults?

BACKGROUND: Although a good deal of research has assessed the positive effects that involvement in religion has on alcohol use, there is relatively little research on the negative aspects of religious life and alcohol problems. OBJECTIVES: This study has two objectives. The first is to see if spiritual struggles are associated with problem drinking. The second is to see if the relationship between spiritual struggles and problem drinking is stronger for younger than for older adults. METHODS: The data come from a recent nationwide survey of adults of all ages who reside in the United States (N = 2142).The study was conducted in 2014. Problem drinking is assessed with the CAGE questionnaire. RESULTS: The findings indicate that people who encounter more spiritual struggles are more likely to experience problem drinking. The relationship between spiritual struggles and problem drinking was stronger than the relationship between three other frequently used measures of religion and problem drinking (i.e., attendance at worship services, private prayer, and affiliation with Evangelical denominations). The results further reveal that spiritual struggles are associated with a greater risk of drinking problems among younger than among older individuals. Conclusions/Importance: Although many studies show that various facets of religion are associated with a lower risk of experiencing problems with alcohol the findings from the current study show that there are negative aspects of religious life that may be associated with a greater risk of having problems with alcohol.

Association of spiritual/religious coping with depressive symptoms in high- and low-risk pregnant women.

AIMS AND OBJECTIVES: To investigate the role of spiritual/religious coping (SRC) on depressive symptoms in high- and low-risk pregnant women. BACKGROUND: Spiritual/religious coping is associated with physical and mental health outcomes. However, only few studies investigated the role of these strategies during pregnancy and whether low- and high-risk pregnant women have different coping mechanisms. DESIGN: This study is a cross-sectional comparative study. METHODS: This study included a total of 160 pregnant women, 80 with low-risk pregnancy and 80 with high-risk pregnancy. The Beck Depression Inventory, the brief SRC scale and a structured questionnaire on sociodemographic and obstetric aspects were used. General linear model regression analysis was used to identify the factors associated with positive and negative SRC strategies in both groups of pregnant women. RESULTS: Positive SRC use was high, whereas negative SRC use was low in both groups. Although we found no difference in SRC strategies between the two groups, negative SRC was associated with depression in women with high-risk pregnancy, but not in those with low-risk pregnancy. Furthermore, positive SRC was not associated with depressive symptoms in both groups. CONCLUSIONS: Results showed that only the negative SRC strategies of Brazilian women with high-risk pregnancies were associated with worsened mental health outcomes. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals, obstetricians and nurse midwives should focus on the use of negative SRC strategies in their pregnant patients.

State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.

State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes.

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.

Spiritual or religious struggle in hematopoietic cell transplant survivors.

BACKGROUND: This study describes the prevalence of religious or spiritual (R/S) struggle in long-term survivors after hematopoietic cell transplantation (HCT), demographic and medical correlates of R/S struggle, and its associations with depression and quality of life. METHODS: Data were collected in conjunction with an annual survey of adult (age ≥18 years) survivors of HCT. Study measures included R/S struggle (negative religious coping, NRC, from Brief RCOPE), measures of quality of life (subscales from 36-item Short Form Health Survey and McGill), and the Patient Health Questionnaire 8. R/S struggle was defined as any non-zero response on the NRC. Factors associated with R/S struggle were identified using multi-variable logistic regression models. RESULTS: The study analyzed data from 1449 respondents who ranged from 6 months to 40 years after HCT. Twenty-seven percent had some R/S struggle. In a multi-variable logistic regression model, R/S struggle was associated with greater depression and poorer quality of life. R/S struggle was also associated with younger age, non-White race, and self-identification as either religious but not spiritual or spiritual but not religious. R/S struggle was not associated with any medical variables, including time since transplant. CONCLUSIONS: Religious or spiritual struggle is common among HCT survivors, even many years after HCT. Survivors should be screened and, as indicated, referred to a professional with expertise in R/S struggle. Further study is needed to determine causal relationships, longitudinal trajectory, impact of struggle intensity, and effects of R/S struggle on health, mood, and social roles for HCT survivors. Copyright © 2015 John Wiley & Sons, Ltd.

Effect of Different Meditation Types on Migraine Headache Medication Use.

Spiritual meditation has been found to reduce the frequency of migraines and physiological reactivity to stress. However, little is known about how introducing a spirituality component into a meditation intervention impacts analgesic medication usage. In this study, 92 meditation-naïve participants were randomly assigned to one of four groups: (1) Spiritual Meditation, (n = 25), (2) Internally Focused Secular Meditation (n = 23), (3) Externally Focused Secular Meditation (n = 22), or (4) Progressive Muscle Relaxation (n = 22); and practiced their technique for 20 min/day over 30 days while completing daily diaries. Headache frequency, headache severity, and pain medication use were assessed. Migraine frequency decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Headache severity ratings did not differ across groups (p = ns). After adjusting for headache frequency, migraine medication usage decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Spiritual Meditation was found to not affect pain sensitivity, but it does improve pain tolerance with reduced headache related analgesic medication usage.

Determining best methods to screen for religious/spiritual distress.

PURPOSE: This study sought to validate for the first time a brief screening measure for religious/spiritual (R/S) distress given the Commission on Cancer's mandated screening for psychosocial distress including spiritual distress. METHODS: Data were collected in conjunction with an annual survey of adult hematopoietic cell transplantation (HCT) survivors. Six R/S distress screeners were compared to the Brief RCOPE, Negative Religious Coping subscale as the reference standard. We pre-specified validity as a sensitivity score of at least 85 %. As no individual measure attained this, two post hoc analyses were conducted: analysis of participants within 2 years of transplantation and of a simultaneous pairing of items. Data were analyzed from 1449 respondents whose time since HCT was 6 months to 40 years. RESULTS: For the various single-item screening protocols, sensitivity ranged from 27 (spiritual/religious concerns) to 60 % (meaning/joy) in the full sample and 25 (spiritual/religious concerns) to 65 % (meaning/joy) in a subsample of those within 2 years of HCT. The paired items of low meaning/joy and self-described R/S struggle attained a net sensitivity of 82 % in the full sample and of 87 % in those within 2 years of HCT but with low net specificities. CONCLUSIONS: While no single-item screener was acceptable using our pre-specified sensitivity value of 85 %, the simultaneous use of meaning/joy and self-described struggle items among cancer survivors is currently the best choice to briefly screen for R/S distress. Future research should validate this and other approaches in active treatment cancer patients and survivors and determine the best times to screen.

Lifetime Trauma, Praying for Others, and C-Reactive Protein.

Research indicates that praying for others may offset the effects of stress on self-rated health and psychological well-being. The purpose of the current study is to extend this literature by seeing whether praying for others moderates the effects of exposure to lifetime trauma on a key marker of inflammation: C-reactive protein. The data come from a recent nationwide survey of adults of all ages (N = 1,589). Levels of C-reactive protein were obtained from assays of blood spots drawn from a capillary fingerstick. The findings suggest that the magnitude of the relationship between lifetime trauma and C-reactive protein is completely offset for study participants who frequently pray for others. The theoretical implications of this research are discussed.