Daaleman, Perrera and Studenski wished to re-examine the effect of religiosity and spirituality on perceptions of older persons, operationalized as geriatric outpatients.
The authors proceeded from two conceptual constructs. The first is that self-reported health status is central to aging research. The old know whereof they speak. Self-ratings are valid because they correlate well with health status over time and, consequently, health service utilization. The second construct is that, no matter how morally they lived as young adults, those in late middle age come to embrace religion and spirituality with more fervor.
Prior research had scrutinized the relationship between religion and health perceptions. Some results were inconclusive, an outcome that the authors attributed to failure to control for such covariates as spirituality.
Definitions vary, the authors acknowledged, but they proposed defining “religiosity” as principally revolving on organized faith while “spirituality” has more to do with giving humans “meaning, purpose, or power either from within or from a transcendent source.” In turn, the dependent variable was measured by a single-item global health from the Years of Healthy Life (YOHL) scale, a self-assessment of general health (would you say your health in general is …) and a 5-item Likert response from excellent to poor.
Fieldwork consisted of including a 5-item measure of religiosity15 and a 12-item spirituality instrument in a 36-month health service utilization, health status, and functional status study among 492 outpatients of a VA and HMO network, all residents of the Kansas City metropolitan area.
The authors were remiss in not formally articulating their hypotheses for the study though one gleans that the alternative hypothesis could have stated, “Structured religion, a deep sense of spirituality, mental status and mobility, and personal and demographic variables materially influence measures of health status and physical functioning.”
In the end, the data was subjected to univariate and multivariate best-fit statistics. The key findings:
|Table 2. Predictors of Self-Reported Good Health|
|Status (N = 277)|
|Factor*||Unadjusted OR (95% CL||Adjusted OR (95% CI)|
|Some high school||0.28||(0.06–1.44)‡|
|High school graduate||0.24||(0.05–1.14)‡|
|Not depressed (GDS)||32.4||(4.03–261)§|
|Quality of life (EuroQol)||1.69||(1.41–2.01)†||1.36||(1.09–1.70)†|
|OR = odds ratio; CI = confi dence interval; GDS = Geriatric Depression Scale; SF36-PFI|
|= Physical Functioning Index from SF-36; NORC = National Opinion Research Center;|
|SIWB = Spirituality Index of Well-Being.|
|*Referent factors: age-1 year younger; female, nonwhite; college graduate; GDS score of|
|0-9; PFI-index of 1 less; EuroQol-score of 0.1 less; SIWB-score of 1 less.|
|† P = .01.|
|‡ P = NS.|
|§ P <.01.|
|¶ P <.05.|
After adjusting for all covariates, the authors tentatively concluded that spirituality was an important explanatory factor for perceptions of one’s own physical well-being. That religiosity did not seem statistically relevant, the authors concede, could be due to having defined the variable partly as attendance at religious services, a behavior possible only if the patient was functional and ambulant. Still, the authors argue, they did include other measures of religiosity and the regression model did hold being functional constant.
While the study did establish a relationship between self-perceptions of health and spirituality, the authors themselves point out the possibility that the two variables are not independent. The conceptual framework of the SIWB spirituality measure includes a “high degree of positive intentionality”, which strikes one as very similar to health optimism as independent variable.
Article 2: Religious coping and psychological functioning in a correctional population
Lonczak, Clifasefi1, Marlatt, Blume, &. Donovan tested the relationship among religious upbringing, coping and mental health outcomes in the admittedly-stressful prison environment.
This time, the authors do not mince words. They preface the literature review with the majority’s belief in God (or some higher being) as the core aspect of religiosity. Second, they point out that two separate meta-analysis carried out in 1983 and 2003 showed mixed results for a relationship between religiosity and coping. Perhaps, they argue, this is because religious coping has negative-coping aspects, such as the conviction that all one’s troubles are due to abandonment by God.
Since a search of the literature had revealed only one study concerning prisoners – the positive effect of meditation on recidivism psychological symptoms in India – Lonczak et al. thought to embark on this study of a neglected population. Secondly, the authors hoped to advance theory by defining religious coping more specifically than had ever been done.
There were multiple hypotheses attending this study:
- That the high degree of stress experienced by prisoners triggers an increase in religious coping behaviors (e.g., prayer, reading, spirituality, attendance in religious activities, etc.).
- That the positive coping encouraged by religiosity brings about comfort and solace and hence increases the likelihood of adaptive outcomes.
- That a religious upbringing provides individuals a repertoire of positive coping behaviors from which to draw strength.
