The Need to Widen the Concept of Health and to Include the Spiritual Dimension.

For many, the World Health Organization's (WHO) definition of health does not reflect their own understanding of health, because it lacks aspects such as spiritual wellbeing. Responding to these concerns, the WHO called in 2023 for a vision of health that integrates physical, mental, psychological, emotional, spiritual, and social wellbeing. To date, medical practitioners are often reluctant to consider spiritual aspects, because of a perceived lack of statistical evidence about the strength of relations. Research on this topic is emerging. A recent study among 800 young people living with HIV in Zimbabwe showed how study participants navigated three parallel, at times contradicting health systems (religious, traditional, medical). Conflicting approaches led to multifaceted dilemmas (= spiritual struggles), which were significantly related to poorer mental and physical health. This illustrates the need for inclusion of spiritual aspects for health and wellbeing in research, and of increased collaboration between all stakeholders in healthcare.

Identifying and Addressing the Spiritual Needs of Older Adults in Care Facilities: Administrators of Chinese Nursing Homes Relate Their Perspectives.

Addressing the spiritual needs of older adults is a central component of holistic service provision. Using a qualitative description design, this study identified: (1) common spiritual needs among Chinese nursing home residents, including the needs of residents with dementia, (2) the process staff use to identify these needs when residents are unable to verbalize them, and (3) the strategies staff implement to meet the identified needs. Semi-structured interviews were conducted with 21 nursing home administrators. Analysis produced five themes, including the need for older adults to express their faith, receive love and care, have contact with their children, interact with others, and participate in activities. For residents with dementia who are unable to verbalize their concerns, staff used two primary strategies to identify spiritual needs: careful observation and communication with family members. To address the identified spiritual needs, multiple strategies were offered including arranging clergy visits and personalizing care.

The Significance of Religion and Spirituality Among Turkish Women Surviving Breast Cancer Without Treatment: A Qualitative Study.

The health of breast cancer survivors is a global concern. It is crucial to adopt a holistic approach when understanding their journey from illness to wellness in order to ensure that the transition is as smooth as possible. This study focused on the experiences of Muslim women who had overcome breast cancer and were adapting to life post-treatment. Snowball sampling was used to select the participants for this qualitative study. Fifteen women who had successfully completed breast cancer treatment and been declared cancer-free were interviewed. These interviews were semi-structured, using open-ended questions to explore their experiences in-depth. The interviews were conducted by phone, and the data were analyzed using qualitative content analysis. The study identified four main themes, nine subthemes, and 41 codes. The main themes were as follows: (a) a life changed by cancer and the difficulties encountered; (b) transition from active treatment to treatment-free living; (c) coping mechanisms; and (d) future hopes and expectations. The findings highlighted the survivors' desire to move past their experience of cancer and normalize their lives, as well as emphasizing their need for support. The participants shared detailed accounts of their journey, the obstacles they encountered during this transition, and the critical role of religion and spirituality in overcoming these challenges. Understanding and effectively managing the experiences of women after breast cancer treatment is vital not only for improving survival rates but also for facilitating their healing process.

The Relationship between Religion, Spirituality, Psychological Well-Being, Psychological Resilience, Life Satisfaction of Medical Students in the Gaziantep, Turkey.

Religion and spirituality have been associated with better psychological health. The present study aims to investigate the relationship between the psychological well-being, psychological resilience, life satisfaction and religion/spirituality. An online cross-sectional study was conducted at the Gaziantep University School of Medicine, Turkey. The data were collected by using Personal Information Form, Individual Religion Inventory (IRI), Psychological Wellbeing Scale (PWBS), Brief Psychological Resilience Scale (BPRS), and Satisfaction with Life Scale (SWLS). A total of 399 students participated in the study, 84% of them stated that they were Muslim. The perception of good psychological health was significantly higher among Muslims (32.7%) than non-Muslims (14.3%) (p = 0.013). The PWBS, BPRS, SWLS scores were significantly higher in those who attached very importance to religious/spiritual practices compared to those who attached little importance. While PWBS scores and BPRS scores did not differ, the SWLS scores was significantly higher in Muslims compared with the non-Muslims. A positive correlation was found between the IRI scores and PWBS (r = 0.446 p < 0.001), BPRS (r = 0.252 p < 0.001), and SWLS scores (r = 0.450 p < 0.001) for Muslim participants. The study showed that giving importance to religious/spiritual practices is associated with better psychological health.

