Religiosity/Spirituality and Physiological Markers of Health

The long-standing interest in the effects of religiosity and spirituality (R/S) on health outcomes has given rise to a large and diverse literature. We conducted a meta-analysis on research involving R/S and physiological markers of health to elucidate both the scope and mechanism(s) of this phenomenon. A combined analysis found a significant, but small, beneficial effect. Subgroup analyses found that some measures of both extrinsic and intrinsic religiosity were significantly associated with health. Several outcome measures, including blood pressure, C-reactive protein, and cardiovascular health markers, were significantly associated with R/S. Our findings suggest that R/S benefits health, perhaps through minimizing the disruptive effects of stress/depression on inflammation. We hope that researchers can use these results to guide efforts aimed at elucidating the true mechanism(s) linking religious/spiritual beliefs and physical health.

     

“The Lord is my Shepherd”: examining spirituality as a protection against mental health problems in youth exposed to violence in Brazil

Intrinsic and institutional spirituality or religiosity may each provide unique protective effects against the negative impacts of stress on mental health. Whether this extends to adolescents exposed to high levels of community violence is unknown. Three hundred twenty-five incarcerated adolescents from São Paulo City, Brazil responded to questions about spirituality and violence exposure drawn from the Social and Health Assessment, and mental health problems drawn from the Strengths and Difficulties Questionnaire. There was some evidence that intrinsic and institutional spirituality/religiosity may buffer the relation between violence exposure and certain mental health problems, and that intrinsic spirituality may mediate the relationship between institutional activities and certain mental well-being outcomes. These findings extend a degree of support to the multi-dimensional nature of spirituality to high-risk youth populations, suggesting a small differential and interactive role that intrinsic and institutional spirituality may play in protecting against some mental health problems.     

Disordered eating and self-objectification in college women: clarifying the roles of spirituality and purpose in life

Spirituality and purpose in life have been associated with positive mental health outcomes. This study examined the effects of spirituality, religiousness, and purpose in life on self-objectification and disordered eating. An ethnically diverse sample of college women (N?=?161), aged 18–25, who were enrolled in the undergraduate level psychology courses, participated by completing a survey assessing relational spirituality, intrinsic religiousness, and purpose in life, as well as self-objectification and disordered eating. Results supported a relationship between self-objectification and disordered eating. Intrinsic religiousness was also associated with self-objectification after controlling for religious affiliation. In addition, women who had less purpose in their lives displayed more disordered eating. These findings suggest that a sense of purpose in life may be a key dimension of spirituality that is associated with eating disturbance.     

Spirituality Predicts Health and Cardiovascular Responses to Stress in Young Adult Women

The primary focus of this study was to investigate the roles of spirituality and religiosity in self-reported physical health, and to determine whether there is an association between an individuals spirituality and cardiovascular responses to two stressors. Fifty-two females participated in both a betrayal interview and a structured interview, during which blood pressure and heart rate were monitored. Spirituality, as assessed by the Spiritual Well-being Scale, was associated with perceived stress, subjective well-being, and medication use. The Existential Well-being subscale predicted fewer physical health symptoms and was associated with lower mean heart rate and decreased heart rate reactivity. The Religious Well-being subscale was associated with reduced systolic blood pressure reactivity in response to the structured interview. These findings suggest that spirituality may have a salutary effect on health, even in a fairly young sample. While previous studies have predominantly reported that religion, as well as spirituality, have a health protective effect, this study did not find strong support for that conclusion. Religiosity in this age group may still be undergoing developmental maturity, which may explain the lack of relationships to health.     

Evaluation of a holistic cardiac rehabilitation in the reduction of biopsychosocial risk factors among patients with coronary heart disease

