Beliefs about God and mental health among American adults.

This study examines the association between beliefs about God and psychiatric symptoms in the context of Evolutionary Threat Assessment System Theory, using data from the 2010 Baylor Religion Survey of US Adults (N = 1,426). Three beliefs about God were tested separately in ordinary least squares regression models to predict five classes of psychiatric symptoms: general anxiety, social anxiety, paranoia, obsession, and compulsion. Belief in a punitive God was positively associated with four psychiatric symptoms, while belief in a benevolent God was negatively associated with four psychiatric symptoms, controlling for demographic characteristics, religiousness, and strength of belief in God. Belief in a deistic God and one's overall belief in God were not significantly related to any psychiatric symptoms.

A national study of chaplaincy services and end-of-life outcomes.

BACKGROUND: Medicine has long acknowledged the role of chaplains in healthcare, but there is little research on the relationship between chaplaincy care and health outcomes. The present study examines the association between chaplaincy services and end-of-life care service choices. METHODS: HealthCare Chaplaincy purchased the AHA survey database from the American Hospital Association. The Dartmouth Atlas of Health Care database was provided to HealthCare Chaplaincy by The Dartmouth Institute for Health Policy & Clinical Practice, with the permission of Dartmouth Atlas Co-Principal Investigator Elliot S. Fisher, M.D., M.P.H. The Dartmouth Atlas of Health Care is available interactively on-line at http://www.dartmouthatlas.org/. Patient data are aggregated at the hospital level in the Dartmouth Atlas of Health Care. IRB approval was not sought for the project because the data are available to the public through one means or another, and neither database contains data about individual patients, i.e. all the variables are measures of hospital characteristics. We combined and analyzed data from the American Hospital Association's Annual Survey and outcome data from The Dartmouth Atlas of Health Care in a cross-sectional study of 3,585 hospitals. Two outcomes were examined: the percent of patients who (1) died in the hospital, and (2) were enrolled in hospice. Ordinary least squares regression was used to measure the association between the provision of chaplaincy services and each of the outcomes, controlling for six factors associated with hospital death rates. RESULTS AND DISCUSSION: The analyses found significantly lower rates of hospital deaths (ß = .04, p < .05) and higher rates of hospice enrollment (ß = .06, p < .001) for patients cared for in hospitals that provided chaplaincy services compared to hospitals that did not. CONCLUSIONS: The findings suggest that chaplaincy services may play a role in increasing hospice enrollment. This may be attributable to chaplains' assistance to patients and families in making decisions about care at the end-of-life, perhaps by aligning their values and wishes with actual treatment plans. Additional research is warranted.

Belief in life-after-death, beliefs about the world, and psychiatric symptoms.

Data from the 2010 Baylor Religion Survey were analyzed by structural equation modeling (SEM) to test five hypotheses: (1) that religious commitment is positively related to belief in life-after-death; that belief in life-after-death is (2) positively related to belief in an equitable world, and (3) negatively related to belief in a cynical world; (4) that belief in a cynical world has a pernicious association with psychiatric symptoms; and (5) that belief in an equitable world has a salubrious association with psychiatric symptoms. As hypothesized, religious commitment was positively related to belief in life-after-death (ß = .74). In turn, belief in life-after-death was negatively associated with belief in a cynical world (ß = -.16) and positively associated with belief in an equitable world (ß = .36), as hypothesized. SEM further confirmed that belief in a cynical world had a significant pernicious association with all five classes of psychiatric symptoms (ß's = .11 to .30). Belief in an equitable world had a weaker and less consistent salubrious association with psychiatric symptoms. The results are discussed in the context of ETAS theory.

Toward a theory of holistic needs and the brain.

This article reviews Maslow's theory of motivation wherein he proposes a hierarchy of human needs. First, it describes the principal elements of Maslow's theory and discusses considerations relating to the flexibility of the hierarchy. Second, it explains the relationship among Maslow's theory of human needs, attachment theory, and evolutionary threat assessment system theory. Third, it provides an overview of the brain structures posited to be involved in attachment and evolutionary threat assessment system theory and their relation to Maslow's hierarchy. Finally, it explains how the 3 theories converge to form a theory of holistic needs.

Religion in America--1972-2006: religious affiliation, attendance, and strength of faith.

