Mental health professionals' perspectives on the relevance of religion and spirituality to mental health care.

BACKGROUND: A large body of evidence indicates that spiritual and religious backgrounds, beliefs, and practices (SRBBPs) are related to better psychological health. Spirituality and religion (R/S) are also important aspects of multicultural diversity. There is evidence that clients would like to talk about their spirituality, and that including it in assessment and treatment planning can be beneficial. However, the extent to which practicing mental health professionals view SRBBPs as relevant to mental health and clinical practice is unclear. METHODS: A survey examining several aspects of addressing SRBBPs in clinical practice was distributed to 894 professionals across mental health disciplines, including psychiatry, psychology, social work, marriage family therapy, licensed professional counselors, certified chemical dependency counselors, and psychiatric mental health nurses. RESULTS: 89% of mental health professionals agreed that clinicians should receive training in R/S competencies. There were no differences between mental health disciplines in ratings of importance of such training. Younger individuals and those who identify as more spiritual were more likely to consider R/S training as important. Although 47.1% of professionals had not received much R/S training, many perceived themselves to be highly competent in R/S clinical integration practices (57.8% considered themselves able to display them very much or completely). In addition, respondents with more R/S training evaluated themselves as more proficient in R/S clinical integration. Nearly two-thirds (65.2%) of respondents reported encountering few to no barriers to engaging in R/S competent mental health care. CONCLUSIONS: There is a growing consensus among mental health care professionals that mental health professionals should be trained in R/S competencies. Strong agreement exists that basic R/S competencies include respect, empathy, examination of bias, and routine assessment of R/S in mental health care. Four in five of those surveyed agree that more active competencies, such as identifying and addressing religious and spiritual struggles and problems and helping clients explore and access R/S strengths and resources should be included, whereas one in five report less comfort with these competencies.

La dimensión espiritual en el anciano desde el modelo de la gerotrascendencia y su abordaje desde la terapia ocupacional: revisión bibliográfica / A dimensão espiritual nos idosos a partir do modelo de gerotranscendência e sua abordagem a partir da terapia ocupacional: uma revisão da literatura / The spiritual dimension in the elderly from the model of gerotranscendence and its approach from Occupational Therapy: a literature review

Resumen Introducción El campo de estudio del envejecimiento conoce un marco teórico conocido como gerotrascendencia. La gerotrascendencia entiende la vejez como la etapa final de una progresión natural que lleva a alcanzar la madurez y la sabiduría. La ancianidad es, así, una etapa de introspección entendida como espiritualidad que se explica también en un contexto religioso. Objetivo Comprobar desde la literatura científica la implementación de la gerotrascendencia y sus aspectos fundamentales en el marco de la terapia ocupacional. Metodología Estudio bibliográfico ejecutado por un estudio previo de Google Trends para conocer el tráfico de datos. Su usan bases de datos especializadas en ciencias de la salud (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos e IBECS), en el área de psicología (Psicodoc, PsycArticles, PsycBooks, PsycInfo y Psychology and Behavioral Sciences Collection), y multidisciplinares (Google Scholar, Web of Science y Scopus) a partir de una exploración booleana/frase (operadores: AND, OR, NOT). Se utilizan los tesauros especializados (MeSH, DeCS y HONselect) usando palabras clave en español e inglés: gerotrascendencia, enfermería, terapia ocupacional. El uso de bases de datos y un sistema de cribado basado en objetivos da como resultado el estudio especifico de seis artículos. Resultados La gerotrascendencia conoce una bibliografía consolidada en inglés, pero que es casi inexistente en español. De entre los estudios en español existen estudios sólidos con resultados que plantean una alternativa a los modelos materialistas que plantean un enfoque que se reducen al paradigma biomédico. Estos estudios plantean una ética de las necesidades y un enfoque centrado en la atención al usuario, donde la espiritualidad (religión interna) y su vivencia religiosa externa tienen una gran importancia. Conclusión La terapia ocupacional no puede olvidar los modelos teóricos centrados en la persona, de modo que puedan salir del corsé biomédico, al que pertenecen, pero al que no se reducen. Parece necesario realizar más abordajes teóricos y estudios cuantitativos y cualitativos que revelen la operatividad de la implementación de modelos que entiendan la fenomenología del envejecimiento de forma holística, como es el caso de la gerotrascendencia.

Resumo Introdução O campo de estudo do envelhecimento está familiarizado com uma estrutura teórica conhecida como gerotranscendência. A gerotranscendência entende a velhice como o estágio final de uma progressão natural em direção à maturidade e à sabedoria. A velhice é, portanto, um estágio de introspecção entendido como espiritualidade que também é explicada em um contexto religioso. Objetivo Verificar na literatura científica a implementação da gerotranscendência e seus aspectos fundamentais no âmbito da terapia ocupacional. Metodologia Estudo bibliográfico realizado por um estudo prévio do Google Trends para conhecer o tráfego de dados. Utiliza bases de dados especializadas em ciências da saúde (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos e IBECS), na área de psicologia (Psicodoc, PsycArticles, PsycBooks, PsycInfo e Psychology and Behavioral Sciences Collection) e multidisciplinar (Google Scholar, Web of Science e Scopus) com base em uma exploração booleana/frase (operadores: AND, OR, NOT). São usados tesauros especializados (MeSH, DeCS e HONselect) usando palavras-chave em espanhol e inglês: gerotranscendência, enfermagem, terapia ocupacional. O uso de bancos de dados e um sistema de triagem baseado em metas resulta no estudo específico de seis artigos. Resultados A gerotranscendência tem uma bibliografia consolidada em inglês, mas é quase inexistente em espanhol. Entre os estudos em espanhol, há estudos sólidos com resultados que propõem uma alternativa aos modelos materialistas que propõem uma abordagem que se reduz ao paradigma biomédico. Esses estudos propõem uma ética das necessidades e uma abordagem centrada no usuário, em que a espiritualidade (religião interna) e a experiência religiosa externa são de grande importância. Conclusão A terapia ocupacional não pode se esquecer dos modelos teóricos centrados na pessoa, para que ela possa sair do espartilho biomédico, ao qual pertence, mas ao qual não se reduz. Parece necessário realizar mais abordagens teóricas e estudos quantitativos e qualitativos que revelem a operacionalidade da implementação de modelos que compreendam a fenomenologia do envelhecimento de forma holística, como é o caso da gerotranscendência.

