Help-Seeking from Clergy and Spiritual Counselors Among Veterans with Depression and PTSD in Primary Care

Little is known about the prevalence or predictors of seeking help for depression and PTSD from spiritual counselors and clergy. We describe openness to and actual help-seeking from spiritual counselors among primary care patients with depression. We screened consecutive VA primary care patients for depression; 761 Veterans with probable major depression participated in telephone surveys (at baseline, 7 months, and 18 months). Participants were asked about (1) openness to seeking help for emotional problems from spiritual counselors/clergy and (2) actual contact with spiritual counselors/clergy in the past 6 months. At baseline, almost half of the participants, 359 (47.2 %), endorsed being “very” or “somewhat likely” to seek help for emotional problems from spiritual counselors; 498 (65.4 %) were open to a primary care provider, 486 (63.9 %) to a psychiatrist, and 409 (66.5 %) to another type of mental health provider. Ninety-one participants (12 %) reported actual spiritual counselor/clergy consultation. Ninety-five (10.3 %) participants reported that their VA providers had recently asked them about spiritual support; the majority of these found this discussion helpful. Participants with current PTSD symptoms, and those with a mental health visit in the past 6 months, were more likely to report openness to and actual help-seeking from clergy. Veterans with depression and PTSD are amenable to receiving help from spiritual counselors/clergy and other providers. Integration of spiritual counselors/clergy into care teams may be helpful to Veterans with PTSD. Training of such providers to address PTSD specifically may also be desirable.     

Patterns of conversation between clergy and their parishioners and referral to other professionals

Clergy deal with mental and physical health care issues as well as spiritual concerns within their congregations. Collaboration with psychotherapists and physicians could be argued to be "best practice" by clergy, but little is known about how clergy collaborate, particularly in non-hospital settings. This study describes reported practice patterns of referral by clergy in the context of their conversations with parishioners. Clergy report that parishioners regularly express psychosocial and medical concerns to them, and clergy also initiate these conversations. Clergy refer to medical providers and psychotherapist 23% of the time, and these referrals are found to be helpful, even though the professionals rarely connect with each other. Physicians and psychotherapists report they refer to clergy 10% and 24% of the time, respectively, and often find these referrals helpful. Further research is needed to understand the barriers and bridges to collaboration between professionals in different domains of care.     

Racial and Ethnic Differences in the Utilization of Prayer and Clergy Counseling by Infertile US Women Desiring Pregnancy

Religion can have a significant influence on the experience of infertility. However, it is unclear how many US women turn to religion when facing infertility. Here, we examine the utilization of prayer and clergy counsel among a nationally representative sample of 1062 infertile US women. Prayer was used by 74.8% of the participants, and clergy counsel was the most common formal support system utilized. Both prayer and clergy counsel were significantly more common among black and Hispanic women. Healthcare providers should acknowledge the spiritual needs of their infertile patients and ally with clergy when possible to provide maximally effective care.     

Training Community Clergy in Serious Illness: Balancing Faith and Medicine

Community-based clergy are highly engaged in helping seriously ill patients address spiritual concerns at the end of life (EOL). While they desire EOL training, no data exist in guiding how to conceptualize a clergy-training program. The objective of this study was used to identify best practices in an EOL training program for community clergy. As part of the National Clergy Project on End-of-Life Care, the project conducted key informant interviews and focus groups with active clergy in five US states (California, Illinois, Massachusetts, New York, and Texas). A diverse purposive sample of 35 active clergy representing pre-identified racial, educational, theological, and denominational categories hypothesized to be associated with more intensive utilization of medical care at the EOL. We assessed suggested curriculum structure and content for clergy EOL training through interviews and focus groups for the purpose of qualitative analysis. Thematic analysis identified key themes around curriculum structure, curriculum content, and issues of tension. Curriculum structure included ideas for targeting clergy as well as lay congregational leaders and found that clergy were open to combining resources from both religious and health-based institutions. Curriculum content included clergy desires for educational topics such as increasing their medical literacy and reviewing pastoral counseling approaches. Finally, clergy identified challenging barriers to EOL training needing to be openly discussed, including difficulties in collaborating with medical teams, surrounding issues of trust, the role of miracles, and caution of prognostication. Future EOL training is desired and needed for community-based clergy. In partnering together, religious–medical training programs should consider curricula sensitive toward structure, desired content, and perceived clergy tensions.     

Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.     

The Spiritual Needs and Resources of Hospitalized Primary Care Patients

Previous studies have recognized the importance of hospitalized primary care patients’ spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients’ internal and external resources for addressing spiritual questions, while also exploring the physician’s role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients’ desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as “R/S respondents”) reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients’ physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it.     

Faith‐Based Decisions? The Consequences of Heightened Religious Salience in Social Service Referral Decisions

Previous research suggests that clergy members are often an initial contact for people seeking advice or social services and clergy often refer such individuals in need to outside agencies. Recent "faith-based initiatives" seek to engage churches and religious groups more deeply in social service delivery, potentially changing the mix of organizations to which clergy might refer people in need. In addition, public debates about faith-based social services have drawn attention to religion, often in politically divisive ways. Using semi-structured interviews and vignettes in which key characteristics of outside agencies are experimentally varied, we explore the implications of this heightened attention to religion on clergy referrals. We find that increasing the salience of religion affects clergy referral choices, with some clergy even willing to sacrifice quality care and resources for an individual in need when religious options are available as referral choices. We argue that this occurs at least in part because making religion salient in policy and referrals makes religious differences salient as well.     