The present study used data from the General Social Survey, collected between 1972 and 2006 (N = 45,463) to analyze changes over time in three aspects of religion among American adults: religious affiliation, frequency of attending religious services, and strength of faith. The last two measures were analyzed only for survey participants who had a religious affiliation. Ordinary least-squares regression confirmed a significant decrease in religious affiliation over time, after controlling for socio-demographic variables that are known to be associated with religion. A significant decrease in attending religious services was found among those survey participants who were religiously affiliated. As expected, participants who were African American, female, older, and from the South were more religious according to all three measures. No effect of birth-cohort was found for any religious measure. The results are discussed in the context of Stark and Bainbridge's 1996 theory of religion.

Religion, evolution, and mental health: attachment theory and ETAS theory.

This article reviews the historical origins of Attachment Theory and Evolutionary Threat Assessment Systems Theory (ETAS Theory), their evolutionary basis and their application in research on religion and mental health. Attachment Theory has been most commonly applied to religion and mental health in research on God as an attachment figure, which has shown that secure attachment to God is positively associated with psychological well-being. Its broader application to religion and mental health is comprehensively discussed by Kirkpatrick (2005). ETAS Theory explains why certain religious beliefs--including beliefs about God and life-after-death--should have an adverse association, an advantageous association, or no association at all with mental health. Moreover, it makes specific predictions to this effect, which have been confirmed, in part. The authors advocate the application of ETAS Theory in research on religion and mental health because it explains how religious and other beliefs related to the dangerousness of the world can directly affect psychiatric symptoms through their affects on specific brain structures.

Beliefs about God, psychiatric symptoms, and evolutionary psychiatry.

The present study analyzed the association between specific beliefs about God and psychiatric symptoms among a representative sample of 1,306 U.S. adults. Three pairs of beliefs about God served as the independent variables: Close and Loving, Approving and Forgiving, and Creating and Judging. The dependent variables were measures of General Anxiety, Depression, Obsessive-Compulsion, Paranoid Ideation, Social Anxiety, and Somatization. As hypothesized, the strength of participants' belief in a Close and Loving God had a significant salutary association with overall psychiatric symptomology, and the strength of this association was significantly stronger than that of the other beliefs, which had little association with the psychiatric symptomology. The authors discuss the findings in the context of evolutionary psychiatry, and the relevance of Evolutionary Threat Assessment Systems Theory in research on religious beliefs.

The correlates of chaplains' effectiveness in meeting the spiritual/religious and emotional needs of patients.

The study was designed to assess the degree to which two sets of measures about chaplains' visits with patients predicted patients' perceptions that their spiritual/religious needs and their emotional needs were met by the chaplain. The first set consisted of seven items about the chaplain's demeanor during the visit. The second set measured patient satisfaction with seven aspects of the chaplain's care, including specific interventions. Overall, the latter items were more highly correlated with, and were better predictors of patients' perceptions that the chaplain met both their spiritual/religious needs and their emotional needs than were the demeanor items. The findings indicate the usefulness of measuring the effectiveness of specific chaplain interventions. The authors discuss that effectiveness measures may be more useful that patient satisfaction measures for assessing pastoral care.

Topography of referrals to chaplains in the Metropolitan Chaplaincy Study.

Understanding referral patterns to chaplains is essential not only to ensure proper patient treatment, but also to assist chaplains seeking to expand the range of patient situations in which they are called to intervene. Information about more than 58,000 chaplain visits was documented during the first two years (2005-2006) of the Metropolitan Chaplaincy Study. Data from 15,655 of these visits, which were made in response to referrals (26.9% of all visits), were analyzed in the present study. Seventy-eight percent of referral requests were met within the same day, and 94.9% of requests and were met within 2 days. Nurses were the most frequent source of referrals to chaplains (45.0%), followed by self-referrals from patients or requests from their family members (30.3%), with the remainder coming from a variety of hospital disciplines. The most common reason for referrals was that patients requested to see a chaplain. Other relatively common reasons for referrals were problems or issues related to illness or treatment, and end-of-life issues, concerns about death and the death of patients, with reasons for referrals differing by referral source. The most common reason for referrals among professional staff was that patients were feeling bad or in pain, followed by medical issues, and end-of-life issues. Patient and family referrals usually involved positive patient affect, whereas staff referrals usually involved negative patient affect.