Abstract Introduction The field of the study of ageing is familiar with a theoretical framework known as gerotranscendence. Gerotranscendence understands old age as the final stage of a natural progression towards maturity and wisdom. Old age is thus a stage of introspection understood as spirituality explained in a religious context. Objective To verify from the scientific literature the implementation of gerotranscendence and its fundamental aspects within the occupational therapy framework. Methodology Bibliographic study carried out by a previous study of Google Trends to know the data traffic. It uses databases specialised in health sciences (Pubmed, Medline, EMBASE, CINAHL complete, LILACS, Medes, CUIDENplus, Cuidatge, Cochrane Library, Trip medical database, Epistemonikos and IBECS) in the area of psychology (Psicodoc, PsycArticles, PsycBooks, PsycInfo and Psychology and Behavioral Sciences Collection), and multidisciplinary (Google Scholar, Web of Science and Scopus) based on a Boolean/phrase exploration (operators: AND, OR, NOT). Specialised thesauri (MeSH, DeCS and HONselect) are used using keywords in Spanish and English: gerotranscendence, nursing, and occupational therapy. The use of databases and a target-based screening system results in the specific study of six articles. Results Gerotranscendence has a consolidated bibliography in English but is almost nonexistent in Spanish. Among the studies in Spanish, there are solid studies with results that propose an alternative to the materialistic models that propose an approach that is reduced to the biomedical paradigm. These studies propose an ethics of needs and a user-centred approach, where spirituality (internal religion) and external religious experience are essential. Conclusion: Occupational therapy must remember the theoretical models centred on the person so that they can get out of the biomedical corset to which they belong but to which they are not reduced. It seems necessary to carry out more theoretical approaches and quantitative and qualitative studies that reveal the operability of implementing models that holistically understand the phenomenology of ageing, as is the case of gerotranscendence.

Gênero e suas implicações nas práticas religiosas: Estudo exploratório entre universitários brasileiros / GENDER AND ITS IMPLICATIONS FOR RELIGIOUS PRACTICES: EXPLORATORY STUDY AMONG BRAZILIAN UNIVERSITIES / GÉNERO Y IMPLICACIONES EN LAS PRÁCTICAS RELIGIOSAS: ESTUDIO EXPLORATORIO ENTRE UNIVERSITARIOS BRASILEÑOS

As social practices, religions reproduce discourses that reflect society. This study aimed to analyze the gender's implications for the religious practices of a group of Brazilian university men and women. Five hundred and sixty-one university students from different undergraduate programs from all regions of Brazil participated in the study, selected through a convenience sample, who answered a virtual form with 48 questions, analyzed using descriptive statistics. The results show the importance of religiosity in the daily life of Brazilian university students and reveal the differences in the way men and women conceive and put it into practice. Women consider themselves more religious and have a greater repertoire of reli-gious beliefs and practices than men, using them more often as a support for the challenges of university life. The data also reveal the importance of proposals that allow for spaces for the discussion of religiosity at the university level.

Como práticas sociais, as religiões reproduzem discursos que refletem a sociedade. Este estudo teve como objetivo analisar as implicações de gênero nas práticas religiosas de um grupo de homens e mulheres universitários brasileiros. Participaram 561 estudantes de diferentes cursos de graduação, selecionados por meio de amostra de conveniência, os quais responderam a um formulário virtual com 48 questões, analisadas por meio de estatística descritiva. Os resultados evidenciam a importância da religiosidade no cotidiano de estudantes universitários e revelam diferenças no modo como homens e mulheres a conce-bem e colocam em prática. As mulheres consideram-se mais religiosas e também possuem um maior re-pertório de crenças e práticas religiosas do que os homens, utilizando-as de forma mais recorrente como suporte para os desafios da vida universitária. Os dados também revelam a importância de propostas que abram espaços para a discussão sobre as religiosidades no âmbito universitário.

Como prácticas sociales, las religiones reproducen discursos que reflejan la sociedad. Este estudio buscó analizar las implicaciones de género en las prácticas religiosas de un grupo de universitarios brasileños. Participaron 561 estudiantes universitarios de diferentes carreras de todas las regiones de Brasil, seleccio-nados a través de una muestra de conveniencia, quienes respondieron un formulario virtual con 48 pre-guntas, analizadas mediante estadística descriptiva. Los resultados muestran la importancia de la religio-sidad en la vida cotidiana de los estudiantes universitarios brasileños y revelan las diferencias en la forma en que hombres y mujeres conciben y ponen en práctica su vida religiosa. Las mujeres se consideran a sí mismas más religiosas y tienen un mayor repertorio de creencias y prácticas religiosas que los hombres, utilizándolas con mayor frecuencia como apoyo para los desafíos de la vida universitaria. Los datos tam-bién revelan la importancia de mayores inversiones en acciones y propuestas que abran espacios para la discusión de la religiosidad a nivel universitario.

Prevalence of spiritual and religious experiences in the general population: A Brazilian nationwide study.

Spiritual and religious experiences (SREs) are common subjective phenomena related to the awareness of transcendence, which transforms one's perception of life, death and suffering. Despite the high prevalence of SREs worldwide, not enough studies have been conducted beyond Europe and North America. To fill this gap, this study investigates the prevalence of SREs in Brazil and their association with socio-demographic variables. This online cross-sectional study includes participants from all regions of Brazil. Sixteen SREs were investigated, being categorized into 4 groups: mystical, mediumistic, psi-related and past life/near-death experiences. Prevalence was calculated as percentages and multinomial logistic regression models were used. A total of 1,053 Brazilians were included; 92% reported one SRE in their lifetime and 47.5% experienced at least one SRE frequently. Participants reported having had at least one mystical experience (35%), one psi-related experience (27.7%), and one mediumistic experience (11%). Half the sample had "felt the presence of a dead person" and 70% experienced precognitive dreams at least once. In a multivariate analysis, SREs were associated with the female gender but showed no associations with income, education, employment status and ethnicity. Mystical experiences were associated with age 55 and older. In summary, SREs are very prevalent across different strata of the population, and deserve more attention from researchers and clinicians in order to clarify their nature and implications for mental health care and research in Brazil.

Defining Spirituality in Healthcare: A Systematic Review and Conceptual Framework.