Spirituality and people with psychosis: A content analysis of influential primetime television programs.

OBJECTIVE: This mixed methods study examined depictions of spirituality among people with psychosis in influential television programming. Spirituality is a central strength for many people with psychosis. Yet, despite the important role media plays in shaping perceptions, little research has examined the intersection between spirituality and psychosis in popular media. METHODS: To address this gap, we conducted a content analysis of the 50 most viewed primetime fictional television shows over a 10-year period as determined by the Nielsen rating organization. Characters with psychosis were identified via keyword searches of online sources (wikis, IMDb, etc.) and subsequently independently coded by two individuals. Characters were rated on 18 items in three domains related to demographics, life status, and character framing. Inter-rater reliability ranged from good to excellent across variables. RESULTS: Of 120 identified focal characters with psychosis, just 16 percent (n = 19) had a spiritual identity. Analysis revealed few differences between spiritual and secular characters on demographic and life status variables. Conversely, an examination of framing variables revealed spiritual characters were comparatively less attractive, exhibited a greater negative impact on society, and were more likely to be referred to pejoratively (as a psychopath) and engage in criminal activity. Trend analysis indicated portrayals of spiritual characters decreased over time. CONCLUSIONS: The results suggest media depictions of spirituality contribute to the stigmatization of spirituality among people with psychosis, potentially mitigating access to important coping resources and discouraging professional help-seeking. Primary care physicians should consider incorporating a spiritual assessment into care to operationalize spiritual coping assets.

Tribal Healing, Suicide, Ethical Issues, Cancer and Measuring Religiosity and Spirituality.

This issue of JORH considers the 'good, the bad and the ugly' of tribal or traditional healers, as well as articles relating to ethical challenges due to contemporary medicine and environmental issues. The concluding series on suicide (Part 2) is also finalized in this issue, as well as a number of research articles from multiple countries relating to cancer. Similar to previous issues, JORH once again adds to its increasing collection of articles relating to the empirical measurement of religion, spirituality and health. Readers are also reminded of the European Congress on Religion, Spirituality and Health (ECRSH) (Salzburg, Austria, May 2024), as well as the inaugural International Moral Injury and Wellbeing Conference (IMIWC) (Brisbane, Australia, September 2024).

Religion and Spirituality in Medical Care from the Patient Perspective in Camden County, New Jersey, USA: An Exploratory Study.

Religion and spirituality (R/S) play a significant role in the way many individuals make decisions and structure their lives. The purpose of this exploratory study was to assess the attitudes and preferences of individuals who live or worship in Camden County, NJ, in regards to physicians addressing their religious and spiritual beliefs during medical care. This study was conducted through a survey which inquired about the level of the participant's religiosity/spirituality, specific religion, and attitudes towards and desires for conversations regarding religious and spiritual beliefs during medical care. Many survey participants shared strong opinions about physicians addressing R/S beliefs during medical encounters, with the majority expressing a positive view of conversations about R/S in medical care. The majority of respondents (75%) reported holding religious or spiritual beliefs that they described as important or very important to them, while 60% of participants indicated that their physician's awareness of their R/S beliefs was at least somewhat important to them. Based on the results of this exploratory study, the recommendation of the AAMC and Joint Commission to include conversations about R/S in medical care, as well as the tenets of osteopathic philosophy are  consistent with the majority opinion about R/S in medical care that was expressed through this survey.

Is mindfulness practice "at risk" of increasing spirituality? Systematic review and critical analysis of a claimed effect.

