Multidimensional Assessment of Spirituality/Religion in Patients with HIV: Conceptual Framework and Empirical Refinement

A decade ago, an expert panel developed a framework for measuring spirituality/religion in health research (Brief Multidimensional Measure of Religiousness/Spirituality), but empirical testing of this framework has been limited. The purpose of this study was to determine whether responses to items across multiple measures assessing spirituality/religion by 450 patients with HIV replicate this model. We hypothesized a six-factor model underlying a collective of 56 items, but results of confirmatory factor analyses suggested eight dimensions: Meaning/Peace, Tangible Connection to the Divine, Positive Religious Coping, Love/Appreciation, Negative Religious Coping, Positive Congregational Support, Negative Congregational Support, and Cultural Practices. This study corroborates parts of the factor structure underlying the Brief Multidimensional Measure of Religiousness/Spirituality and some recent refinements of the original framework.     

Convergent/Divergent Validity of the Brief Multidimensional Measure of Religiousness/Spirituality: Empirical Support for Emotional Connectedness as a “Spiritual” Construct

The objective of this article is to determine the convergent/divergent validity of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS; Fetzer Institute & National Institute on Aging Working Group 1999) subscales by correlating it with the Temperament and Character Inventory (TCI) Self-Transcendence subscales (i.e., Mysticism, Transpersonal Identification, Self-Forgetfulness; Cloninger et al. 1994). The cross-sectional analysis of 97 undergraduate/graduate students from a Midwestern university was made. The results are (1) all five BMMRS spirituality subscales were significantly correlated with the TCI Mysticism scale; (2) two BMMRS scales (i.e., Daily Spiritual Experiences, Values/Beliefs) were significantly correlated with the TCI Transpersonal Identification scales; (3) no BMMRS spiritual subscales were significantly correlated with the TCI Self-Forgetfulness scale; and (4) of the BMMRS religion scales, only the Organizational Religiousness subscale was correlated with any TCI subscale (i.e., Mysticism). The BMMRS appears to have adequate convergent/divergent validity, although the need exists to determine specific dimensions of spirituality. Inspection of the specific items of the BMMRS and TCI spiritual subscales that were most consistently correlated (i.e., BMMRS Daily Spiritual Experiences, Values/Beliefs; TCI Mysticism, Transpersonal Identification) suggests the existence of a distinct spiritual construct that is best conceptualized as the experience of emotional connectedness to the divine, nature, and/or others.     

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

Korean American Adolescents’ Depression and Religiousness/Spirituality: Are There Gender Differences?

The purpose of this study was to examine depression and religiousness/spirituality (R/S) in Korean American adolescents with an interest in exploring gender differences. The sample consisted of 182 adolescents attending ethnic Catholic churches in the NY and NJ metropolitan area. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression Scale, and R/S was measured by the Brief Multidimensional Measure of Religiousness/Spirituality. Results suggest no gender difference in depression, but a high rate of depression in both genders. Additionally, girls showed higher levels of Forgiveness and boys showed higher levels of Negative Religious Coping. Further, we found four R/S variables are associated with depression in each gender: Daily Spiritual Experiences, Forgiveness, Positive Religious Coping, and Negative Religious Coping for girls; and Forgiveness, Negative Religious Coping, Congregational Support, and Overall Self-Ranking for boys. Lastly, the four R/S variables together explained 20 % and 23 % of the variance in depression for boys and girls, respectively, with Forgiveness and Negative Religious Coping remaining significant for girls, and Negative Religious Coping staying significant for boys. The current findings are discussed along with limitations and directions for future research, and clinical implications.     

