Spiritual Assessment in African-Americans: A Review of Measures of Spirituality Used in Health Research

Background A number of instruments have been developed for investigating relationships between spirituality and health, and have been used to assess spirituality in African-Americans. Yet, the cultural appropriateness for African-Americans of these instruments has not been investigated to date. Objectives To evaluate the construct validity and reliability of spirituality measures used in health research from 1982 to 2005. Method Systematic review of the literature. Results Thirty five studies and five measures of spirituality met the inclusion criteria. Most of the spirituality measures were developed in primarily Caucasian-American samples. African-Americans were represented in 71% of the studies (n = 25) using spirituality measures in health research. Distinct cultural attributes of African-American spirituality were omitted in most of the spirituality measures. Two studies were retrieved in which psychometric evaluation was conducted in entirely African-American samples. Discussion Spirituality is a significant cultural experience and belief that influences the health behaviors of African-Americans. The lack of a culturally appropriate measure of African-American spirituality is a major limitation of studies investigating spirituality and health in this population. Development of a culturally appropriate and sensitive measure of spirituality in African-Americans is suggested to strengthen the quality of research in this area.     

A Qualitative Study of Faith Leaders’ Perceptions of Health and Wellness

The effectiveness of faith-based health and wellness interventions is moderated by the attitudes, perceptions, and participation of key leaders within faith-based organizations. This qualitative study examined perceptions about the link between health, spirituality, and religion among a volunteer sample of faith leaders (n = 413) from different denominations. The major themes included: influences on health and wellness promotion and a relationship between spirituality and health. The results indicated that perceptions about the link among health, spirituality, and religion vary among faith leaders, regardless of denomination. Future faith-based interventions should be developed with consideration for denomination as a socially and culturally relevant factor.     

The Role of Religion in Psychotherapy: A Cross-Cultural Examination

The question of whether religion should be considered in psychotherapy continues to be a point of debate. Many authors, notably Boyd-Franklin and Peck, feel that it is a serious oversight for mental health workers to ignore the role of spirituality in the development of the psyche. The present author offers a training program for mental health workers to aid in their understanding of the psycho-spiritual development of their clients. Moreover, the role of religious folk belief in psychotherapy is highlighted to aid therapists in understanding the explanations that clients from culturally diverse backgrounds may give in attempting to explain the causes of mental illness. Finally, a differential diagnosis of spirit possession versus schizophrenia is discussed. Several case examples are presented.     

Making sense of the study of spirituality: late modernity on trial

ABSTRACT

In this article I offer a meta-theoretical mapping of spirituality studies and its many controversies. I begin by distinguishing between two projects that together constitute the field: the study for and the study of spirituality. I argue a good deal of the confusion surrounding ‘spirituality’ is the result of scholars failing to make this distinction. Next, I outline the few areas of agreement within the study of spirituality in order to illuminate what I consider the issue that defines the field: the merits and shortcomings of late modernity. By late modernity I mean the current era, whose origins can be traced roughly to the 1960s. I then offer a meta-theoretical analysis of the social-cum-political theoretical frameworks commonly used to study spirituality, delineating them according to their assessments of the contemporary epoch. I contend this is a useful and much-needed means of dispelling some of the fuzziness that characterizes the field.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Response Bias in Research on Religion,Spirituality and Mental Health: A Critical Review of the Literature and Methodological Recommendations

Although a significant body of research supports the psychological benefits of religion and spirituality, more investigations are needed to understand the mechanisms by which they impact mental health. While some studies suggest a causal direct influence, the findings may still be subject to unmeasured factors and confounders. Despite compelling empirical support for the dangers of response bias, this has been a widely neglected topic in mental health research. The aim of this essay is to critically examine the literature addressing the role of response bias in the relationship between religion, spirituality and mental health. A survey of the diverse types of bias in this research area is presented, and methodological and theoretical issues are outlined. The validity and generalizability of the evidence are discussed, as well as the implications for mental health practice. A list of methodological remedies to reduce bias is suggested. The article is then concluded with a summary of the studies reviewed and directions for future research.

     

Spirituality and mental health status among Northern Plain tribes

Spirituality measures often show positive associations with preferred mental health outcomes in the general population; however, research among American Indians (AIs) is limited. We examined the relationships of mental health status and two measures of spirituality – the Midlife Development Inventory (MIDI) and a tribal cultural spirituality measure – in Northern Plains AIs, aged 15–54 (n?=?1636). While the MIDI was unassociated with mental health status, the tribal cultural spirituality measure showed a significant relationship with better mental health status. Mental health conditions disproportionately affect AIs. Understanding protective factors such as cultural spirituality that can mitigate mental health disorders is critical to reducing these health disparities.     