Coming to data processing and statistical “tests”, Longczak et al. employed principal component analyses using Varimax rotation. The result was a four-factor model with their respective Cronbach alpha reliability estimates:
- Spirituality (0.97);
- “Good deeds” and active participation in coping related activities (0.89);
- Pleading (0.83); and,
- Discontentment (0.74).
In addition, the researchers administered the Brief Symptom Inventory to measure four dimensions: depression, anxiety, somatization and hostility.
At the first stage of analysis, relationships between religiosity on one hand and either gender or ethnic group on the other were tested for in bivariate correlations, t-tests, ANOVAs, or chi square tests.
Subsequently analyses involved four hierarchical linear regressions (one for each outcome) including both gender and stressful life events by each of the five religion measures. In order to examine the relationships between religion-focused predictors and outcomes with and without separate statistical adjustment for sociodemographic variables, variables were processed in a given sequence (below) and non-significant terms removed from later analyses.
- Religious upbringing, participation, spirituality, pleading and discontentment in the first block;
- Gender, ethnic group, age, education, and stressful life events in the second block; and,
- Interaction terms in the third and fourth blocks.
The findings provided support for the hypothesis that an upbringing characterized by formal or structured religion has positive mental health ramifications, including less depression and hostility. Secondly, women are more adversely affected by discontentment-based coping. Religious pleading notwithstanding, thirdly, prisoners who had experienced stressful life events were more likely to evince depression and hostility.
Article #4: Effect of religion on suicide attempts in outpatients with schizophrenia or schizo-affective disorders compared with inpatients with non-psychotic disorders
Huguelet et al. also focused on religion, this time in relation to psychosis and, specifically the propensity to suicide. Among the 115 patients with schizophrenia or schizo-affective disorders covered by the study, 43% had previously attempted suicide. Broadly speaking, the team wished to find out whether religion was a protective or impelling factor in these suicide attempts.
Suicide deserves attention, the authors maintained, because over 9 in 10 suicides are accompanied by a diagnosis of psychiatric illness. Over the lifetime of a schizophrenic, in particular, meta-analysis has shown a 0.049 probability of death by suicide.
Given the importance of reducing suicidal behavior, it seemed encouraging that spirituality and religious activities had ameliorate the risk. Prior research on piety and spirituality had suggested that the coping mechanisms could involve both a more positive world view and a shield against stress.
HYPOTHESIS AND STATISTICAL ANALYSIS:
No relationship could be found for religiousness and the tendency to attempt suicide. Twenty-five percent of all the study subjects acknowledged that religion inhibited them from considering suicide versus only one in ten that articulated an “incentive” role for religion.
Overview of Findings
The four articles explored different facets of spirituality and religiosity. Daaleman, Perrera and Studenski related spirituality to health perceptions. Lonczak et al.turned their attention to whether a religious upbringing helped adults cope better with a stressful environment, imprisonment in this case. In the case of Huguelet et al., the question was whether present religious beliefs encouraged suicide or strengthened coping mechanisms for resisting self-destructive compulsions.
After adjusting for all covariates, Daaleman, Perrera and Studenski tentatively concluded that spirituality was an important explanatory factor for perceptions of one’s own physical well-being. Religiosity was not a factor, for reasons already explained. One doubts this will be the last word on the matter, however, since the study lacked rigor.
Nonetheless, the finding about spirituality is helpful given that therapy is a way of expanding awareness and identity. As well, Transactional Analysis “recognizes the spiritual dimension of each person as an important part of the therapeutic process” (Trautman, 2003). On the other hand, one realizes the limitations of analyzing spirituality vis-à-vis health perception when the two variables overlap, at least on the aspect of optimism.
One is therefore led to wonder, might it not advance therapy theory and praxis if: a) Spirituality and religiosity were qualitatively tested as a compound, unified variable; and, b) Health-related research include objective measures of well-being as the realistic dependent variable?
For Lonczak et al. the implications for counseling have more to do with discontent and religious pleading. Counseling might address the roots and implications of religious distress and assist patients in developing more adaptive coping strategies. Notwithstanding the focus on a tightly defined population segment (older adults jailed for alcohol- and drug-related offenses), the authors are correct to point out the immense social good clinicians and prison administrators could foster if low-cost religious or spirituality-enhancing programs did contribute to “significant reductions in behavior management problems, psychological impairment, and subsequent recidivism.”
Similarly, the findings of Huguelet et al. suggest that suicide rates among psychotic patients could well be reduced if therapy embraced reinforcement or revival of religious beliefs.
Trautmann, R. (2003) Psychotherapy and spirituality. Transactional Analysis Journal, 33, (1) 32-36.