Reliability and Validity of the Brief Multidimensional Measure of Religiousness/Spirituality Among Adolescents

Background Developed for use in health research, the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) consists of brief measures of a broad range of religiousness and spirituality (R/S) dimensions. It has established psychometric properties among adults, but little is known about its appropriateness for use with adolescents. Purpose We assessed the psychometric properties of the BMMRS among adolescents. Method We recruited a racially diverse (85% non-White) sample of 305 adolescents aged 12–18 years (median 16 yrs, IQR 14–17) from 3 urban medical clinics; 93 completed a retest 1 week later. We assessed internal consistency and test–retest reliability. We assessed construct validity by examining how well the measures discriminated groups expected to differ based on self-reported religious preference, and how they related to a hypothesized correlate, depressive symptoms. Religious preference was categorized into “No religion/Atheist” (11%), “Don’t know/Confused” (9%), or “Named a religion” (80%). Results Responses to multi-item measures were generally internally consistent (alpha ≥0.70 for 12/16 measures) and stable over 1 week (intraclass correlation coefficients ≥0.70 for 14/16). Forgiveness, Negative R/S Coping, and Commitment items showed lower internal cohesiveness. Scores on most measures were higher (p < 0.05) among those who “Named a religion” compared to the “No religion/Atheist” group. Forgiveness, Commitment, and Anticipated Support from members of one’s congregation were inversely correlated with depressive symptoms, while BMMRS measures assessing negative R/S experiences (Negative R/S Coping, Negative Interactions with others in congregation, Loss in Faith) were positively correlated with depressive symptoms. Conclusions These findings suggest that most BMMRS measures are reliable and valid for use among adolescents.

Relationships Among Spirituality, Religious Practices, Personality Factors, and Health for Five Different Faith Traditions

To determine: (1) differences in spirituality, religiosity, personality, and health for different faith traditions; and (2) the relative degree to which demographic, spiritual, religious, and personality variables simultaneously predict health outcomes for different faith traditions. Cross-sectional analysis of 160 individuals from five different faith traditions including Buddhists (40), Catholics (41), Jews (22), Muslims (26), and Protestants (31). Brief multidimensional measure of religiousness/spirituality (BMMRS; Fetzer in Multidimensional measurement of religiousness/spirituality for use in health research, Fetzer Institute, Kalamazoo, 1999); NEO-five factor inventory (NEO-FFI; in Revised NEO personality inventory (NEO PI-R) and the NEO-five factor inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, Costa and McCrae 1992); Medical outcomes scale-short form (SF-36; in SF-36 physical and mental health summary scores: A user??s manual, The Health Institute, New England Medical Center, Boston, Ware et al. 1994). (1) ANOVAs indicated that there were no significant group differences in health status, but that there were group differences in spirituality and religiosity. (2) Pearson??s correlations for the entire sample indicated that better mental health is significantly related to increased spirituality, increased positive personality traits (i.e., extraversion) and decreased personality traits (i.e., neuroticism and conscientiousness). In addition, spirituality is positively correlated with positive personality traits (i.e., extraversion) and negatively with negative personality traits (i.e., neuroticism). (3) Hierarchical regressions indicated that personality predicted a greater proportion of unique variance in health outcomes than spiritual variables. Different faith traditions have similar health status, but differ in terms of spiritual, religious, and personality factors. For all faith traditions, the presence of positive and absence of negative personality traits are primary predictors of positive health (and primarily mental health). Spiritual variables, other than forgiveness, add little to the prediction of unique variance in physical or mental health after considering personality. Spirituality can be conceptualized as a characterological aspect of personality or a distinct construct, but spiritual interventions should continue to be used in clinical practice and investigated in health research.     

Religious and Psychological Implications of Positive and Negative Religious Coping in Iran

This study examined the religious and psychological implications of religious coping in Iran. University students (N = 224) responded to the Brief Positive and Negative Religious Coping Scales along with measures of Religious Orientation, Integrative Self-Knowledge, Self-Control, Mindfulness, Self-Compassion, Self-Esteem, Guilt, Shame, and Self-Criticism. As in previous research elsewhere, Positive Religious Coping was stronger on average than Negative Religious Coping, and Positive and Negative Religious Coping predicted adjustment and maladjustment, respectively, In addition, this study demonstrated that direct relationships between Positive and Negative Religious Coping appeared to be reliable in Iran; that Positive Religious Copings was broadly compatible with, and Negative Religious Coping was largely irrelevant to, Iranian religious motivations; and that Negative Religious Coping obscured linkages of Positive Religious Coping with religious and psychological adjustment.     