Objective: To investigate the definitions of spirituality in the healthcare field, identifying its main dimensions and proposing a framework that operationalizes the understanding of this concept. Methods: This is a systematic review following the PRISMA guideline (PROSPERO: CRD42021262091), searching for spirituality definitions published in scientific journals. Searches were carried out in PubMed (all articles listed up to October 2020) and in the reference lists of the articles found in the database, followed by selection under specific eligibility criteria. Results: From a total of 493 articles, 166 were included in the final analysis, showing that there is a large body of scientific literature proposing and analyzing spirituality definitions. In these articles, 24 spirituality dimensions were found, most commonly related to the connectedness and meaning of life. Spirituality was presented as a human and individual aspect. These findings led us to construct a framework that represents spirituality as a quantifiable construct. Conclusions: Understanding spirituality is an important aspect for healthcare research and clinical practice. This proposed framework may help to better understand the complexity of this topic, where advances are desirable, given the relevance it has acquired for integral health care.

Experiências anômalas e dissociativas em contexto religioso: uma abordagem autoetnográfica / Anomalous and dissociative experiences in a religious context: an autoethnographic approach / Experiencias anómalas y disociativas en un contexto religioso: un enfoque autoetnografico

A presente pesquisa investigou as características fenomenológicas das experiências anômalas (EAs) relatadas em contextos mediúnicos umbandistas, a partir de uma comparação entre EAs reportadas durante rituais envolvendo o uso da substância Ayahuasca e rituais sem o uso dessa substância. Para tanto, comparamos indivíduos com diferentes graus de envolvimento com as práticas mediúnicas umbandistas, tendo por base uma abordagem autoetnográfica. A perspectiva metodológica adotada nos permitiu confrontar os dados subjetivos com o conhecimento disponível na literatura acadêmica acerca das EAs, dos fenômenos dissociativos e estados alterados de consciência, tendo sido fundamental para uma compreensão mais sensível das nuances e características dessas experiências. Os relatos analisados atestam uma semelhança significativa entre as experiências vivenciadas com e sem o uso de Ayahuasca em contextos mediúnicos. Em ambos os casos, os experienciadores puderam reconhecer similaridades no que diz respeito à redução do controle motor, às alterações perceptivas e mnêmicas experimentadas, à comunicabilidade da experiência, à recepção anômala de informação e a um aumento da sensibilidade interpessoal. Os resultados indicam a viabilidade metodológica da autoetnografia como recurso para um aprofundamento de aspectos das EAs e outras experiências subjetivas usualmente de difícil investigação por outros métodos.

The present study explored the phenomenological characteristics of anomalous experiences (AEs) reported during Umbanda rituals, a mediumistic Brazilian religion, with the aim of comparing AEs reported during rituals involving the use of Ayahuasca (an entheogen frequently used in some Umbanda contexts) and rituals without the use of this substance. In order to do so, we compared individuals with different levels of involvement with the mediumistic practices. The study was based on an auto-ethnographic approach. This methodological perspective allowed us to confront subjective data with the available knowledge in the scientific literature about AEs, dissociative phenomena and altered states of consciousness and was of fundamental importance for a more sensitive understanding of the nuances and characteristics of these experiences. The results attest to a significant similarity between the experiences reported with and without the use of Ayahuasca in mediumistic contexts. In both groups, the experiencers were able to identify certain similarities in their experiences regarding a reduction of voluntary motor control, changes in memory and perception, communicability and accessibility of experiences, anomalous information reception and increases in interpersonal sensitivity. The results support the methodological feasibility of autoethnography as a research tool and point to its relevance to a deeper understanding of AEs and other subjective experiences usually of difficult investigation by other research methods.

En la presente investigación se analiso las características fenomenológicas de experiencias anómalas (EAs) relatadas en contextos mediúmnicos umbandistas por medio de una comparación entre EAs reportadas durante rituales con el uso de la sustancia Ayahuasca y rituales sin el uso de esa sustancia. Para alcanzar ese objectivo, comparamos algunas caracteristicas de individuos con diferentes grados de involucracion con las prácticas mediúmnicas. Utilizamos un enfoque autoetnográfico. La perspectiva metodológica adoptada nos permitió evaluar los datos subjetivos con el conocimiento disponible en la literatura académica acerca de las EAs, de los fenómenos disociativos y los estados alterados de conciencia. Este acercamiento metodológico fue fundamental para una comprensión más sensible de los matices y características de las experiencias investigadas. Los relatos analizados atestiguan una similitud significativa entre las experiencias vivenciadas con y sin el uso de Ayahuasca en contextos mediúmnicos. En ambos casos, los participantes reconoceran similitudes en lo que se refiere a la reducción del control motor, a las alteraciones perceptivas y mnémicas experimentadas, a la comunicabilidad de la experiencia, a la recepción anómala de información, y un aumento de la sensibilidad interpersonal. Los resultados indican la viabilidad metodológica de la autoetnografía como recurso para una compreension profunda de aspectos de las EAs y otras experiencias subjetivas usualmente de difícil investigación por otros métodos.

Na sala de espera do terreiro: uma investigação com adeptos da umbanda com queixas de adoecimento / In the waiting room of the terreiro: an investigation with Umbanda adepts with health complaints

Resumo As queixas de adoecimento fazem parte de uma importante parcela das demandas religiosas em diversas crenças, com destaque para a umbanda no cenário brasileiro. O objetivo deste estudo etnopsicológico foi conhecer o modo como adeptos da umbanda com queixas de adoecimento compreendem os processos de saúde-doença. Participaram 20 adeptos atendidos em dois terreiros localizados em uma cidade de médio porte do estado de Minas Gerais, Brasil. O corpus foi composto por entrevistas semiestruturadas transcritas e organizadas pela análise temática. Destacam-se as ambivalências no processo de compreensão do adoecimento e das trajetórias terapêuticas que permeiam os relatos desses adeptos. Em que pesem as explicações de ordem médica, ligadas ao corpo físico e aos medicamentos, também emergem narrativas espirituais relativas ao mundo interno e à saúde mental. E não obstante as referências ao trabalho das entidades incorporadas, também são resgatadas críticas ao modo como profissionais de saúde se distanciam da religiosidade/espiritualidade - tanto a sua como a do paciente. Apesar dessas ambivalências, os adeptos expressam uma noção integrada de saúde quando buscam atendimento no terreiro, mesclando elementos científicos com expressões religiosas. Esse movimento reafirma a umbanda como um espaço de acolhimento da diversidade, em que diferentes racionalidades podem conviver.