INTRODUCTION: Mindfulness meditation has gained prominence in somatic and psychiatric care in several countries including France. Studies have shown its effectiveness in various conditions, in particular the prevention of depressive relapses. However, there are criticisms and concerns about its potential links to Buddhism and spirituality, raising issues of secularism and sectarianism. This issue is particularly conflicting in France with regard its historical and political relationship with secularism. OBJECTIVES: This study aims to assess quantitative data regarding the impact of mindfulness meditation on spirituality and religiosity using quantitative validated scales. METHODS: A systematic review was conducted. PubMed was searched for relevant studies using keywords related to mindfulness and spirituality/religiosity scales. Four scales assessing spirituality were identified: FACIT-sp, INSPIRIT, DSES, and DUREL. Qualitative analysis determined if scale items pertained to spirituality or other topics considered by opponents to mindfulness as "at risk" for deviances or sectarian aberrations. Quantitative analysis assessed the effect size of changes in scale scores before and after mindfulness meditation interventions. RESULTS: Eighteen studies were analyzed, with varying scales and program durations including 1272 participants. Qualitative analysis showed that most scales contained items related to spirituality as well as "at risk" elements like religion and mysticism. Quantitative analysis revealed that a few studies reported significant increases in spirituality scores following mindfulness meditation, but the clinical relevance of these changes was questioned. In general, control groups had smaller score changes. INTERPRETATION: While some studies suggest a potential increase in spirituality due to mindfulness meditation, the clinical significance of these findings remains uncertain. Moreover, mindfulness meditation's ties to Buddhism are disputed, and its roots are intertwined with various psychotherapy traditions that incorporate spirituality. The role of secularism in psychotherapy is also debated in France, emphasizing the need for proper use and regulation policy rather than prohibition of mindfulness-based approaches. This study highlights the complexity of assessing the impact of mindfulness meditation on spirituality and religiosity. It suggests that a pragmatic approach focusing on risk and harm reduction may be more suitable than labeling the practice as "at risk". Further research is needed to clarify these issues in the specific cultural context of France.

The link between spirituality and longevity.

We are facing an inverted demographic pyramid with continuously growing aged populations around the world. However, the advances that prolong physical life not always contemplate its psychological and social dimensions. Longevity is a complex outcome influenced by a wide range of factors, including genetics, lifestyle choices, access to healthcare, socio-economic conditions, and other environmental factors. These factors have been generally considered in the compelling research that seeks the determinants of longevity, particularly those concerning personal lifestyle choices, socioeconomic conditions, and molecular mechanisms proposed to mediate these effects. Nonetheless, fundamental aspects that can affect health and well-being, such as spirituality and religiosity, have been somehow left aside despite numerous epidemiological studies showing that higher levels of spirituality/religiosity are associated with lower risk of mortality, even after adjusting for relevant confounders. Because spirituality/religiosity are dimensions of great value for patients, overlooking them can leave them with feelings of neglect and lack of connection with the health system and with the clinicians in charge of their care. Integrating spirituality and religiosity assessment and intervention programs into clinical care can help each person obtain better and complete well-being and also allowing clinicians to achieve the highest standards of health with holistic, person-centered care. The present narrative review aims to explore the available evidence of a relationship between spirituality/religiosity and longevity and discusses the possible mechanisms that can help explain such relationship.

Placing the US Federal Investment in Religion, Spirituality, and Health Research in Context: A Systematic Review and Comparison with Social Support and Optimism Funding Levels.

Religion and spirituality (R/S) have been linked to better physical and mental health. The US government has funded several research studies that include a focus on R/S but the amount of support over the last several years appears to be declining. To better understand these funding trends for R/S and health research, we chose relevant comparisons from projects that include a focus on social support and optimism. We identified total amount of funding, change in funding patterns over time, and characteristics of funded projects from a large database of US research projects (Federal RePORTER). We reviewed 5093 projects for social support and 6030 projects for optimism before narrowing the number of eligible studies to 170 and 13, respectively. Social support projects received the largest investment of $205 million dollars. Funded awards for social support and optimism remained stable over time while R/S decreased (p = 0.01), intervention research was more characteristic and studies of African-American/Black participants were less characteristic of funded projects in social support than of R/S (ps < 0.001). Future research for R/S and health would likely benefit from continued focus on minority communities and on identifying and developing appropriate interventions to support individual and community health and well-being.