The association of religiosity,spirituality, and ethnic background with ego-pathology in acute schizophrenia

Studies have highlighted the impact of ego-consciousness, religiosity and spirituality on psychotic symptoms, although so far no study has investigated if and how these factors may be interrelated. In this exploratory cross-sectional study, involving 42 patients with a diagnosis of acute paranoid schizophrenia (DSM-IV), we assessed religiosity (Religious Orientation Test) spirituality (Spiritual Transcendence Scale) and ego-pathology (Ego Pathology Inventory) and analysed any relationship with these and psychopathological symptoms (Positive and Negative Symptom Scale). The subjects were divided into four ethnic groups (Caucasian, Afro-Caribbean, African, and Asian) and a structured, qualitative interview on religious needs and self-concepts was also conducted. Using a multivariate analysis, we found statistically significant negative associations between the scores on ego and common pathology and religiosity and spirituality as covariates. This was seen across all ethnic groups. The findings are discussed in respect of the potential clinical importance of ethnic, religious and spiritual factors for assessment and management of patients with schizophrenia.     

Spirituality,religiousness, personality as predictors of stress and resilience among middle-aged Vietnamese-Born American Catholics

ABSTRACT

The aim of this study was to examine the predictive power of spirituality and religiousness in terms of well-being. Spirituality and religiousness were measured by the ASPIRES Scale. Participants in this study were 171 middle-aged Vietnamese-born American Catholics. Results indicated that both resilience and stress significantly related to Prayer Fulfillment, Religious Involvement, and Religious Crisis, and Universality related significantly to resilience. A series of hierarchical multiple regressions examined the incremental predictive validity of spirituality and religiousness over gender, religious status, and personality. Results demonstrated that spirituality and religiousness incrementally predicted stress overload and resilience in midlife over these other variables (Δ R² scores ranged from .02 to .06). These findings provided further support for the hypothesis that spirituality and religiousness are important resources for managing stress and maintaining resilience for middle-aged Vietnamese-born American immigrants.     

Taking spiritual experiences seriously in the religious education classroom: a transrational approach

ABSTRACT

Spiritual experiences are common across religious and non-religious faiths, but schoolchildren are often afraid to share these because they fear ridicule from peers who are convinced religion is irrational. The need to speak about spirituality in religious education is increasingly recognised. Signposts suggests that intercultural understanding implies recognising religious students’ perception of reality and helping others understand it. Religious education in Norway now includes exploration of existential questions as a core element, and in England, making sense of religious, spiritual and mystical experiences has been suggested as a big idea. In this paper, we discuss how the dualistic paradigm of modern science makes it difficult to take spirituality seriously as lived experience and empirical phenomenon. Instead we suggest a transrational approach to explore our multidimensional reality in an intercultural dialogue where insiders and outsiders learn from each other. We also explore examples of transrational research on spiritual phenomena.     

Spiritual Openness,Revisiting a Potentially Important Aspect of Spirituality: Scale Review and Revision

Religiousness and spirituality (R/S) exert important influences on individuals across a range of domains. Spiritual Openness is theoretically linked with the personality trait of Openness to Experience, suggesting promise for future research. Using responses from 366 undergraduates on the Spiritual Experience Index-Revised (SEI-R: subscales of Spiritual Openness and Spiritual Support), analyses evaluated and revised the SEI-R, deleting poor items and generating a 10-item measure. The new SEI-S exhibits better psychometric properties and reduced participant burden, and subscales displayed a curvilinear relationship in which increases in Spiritual Openness showed a trade-off in levels of Spiritual Support.     