The purpose of this pilot study is to evaluate the effectiveness of the Lifestyle Change Program (LSCP). LSCP was a holistic cardiac rehabilitation (CR) intervention focusing on several psychosocial and biological predictors of coronary heart disease including depression, hostility, low social support, high perceived stress, low spirituality, low life satisfaction, overall health status and cholesterol levels. Utilising a quasi-experimental design, overall health scores of LSCP patients were compared with those of a control group. To assess differences within-and between- groups, two (programme type) × 2 (age) × 2 (gender) × 2 (time) mixed design ANOVAs were used. Within-group relationships for psychosocial assessments and cholesterol levels were analysed using paired-samples t-tests. Results suggest that there were no significant differences between the LSCP group and the control group with regard to overall health status. However, the LSCP participants reported significantly lower levels of depression and perceived stress, as well as significantly higher levels of life satisfaction and spirituality upon programme completion. In addition, lipid panels changed significantly: A significant decrease in total cholesterol, low-density lipoproteins and triglycerides, as well as a significant increase in high-density lipoproteins. These trends suggest that holistic CR may be effective at reducing biopsychosocial risk factors for future cardiac events. Future studies, utilising an experimental design, are necessary to determine whether holistic programmes are more effective than traditional programmes in the reduction of cardiac risk factors.     

The heart's content: the association between positive psychological well-being and cardiovascular health

This review investigates the association between positive psychological well-being (PPWB) and cardiovascular disease (CVD). We also consider the mechanisms by which PPWB may be linked with CVD, focusing on the health behaviors (e.g., smoking, alcohol consumption, physical activity, sleep quality and quantity, and food consumption) and biological functions (e.g., cardiovascular, inflammatory, and metabolic processes) that are most relevant for cardiovascular health. Because PPWB is a broad concept, not all aspects of PPWB may be associated with cardiovascular health. Thus, we distinguish between eudaimonic well-being, hedonic well-being, optimism, and other measures of well-being when reviewing the literature. Findings suggest that PPWB protects consistently against CVD, independently of traditional risk factors and ill-being. Specifically, optimism is most robustly associated with a reduced risk of cardiovascular events. In general, PPWB is also positively associated with restorative health behaviors and biological function and inversely associated with deteriorative health behaviors and biological function. Cardiovascular health is more consistently associated with optimism and hedonic well-being than with eudaimonic well-being, although this could be due in part to more limited evidence being available concerning eudaimonic well-being. Some similarities were also evident across different measures of PPWB, which is likely due to measurement overlap. A theoretical context for this research is provided, and suggestions for future research are given, including the need for additional prospective investigations and research that includes multiple constructs of psychological well-being and ill-being.     

Lay Conceptualizations of Spirituality and Religiousness Among Jewish Israeli Men and Women

In order to clarify the lay conceptualization of spirituality and the overlap between the constructs of spirituality and religiousness, the relations between a multidimensional measure of spirituality and overall measures of spirituality and religiousness were examined. A total of 111 Israeli Jewish men and women responded to the Spiritual Orientation Inventory (SOI), a multidimensional measure of humanistic spirituality, and to single-item overall measures of spirituality and religiousness. For both men and women, all SOI sub-scales were significantly related to spirituality. In contrast, three SOI sub-scales—Altruism, Idealism, and Awareness of the tragic—were not related to religiousness. Regression analysis indicated that for men, spirituality is a more one-dimensional construct strongly associated with the experiential aspects of spirituality. In comparison, women demonstrated a more complex perception of spirituality associated with a variety of intrinsic spiritual values. In addition, for men the overlap between religiousness and spirituality centers on life coherency whereas for women the overlap appears to be more general.     

Understanding the Relationship Between Religiousness, Spirituality, and Underage Drinking: The Role of Positive Alcohol Expectancies

Research has consistently found that religiousness and spirituality are negatively associated with underage drinking. However, there is a paucity of research exploring the mechanisms by which these variables influence this important outcome. With 344 underage young adults (ages 18–20; 61 % women), we investigated positive alcohol expectancies as a mediator between religiousness and spirituality (measured separately) and underage alcohol use. Participants completed the Religious Commitment Inventory-10, Daily Spiritual Experiences Scale, Alcohol Expectancies Questionnaire, and Drinking Styles Questionnaire. Results indicate less positive alcohol expectancies partially mediate the relationship between both religiousness and spirituality and underage alcohol use. This suggests religiousness and spirituality’s protective influence on underage drinking is partly due to their influence on expectations about alcohol’s positive effects. Since underage drinking predicts problem drinking later in life and places one at risk for serious physical and mental health problems, it is important to identify specific points of intervention, including expectations about alcohol that rise from religious and spiritual factors.     