Military Perspectives on the Provision of Spiritual Care in the Australian Defence Force: A Cross-Sectional Study.

A module to explore perspectives on chaplaincy services was included in an online enterprise survey randomly distributed to members of the Australian Defence Force (ADF) during 2021. Up to eight questions were answered by 2783 active military personnel relating to their perception of chaplain activities and the impact of chaplaincy services. Of those military participants answering the question on religious status (n = 1116), a total of 71.6% (n = 799) of respondents identified as non-religious while 28.4% (n = 317) identified as holding a religious affiliation. Approximately 44.2% (n = 1230) of participants had sought support from a chaplain, of which 85.3% (n = 1049) found chaplaincy care to be satisfactory or very satisfactory. While the data suggest there is a lack of clarity around the multiple roles undertaken by chaplaincy, nevertheless respondents were just as likely to prefer chaplains for personal support (24.0%), as they were to seek help from non-chaplaincy personnel such as a non-ADF counsellor (23.2%), their workplace supervisor (23.1%) or a psychologist (21.8%). This evidence affirms that the spiritual care provided by military chaplaincy remains one of several preferred choices and thus a valued part of the holistic care provided by the ADF to support the health and wellbeing of its members.

Meeting the Religious and Cultural Needs of Patients at Different Points in Their Care.

True holistic care implies an in-depth assessment and understanding of patient needs based on their physical, social, psychological, and spiritual makeup. These parameters are affected by their native culture as well as their adopted culture. The culture of a patient is composed of beliefs, values, and lifestyles. Understanding the general elements of specific cultures and religions can provide a basis for more insightful inquiry with patients regarding their preferences in health care. This article includes basic beliefs and practices related to 5 patient populations.

Spirituality, Mental Health, and COVID-19.

This issue of JORH presents a broad range of articles that consider spirituality and spiritual care from various international perspectives. It also looks at a diverse range of articles relating to mental health disorders and addictions. Lastly, this issue considers the aftermath of COVID-19. Readers are also reminded of the European Congress on Religion, Spirituality, and Health (ECRSH) (Salzburg, Austria), as well as the inaugural International Moral Injury and Wellbeing Conference (IMIWC), Brisbane, Australia, 2024.

The Place of Religiosity and Spirituality in Frankl's Logotherapy: Distinguishing Salvific and Hygienic Objectives.

The relationship between psychology and religion has been widely debated in the field of psychology from its foundation as an empirical science to the present day. One author who was interested in the relationship between psychology and religion, the place of the latter in human nature, and its role in psychotherapy was the Viennese neurologist, psychiatrist, and philosopher Viktor Emil Frankl (1905-1997), the founder of logotherapy. This paper presents Frankl's main ideas about religion, the religious nature of the human being, and the relationship between religiosity, psychotherapy, and logotherapy, as well as a review of the main criticisms he has received in this regard. Frankl always defended the differences and limits between religion and psychotherapy, between the priestly cure of souls and the medical cure of souls, and between the salvific objective of religion and the hygienic objective of psychotherapy. In our opinion, critical authors have failed to appreciate Frankl's efforts to expose this distinction.

Prostate Cancer and Spirituality: A Systematic Review.

The diagnosis, treatment, and sequels of cancer are relevant sources of stress, conflicts, and suffering, but spirituality may be a positive coping element. However, studies involving the correlation between prostate cancer patients and spirituality are few and heterogeneous. MEDLINE (PUBMED), SCOPUS, and EMBASE were the databases used for this review with the keywords "spirituality," "religion," and "prostate cancer." The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. About 250 articles were found, and 30 were eligible. Most studies (N = 26; 86.6%) reported the relationship between spirituality and better health findings such as 80% being positively associated with more screening for prostate cancer and better patients' quality of life. More interventional, randomized, and multicentric trials are needed to clarify this relationship.

Methodological Exclusion of the Transcendent? Implications for Theory and Research in Religion, Spirituality and Health.

