The “religiosity gap” in a clinical setting: experiences of mental health care consumers and professionals

ABSTRACT

In Western countries, professionals in mental health care (“professionals”) tend to be less religious than “consumers”. This qualitative study explores the meaning of this “religiosity gap” for professionals and consumers in mental health care. Both a regular, secular and a Christian clinic in the Netherlands participated in this study. Content analysis was applied to 35 consumer interviews and 18 interviews with professionals. Consumers reported negative experiences (e.g., perceived disrespect and a lack of confidence) and/or negative expectations (e.g., misunderstanding and misinterpretation) related to a religiosity gap. They also mentioned advantages of a “religiosity match”, like safety and confidence and appreciated professionals’ religious/spiritual self-disclosure. Professionals in secular care setting tended to avoid religion and spirituality. In both clinics, they tended to neutralise religious/spiritual differences and be reticent in self-disclosure. Professionals are recommended to recognise the relevance of a religiosity gap and to consider different strategies in approaching religion/spirituality.     

Psychiatry and religion: a perspective on meaning

ABSTRACT

A Position Statement on Spirituality and Religion in Psychiatry was issued by the World Psychiatric Association in 2016. Among many recommendations, this statement underscores the need for research on both religion and spirituality in psychiatry, especially on their clinical applications. In this contribution we will put light on the issue of meaning and meaning-making, i.e., an important field for every human, Particularly for individuals suffering from severe mental disorders. After an introduction about meaning in its religious/spiritual dimension, we will describe what needs to be studied in order to get a better knowledge as to how patients cope with meaning, and how they process (in terms of meaning-making) the outburst of a severe mental disorder such as schizophrenia.     

Religiosity and the mental health of adolescents in Great Britain

Most studies show that religion is a protective factor for mental health. A few argue that it is detrimental and the remainder conclude it makes no difference. We investigate the religiosity correlates of childhood psychopathology – strength of belief, importance of being able to practice one’s religion, and worship frequency. Questions on religiosity were included in the mental health survey of children in Great Britain administered to 2992 11–19-year-olds in 2007. The Development and Well-Being Assessment was used to generate rates of clinically recognisable mental disorders. Logistic regression analysis was used to establish the magnitude of the religiosity correlates of emotional and conduct disorders. Young people with a stated religion who had weakly held beliefs or who regarded religious practice as unimportant were those with the greater likelihood of having emotional disorders. Regular attendance at religious services or prayer meetings reduced the likelihood of having a conduct disorder.     

Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)?

There are several lines of evidence that suggest religiosity and spirituality are protective factors for both physical and mental health, but the association with obesity is less clear. This study examined the associations between dimensions of religiosity and spirituality (religious attendance, daily spirituality, and private prayer), health behaviors and weight among African Americans in central Mississippi. Jackson Heart Study participants with complete data on religious attendance, private prayer, daily spirituality, caloric intake, physical activity, depression, and social support (n = 2,378) were included. Height, weight, and waist circumference were measured. We observed no significant association between religiosity, spirituality, and weight. The relationship between religiosity/spirituality and obesity was not moderated by demographic variables, psychosocial variables, or health behaviors. However, greater religiosity and spirituality were related to lower energy intake, less alcohol use, and less likelihood of lifetime smoking. Although religious participation and spirituality were not cross-sectionally related to weight among African Americans, religiosity and spirituality might promote certain health behaviors. The association between religion and spirituality and weight gain deserves further investigation in studies with a longitudinal study design.     

Religiousness and Mental Health: Systematic Review Study

Many people use religious beliefs and practices to cope with stressful life events and derive peace of mind and purpose in life. The goal of this paper was to systematically review the recent psychological literature to assess the role of religion in mental health outcomes. A comprehensive literature search was conducted using medical and psychological databases on the relationship between religiosity and mental health. Seventy-four articles in the English and Arabic languages published between January 2000 and March 2012 were chosen. Despite the controversial relationship between religion and psychiatry, psychology, and medical care, there has been an increasing interest in the role which spirituality and religion play in mental health. The findings of past research showed that religion could play an important role in many situations, as religious convictions and rules influence the believer’s life and health care. Most of the past literature in this area reported that there is a significant connection between religious beliefs and practices and mental health.     