Spiritual experience and mental distress: A clergy perspective

This qualitative study is based on a small group of clergy in the UK. The study explored the clergy’s views and perceptions on the relationship between spiritual experience and mental distress. Six clergy were interviewed using a semi-structured technique, and the interviews were recorded, transcribed, and analysed thematically. The findings explore the nature of spirituality in relation to mental distress highlighting a relationship between mental distress and spiritual experience and add to the debate surrounding these concepts. Implications and recommendations for future research are discussed.     

A systematic review of research on religion and spirituality in the Journal of Traumatic Stress: 1990–1999

Surveys reveal that religion and spirituality are highly valuable to many people in times of crisis, trauma, and grief. The relationship between coping with trauma and the use of various spiritual beliefs is well established. The importance of clergy in trauma recovery is also well documented. A review of the 469 research and non-research articles published between 1990 and 1999 in the Journal of Traumatic Stress revealed that 8.7% (6/69) of non-research articles, 4.1% (15/366) of quantitative research articles and 2.9% (1/34) of qualitative research articles considered religion or spirituality in their work. Analysis of variance found a significant overall increase in the percentage of articles that mentioned religion/spirituality between the first half (1990–1994) and the second half (1995–1999) of the study period. The results are discussed in the context of the trauma research and in comparison to related disciplines. Recommendations for future research and clinical application are suggested for both traumatologists and religious scholars.     

Predictors of university students’ willingness in the USA to use clergy as sources of skilled help

This exploratory study investigated U.S. university students’ perceptions (N = 186) and the predictor variables associated with their willingness to use clergy as a source of help. In the final regression analysis using the predicted variable of willingness to use clergy as a source of help (R = 0.816, R ²= 0.665, Adjusted R ²= 0.650), there were seven significant predictor variables: (a) trust of clergy, (b) empathic ability of clergy, (c) having previously sought help from clergy, (d) respondents’ dominant/minority cultural identification, (e) attendance at religious services at least once a year, (f) believing that spiritual counselling is as effective as psychotherapy, and (g) receiving religious/spiritual education as a child. An eighth variable was retained in the final regression model because of its proximity to significance (Friendships between clergy and people, p = 0.051). Accusations against clergy and the belief that clergy are held to a higher standard did not predict willingness to use clergy as a source of help. A general linear model (F = 125.696, df = 10, p < 0.001) revealed that those who self-identified with Protestant Christianity, Catholic/Orthodox Christianity, and Judaism were more likely to consider seeking help from clergy than those who self-identified with another religious tradition (Hinduism, Islam, or Buddhism), or adherence to spiritual not religious belief. Further, those who self-identified as Jewish or Christian were also more like to perceive clergy as trustworthy and empathic. Finally, African American/Caribbean Black respondents were more likely than either Latino/Latino American respondents or European American respondents to seek help from clergy, to perceive clergy as empathic, and to believe that spiritual counselling is as effective as psychotherapy (F = 1495, df = 12, p < 0.001).     

Youth Suicide: The Knowledge and Attitudes of Australian Teachers and Clergy

This is the first study of the suicide-related knowledge and attitudes of teachers and clergy in Australia. These professional groups have been identified as “gatekeepers” who might serve as a first line of assistance for distressed young people. Such gatekeepers, along with medical and mental health professionals, have a vital role to play in the prevention of youth suicide, of which Australia has the highest rates in the world. This research confirmed that high numbers of teachers and clergy have been approached by suicidal young persons. However, their gatekeeping role may be compromised by a low level of knowledge about signs of suicide risk, which was found even among those who had taken courses in suicide or death and dying or who had personally known someone who suicided. Suicidal behavior was found to be generally regarded as unacceptable, especially by those with a high religious commitment. Further educational efforts about suicide risk identification and prevention seem to be needed for both teachers and clergy; it will be important for such education to take into account attitudinal issues and how these might affect communication with young suicidal people.     

Spiritual support for caregivers of dementia patients

Dementia is considered the major psychiatric disorder of old age and affects over 4 million people in the United States. As Alzheimer's disease and other dementias progress, the patient can become increasingly dependent on the family for care. This dependency can place the caregiver in a role that is both difficult and demanding. In this study coping strategies used by family caregivers of dementia patients and caregivers' sense of burden were assessed. Burden scores were significantly correlated with spiritual support, an external coping strategy. When spiritual well-being is integrated with medical and psychosocial needs, the clergy and spiritual community can play an integral role in the care for families and dementia patients.     