Early in the founding of psychology of religion, a debated issue was the methodological exclusion of the transcendent (MET). While cautiously endorsed by Theodore Flournoy, others, notable William James and Frederic Myers, refused to be limited by this principle. This paper discusses (a) what is MET as proposed by Flournoy and the reasons he provided to adopt it, (b) problems with MET, implications for research and theory in religion/spirituality and health, and why the transcendent should be included in psychological, medical and other academic research and theory on spiritual experiences (SE), and (c) some methodological guidelines perform it fruitfully.

Existential meaning, spiritual unconscious and spirituality in Viktor Frankl.

There is robust evidence to support the relationship between spirituality and mental health, but the mechanisms of this association are not well-understood. The existential meaning provided by spirituality may be one of these mechanisms. This was the central theme of Viktor Frankl's psychology, which he explained using the notion of the spiritual unconscious. Thus, we sought to explain how Frankl understands this spiritual unconscious and the two pieces of evidence he presents for its existence: the phenomenological description of responsible action and the analysis of dreams. Lastly, we discuss his contribution to the current understanding of the relationship between having an overarching purpose and/or religious meaning and improvement in mental health.

Holistic care in healthy aging: Caring for the wholly and holy human.

Health care should address the holistic gap between health outcomes, spirituality, religion, and humanistic care to optimize patient care. Treating the whole person encompasses both physical and metaphysical elements. Patients want health care professionals to recognize their spiritual and religious preferences, because these matter in their approach to illness, coping, and long-term outcomes.

Religion, Spirituality, and Health Revisited: Bringing Mainline Western Protestant Perspectives Back into the Discourse-Theology's "Seat at the Table".

Theological perspectives have been given short shrift in the literature on religion and health research. This study demonstrates how including different schools of mainline Western Protestant theological thought (evolutionist, correlationist, and dialectical) in the scientific process could contribute to clarifying controversies. The issue is not just theoretical: Theology can even challenge assumptions on elicitability and reproducibility. Theology perceives spirituality as a dialogue with the Total Other, thus making each encounter with the transcendent (not just the individuality of the person) unique and unpredictable. By accepting setbacks on a journey with wide-ranging aspirations, theology redefines health as the momentum of constant striving toward the divine spirit. Since these theological insights relate to interventions that affect patients' intimacy, attempting to recognize the (albeit implicit) spiritual-theological standpoint of the patient and the self-and how these relate to authentic traditions of spirituality-appears to be an essential prerequisite for ethical spiritual intervention.

Associations of religious and existential variables with psychosocial factors and biomarkers of cardiovascular risk in bereavement.

Bereavement increases in prevalence as people age and is associated with multiple psychological and health risks, including cardiovascular risk. Religious and existential variables may play an important role in the health impacts of bereavement. Theorized pathways linking religious and existential variables with health have suggested these associations are due to intermediary psychosocial variables, but have not been tested in bereavement. This research empirically tested these pathways in a bereaved population. In N = 73 adults within 1 year of bereavement (mean age = 64.36), this study examined associations between (1) religious and existential characteristics (religious and spiritual struggles, intrinsic religiosity, and existential quest) and intermediary psychosocial variables (depression, loneliness, and difficulties in emotion regulation), and between (2) intermediary psychosocial variables and bereavement-relevant health outcomes (self-reported health, change in health since last year, grief severity, and cardiovascular biomarkers). Cardiovascular biomarkers (heart rate, heart rate variability, and blood pressure) were collected before, during, and after a laboratory grief recall emotion elicitation. Anticipated associations between self-reported religious and existential characteristics and intermediary variables, and between intermediary variables and self-reported bereavement-relevant outcomes, were consistently observed. However, associations between intermediary variables and cardiovascular biomarkers were largely unobserved. This study examined the role of religious and existential variables in whole-person health after bereavement and is among the first to include biomarkers of cardiovascular risk. Results suggest that although religious and existential variables are associated with important bereavement-related outcomes, these associations may be "skin-deep," and extensions to cardiovascular functioning should be re-examined.