Trends in the Scientific Study of Religion, Spirituality, and Health: 1965–2000

The present study examined the degree to which interest in religion, spirituality, and health has changed in psychology and the behavioral sciences over the past few decades. To accomplish this, searches were conducted on the PsycINFO database between the years 1965 and 2000. Three basic searches were conducted combining the word “health” with the following search terms: 1. (religion OR religious OR religiosity) NOT (spiritual OR spirituality); 2. (spiritual OR spirituality) NOT (religion OR religious OR religiosity); and 3. (religion OR religious OR religiosity) AND (spiritual OR spirituality). The rate per 100,000 articles was then calculated for each of the three search-terms: religion, spirituality, religion and spirituality. A significant upward trend across years was found for the rate of articles dealing with spirituality, r(34) = .95, p<.001, and religion and spirituality, r(34) = .86, p<.001. A significant downward trend was found for articles that only addressed religion, r(34) = −.64, p<.001. The consequences of these trends are discussed.Dr. Andrew J. Weaver is a United Methodist minister and clinical psychologist. He is the Associate Publisher of Zion’s Herald, an independent religious journal founded in 1823 and is co-author of numerous professional and popular articles and eleven books. His recent book titles include Counseling Survivors of Traumatic Events and Reflections on Grief and Spiritual Growth.Dr. Kenneth I. Pargament is professor of clinical psychology at Bowling Green State University. Dr. Pargament has published over 100 articles on the meanings of religion and spirituality, the vital role of religion in coping with stress and trauma, perceptions of sacredness in life, and psychospiritual treatment. He is author of The Psychology of Religion and Coping: Theory, Research, Practice.Dr. Kevin J. Flannelly has been the Associate Director of Research at The Health Care Chaplaincy since 2001. Dr. Flannelly has published more than 100 studies in various areas of psychology and he has worked in the field of religion, spirituality and health since 1996. He recently published a review and analysis of the methodological quality of research on religion and health in the Southern Medical Journal.Julia Oppenheimer is a Ph.D. student at the University of Oregon, studying child development and clinical practice in the Clinical Psychology program. She has conducted research on the etiology and treatment of anxiety disorders, as well as publishing a number of studies on religion and mental health. Her current research on the development of children’s self-perceptions of personality is funded by a National Science Foundation Graduate Research Award. Correspondence to Dr. Kevin J. Flannelly, kflannelly@healthcarechaplaincy.org.     

Religion and Suicide: Buddhism,Native American and African Religions,Atheism, and Agnosticism

Research has repeatedly demonstrated that religiosity can potentially serve as a protective factor against suicidal behavior. A clear understanding of the influence of religion on suicidality is required to more fully assess for the risk of suicide. The databases PsycINFO and MEDLINE were used to search peer-reviewed journals prior to 2008 focusing on religion and suicide. Articles focusing on suicidality across Buddhism, Native American and African religions, as well as on the relationship among Atheism, Agnosticism, and suicide were utilized for this review. Practice recommendations are offered for conducting accurate assessment of religiosity as it relates to suicidality in these populations. Given the influence of religious beliefs on suicide, it is important to examine each major religious group for its unique conceptualization and position on suicide to accurately identify a client’s suicide risk.     

The Imagination of Images and Images of Imagination: How the Imagination Relates to Aging,Health, and Spirituality

ABSTRACT

Psychological literature suggests that religion and spirituality increase in late adulthood. Yet, operational definitions of spirituality and religiosity remain widely debated and inadequate for the concepts they are designed to measure. The empirical studies of religion and spirituality as one ages are of poor design and often measure only limited aspects of religion or spirituality. Few empirical studies exist which have been conceived to only study religiosity and spirituality in late adulthood. The purpose of this study was to determine the defining aspects of religiosity and spirituality using the Allport, Ross Intrinsic, Extrinsic Religiosity Scale, Ellison's Spiritual Well-Being Scale, and Neugarten's Life Satisfaction Instrument. Using a principal component factor analysis, the study examined the factor structure using an older adult sample of 320 individuals 65 years of age and older. Having a purpose in life combines with intrinsic religious questions for the first factor. Life satisfaction questions group together on two factors and extrinsic religiosity is clearly one factor. The scales used hold together well when combined. A new, shortened scale to measure aspects of religiosity and spirituality is proposed.     

Religious experience and mental health: anthropological and psychological approaches

ABSTRACT

Moreira-Almeida, Sharma, van Rensburg, Verhagen and Cook have written a very comprehensive position statement pertaining to religion and psychiatry. While presenting a good overview of studies of religion, spirituality and mental health it does not include the important area of the health implications of religious experience which is the focus of this piece. I begin by discussing definitions of religious experience before examining the work of William James. The second part of this paper focuses upon specific religious experiences and psychopathology with a focus on mysticism, hallucinations and culture.     

