Transcript Research Grants

State of the Art in Research on
Faith and Health
Harold G. Koenig, MD
Departments of Psychiatry and Medicine
Duke University Medical Center
GRECC VA Medical Center
Overview
10:15-11:00
1. Definitions: Religion and Spirituality
2. Research on R/S and mental health
3. Research on R/S and health behaviors
4. Research on R/S, physical health, and longevity
5. Understanding the relationship between R/S and health
6. Further resources
Definitions
Religion
Involves beliefs, practices, and rituals related to the
‘transcendent,” where the transcendent is that which relates
to the mystical, supernatural, or God in Western religious
traditions, or to Divinities, ultimate truth/reality, or
enlightenment in Eastern traditions. Religions usually have
specific beliefs about life after death and rules about conduct
within a social group. Religion is often organized and
practiced within a community, but it can also be practiced
alone and in private. Central to its definition, however, is that
religion is rooted in an established tradition that arises out of a
group of people with common beliefs and practices concerning
the transcendent. Religion is a unique construct, whose
definition is generally agreed upon.
Spirituality
Spirituality is a concept which today is viewed as broader
and more inclusive than religion. It is a term more popular
today, more so than religion. Spirituality is considered
personal, something individuals define for themselves that
may be free of the rules, regulations, and responsibilities
associated with religion. Spirituality is more difficult to define
than religion, and agreement on what the term means is
often lacking – especially since the definition of spirituality
has been changing, and expanding.
Traditional-Historical Understanding
Source
Mental Health
Physical Health
Religion
Meaning
Purpose
Connectedness
Suicide
Ex. well-being
Anxiety
Peace
Secular
Hope
Psychoneuroimmunology
Depression
Spirituality
v s.
Cardiovascular
Disease
Cancer
Addiction
Mortality
M odern Understanding
Source
Mental Health
Physical Health
Spirituality
Meaning
Cardiovascular
Disease
Religion
Purpose
Suicide
Connectedness
v s.
Ex. well-being
Anxiety
Peace
Addiction
Secular
Hope
Psychoneuroimmunology
Depression
Cancer
Mortality
M odern Understanding - Tautological Version
Source
Mental Health
Meaning
Physical Health
Cardiovascular
Disease
Depression
Purpose
Spirituality
Connectedness
Suicide
Ex. well-being
Anxiety
Peace
v s.
Hope
Secular
Psychoneuroimmunology
Religion
Cancer
Addiction
Mortality
M odern Understanding - Clinical Application only
Source
Mental Health
Meaning
Physical Health
Cardiovascular
Disease
Depression
Purpose
Connectedness
Spirituality
Ex. well-being
Suicide
Anxiety
Peace
Secular
Hope
Psychoneuroimmunology
Religion
Cancer
Addiction
Mortality
Not a Researchable M odel
Comments on Measuring Spirituality in Research
(Journal of Nervous and Mental Disease 2008; 196(5):349-355)
1. Currently, “spirituality” is either measured as (1) religion, (2) positive
psychological states, or (3) positive character traits
2. Positive psychological states include having purpose and meaning in
life, being connected with others, experiencing peace, harmony, and
well-being
3. Positive character traits include being forgiving, grateful, altruistic,
or having high moral values and standards
4. Problem: Atheists or agnostics may deny any connection with
spirituality, but rightly claim their lives have meaning, purpose, are
connected to others, practice forgiveness and gratitude, are altruistic,
have times of great peacefulness, and hold high moral values
Measuring Spirituality (cont)
5. Problem: Confusing to use religious language (spirituality or that having
to do with the spirit) to describe secular psychological terms
6. Problem: Can no longer examine relationships between spirituality and
mental health (since spirituality scales confounded by items assessing
mental health) ***
6. Problem: Can no longer examine relationships between spirituality and
physical health (since mental health affects physical health through the
mind-body relationship)
7. Problem: Can no longer study the negative effects of spirituality on
health, since positive effects are predetermined by the definition of
spirituality
Result:
Meaningless tautological associations between spirituality and health
To keep things simple and clear, I use the terms
religion and spirituality interchangeably, or simply
use the word religion
When research has been conducted on religion it
has been distinctive and not confounded with
indicators of positive mental health, as research
involving spirituality has.
Research on Religion and Mental Health
1.