A feasibility study of psychological strengths and well-being assessment in individuals living with recurrent depression

Current conceptualizations of mental illness focus on assessing psychopathology. A balanced approach would assess strengths that individuals bring to coping with illness. This study measures psychological strengths in individuals with recurrent depression, their coping strategies, and their perceptions of the usefulness of strengths assessment as a component of psychological assessment. Individuals (N?=?112) with recurrent depression completed an online questionnaire measuring several psychological strengths, including gratitude, forgiveness, spirituality, and hope. Participants also described their use of coping strategies and their reaction to the utility of the two-continua model of mental health. A subset (n?=?10) completed a follow-up telephone interview. Higher levels of gratitude, self-forgiveness, hope, and spirituality and lower levels of optimism were indicative of higher life satisfaction. Self-forgiveness, spirituality, and gratitude were predictors of happiness. Higher levels of hope and self-forgiveness predicted positive affect whereas lower levels of self-forgiveness predicted negative affect. Participants reported using a range of coping resources and indicated that they valued strengths assessment, perceiving the two-continua model of mental health as empowering. The researcher discusses implications for clinical practice.     

Connection,Action, and Hope: an Invitation to reclaim the “Spiritual” in Health Care

The complex process of health has, until recently, been understood devoid of a spiritual component. The present article offers a model of health inclusive of spirituality with implications for the health communication field. Amending the assumptive non-relevance of spirituality to individual health, a growing body of scholarship in various disciplines recognizes the ways in which spirituality connects to overall wellness. As a whole, this literature equates spirituality with seeking, striving, and forward movement. Given the potential for health communication scholars to make significant contributions at the forefront of this research, this article proposes a dynamic model of health inclusive not only of the physical and mental, but of the spiritual as well. Recognizing its centrality to wellbeing, the model locates the spiritual self at the center. Specifically, the spiritual self is described as engaging action, hope, and connection to self, others, and/or the universe.     

Counseling and Spirituality: A Historical Review

Evolution of the relationship between counseling and spirituality since 1840 is examined in terms of the number of publications that have appeared over time that include these terms. The author retrieved the data using the American Psychological Association's PsycINFO database. A similar search was done adding the term training. The rise of behaviorism and cognitive psychology is discussed as possible explanations for the absence of a discussion of spirituality in the early psychological literature. A. H. Maslow's (1969a, 1969b; Association for Transpersonal Psychology, n.d.) work; the evolution of the Association for Spiritual, Ethical, and Religious Values in Counseling; and multiculturalism are suggested as possible influences on the growth in the number of publications on spiritual and counseling issues over the last 30 years.     

Psychological individual differences as predictors of refugees’ local language proficiency

Learning the local language is important for the successful integration of immigrants. Previous research has identified a number of sociodemographic factors that are associated with the effectiveness of local language acquisition among immigrants, but little is known about the influence of psychological differences on immigrants’ local language acquisition. In the present research, individual differences in general mental ability (GMA), work search intention, and personality traits Conscientiousness and Openness were studied among recently arrived Syrian (n = 1054) and Eritrean (n = 500) refugees in the Netherlands. The results revealed that in addition to the effects of age of arrival, local length of stay, premigration educational attainment, and psychological distress, GMA and work search intention were positively associated with refugees’ local language proficiency. Additionally, work search intention was found to strengthen the effect of GMA on local language proficiency. No positive linear effects were observed for Conscientiousness and Openness. Some evidence was found for curvilinear relationships between psychological predictors and local language proficiency. Implications are discussed.     

Mental Health Professionals’ Attitudes,Perceptions, and Stereotypes Toward Latino Undocumented Immigrants

We assessed the attitudes, perceptions, and stereotypes toward Latino immigrants among 247 mental health professionals across 32 U.S. states. We also randomly presented two versions of an attitude measure that varied in their references to immigrants (“illegal aliens” or “undocumented immigrants”). Participants reported that they did not agree with the anti-immigration law Arizona SB 1070 and other similar bills. Also, greater multicultural awareness was related to positive attitudes and fewer stereotypes toward immigrants. Furthermore, participants who were asked to think about “undocumented immigrants” viewed Latino immigrants more positively than those who were asked think about “illegal aliens.” Findings show the continued need for multicultural awareness and competence training for mental health professionals, which align with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (i.e., Principle E: Respect for People’s Rights and Dignity and Standard 3.01: Unfair Discrimination). Limitations and future directions for research are discussed.     