Divine Emotions: On the Link Between Emotional Intelligence and Religious Belief

There have been only few attempts to explore the relationship between emotional intelligence (EI) and religiosity. However, none of them included measures of ability EI. In two studies, we investigated the potential associations between various aspects of religious belief and ability and trait EI. In Study 1 (N = 240), we found that ability EI was positively associated with general level of religious belief. Study 2, conducted among Polish Christians (N = 159), replicated the previous result on the connection between ability EI and religion. Moreover, both trait and ability EI were negatively correlated with extrinsic religious orientation and negative religious coping. Additional analysis showed that extrinsic orientation mediated the relationship between ability EI and religiosity.     

An Investigation of Religion and Spirituality of Sexual Minorities in the United States: Exploring Perceptions,Intrinsic Religiosity,and Outness to Religious Communities

We investigated how sexual minority participants in the United States (N = 217; M age = 36.36 years) viewed organized religion and their relationships with a higher power. In addition, we examined the associations between levels of outness in religious communities, internalized heterosexism (IH), intrinsic religiosity, and depression. Open-ended responses revealed that views of organized religion fell into three categories—negative (57.9%), positive (9.1%), and ambivalent (33%)—and participants reported a variety of relationships to a higher power—existing relationship (61.5%), no relationship (19%), fractured relationship (4.6%), and some who felt unsure (10.8%). Participants with greater outness to a religious community reported less IH and higher intrinsic religiosity. Also, outness to a religious community moderated the association between IH and depression, such that there was not a significant association between IH and depression for individuals with low levels of outness. However, at average to high levels of outness, there was a significant association between IH and depression.     

Can Religious Beliefs be a Protective Factor for Suicidal Behavior? A Decision Tree Analysis in a Mid-Sized City in Iran, 2013

This study aimed to assess using tree-based models the impact of different dimensions of religion and other risk factors on suicide attempts in the Islamic Republic of Iran. Three hundred patients who attempted suicide and 300 age- and sex-matched patient attendants with other types of disease who referred to Kerman Afzalipour Hospital were recruited for this study following a convenience sampling. Religiosity was assessed by the Duke University Religion Index. A tree-based model was constructed using the Gini Index as the homogeneity criterion. A complementary discrimination analysis was also applied. Variables contributing to the construction of the tree were stressful life events, mental disorder, family support, and religious belief. Strong religious belief was a protective factor for those with a low number of stressful life events and those with a high mental disorder score; 72 % of those who formed these two groups had not attempted suicide. Moreover, 63 % of those with a high number of stressful life events, strong family support, strong problem-solving skills, and a low mental disorder score were less likely to attempt suicide. The significance of four other variables, GHQ, problem-coping skills, friend support, and neuroticism, was revealed in the discrimination analysis. Religious beliefs seem to be an independent factor that can predict risk for suicidal behavior. Based on the decision tree, religious beliefs among people with a high number of stressful life events might not be a dissuading factor. Such subjects need more family support and problem-solving skills.     

Religiosity and Religious Coping in Patients with Cardiovascular Disease: Change over Time and Associations with Illness Adjustment

Little is known about the longitudinal relationship between religiosity/spirituality (R/S) and patient physical and mental health in patients with cardiovascular disease. Forty-three patients with a first-time myocardial infarction or coronary artery revascularization bypass surgery completed measures of religiosity, religious coping, quality of life (QOL), and weight prior to a cardiac rehabilitation program and 1 and 2 years later. R/S changed over time; the direction of the change varied by type of R/S. Increases in religiosity were associated with increases in weight and QOL; increases in religious coping were associated with decreases in weight and increases in QOL.     

Similarities and Differences Between Religiosity and Spirituality in African American College Students: A Preliminary Investigation

To explore similarities and differences between religiosity and spirituality, the authors used several measures of religiosity and spirituality to examine the level of their association in 171 African American college students. Results support the multidimensionality of both constructs. An intrinsic religious orientation accounted for most of the variance in each type of spirituality; conversely. 1 type of extrinsic religious orientation accounted for almost none. The authors also found no significant differences between men's and women's scores on any of the religiosity and spirituality measures. The authors discuss implications for addressing religion and spirituality with African American clients.     

Spiritual Versus Religious Identity: A Necessary Distinction in Understanding Clinicians’ Behavior and Attitudes Toward Clinical Practice and Medical Student Teaching in This Realm