Religion and spirituality. Linkages to physical health

Evidence is presented that bears on 9 hypotheses about the link between religion or spirituality and mortality, morbidity, disability, or recovery from illness. In healthy participants, there is a strong, consistent, prospective, and often graded reduction in risk of mortality in church/service attenders. This reduction is approximately 25% after adjustment for confounders. Religion or spirituality protects against cardiovascular disease, largely mediated by the healthy lifestyle it encourages. Evidence fails to support a link between depth of religiousness and physical health. In patients, there are consistent failures to support the hypotheses that religion or spirituality slows the progression of cancer or improves recovery from acute illness but some evidence that religion or spirituality impedes recovery from acute illness. The authors conclude that church/service attendance protects healthy people against death. More methodologically sound studies are needed.     

An Interpersonal Approach to Religiousness and Spirituality: Implications for Health and Well‐Being

The interpersonal tradition (Horowitz & Strack, 2011) provides a rich conceptual and methodological framework for theory‐driven research on mechanisms linking religiousness and spirituality (R/S) with health and well‐being. In three studies, we illustrate this approach to R/S. In Studies 1 and 2, undergraduates completed various self‐report measures of R/S, interpersonal style, and other aspects of interpersonal functioning. In Study 3, a community sample completed a wide variety of R/S measures and a measure of interpersonal style. Many, but not all, aspects of religiousness (e.g., overall religiousness, intrinsic religiousness) were associated with a warm interpersonal style, and most aspects and measures of spirituality were associated with a warm and somewhat dominant style. Spirituality and related constructs (i.e., gratitude, compassion) were associated with interpersonal goals that emphasize positive relationships with others, and with beneficial interpersonal outcomes (i.e., higher social support, less loneliness, and less conflict). However, some aspects of R/S (e.g., extrinsic religiousness, belief in a punishing God) were associated with a hostile interpersonal style. R/S have interpersonal correlates that may enhance or undermine health and emotional adjustment. This interpersonal perspective could help clarify why some aspects of religiousness and spirituality are beneficial and others are not.     

The link between religion and spirituality and psychological adjustment: the mediating role of optimism and social support

Although optimism, social support, religiousness, and spirituality are important predictors of adjustment, rarely have studies examined these variables simultaneously. This study investigated whether optimism and social support mediated the relationship between religiousness and adjustment (distress and life satisfaction) and between spirituality and adjustment. Findings indicate that the relationship between intrinsic religiousness and life satisfaction and between prayer fulfillment and life satisfaction was mediated by optimism and social support. Furthermore, the relationship between religiousness and adjustment varied depending on how religiousness was operationalized and whether positive versus negative adjustment indicators were used. That is, intrinsic religiousness and prayer fulfillment were associated with greater life satisfaction, but extrinsic religiousness was not associated with life satisfaction. These findings were significant even after accounting for covariates (age, gender, ethnicity, social desirability). Results suggest religiousness and spirituality are related but distinct constructs and are associated with adjustment through factors such as social support and optimism.     

Psychological hardiness predicts cardiovascular health

Many, but not all people experience diminished health, performance and well-being as a function of exposure to stress. However, the underlying neurophysiological processes which characterize hardy or resilient people are not well understood. This study examines psychological hardiness and several indicators of cardiovascular health, including body mass index (BMI) and blood cholesterol markers in a sample of 338 middle-aged adults enrolled in a national security education program. Hierarchical regression analyses reveal that after controlling for the influence of age and sex, high hardiness is related to higher HDL – high density lipoprotein and less body fat (BMI). Lower hardiness is associated with greater total cholesterol to HDL ratio, a cardiovascular disease risk factor. These results suggest that psychological hardiness confers resilience in part through an influence on cholesterol production and metabolism.     

Religiosity/spirituality and health. A critical review of the evidence for biological pathways

The authors review evidence regarding the biological processes that may link religiosity/spirituality to health. A growing body of observational evidence supports the hypothesis that links religiosity/spirituality to physiological processes. Although much of the earliest evidence came from cross-sectional studies with questionable generalizability and potential confounding, more recent research, with more representative samples and multivariate analysis, provides stronger evidence linking Judeo-Christian religious practices to blood pressure and immune function. The strongest evidence comes from randomized interventional trials reporting the beneficial physiological impact of meditation (primarily transcendental meditation). Overall, available evidence is generally consistent with the hypothesis that religiosity/spirituality is linked to health-related physiological processes--including cardiovascular, neuroendocrine, and immune function--althogh more solid evidence is needed.     