Abstract Health complaints are an important part of the religious demands of various beliefs, especially Umbanda in Brazil. This ethnopsychological study analyzes how Umbanda adepts with health complaints perceive the health-disease process. A total of 20 Umbanda practitioners from two terreiros located in a medium-sized municipality in the state of Minas Gerais, Brazil, were selected as participants. The corpus was constituted by semi-structured interviews transcribed and organized according to the thematic analysis. Ambivalence was observed in the process of understanding the illness and the therapeutic trajectories embedded in the reports of these followers,. From such medical explanations related to the physical body and medicine also emerge spiritual narratives related to the inner world and to mental health. Despite referencing the work of incorporating entities, criticism is also given to the way health professionals distance themselves from religiosity/spirituality, both their own and that of the patient. Regardless of such ambivalence, these adepts express an integrated notion of health when they seek care in the terreiro, mixing formal and scientific elements with religious expressions, wherein Umbanda is a safe space for this diversity. This movement reaffirms Umbanda as a diverse space in which different kinds of reasoning can live.

A religiosidade/espiritualidade (R/E) como componente curricular na graduação em Psicologia: relato de experiência / The religiosity/spirituality (R/S) as a curricular component in the Psychology course: experience report / La religiosidad/espiritualidad (R/E) como componente curricular en el pregrado en Psicología: relato de experiencia

Temas como religião, religiosidade e espiritualidade estão presentes na vivência subjetiva das pessoas e são frequentemente debatidos pelos Conselhos de Psicologia, embora tal discussão seja considerada insuficiente na formação em Psicologia. Reconhecendo as evidências que sugerem relações positivas entre essas dimensões e a saúde física e mental e a lacuna no tema na graduação em Psicologia, objetiva-se apresentar um relato de experiência da inclusão da temática, como disciplina eletiva, para 20 alunos da Universidade Federal do Triângulo Mineiro, no 1º semestre de 2017. Como forma de avaliação dessa experiência, foi aplicado um questionário com 10 questões abertas com perguntas versando sobre expectativas em relação à disciplina, avaliação sobre o conteúdo ofertado, definição de religiosidade e espiritualidade, contribuições enquanto futuro psicólogo, a importância de uma disciplina que aborde a temática na formação, além de dados para caracterização dos sujeitos. As respostas foram categorizadas e apresentadas em quatro eixos temáticos: (a) Religiosidade e espiritualidade para alunos de graduação, (b) Expectativas em relação à disciplina, (c) Ausência de conteúdos relacionados ao tema durante a graduação e (d) Importância da disciplina no currículo de Psicologia. Conclui-se que a experiência possibilitou aos alunos aprendizados e conscientização a cerca da importância dessa temática na Psicologia.

Topics such as religion, religiosity and spirituality are present in the subjective experience of people and are often discussed by the Psychology Council, although such discussion is considered insufficient in a Psychology undergraduate degree. Recognizing the evidences that suggest positive relations between these dimensions and the physical and mental health and the gap in the subject in the Psychology course, the objective is to present an experience report of the inclusion of the theme, as an elective subject for 20 students from the Federal University of the Triângulo Mineiro, in the 1st semester of 2017. As a way of evaluating this experience, a questionnaire was applied with 10 open questions about expectations regarding the subject, evaluation on the content offered, definition of religiosity and spirituality, contributions as a future psychologist, the importance of a discipline that addresses the theme in the formation, besides data for characterization of the subjects. The answers were categorized and presented in four thematic axes: (a) Religiosity and spirituality for undergraduate students; (b) Expectations regarding the subject; (c) Absence of content related to the subject during graduation; (d) Importance of the discipline in the Psychology curriculum. It is concluded that the experience enabled the students to learn and raise awareness about the importance of this subject in Psychology.

Temas como religión, religiosidad y espiritualidad están presentes en la vivencia subjetiva de las personas y son frecuentemente debatidos y discutidos por los Consejos de Psicología, tal discusión es considerada insuficiente durante la formación en Psicología. Reconociendo las evidencias que sugieren relaciones positivas entre esas dimensiones y la salud física y mental y la brecha sobre esa discusión en el pregrado en Psicología, este articulo tiene como objetivo presentar un relato de experiencia de la inclusión de la temática, como disciplina electiva, para 20 alumnos de la Universidad Federal del Triángulo Minero, en el primer semestre de 2017. Como forma de evaluación de esta experiencia, se aplicó un cuestionario con 10 preguntas abiertas versando sobre expectativas en relación a la disciplina, evaluación sobre el contenido ofrecido, definición de religiosidad y espiritualidad, contribuciones como futuro psicólogo, la importancia de una disciplina que aborde la temática en la formación, además de datos para caracterización de los sujetos. Las respuestas fueron categorizadas y presentadas en cuatro ejes temáticos: (a) Religiosidad y espiritualidad para alumnos de pregrado, (b) Expectativas en relación a la disciplina, (c) Ausencia de contenidos relacionados al tema durante la formación y (d) Importancia de la disciplina en el currículo de Psicología. Se concluye que la experiencia posibilitó a los alumnos aprendizaje y concientización sobre la importancia de esta temática en la Psicología.

The free spirit: spiritualism meanings by a Nursing team on psychiatry / El espíritu suelto: significados de espiritualidad por equipo de enfermería en psiquiatría / O espírito solto: significados de espiritualidade por equipe de enfermagem em psiquiatria

ABSTRACT Objective: To analyze the meanings attributed by nursing professionals in psychiatry to spirituality and its relationship with care. Method: Clinical-qualitative, with appreciation of symbolic meanings. We interviewed 18 individuals for a semi-structured script of open questions and the data were analyzed in the light of psychoanalytic hermeneutics. The discussion was undertaken with the overlap of understanding of the sacred symbol, psychological and the meaning of life. Results: Different spiritualities are interposed by personal restlessness and the experience of transience. Spirituality aids in social functions, personal balance and commitment to endure the anguish of transience. Among professionals, it has been shown as an ethical-combative attitude to evil forms, but there is a restriction in dealing with patients' spirituality. Final considerations: The meanings pointed to the limits of human reason, resembling caregivers and patients in subjective conditions by which they avoid spirituality in psychiatry. It is suggested that spiritual attention be given to professionals.