Social sciences view spirituality and religion separately; medicine views them together. We identified distinctions regarding clinical practice and teaching among clinician educators based on their self-identified spirituality versus religiosity. We emailed a 24-item survey on spiritual/religious (S/R) issues to clinician educators (n = 1,067) at our institution. Three summary scales were created. Responses to statements, ‘I consider myself to be spiritual’ and ‘I consider myself to be religious’ generated four comparison groups: ‘spiritual only,’ ‘religious only,’ ‘both spiritual and religious’ and ‘neither.’ Analyses employed ANOVA and T tests. A total of 633 (59 %) surveys were completed. Four percentage self-identified as ‘religious only’; remaining respondents divided evenly, about 30 % into each of the other categories. Groups differed from one another on all summary scales (p < .0001). Using T tests, the ‘spiritual only’ group differed from the ‘religious only’ group regarding teaching. The ‘spiritual and religious’ group had the highest mean ratings for all summary scales. The ‘neither’ and ‘religious only’ group had the lowest mean ratings. Clinicians’ spiritual versus religious identity is associated with differences in behavior/attitudes regarding S/R toward clinical practice and medical student teaching. These findings elucidate opportunities for faculty development to explore effects of beliefs on behavior and attitudes within this realm.     

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.     

The Importance of Spirituality in Well-Being for Jews and Christians

There is a well-known association between religion and happiness, although it is not known which particular aspects of religiosity correlate with life satisfaction, or if the correlates are different for people of different religions. In three studies, the correlations of different facets of religiosity with happiness or life satisfaction were explored. In different samples and with different measures, congregational support and public practice of religion appear to correlate similarly with measures of life satisfaction for members of different religions. However, spirituality, religious coping, and religious belief were better predictors of happiness and quality of life for Protestants and Catholics than for Jews. It is therefore contended that religion should be an important consideration, along with religiosity, in study of satisfaction with life, and that the link between spirituality and life satisfaction be followed up, particularly among Christians.     

Examining Social Desirability in Measures of Religion and Spirituality Using the Bogus Pipeline

A primary concern in the psychology of religion is the distinct possibility that responses to empirical assessments of individuals’ degree and type of religiosity and spirituality are exaggerated owing to social desirability bias. In spite of increased secularization in American culture and a growing distrust of organized religion, religious involvement, personal religiosity, and spirituality are still viewed as highly desirable characteristics. This study estimates the extent of social desirability biases that affect self-reports of religion and spirituality by utilizing a bogus pipeline procedure. In this procedure, participants are convinced that experimenters can detect disingenuous responses to individual items on questionnaires through the use of physiological measures, although no physiological data are actually collected. If the self-reports of participants in the bogus pipeline condition indicate greater religiosity or spirituality than those in the control condition, self-report bias is indicated. The bogus pipeline procedure has been used in other areas of study to increase veracity of self-reports when social desirability effects are present (such as reporting sexual behaviors or prejudice). The results indicate that social desirability biases influence multiple constructs including religious orientations, religious coping, and daily spiritual experiences. Implications for future research relying on self-reports of religion and spirituality are discussed.     

What Mediates the Relationship Between Religious Service Attendance and Aspects of Well-Being?

Religious service attendance predicts increased well-being across a number of studies. It is not clear, however, whether this relationship is due to religious factors such as intrinsic religiosity or due to nonreligious factors such as social support or socially desirable responding. The purpose of the present study was to examine the relationship between religious service attendance and well-being while simultaneously examining intrinsic religiosity, social support, and socially desirable responding as potential mediators of the relationship. A sample of 855 participants (71 % female, average age 19.5) completed questionnaires assessing religiosity, social support, socially desirable responding, and well-being. Path models were estimated using maximum likelihood estimation to analyze the data. Intrinsic religiosity was the strongest mediator of the relationship between religious service attendance and depressive and anxiety symptoms. This suggests that the mental health benefits of religious service attendance are not simply the result of increased social support or a certain response style on questionnaires; rather, it appears that the relationship is at least partly the result of people trying to live their religion in their daily lives.     

When Meaning Matters: Coping Mediates the Relationship of Religiosity and Illness Appraisal with Well-Being in Older Cancer Patients

When individuals face serious, traumatic illnesses such as cancer, religion can contribute to their coping processes and psychosocial adjustment. In the current study, we examined the relationship between religiosity conceptualized as the religious meaning system, illness appraisal, and psychological well-being with religious and nonreligious coping as potential mediators of this relationship among older cancer patients. In a cross-sectional design, 215 older Polish patients (60–83 years of age; 80% Catholic, 9% Protestant) with gastrointestinal cancer completed measures of religiosity, illness appraisal, religious coping, nonreligious coping, and psychological well-being. Using structural equation modeling analysis, we found support for our model depicting a mediated relationship between religiosity, illness appraisal, and psychological well-being. Three forms of coping—negative religious, problem focused, and meaning focused—were key mechanisms in the relationship between the religious meaning system, positive and negative illness appraisal, and psychological well-being. These findings suggest that both religious factors (religiosity and religious coping) and nonreligious factors (illness appraisal and nonreligious coping) can operate together in influencing older cancer patients’ well-being.