Spiritual needs: Gender differences among professional spiritual care providers.

The current study explored gender differences regarding spirituality by comparing the relative frequency with which male (n = 85) and female (n = 103) professional chaplains experience various facets of the spiritual experience. The women in the sample reported experiencing five of the seven spiritual constructs examined significantly more often than men, including the need for (1) belonging, (2) meaning, (3) hope, (4) beauty, and (5) acceptance of death. No significant gender differences were found for spiritual needs related to morality concerns or religious practices.

Beliefs, mental health, and evolutionary threat assessment systems in the brain.

This article reviews aspects of the literature on neuroscience, psychiatry, and cognitive and evolutionary psychology to illustrate how primitive brain mechanisms that evolved to assess environmental threats underlie psychiatric disorders, and how beliefs can affect psychiatric symptoms through these brain systems. Psychiatric theories are discussed that (a) link psychiatric disorders to threat assessment and (b) explain how the normal functioning of threat assessment systems can become pathological. Three brain structures that are consistently implicated in psychiatric symptomology also are involved in threat assessment and self-defense: the prefrontal cortex, the basal ganglia, and parts of the so-called limbic system. We propose that as these structures evolved over time they formed what we refer to as evolutionary threat assessment systems, which detect and assess potential threats of harm. Drawing on various psychological and psychiatric theories we propose how beliefs about the world can moderate psychiatric symptoms through their influence on evolutionary threat assessment systems.

A preliminary proposal for a scale to measure the effectiveness of pastoral care with family members of hospitalized patients.

The authors conducted an electronic search of the Medline database for articles measuring family satisfaction. Content analysis was then performed on the relevant studies to determine the types of themes included in scales measuring family satisfaction in healthcare settings. The authors used these themes to develop a scale for measuring the effectiveness of pastoral care with family members. A convenience sample of chaplains that was asked to judge the usefulness of each of the scale items, rated them all, on average, to be "somewhat useful" to "very useful" for evaluating chaplains' effectiveness. The value of the scale is discussed in terms of its being a more outcome-oriented measure of effectiveness compared to typical family satisfaction instruments.

Spiritual pain among patients with advanced cancer in palliative care.

BACKGROUND: The large body of empirical research suggesting that patients' spiritual and existential experiences influence the disease process has raised the need for health care professionals to understand the complexity of patients' spiritual pain and distress. OBJECTIVE: The current study explores the multidimensional nature of spiritual pain, in patients with end-stage cancer, in relation to physical pain, symptom severity, and emotional distress. DESIGN/MEASUREMENTS: The study combines a quantitative evaluation of participants' intensity of spiritual pain, physical pain, depression, and intensity of illness, with a qualitative focus on the nature of patients' spiritual pain and the kinds of interventions patients believed would ameliorate their spiritual pain. SETTING/SUBJECTS: Fifty-seven patients with advanced stage cancer in a palliative care hospital were interviewed by chaplains. RESULTS: Overall, 96% of the patients reported experiencing spiritual pain, but they expressed it in different ways: (1) as an intrapsychic conflict, (2) as interpersonal loss or conflict, or (3) in relation to the divine. Intensity of spiritual pain was correlated with depression (r = 0.43, p < 0.001), but not physical pain or severity of illness. The intensity of spiritual pain did not vary by age, gender, disease course or religious affiliation. CONCLUSIONS: Given both the universality of spiritual pain and the multifaceted nature of pain, we propose that when patients report the experience of pain, more consideration be given to the complexity of the phenomena and that spiritual pain be considered a contributing factor. The authors maintain that spiritual pain left unaddressed both impedes recovery and contributes to the overall suffering of the patient.

Discipline and sex differences in religiosity and spirituality among health care professionals.

Significant discipline and sex differences were found among random samples of hospital chaplains, nurses, physicians, and social workers who were asked to rate their religiosity and spirituality. Chaplains were significantly higher and physicians were significantly lower than other disciplines in religiosity. Spirituality was higher than religiosity for all disciplines. Overall, women rated themselves higher on spirituality than men.

A national survey of hospital directors' views about the importance of various chaplain roles: differences among disciplines and types of hospitals.