RESUMEN Objetivo: Analizar los significados atribuidos por profesionales de enfermería en psiquiatría a la espiritualidad y su relación con el cuidado. Método: Clínico-cualitativo, con estimación de los significados simbólicos. Fueron entrevistados 18 sujetos por un itinerario semiestructurado de preguntas abiertas y los datos analizados a la luz de la hermenéutica psicoanalítica. La discusión se emprendió con la superposición del entendimiento del símbolo sagrado, psicológico y del sentido de la vida. Resultados: Distintas espiritualidades se interponen por la inquietud personal y la experiencia con la transitoriedad. La espiritualidad ayuda en las funciones sociales, en el equilibrio personal y en el empeño en soportar las angustias de la transitoriedad. Entre los profesionales se mostró como una actitud ético-combativa a las formas maléficas, pero hay restricción en trabajar con la espiritualidad de los pacientes. Consideraciones finales: Los significados señalaron los límites de la razón humana, asemejando cuidadores y pacientes en condiciones subjetivas por las que evitan la espiritualidad en la psiquiatría. Se sugiere atención espiritual para los profesionales.

RESUMO Objetivo: Analisar os significados atribuídos por profissionais de enfermagem em psiquiatria à espiritualidade e sua relação com o cuidado. Método: Clínico-qualitativo, com apreciação dos significados simbólicos. Entrevistou-se 18 sujeitos por um roteiro semiestruturado de questões abertas e os dados foram analisados à luz da hermenêutica psicanalítica. A discussão se empreendeu com a sobreposição do entendimento do símbolo sagrado, psicológico e do sentido da vida. Resultados: Distintas espiritualidades se interpõem pela inquietação pessoal e a experiência com a transitoriedade. A espiritualidade ajuda nas funções sociais, no equilíbrio pessoal e no empenho em suportar as angústias da transitoriedade. Entre os profissionais, se mostrou como uma atitude ético-combativa às formas maléficas, mas há restrição em lidar com a espiritualidade dos pacientes. Considerações finais: Os significados apontaram para os limites da razão humana, assemelhando cuidadores e pacientes em condições subjetivas pelas quais evitam a espiritualidade em psiquiatria. Sugere-se atenção espiritual para os profissionais.

Patients' and caregivers' needs, experiences, preferences and research priorities in spiritual care: A focus group study across nine countries.

BACKGROUND: Spiritual distress is prevalent in advanced disease, but often neglected, resulting in unnecessary suffering. Evidence to inform spiritual care practices in palliative care is limited. AIM: To explore spiritual care needs, experiences, preferences and research priorities in an international sample of patients with life-limiting disease and family caregivers. DESIGN: Focus group study. SETTING/PARTICIPANTS: Separate patient and caregiver focus groups were conducted at 11 sites in South Africa, Kenya, South Korea, the United States, Canada, the United Kingdom, Belgium, Finland and Poland. Discussions were transcribed, translated into English and analysed thematically. RESULTS: A total of 74 patients participated: median age 62 years; 53 had cancer; 48 were women. In total, 71 caregivers participated: median age 61 years; 56 were women. Two-thirds of participants were Christian. Five themes are described: patients' and caregivers' spiritual concerns, understanding of spirituality and its role in illness, views and experiences of spiritual care, preferences regarding spiritual care, and research priorities. Participants reported wide-ranging spiritual concerns spanning existential, psychological, religious and social domains. Spirituality supported coping, but could also result in framing illness as punishment. Participants emphasised the need for staff competence in spiritual care. Spiritual care was reportedly lacking, primarily due to staff members' de-prioritisation and lack of time. Patients' research priorities included understanding the qualities of human connectedness and fostering these skills in staff. Caregivers' priorities included staff training, assessment, studying impact, and caregiver's spiritual care needs. CONCLUSION: To meet patient and caregiver preferences, healthcare providers should be able to address their spiritual concerns. Findings should inform patient- and caregiver-centred spiritual care provision, education and research.

Significado de alucinação e mediunidade para profissionais da saúde mental de um hospital psiquiátrico e médiuns de um centro espírita de um município paulista / The meaning of hallucination and mediumship for mental health professionals from a pyschiatric hospital and mediums from a spiritist center in a city in the state of São Paulo

As pesquisas que estudam a relação entre fenômenos mediúnicos e saúde mental, embora tenham aumentado nas últimas décadas, ainda não produziram informações suficientes para a consolidação de práticas alternativas às tradicionais. Entretanto, a literatura aponta a necessidade de ampliar os dados por meio de pesquisas que aprofundem nessa temática. Realizou-se um estudo transversal de natureza exploratório-descritiva com abordagem qualitativa dos dados, com objetivo de investigar os significados de alucinação e mediunidade por médiuns de um centro espírita e profissionais da saúde mental de um hospital psiquiátrico de um município paulista. Foram entrevistados 10 médiuns e 10 profissionais de saúde. Utilizou-se como referencial teórico metodológico a abordagem Histórico-Cultural baseada na obra de Vigotski e os Núcleos de Significação de Wanda Aguiar e Sérgio Ozella baseados no referido autor. Foram construídos de três núcleos de significação: "Entre o real e o imaginário: alterações e perturbações"; "Entre o fenômeno e a religião: razão ou loucura"; e "Entre o patológico e o espiritual: fenômenos que se relacionam, mas são distintos". Os resultados demonstram que os médiuns significam a mediunidade com mais precisão do que os profissionais da saúde mental enquanto estes significam a alucinação conceitualmente com mais exatidão. Contudo os significados de alucinação para os médiuns e o de mediunidade para os profissionais não destoam, o que demonstra a disseminação cultural dos conceitos. A maioria dos médiuns e profissionais relataram ter dificuldade para distinguir os fenômenos pesquisados e referiram desconhecer a literatura produzida sobre o tema