“God loves me no matter how I am”: a phenomenological analysis of the religious and spiritual experiences of HIV-infected African-American women with depression

Depression is associated with increased HIV morbidity and mortality, particularly among African-American women (AAW) in the United States. The purpose of this qualitative study was to explore religious practices, spiritual beliefs, and experiences among AAW with co-occurring HIV infection and depression. A transcendental phenomenological study design was used to explore the experiences of AAW's religion and spirituality after an HIV diagnosis and living with depression. The four themes that were identified included: Religious Conflict and Return to Religious Practices; Religious Fortitude Broken and Feeling Judged; Spiritual Connection is More Powerful than Attending Church Services; and Spiritual Healing and Re-Connecting with Spirituality. These findings suggest that the distinction between internal and external manifestations of spirituality is important and that given the current religious climate, interventions that focus on supporting internal spiritual practice may be a more important and effective approach for AAW with co-occurring HIV infection and depression.     

Religiosity and Spirituality: A Psychometric Evaluation of the Santa Clara Strength of Religious Faith Questionnaire

The Santa Clara Strength of Religious Faith Questionnaire (SCSORF) was administered to 124 undergraduate college students attending a private Catholic university and the result was compared to measures of spirituality, religious behavior, religious coping, and affect. The present study found that the SCSORF was strongly related to spirituality, in particular, seeking support from one's spirituality. However, the SCSORF was not correlated with an openness to new spiritual experiences. The SCSORF was also related to religious behavior and religious coping. The SCSORF was not related to affect, indicating that scores on the SCSORF were not affect-dependent. Results from this study provide additional evidence that the SCSORF is a reliable and valid measure of religious faith.     

The Rasch Scaling of Mystical Experiences: Construct Validity and Correlates of the Mystical Experience Scale (MES)

This study evaluated the relationships that exist between the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the mental health of individuals with heterogeneous medical disorders. The participants were 168 individuals with heterogeneous medical disorders (i.e., 61 brain injury, 32 stroke, 25 spinal cord injury, 25 cancer, 25 primary care). The measures were BMMRS subscales (conceptualized as spiritual experiences, religious practices, and congregational support), Medical Outcomes Scale–Short Form 36 General Mental Health scale. Pearson correlations indicated that, in general, mental health is positively correlated with positive spiritual experiences and positive congregational support but negatively correlated with negative spiritual coping and negative congregational support. Mental health was not correlated with private religious practices (e.g., prayer). Hierarchical regressions indicated that congregational support was the only BMMRS scale to predict mental health, explaining 6% of the variance beyond the 14% explained by demographic factors. The mental health of individuals with significant medical conditions appears to be primarily related to positive spiritual beliefs and especially congregational support. Mental health does not appear to be related to religious practices such as prayer, which is likely related to the fact that many individuals with serious medical conditions increase prayer with declining mental health status. These results stress the need for active congregational support and spiritual interventions to improve the mental health of persons with serious medical conditions.     

Different Types of Religious/Spiritual Well-Being in Relation to Personality and Subjective Well-Being

In this study the authors attempt to present different types of Religious/Spiritual Well-Being (RSWB) and discuss their relation to personality and psychological well-being. The Multidimensional Inventory for Religious/Spiritual Well-Being 48 is employed for this study, which consists of 6 subscales. To find different types of RSWB, an agglomerative cluster analysis on these subscales was performed based on the responses obtained in a nonclinical adult sample (n = 463). A 4-cluster solution was accepted. The clusters were labeled as Religious/Spiritual High, Religiously Oriented, Existentially Oriented, and Religious/Spiritual Low, and were found to be substantially related to Sense of Coherence (n = 263) and Six Factors of Personality (n = 200) in two different subsamples. By presenting a first empirical model for a 4-field typology of RSWB, we hope to further contribute to the ongoing discussion on how to deal with religious/spiritual issues in personality research.     

