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Spirituality and Health

Prior to the year 2000, approximately 1200 studies had examined the relationship between religious or spiritual involvement and health.1 Of those, about two-thirds indicated that religious beliefs and practices are related to better mental health, physical health, or use of health services. In the past 10 years, the research in this area has been rapidly accumulating. Close to 2,000 additional quantitative studies have now been published in peer-reviewed medical, nursing, public health, sociology, psychology, behavioral medicine, aging, and psychiatry journals from around the world. Again, one-half to two-thirds of studies report statistically significant positive relationships between religion/spirituality and health. This recent research is now in the process of being documented.2 Likewise, the mechanisms of how religion influences health through psychological, social, and behavioral pathways are being identified.3,4

Nevertheless, clinical applications are lagging far behind the research literature. Admittedly, most of the studies referred to above are epidemiological or observational, not randomized clinical trials (RCTs). RCTs are technically difficult to design in studying the religion-health relationship, and they are expensive to carry out. The general lack of research funding for such trials from NIH and NSF has been a major impediment to moving the knowledge base forward. However, epidemiological research can tell us a lot about the relationship between religion/spirituality and health, just as it told us a lot about the relationship between cigarette smoking and lung cancer decades ago.

The research findings linking religion and health have enormous clinical implications, and would have implications regardless of that research, simply based on common sense. We live in a very religious country, and parts of it (like the Southeast US) are more religious than the country as a whole. Studies in North Carolina have documented that over 90% of hospitalized patients turn to religion in order to cope with the psychological stress of illness and of treatments in healthcare settings, and over 40% of patients indicate that it is the most important factor that keeps them going. Literally hundreds of quantitative studies and even more qualitative studies report that religious coping (praying, meditating, reading inspirational scriptures, turn to one’s faith community for support) is common among sick patients no matter what part of the U.S. they live. And those who engage in these practices cope better, experience less depression, and recover more quickly from depression.5 Furthermore, religious beliefs influence the medical decisions that patients make about their health care, and there is growing evidence that failure of physicians to discuss these issues with patients is causing unnecessary expenditures of healthcare resources.6 Despite this, however, less than one in ten U.S. physicians regularly addresses these issues in clinical care.

What do I mean by "address" these issues in clinical care? Understandably, most physicians have no training or preparation to address the spiritual needs of patients, and most have neither the time nor the desire to do so. We are in the same situation as 20 years ago when people were advocating that physicians inquire about and address sexual practices of patients. Few physicians were trained to do so, and this was a personal area that many feared to tread upon. As research has shown the role of sexual behaviors in health and disease, however, this attitude has changed. More than three-quarters of U.S. medical schools are now include content on spirituality and medicine in their curricula, so things may be changing. What then is being asked of physicians with regard to addressing spirituality?

Given the restraints of physician time and training, there are sensible ways of addressing spiritual issues in clinical practice.7 The primary way is by taking a brief screening spiritual history and being willing to communicate with patients about these issues -- issues that are often central to the way patients cope with the stress of illness and make medical decisions about it. Taking a spiritual history does not take a lot of the physician’s time, and can make a real difference in both the patient’s mental health and functioning – based on data from a randomized clinical trial.8

Patients are not the only ones who benefit from physicians addressing this area. The joy of practicing medicine has become challenged these days with issues related to economics, liability, shrinking time and increasing responsibilities. Addressing the spiritual aspects of illness – or at least being sensitive to them and being open to the role they play in the health and well-being of patients – can help return meaning and satisfaction to this incredibly important work that we do.

 

Harold G. Koenig, M.D.
Professor of Psychiatry & Behavioral Sciences
Associate Professor of Medicine
Duke University Medical Center
Durham, North Carolina
koenig@geri.duke.edu

 

 


 

 

References

 

  1. Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. NY, NY: Oxford University Press, 2001
  2. Koenig HG, King DE, Meador. Handbook of Religion and Health, 2nd Ed. NY, NY: Oxford University Press, 2011
  3. Koenig HG, Cohen HJ. The Link Between Religion and Health: Psychoneuroimmunology and the Faith Factor. NY, NY: Oxford University Press, 2002
  4. Koenig HG. Medicine, Religion and Health. Philadelphia, PA: Templeton Press, 2008
  5. Koenig HG. Research on religion, spirituality and mental health: A review. Canadian Journal of Psychiatry 2009; 54 (5):283-291
  6. Phelps, A.C., Maciejewski, P.K., Nilsson, M., Balboni, T.A., Wright, A.A., Paulk, M.E., Trice, E., Schrag, D., Peteet, J.R., Block, S.D., Prigerson, H.G. Religious coping and use of intensive life-prolonging care near death in patients with advanced cancer. Journal of the American Medical Association 2009; 301 (11):1140-1147.
  7. Koenig HG. Spirituality in Patient Care. Philadelphia, PA: Templeton Press, 2008
  8. Kristeller, J. L., Rhodes, M., Cripe, L. D., & Sheets, V. (2005). Oncologist Assisted Spiritual Intervention Study (OASIS): patient acceptability and initial evidence of effects. International Journal of Psychiatry in Medicine 2005; 35(4): 329-347.

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