Although research about the relationship of mediumic phenomena and mental health has grown in the past decades, it has yet to produce sufficient information for the consolidation of practices alternative to traditional ones. However, literature shows the need to expand data through research that can dive deeper into this topic. This work makes a transversal study of exploratory-descriptive nature, with qualitative approach of data, aiming to explore the meaning of hallucination and mediumship for mediums in a spiritist center and mental health professionals from a psychiatric hospital, in a city in the state of São Paulo. Ten mediums and ten health professionals have been interviewed. As theoretical reference, the Historic-Cultural approach based on Vigotski and the Nuclei of Meanings of Wanda Aguiar and Sérgio Ozella, based also on the said author, have been employed. Three Nuclei of Meanings have been developed: "Between real and imaginary: alterations and perturbations"; "Between phenomenon and religion: reason or insanity"; and "Between pathological and spiritual: related but distinct phenomena". Results show that mediums signify mediumship with more precision when compared to mental health professionals, while the latter signify hallucination conceptually with more accuracy. However, the meanings of hallucination for mediums and mediumship for mental health professionals do not diverge, showing the cultural dissemination of these concepts. Most mediums and mental health professionals report difficulty to distinguish the researched phenomena and claimed to ignore the literature produced about the topic

Corrigendum: Marital Satisfaction, Sex, Age, Marriage Duration, Religion, Number of Children, Economic Status, Education, and Collectivistic Values: Data from 33 Countries.

[This corrects the article on p. 1199 in vol. 8, PMID: 28785230.].

[Attitude towards organ and tissue donation in Europe : Prerequisite for osteochondral allograft treatment]. / Bereitschaft zur Organ- und Gewebespende in Europa : Voraussetzung für die Behandlung mit osteochrondralen Allografts.

BACKGROUND: The biggest obstacle to overcome for routine treatment of various pathologies with fresh osteochondral allograft is the availability of tissue for transplantation. Large fresh osteochondral allografts are usually harvested from organ donors, but in contrast to organs, tissues can be procured after cardiac arrest. OBJECTIVE: Medical staff as well the general public are much less aware of the possibilities and requirements of tissue donation compared to organ donation. This review aims to highlight the current situation of organ and tissue donation in Europe and to raise this much needed awareness. MATERIAL AND METHODS: For this research, PubMed database was scanned using the terms "tissue/organ donation", "bone donation/transplantation", "cartilage transplantation/allografts" and "osteochrondral allografts". RESULTS: Relatives of potential donors are often not approached because physicians and nurses do not feel sufficiently prepared for this task and, thus, are reluctant to address this topic. Different options could alleviate the pressure medical staff is feeling. Furthermore, there are different factors influencing consent that can be addressed to increase donation rates. CONCLUSION: Currently, a lot of potential concerning musculoskeletal tissue grafts remains unused. Most importantly, families should be encouraged to speak about their potenzial will to donate and educational programs should be established to increase trust in organ and tissue donation and the allocation system and to increase knowledge about the importance of transplantation medicine. But joined efforts of different parts of the medical systems and different organizations involved in tissue transplantation should improve the situation for patients waiting for much needed transplants.

Effect of a Faith-Based Education Program on Self-Assessed Physical, Mental and Spiritual (Religious) Health Parameters.

The aim of the study was to determine the effect of attending a faith-based education program (FBEP) on self-assessed physical, mental and spiritual health parameters. The study was designed as a prospective, observational, cohort study of individuals attending a 5-day FBEP. Out of 2650 sequential online registrants, those previously unexposed to the FBEP received automated invitations to complete 5 sequential Self-Assessment Questionnaire's (SAQ's) containing: (1) Duke University Religion Index (DUREL); (2) Negative Religious Coping (N-RCOPE); (3) Perceived Stress Scale (PSS); (4) Center for Epidemiology and Statistics-Depression Scale (CES-D); (5) Brief Illness Perception Questionnaire (BIPQ); and the (6) State Trait Anxiety Inventory (STAI). Pre-attendance SAQ (S1) was repeated immediately post-FBEP (S2), at 30 days (S3), 90 days (S4) and after 1 year (S5). Of 655 invited, 274 (42 %) succeeded, 242 (37 %) failed and 139 (21 %) declined to complete S1. Of the 274, 37 (14 %) were excluded at on-site interview; 26 (9 %) never attended the FBEP (i.e., controls: 5♂; 21♀; 27-76 years); and 211 (77 %) participated (i.e., cases: 105♂; 106♀; 18-84 years) and were analyzed over time: 211 (S1); 192 (S2); 99 (S3); 52 (S4); 51 (S5). IRB approval was via the Human Research Ethics Committee of Stellenbosch University. DUREL showed significant, sustained changes in Intrinsic Religiosity. N-RCOPE showed significant, lasting improvement. In others, median values dropped significantly immediately after the FBEP (S1:S2) for STAI-State p < 0.0001; PSS p < 0.0001; BIPQ p < 0.0001; and CES-D p < 0.0001; and at 1 month (S1:S3) for STAI-Trait p < 0.001; all changes were sustained (S3 through S5). This FBEP produced statistically and clinically significant changes; these lasted in those followed up >1 year.

Fenomenologia da percepção extracorpórea: análise de experiências fora do corpo / Phenomenology of extracorporeal perception: analysis of out-of-body experiences / Fenomenología de la percepción extracorpórea: análisis de experiencias fuera del cuerpo

Diversos autores apontam conceitos e etiologias para o fenômeno de Experiências Fora do Corpo (EFC). O presente artigo objetivou descrever e analisar as EFC a partir da experiência do vivido, elencando diferentes experiências denominadas EFC, comparando-as entre si e com o conceito científico de EFC, e investigando os sentidos dados a estas, bem como seu papel na vida cotidiana daqueles que alegam praticá-las, de modo a explorar as variedades de experiências rotuladas como EFC. Treze sujeitos foram entrevistados quanto a suas experiências, crenças e a consequência das EFC em suas vidas. Utilizou-se a análise de conteúdo, adotando Merleau-Ponty como principal referencial teórico para a interpretação dos dados. Os relatos de EFC foram divididos em dois grupos: aqueles que têm convicção da natureza espiritual destas - e que, assim, relataram experiências com presença de seres espirituais que os auxiliaram - e aqueles ressabiados de suas percepções - que se mantiveram céticos e, quando em EFC, permaneceram nos cômodos onde estavam fisicamente. Contudo, em ambos os casos, a experiência possuía um papel importante no entendimento e no modo de ser no mundo de tais sujeitos, sendo utilizada como coping para questões desde doenças crônicas, com risco de morte; ao desinteresse pela vida.(AU)