Book Review

Previous efforts to demonstrate the coping benefits of Muslim beliefs have yielded ambiguous outcomes. With a sample of 200 Pakistani adults, this project used the Islamic Positive Religious Coping and Identification (IPRCI) subscale within the Psychological Measure of Islamic Religiousness (PMIR) to examine relationships with the experience and behaviour of Ramadan. Preliminary confirmatory factor analyses revealed a need to focus on a Positive Islamic Coping factor within the IPRCI. Positive Islamic Coping correlated directly with Positive Ramadan Experience and Ramadan Behaviour and inversely with Negative Ramadan Experience. Along with other PMIR variables assessing Muslim commitments more generally, Positive Islamic Coping helped mediate relationships between Ramadan Experience and Ramadan Behaviour. Punishing Allah Reappraisal from the PMIR displayed only minimal evidence that it recorded a maladaptive form of religious coping. These data confirmed Positive Islamic Coping as an operationalisation of adaptive Muslim coping and illustrated the importance of examining measures that are relevant within a religious tradition.     

Dimensions of religious/spiritual well-being and schizotypal personality

Dimensions of religious/spiritual well being (RSWB; such as hope, forgiveness, or general religiosity) have been examined comprehensively, and its positive relation to subjective well-being has been confirmed. However, there also might be facets of RSWB linked to mental illness (e.g. delusional ideas). The aim of the present study was to investigate the association between different dimensions of RSWB, magical thinking as an indicator of schizotypy and Eysenck´s three personality factors (psychoticism, extraversion, neuroticism), as there might be facets of RSWB also linked to mental illness (e.g. delusional ideas). One hundred and two undergraduate students (53 female, 49 male) completed the Multidimensional Inventory of Religious/Spiritual Well-Being (MI-RSWB), the Eysenck Personality Questionnaire in short version (EPQ-RK) together with the Magical Ideation Scale. Results indicate that facets of RSWB based on magical thinking could also be understood as neurotic symptoms. This underlines the hypothesis, that there might be pathogenetic as well as salutogenetic aspects of religiosity/spirituality associated with personality and subjective well-being.     

Religio-Biography, Coping, and Meaning-Making Among Persons with HIV/AIDS

Recently, quality of life studies among patients with HIV/AIDS have shown high levels of life satisfaction. Spiritual and religious factors may contribute to these positive outcomes. We interviewed 19 patients with HIV/AIDS in order to understand better the role of religious‐spiritual biographies and orientations in quality of life, and found four patterns to describe the ways in which past experiences with religion/spirituality and religious/spiritual meaning‐making help to explain how patients are currently coping with HIV/AIDS. We illustrate each of these patterns with a prototypic patient: (1) the Deferring Believer (“God allows things to happen for a reason.”); (2) the Collaborating Believer (“This is where I'm supposed to be.”); (3) the Religious/Spiritual Seeker (“I'm trying to get my life together.”); and (4) the Self‐Directing Believer (“What else is new?”). The findings support a previously described theoretical model of meaning‐making in response to adversity, and they suggest the value of life course and narrative approaches to understanding religious coping.     

Smoking,Muslim religious commitments,and the experience and behaviour of Ramadan in Pakistani men

This study examined the possibility that smoking may interfere with Muslim commitments in general and with the experience and behaviour of Ramadan in particular. During Ramadan, a sample of 29 smoking and 46 non-smoking Pakistani men responded to measures of smoking, Religious Orientation, Religious Interest, Positive and Negative Ramadan Experience, and Ramadan Behaviour. Various indices of smoking predicted a disinterest in religion, less of an Intrinsic Religious Orientation, lower levels of Positive Ramadan Experience, higher Negative Ramadan Experience, and reductions in Ramadan Behaviour. These data offered preliminary support for the suggestion that smoking presents a challenge to Muslim beliefs and practices, especially during Ramadan.     

School Counseling Programs as Spiritual and Religious Safe Zones

The authors present a model for creating spiritual and religious safe zones in school counseling programs that implements the Association for Spiritual, Ethical and Religious Values in Counseling's (ASERVIC; 2009) Competencies for Addressing Spiritual and Religious Issues in Counseling in a school setting. The authors frame the model within the context of issues related to the First Amendment of the U.S. Constitution and posit that students' ability to discuss and explore spiritual and religious issues promotes their personal and social‐emotional development.