Does spirituality really matter?: A study on the potential of spirituality for older adult's adjustment to aging

This study intended to analyze the indicators of adjustment to aging (AtA) and to investigate the latent constructs that can work as major determinants in spirituality for a cross‐national older community‐dwelling population. Questionnaires were completed to assess the participants' background information. Interviews were performed, addressing one core area: indicators of AtA. Complete data were available for 154 older adults from two nationalities (German and Portuguese), aged between 75 and 103 years (M = 86.6; SD = 6.98). The data were subjected to content analysis. Representations of the associations and latent constructs were analyzed using a multiple correspondence analysis (MCA). The most prevalent response of the interviewed participants for indicators of AtA was spirituality (43.2%). Spiritual activities was the most reported response regarding spirituality (20.0%). A significant moderate association was found between spiritual activities and nationality (V = .365; p < .001). Spirituality for older adults was explained by a three‐dimensional overall model: spiritual and existential meaning, limit‐related awareness and community embeddedness. The findings presented in this paper emphasized the need to explore the potential of spirituality for AtA and the need for improving the spiritual dimension of health care for the older cross‐national population.     

Religion,Spirituality, and Alternative Health Practices: The Baby Boomer and Cold War Cohorts

Research in religion and health has suggested positive relationships, and most recently has concentrated on the experience of religion, or spirituality. Currently, cohort studies have shown that the baby boomers differ significantly from their elders in their approach to religion, preferring to explore spirituality rather than the religious doctrine of their elders. They also differ in their approaches to health, including greater acceptance and use of alternative health practices. This study isolates the baby boomer and cold war cohorts in order to explore differences in religion, spirituality and alternative health practices. Findings indicate that, for boomers, increased spirituality is significantly related to increased positive health perceptions, while their elders' health perceptions are related to increased religiosity. Alternative health practices and spirituality, however, are not related for either cohort. However, this study does identify important distinctions between the two cohorts. Future studies must recognize differing cohort constructions of reality concerning the meanings of health, spirituality and religion.     

Aetiology of Coexisting Mental Health and Alcohol and Other Drug Disorders: Perspectives of Refugee Youth and Service Providers

In the general population, people with comorbid mental health (MH) and alcohol and other drug (AOD) disorders (comorbidity) have great difficulty accessing appropriate services, and poor outcomes. Little is known about comorbidity in resettled refugees in Australia. This study was designed to identify risk factors and patterns of comorbidity development in young people from refugee backgrounds living in a disadvantaged urban region of Adelaide, South Australia. This qualitative study utilised in‐depth semi‐structured interviews (n = 30) with resettled refugee youth and workers from MH, AOD, and refugee support services. Thematic analyses were conducted to investigate the aetiology of MH and AOD disorders in young refugees. Interviews with both groups revealed how the interrelated nature of risk factors may place young people from refugee backgrounds at heightened risk of experiencing MH and AOD problems. The situations and conditions described by both groups are discussed under six main themes: pre‐migration experiences of torture and trauma; familial factors of intergenerational conflict; post‐migration adjustment difficulties in terms of language, culture, education, and employment; exposure to and availability of substances; maladaptive coping strategies and self‐medication; and access to information and services. Implications for psychologists and MH professionals are identified, emphasising the need for clinicians to understand the complexities surrounding the aetiology of comorbidity in these youth. The initial assessment needs to be comprehensive, including pre‐ and post‐settlement experiences and cultural and family dimensions of their current situation. Treatment may often need to simultaneously address multiple contributing factors and involve culturally sensitive psycho‐education.     

Unusual but sound minds: Mental health indicators in spiritual individuals

Previous research has linked certain types of modern spirituality, including New Age and Pagan, with either benign schizotypy or insecure attachment. While the first view emphasizes a positive aspect of spiritual believers’ mental health (benign schizotypy), the second view emphasizes a negative aspect, namely the unhealthy emotional compensation associated with an insecure attachment style. This study addresses these two conflicting views by comparing a sample of modern spiritual individuals (N = 114) with a contrast group of traditional religious believers (N = 86). Measures of schizotypy and attachment style were combined with mental health scales of anxiety and depression. We further assessed death anxiety to determine whether modern spiritual beliefs fulfilled a similar function as traditional religious beliefs in the reduction of existential threat. Our results support a psychological contiguity between traditional and modern spiritual believers and reinforce the need to de‐stigmatize spiritual ideas and experiences. Using hierarchical regression, we showed that unusual experiences and ideas are the major predictor of engagement in modern spiritual practices. Anxiety, depression variables, and insecure attachment were not significant predictors of spirituality or correlated with them; on the other hand, the results show that spiritual believers report high social support satisfaction and this variable predicts involvement in modern spirituality. Further, spiritual practices were negatively correlated with and negatively predicted by death anxiety scores. Overall, the results strengthen the association between modern spirituality, good mental health, and general well‐being.     