Several authors point out concepts and causes for the phenomenon of Out of Body Experiences (OBE). This article aimed to describe and analyze the OBE from the experience of the lived, listing different experiences called EFC, comparing them with each other and with the scientific concept of OBE, and investigating the meanings given to them, and their role in everyday life of those who claim to practice them in order to explore the variety of experiences named as OBE. Thirteen people were interviewed about their experiences, beliefs and consequence of OBE in their lives. We used content analysis, adopting Merleau-Ponty as the main theoretical framework for the interpretation of data. Reports of OBE were divided into two groups: those who have belief in the spiritual nature of such experiences - and thus reported experiences with the presence of spiritual beings who helped them - and those distrustful of their perceptions - who were skeptical and when in OBE, remained in the rooms where they were physically. However, in both cases, the experience had an important role in the understanding and being in the world of the experient, and is used as coping for questions from chronic diseases; life-threatening; to the lack of interest in life.(AU)

Varios autores señalan conceptos y las causas del fenómeno de Experiencias fuera del cuerpo (EFC). Este artículo tiene como objetivo describir y analizar el EFC de la experiencia de lo vivido, enumerando las diferentes experiencias llamadas EFC, comparándolos entre sí y con el concepto científico de EFC, y la investigación de los significados que se les da, así como su papel en la vida cotidiana de aquellos que dicen practicarlas; con el fin de explorar la variedad de experiencias etiquetadas como EFC. Fueron entrevistados trece sujetos acerca de sus experiencias, creencias y consecuencia de la EFC. Se utilizó el análisis de contenido, la adopción de Merleau-Ponty como el principal marco teórico para la interpretación de los datos. Informes de EFC se dividieron en dos grupos: aquellos que tienen fe en la naturaleza espiritual de estos - y por lo tanto las experiencias reportadas con la presencia de los seres espirituales que les ayudaron - y los que desconfían de su percepción - que eran escépticos y cuando en EFC, se quedaron en las habitaciones donde estaban físicamente. Sin embargo, en ambos casos, la experiencia tuvo un papel importante en la comprensión y ser en el mundo de tales sujetos, siendo utilizados como un afrontamiento para las cuestiones de las enfermedades crónicas, el riesgo de muerte; la falta de interés en la vida.(AU)

Fenomenologia da percepção extracorpórea: análise de experiências fora do corpo / Phenomenology of extracorporeal perception: analysis of out-of-body experiences / Fenomenología de la percepción extracorpórea: análisis de experiencias fuera del cuerpo

Diversos autores apontam conceitos e etiologias para o fenômeno de Experiências Fora do Corpo (EFC). O presente artigo objetivou descrever e analisar as EFC a partir da experiência do vivido, elencando diferentes experiências denominadas EFC, comparando-as entre si e com o conceito científico de EFC, e investigando os sentidos dados a estas, bem como seu papel na vida cotidiana daqueles que alegam praticá-las, de modo a explorar as variedades de experiências rotuladas como EFC. Treze sujeitos foram entrevistados quanto a suas experiências, crenças e a consequência das EFC em suas vidas. Utilizou-se a análise de conteúdo, adotando Merleau-Ponty como principal referencial teórico para a interpretação dos dados. Os relatos de EFC foram divididos em dois grupos: aqueles que têm convicção da natureza espiritual destas - e que, assim, relataram experiências com presença de seres espirituais que os auxiliaram - e aqueles ressabiados de suas percepções - que se mantiveram céticos e, quando em EFC, permaneceram nos cômodos onde estavam fisicamente. Contudo, em ambos os casos, a experiência possuía um papel importante no entendimento e no modo de ser no mundo de tais sujeitos, sendo utilizada como coping para questões desde doenças crônicas, com risco de morte; ao desinteresse pela vida.

Several authors point out concepts and causes for the phenomenon of Out of Body Experiences (OBE). This article aimed to describe and analyze the OBE from the experience of the lived, listing different experiences called EFC, comparing them with each other and with the scientific concept of OBE, and investigating the meanings given to them, and their role in everyday life of those who claim to practice them in order to explore the variety of experiences named as OBE. Thirteen people were interviewed about their experiences, beliefs and consequence of OBE in their lives. We used content analysis, adopting Merleau-Ponty as the main theoretical framework for the interpretation of data. Reports of OBE were divided into two groups: those who have belief in the spiritual nature of such experiences - and thus reported experiences with the presence of spiritual beings who helped them - and those distrustful of their perceptions - who were skeptical and when in OBE, remained in the rooms where they were physically. However, in both cases, the experience had an important role in the understanding and being in the world of the experient, and is used as coping for questions from chronic diseases; life-threatening; to the lack of interest in life.

Varios autores señalan conceptos y las causas del fenómeno de Experiencias fuera del cuerpo (EFC). Este artículo tiene como objetivo describir y analizar el EFC de la experiencia de lo vivido, enumerando las diferentes experiencias llamadas EFC, comparándolos entre sí y con el concepto científico de EFC, y la investigación de los significados que se les da, así como su papel en la vida cotidiana de aquellos que dicen practicarlas; con el fin de explorar la variedad de experiencias etiquetadas como EFC. Fueron entrevistados trece sujetos acerca de sus experiencias, creencias y consecuencia de la EFC. Se utilizó el análisis de contenido, la adopción de Merleau-Ponty como el principal marco teórico para la interpretación de los datos. Informes de EFC se dividieron en dos grupos: aquellos que tienen fe en la naturaleza espiritual de estos - y por lo tanto las experiencias reportadas con la presencia de los seres espirituales que les ayudaron - y los que desconfían de su percepción - que eran escépticos y cuando en EFC, se quedaron en las habitaciones donde estaban físicamente. Sin embargo, en ambos casos, la experiencia tuvo un papel importante en la comprensión y ser en el mundo de tales sujetos, siendo utilizados como un afrontamiento para las cuestiones de las enfermedades crónicas, el riesgo de muerte; la falta de interés en la vida.

Ethnic and Gender Differences in Additive Effects of Socio-economics, Psychiatric Disorders, and Subjective Religiosity on Suicidal Ideation among Blacks.