Religious Coping Among the Religious: The Relationships Between Religious Coping and Well-Being in a National Sample of Presbyterian Clergy, Elders, and Members

This study examined whether the relationships between religious coping and well-being are moderated by the salience of religion to the individual's identity and social roles. As part of a national survey of Presbyterians, 1,260 clergy, 823 elders, and 735 members completed measures of demographic variables, global religiousness, life stressors, positive and negative religious coping, and well-being (positive affect, depressive affect, religious satisfaction). Our predictions were largely confirmed. First, clergy reported higher levels of positive religious coping than elders, who, in turn, indicated more positive religious coping than members. Second, positive and negative religious coping were associated with higher and lower levels of well-being respectively. Finally, positive and negative religious coping were more strongly related to well-being for clergy than for members. Furthermore, the drawbacks of negative religious coping for the clergy were not offset completely by the benefits of positive religious coping. Longitudinal studies of the longer term implications of positive and negative religious coping are clearly warranted. The results also suggest the need for supportive and educational services to help clergy draw on their religious coping resources and come to terms with their spiritual struggles.     

Review of Clinical Medicine and Religious Practice

The purpose was to evaluate faith-based studies within the medical literature to determine whether there are ways to help physicians understand how religion affects patients’ lives and diseases. We reviewed articles that assessed the influence of religious practices on medicine as a primary or secondary variable in clinical practice. This review evaluated 49 articles and found that religious faith is important to many patients, particularly those with serious disease, and patients depend on it as a positive coping mechanism. The findings of this review can suggest that patients frequently practice religion and interact with God about their disease state. This spiritual interaction may benefit the patient by providing comfort, increasing knowledge about their disease, greater treatment adherence, and quality of life. The results of prayer on specific disease states appear inconsistent with cardiovascular disease but stronger in other disease states.     

A survey of the views of trainees in psychiatry regarding religious issues

Abstract

Although 94% of Americans believe in God, little is known about the religiosity of psychiatric residents and the role of religion in residents’ practice. We aimed to determine residents’ perceptions about (1) the importance of knowledge of religious beliefs, practices and priority of psychotherapy, psychopharmacology and general medical patients and (2) the relative difficulty religious issues presented compared with race, age, gender and sexuality.

All psychiatric trainees in one training program during two academic years were surveyed (n = 96). The 38 respondents (40%) reported a substantial degree of religiosity [high belief (74%), high practise (50%), high priority (71%)]. Significantly more residents reported that it was more important to know about the religiosity of psychotherapy patients than of psychopharmacology or general medical patients. Race was the only issue that the majority of residents reported as presenting more difficulty than religion.

In conclusion, the subgroup of residents who responded to the survey were more religious than expected, based on previous surveys of psychiatrists. They clearly differentiated psychotherapy patients from others when considering the importance of religion. That residents viewed religion to be a challenging issue underlines the need for further training and clinical focus on religion.     

Health Care Behaviours and Beliefs in Hasidic Jewish Populations: A Systematic Review of the Literature

Cultural issues impact on health care, including individuals’ health care behaviours and beliefs. Hasidic Jews, with their strict religious observance, emphasis on kabbalah, cultural insularity and spiritual leader, their Rebbe, comprise a distinct cultural group. The reviewed studies reveal that Hasidic Jews may seek spiritual healing and incorporate religion in their explanatory models of illness; illness attracts stigma; psychiatric patients’ symptomatology may have religious content; social and cultural factors may challenge health care delivery. The extant research has implications for clinical practice. However, many studies exhibited methodological shortcomings with authors providing incomplete analyses of the extent to which findings are authentically Hasidic. High-quality research is required to better inform the provision of culturally competent care to Hasidic patients.     

Spiritual well-being and spiritual practices in elderly depressed psychiatric inpatients

This study's aims were to describe the spirituality of depressed elderly psychiatric inpatients and to examine associations among spirituality, depression, and quality of life (QOL). Forty-five persons participated. Most reported frequent, stable spiritual practices and experiencing spiritual comfort and guidance. Some reported spiritual distress and changes in spirituality. During hospitalization, participants demonstrated increased spiritual well-being (SWB) and peacefulness, and reduced hopelessness, worthlessness, and guilt. Positive associations were found between SWB and QOL and negative associations between SWB and depression.     

Bridging Science and Religion: How Health‐Care Workers as Storytellers Construct Spiritual Meanings

Contrary to the notion that medical science has supplanted religious understandings of human suffering, recent research suggests that health‐care workers like nurses can still portray their confrontations with illness and death in spiritual terms through storytelling. However, scholars have yet to systematically analyze the rhetorical devices used to construct spiritual meanings. Drawing on a symbolic interactionist perspective, we theorize that front‐line health professionals can deploy various rhetorical devices to infuse their workplace interactions with a spiritual significance. We also propose novel fuzzy set analysis techniques for determining which configurations of devices are most important in developing spiritual meanings. This approach was illustrated by examining 173 stories elicited from nurses at a nonsectarian, teaching hospital about encounters at work that significantly impacted their understanding of spirituality. Consistent with our expectations, the way in which nurses tell stories about their experiences not only shapes whether they attach spiritual significance to them, but whether they perceive spirituality and medicine to be compatible. We discuss the implications of our findings for future research on lived religion, conflicting identities, and institutional boundaries.