A national random sample of hospital directors was asked to rate the importance of seven categories of chaplain roles and functions: 246 nursing directors, 267 social services directors, 307 medical directors, and 611 pastoral care directors. All four groups rated end-of-life care, prayer, and emotional support as being between very important and extremely important. Other roles, including consultation, advocacy, community outreach, and religious services and rituals were rated significantly less important. Significant differences were found across disciplines and hospital settings (general, psychiatric, etc.). Medical directors rated most chaplain roles lower than other directors did, and directors in psychiatric hospitals rated all roles, except religious services/rituals, lower than their counterparts in other types of hospitals. The importance that directors accorded to all the chaplain roles examined was also influenced by their own spirituality and religiosity, as well as the religious affiliation of their institution.

Department directors' perceptions of the roles and functions of hospital chaplains: a national survey.

A national survey of hospital directors of medicine, nursing, social services, and pastoral care was conducted to obtain opinions about the importance of various chaplain roles. On average, directors in all four disciplines rated three of the seven chaplain roles (grief and death, prayer, and emotional support) to be "very" to "extremely" important. Most of the others roles were rated between "moderately" and "very" important (religious services-rituals consultation and advocacy, community liaison-outreach). Several significant differences were found among disciplines, as physicians rated the importance of most chaplains' roles lower than did other disciplines. Overall, there was a tendency for directors in smaller hospitals, especially those with fewer than 100 patients, to place less importance on most of the chaplain roles investigated here.

A methodological analysis of chaplaincy research: 2000-2009.

The present article presents a comprehensive review and analysis of quantitative research conducted in the United States on chaplaincy and closely related topics published between 2000 and 2009. A combined search strategy identified 49 quantitative studies in 13 journals. The analysis focuses on the methodological sophistication of the studies, compared to earlier research on chaplaincy and pastoral care. Cross-sectional surveys of convenience samples still dominate the field, but sample sizes have increased somewhat over the past three decades. Reporting of the validity and reliability of measures continues to be low, although reporting of response rates has improved. Improvements in the use of inferential statistics and statistical controls were also observed, compared to previous research. The authors conclude that more experimental research is needed on chaplaincy, along with an increased use of hypothesis testing, regardless of the research designs that are used.

Complementary alternative medicine practices used by religious professionals.

Religious professionals completed an online survey of their use of health related practices currently known as complementary and alternative medicine (CAM). They indicated how often they engaged in these practices and how often they had used these practices when helping other people. The majority of religious professionals used at least one of the practices when alone and when helping other people. The most frequently used practices were meditation and deep breathing exercises used both when alone and when helping others. Female respondents were more likely to use these practices on their own and when helping others than were males, and older respondents were more likely to use multiple CAM practices than their younger counterparts. Other Faith/Humanists used the most CAM practices when alone and Jewish respondents used the fewest. In general, religious professionals used fewer practices when helping others than they used for themselves. Limitations of this study and suggestions for future studies for examining CAM practices among religious professionals are discussed.

A brief review of religious beliefs in research on mental health and ETAS theory.

The present study briefly describes and critiques the kinds of variables used to measure religion in research on mental health and analyzes data from the Handbook of Religion and Health to assess what variables are most commonly used to do so. The analysis found that organizational religion and subjective religiosity were the most widely used measures in research on psychological well-being, depression, and anxiety, with 30%-52% of studies measuring organizational religion and 34%-36% measuring subjective religiosity. In contrast, only 9%-11% of studies measured religious beliefs. The paper discusses the associations between religious beliefs and mental health that have been reported and the value of measuring religious beliefs in light of ETAS Theory.

To pray or not to pray: considering gender and religious concordance in praying with the ill.

Analysis of Covariance was conducted on quantitative data collected by chaplains from January 2005 to December 2008. Data from 82 Catholic, Jewish, and Protestant chaplains, consisting of 53 CPE students and 29 professional chaplains were used in this study. Overall, chaplains exhibited a statistically significant higher rate of prayer with patients from their own religion (religious concordance) than they did with patients of different religions (religious discordance). There was also an interaction of chaplain religion and religious concordance wherein Protestant chaplains were 50% more likely to pray with Protestant patients than with patients of other religions, and Catholic chaplains were 20% more likely to pray with Catholic patients than with other patients. Chaplains were also significantly more likely to pray with patients of their own gender (gender concordance) than with patients of the other gender (gender discordance).