Revisiting Mahoney’s ‘My body is a temple…’ study: spirituality as a mediator of the religion–health interaction among adolescents

This study proposes and tests a new model that seeks to explain associations between religion, spirituality and health outcomes among adolescents. Specifically, we test for mediating effects of perceived spirituality on religion–health relations. Using data from the 4-H Study of Positive Youth Development, we find that perceived spirituality mediates religion–health relations, but that varies based on youths’ conceptualisation of spirituality. With findings confirming that perceived spirituality potentially promote youths’ psychosocial health, we offer some future research directions and implications regarding relations between youths’ spirituality, religion and health behaviours.     

How well do people recall risk factor test results? Accuracy and bias among cholesterol screening participants.

The authors conducted a community-based cholesterol screening study to examine accuracy of recall for self-relevant health information in long-term autobiographical memory. Adult community residents (N = 496) were recruited to participate in a laboratory-based cholesterol screening and were also provided cholesterol counseling in accordance with national guidelines. Participants were subsequently interviewed 1, 3, or 6 months later to assess their memory for their test results. Participants recalled their exact cholesterol levels inaccurately (38.0% correct) but their cardiovascular risk category comparatively well (88.7% correct). Recall errors showed a systematic bias: Individuals who received the most undesirable test results were most likely to remember their cholesterol scores and cardiovascular risk categories as lower (i.e., healthier) than those actually received. Recall bias was unrelated to age, education, knowledge, self-rated health status, and self-reported efforts to reduce cholesterol. The findings provide evidence that recall of self-relevant health information is susceptible to self-enhancement bias.     

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.     

Religiosity and Spirituality as Resiliency Resources: Moderation,Mediation, or Moderated Mediation?

A growing body of literature indicates a modestly positive association between religiosity and spirituality as predictors of psychological health (anxiety and depression), suggesting they serve as personal resiliency factors. The purpose of this study was to expand our understanding of the relationships among these constructs. Using Lazarus's Transactional Model of Stress as a theoretical framework, we examined: (a) the extent to which spirituality and religiosity mediated and/or moderated the association between perceived stress and psychological health and (b) whether there was a moderated (religiosity) mediation (spirituality) between stress and health. The Perceived Stress Scale, Daily Spiritual Experiences Scale, Religious Commitment Inventory, and Hospital Anxiety and Depression Scale were administered to measure the following constructs: stress, spirituality, religiosity, and psychological health. This study utilized a nonexperimental, quantitative, correlational, cross‐sectional, moderated‐mediation design, and included a convenience sample of 331 research participants. Both spirituality and religiosity moderated stress and health. However, only spirituality partially mediated the relationship. In addition, religiosity did not moderate the mediating effects of spirituality. Overall, this study confirmed the role of both religiosity and spirituality as effective resiliency resources.     

Mental Health, Depression, and Dimensions of Spirituality and Religion

The author explores the relationship between spirituality and religion and human growth and development, specifically examining emotional well-being during adulthood. Dimensions of spirituality to be explored are meaning in life, a transcendent purpose, intrinsic values, and spiritual community. The argument is made that spirituality is related to emotional well-being during adulthood. Implications for further research and relevant information for counselors, psychologists, and educators are included.     

Is Evidence Able to Persuade Physicians to Discuss Spirituality with Patients?

Patients believe that spirituality informs health; frequently, they wish to share their beliefs with physicians. Although a large number of physicians believe it their responsibility to be aware of patient beliefs, many do not address spirituality because they do not believe it their role to do so. These physicians would perhaps feel differently if presented with evidence that associated spirituality with positive health outcomes. This national sample of family medicine residents were asked if, presented with evidence that spirituality was associated with improved outcomes, they would be more likely to initiate discussions of spirituality with patients. To varying degrees, most residents agreed that they would be more willing to initiate spirituality discussions if presented with good evidence. Geographic region of training, religious preference, and Spiritual Well-Being Scale quartile predicted both strength of agreement and whether a resident would be as responsive to spirituality oriented research as to investigations of traditional therapeutic modalities. Although residents indicated that they would be more responsive to publications on traditional medical therapies, familiarity with the spirituality literature as part of a residency educational curriculum may help break down barriers to addressing this issue with patients.     

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.