Cognitive testing in non‐demented Turkish immigrants ‐ comparison of the RUDAS and the MMSE

Nielsen, T. R. Vogel, A., Gade, A. & Waldemar, G. (2012). Cognitive testing in healthy Turkish immigrants ‐ comparison of the RUDAS and the MMSE. Scandinavian Journal of Psychology 53, 455–460. Methods for culturally and linguistically appropriate cognitive testing of elderly minority populations are lacking in Europe. The aim of this study was to compare performance on the Rowland Universal Dementia Assessment Scale (RUDAS) and the Mini Mental State Examination (MMSE) in Turkish immigrants in Denmark and determine the impact of demographic and health‐related variables on test performance. A sample of non‐demented community‐dwelling Turkish immigrants was recruited from the greater Copenhagen area. All participants completed a structured interview regarding demographic, physical and mental health status, as well as measures of depression and acculturation, and cognitive testing with the RUDAS and the MMSE. A total of 76 non‐demented participants aged 50 or more were included in the study. The mean performance on the RUDAS and the MMSE was 26.8 (SD 2.4) and 23.7 (SD 4.3), respectively. In group comparisons, correlation analyses and regression analyses, level of schooling represented a more significant variable for RUDAS and MMSE performance than any other variable. However, the impact of schooling was considerably more pronounced on the MMSE and the test was not found to be a valid measure of general cognitive function in subjects with less than five years of schooling. Although not entirely free of educational bias, the RUDAS can be a valuable supplement to the MMSE for assessment of general cognitive function in Turkish minority populations.     

Knowing minds: Culture and perceptions of mental state access

How does culture influence the ways in which individuals reflect upon their knowledge of others’ mental states? We addressed this question in a two‐study cross‐cultural investigation examining perceptions of mental state access in the United States and Japan. Study 1 (n = 100) revealed that American participants reported greater mental state access than did Japanese participants. Study 2 (n = 146) showed that both Americans and Japanese perceived greater access to the mental states of a close friend relative to a casual friend and that the observed cultural differences in perceived mental state access to a close friend’s mental states were mediated by how much access was considered appropriate. Overall, the results indicate that culturally variable norms specifying appropriate levels of mental state access play an important role in how individuals estimate their knowledge of other people’s minds in close relationships.     

Contextualizing Acculturation: Gender, Family, and Community Reception Influences on Asian Immigrant Mental Health

This article investigates differences in the mental health among male and female immigrants from an ecological perspective, testing the influences of both individual acculturation domains and social contexts. Data from the first nationally representative psychiatric survey of immigrant Asians in the US is used (N = 1,583). These data demonstrate the importance of understanding acculturation domains (e.g., individual differences in English proficiency, ethnic identity, and time in the US), within the social contexts of family, community, and neighborhood. Results demonstrate that among immigrant Asian women, the association between family conflict and mental health problems is stronger for those with higher ethnic identity; among immigrant Asian men, community reception (e.g., everyday discrimination) was more highly associated with increases in mental health symptoms among those with poor English fluency. Findings suggest that both individual domains of acculturation and social context measures contribute to immigrant mental health, and that it is important to consider these relationships within the context of gender.     

Whither the Psychology of Religion: A Spirituality-Focused Discussion of Paloutzian and Park’s (2005)

Presuming Rayburn’s (2006: Child & Family Behavior Therapy, 28, 86–92) review of (Paloutzian and Park, 2005, Handbook of the psychology of religion and spirituality. New York: The Guilford Press) and sketching an alternative paradigm, this review focuses on the Handbook’s virtual conflation of religion and spirituality; relates this conflation to the hegemony of Protestant theology in North American psychology of religion; highlights the Handbook’s neglect of spirituality per se, which, if not inseparably linked with theism, is, nevertheless, related to the self-transcending, meaning-making dimension of the human mind, could provide an explanatory breakthrough in the field of the psychology of religion and of the social sciences overall; and sees Handbook’s advocacy for a “multilevel interdisciplinary paradigm” as a regrettable acceptance of the failed, long-term strategy of the field of psychology in general.