BACKGROUND: This study aimed to investigate the additive effects of socio-economic factors, number of psychiatric disorders, and religiosity on suicidal ideation among Blacks, based on the intersection of ethnicity and gender. METHODS: With a cross-sectional design, data came from the National Survey of American Life, 2001-2003, which included 3570 African-American and 1621 Caribbean Black adults. Socio-demographics, perceived religiosity, number of lifetime psychiatric disorders and lifetime suicidal ideation were measured. Logistic regressions were fitted specific to groups based on the intersection of gender and ethnicity, while socioeconomics, number of life time psychiatric disorders, and subjective religiosity were independent variables, and lifetime serious suicidal ideation was the dependent variable. RESULTS: Irrespective of ethnicity and gender, number of lifetime psychiatric disorders was a risk factor for lifetime suicidal ideation (odds ratio [OR] ranging from 2.4 for Caribbean Black women to 6.0 for Caribbean Black men). Only among African-American men (OR = 0.8, 95% confidence interval = 0.7-0.9), perceived religiosity had a residual protective effect against suicidal ideation above and beyond number of lifetime psychiatric disorders. The direction of the effect of education on suicidal ideating also varied based on the group. CONCLUSIONS: Residual protective effect of subjective religiosity in the presence of psychiatric disorders on suicidal ideation among Blacks depends on ethnicity and gender. African-American men with multiple psychiatric disorders and low religiosity are at very high risk for suicidal ideation.

Spirituality and Health Education: A National Survey of Academic Leaders UK.

Whole person care is deemed important within UK medical practice and is therefore fundamental in education. However, spirituality is an aspect of this often neglected. Confusion and discomfort exists regarding how care relating to issues of spirituality and health (S&H) should be delivered. Different interpretations have even led to disciplinary action with professionals seeking to address these needs [ http://www.telegraph.co.uk/health/healthnews/4409168/Nurse-suspended-for-offering-to-prayfor-patients-recovery.html ]. Previous research shows 45% of patients want spiritual needs to be addressed within their care (Jackson and Summerton 2008). Two-thirds of healthcare professionals want to do this. However, lack of knowledge is a significant barrier (Moynihan 2008). Little is known regarding how Medical schools address S&H, only one limited study exists in the literature (Koenig et al. in Int J Psychiat Med 40: 391-8, 2010). Thirty-two UK educational institutions were surveyed. The chosen survey was compiled by Koenig and Meador (Spirituality and Health in Education and Researc. Duke University, Durham, 2008). Fifty-nine academics were contacted across UK medical schools, and the response rate was 57.6%. Statistical analysis was performed using SPSS 16.0. 5.6% institutions provide required and dedicated S&H teaching, 63.4% provided it as an integrated component. Nearly 40% felt staff were not adequately trained to teach S&H but welcomed opportunities for training. S&H is given value in undergraduate education but with little evidence of formal teaching. Institutions feel that this area is addressed within other topic delivery, although previous studies have shown integrating S&H with PBL leads to poor clinical performance (Musick et al. in Acad Psychiatry 27(2):67-73, 2003). Seminars or lectures are students' preferred methods of learning (Guck and Kavan in Med Teach 28(8):702-707, 2006). Further consideration should be given towards S&H delivery and training for practice.

Religiousness and health-related quality of life of older adults / Religiosidade e qualidade de vida relacionada à saúde do idoso

OBJECTIVE To examine whether religiousness mediates the relationship between sociodemographic factors, multimorbidity and health-related quality of life of older adults. METHODS This population-based cross-sectional study is part of the Survey on Health, Well-Being, and Aging (SABE). The sample was composed by 911 older adults from Sao Paulo, SP, Southeastern Brazil. Structural equation modeling was performed to assess the mediator effect of religiousness on the relationship between selected variables and health-related quality of life of older adults, with models for men and women. The independent variables were: age, education, family functioning and multimorbidity. The outcome variable was health-related quality of life of older adults, measured by SF-12 (physical and mental components). The mediator variables were organizational, non-organizational and intrinsic religiousness. Cronbach's alpha values were: physical component = 0.85; mental component = 0.80; intrinsic religiousness = 0.89 and family APGAR (Adaptability, Partnership, Growth, Affection, and Resolve) = 0.91. RESULTS Higher levels of organizational and intrinsic religiousness were associated with better physical and mental components. Higher education, better family functioning and fewer diseases contributed directly to improved performance in physical and mental components, regardless of religiousness. For women, organizational religiousness mediated the relationship between age and physical (β = 2.401, p < 0.01) and mental (β = 1.663, p < 0.01) components. For men, intrinsic religiousness mediated the relationship between education and mental component (β = 7.158, p < 0.01). CONCLUSIONS Organizational and intrinsic religiousness had a beneficial effect on the relationship between age, education and health-related quality of life of these older adults.

OBJETIVO : Analisar se a religiosidade exerce efeito mediador na relação entre fatores sociodemográficos, multimorbidade e qualidade de vida relacionada à saúde em idosos. MÉTODOS : Este estudo transversal, de base populacional, é parte do estudo Saúde, Bem-Estar e Envelhecimento (SABE). A amostra foi composta por 911 idosos da cidade de São Paulo, residentes na comunidade. A modelagem de equações estruturais foi realizada para verificar o efeito mediador da religiosidade na relação entre variáveis selecionadas e a qualidade de vida relacionada à saúde dos idosos, com modelos para homens e mulheres. As variáveis independentes foram: idade, escolaridade, funcionalidade familiar e multimorbidade. A variável de desfecho foi a qualidade de vida relacionada à saúde, medida pelo SF-12 (componentes físico e mental). As variáveis mediadoras foram a religiosidade organizacional, a não organizacional e a intrínseca. Os coeficientes alfa de Cronbach foram: componente físico = 0,85; componente mental = 0,80; religiosidade intrínseca = 0,89 e Apgar familiar = 0,91. RESULTADOS : Maiores níveis de religiosidade organizacional e intrínseca estiveram associados a melhor componente físico e mental para os idosos. Maior escolaridade, melhor funcionalidade familiar e menor número de doenças contribuíram diretamente para melhor desempenho nos componentes físico e mental, independente da religiosidade. Para as mulheres, a religiosidade organizacional mediou a relação entre a idade e os componentes físico (β = 2,401; p < 0,01) e mental (β = 1,663; p < 0,01). Para os homens, a religiosidade intrínseca mediou a relação entre a escolaridade e o componente mental (β = 7,158; p < 0,01). CONCLUSÕES : A religiosidade organizacional e intrínseca exercem efeito benéfico sobre a relação entre idade, escolaridade e a qualidade de vida relacionada à saúde desses idosos.