2.
3.
4.
5.
Well-being
Depression
Suicide
Anxiety
Substance abuse
Religion and Well-being in Older Adults
Religion
and
Well-being in Older Adults
The Gerontologist 1988;
28:18-28
Well-being
Well-being
The Gerontologist 1988; 28:18-28
Low
Low
Moderate
Moderate
High
High
Very
Very High
High
Church
Church Attendance
Attendance or
or Intrinsic
Intrinsic Religiosity
Religiosity
Religious
Religious categories
categories based
based on
on quartiles
quartiles (i.e.,
(i.e., low
low is
is 1st
1st quartile,
quartile, very
very high
high is
is 4th
4th quartile)
quartile)
Religion and Depression in Hospitalized Patients
Percent Depressed
35%
23%
22%
17%
Low
Moderate
High
Very High
De gre e of Re ligiou s C opin g
Geriatric Depression Scale
Information based on results from 991 consecutively admitted patients (differences significant at p<.0001)
Time to Remission by Intrinsic Religiosity
(N=87 patients with major or minor depression by Diagnostic Interview Schedule)
Probability of Non-Remission
100%
80
Low Religiosity
60
Medium Religiosity
40
High Religiosity
20
0
0
10
20
30
Weeks of Followup
American Journal of Psychiatry 1998; 155:536-542
40
50
Probability of Non-Remission
100%
845 medical inpatients > age 50 with major or minor depression
80
60
Other Patients
40
Highly Religious(14%)
20
HR=1.53, 95% CI=1.20-1.94, p=0.0005, after control for
demographics, physical health factors, psychosocial
stressors, and psychiatric predictors at baseline
diagnosis
0
0
4
8
12
Weeks of Followup
16
20
24
Well-being and Depression
(systematic review: 1806-2009)*
Religious involvement is related to:
•
Greater well-being and happiness
(278 of 359 studies) (77%)
•
Less depression, faster recovery from depression
(204 of 324 studies) (63%)
* Sources:
Handbook of Religion and Health (2001, Oxford University Press)
Handbook of Religion and Health (2011, 2nd ed, OUP)
Suicide
(systematic review)
Religious involvement is related to:
Less suicide and more negative attitudes toward suicide
(106 of 141 or 74% of studies)
Why?
A religious world-view gives people a reason for living – it
gives life meaning.
Meaning, Purpose, and Hope
(systematic review)
Religious involvement is related to:
•
Significantly greater meaning and purpose in life
(42 of 45 studies) (93%)
•
Significantly greater hope
(29 of 39 studies) (74%)
Forgiveness, Altruism, and Gratitude
(systematic review)
Religious involvement is related to:
•
Significantly more forgiveness
(34 of 40 studies) (85%)
•
Significantly more altruism / volunteering
(33 of 47 studies) (70%)
•
Significantly more gratitude
(5 of 5 studies) (100%)
Social Support
(systematic review)
Religious involvement is related to:
•
Great social support
(61 of 74 studies) (82%)
Religion and Health Behaviors
Health Behaviors
Religion is related to:
•
More exercise/physical activity
(25 of 37 studies) (68%)
•
Less cigarette smoking, especially among the young
(120 of 134 studies) (90%)
•
Less alcohol/drug use, especially among the young
(276 of 324 studies) (85%)
The Mind-Body
Relationship
Model of Religion's Effects on Health
Handbook of Religion and Health(Oxford University Press, 2001)
Adult Decisions
Childhood Training
Mental
Health
Stress
Hormones
Cancer
Heart Disease
Immune
System
Hypertension
Adult Decisions
Religion
Values and Character
Genetic susceptibility, Gender, Age, Race, Education, Income
Infection
Social
Support
Health
Behaviors
Autonomic
Nervous
System
Disease
Detection &
Treatment
Compliance
Smoking
High Risk Behaviors
Alcohol & Drug Use
Stroke
Stomach &
Bowel Dis.
Liver & Lung
Disease
Accidents
& STDs*
Religion and Physical Health
Religion & Physiological Functions
Immune
Endocrine
Cardiovascular
Immune and Endocrine Functions
(systematic review)
Religious involvement is related to:
Better immune functions
(19 of 31 studies) (61%)
Better endocrine functions
(21 of 32 studies) (66%) (majority involving meditation)
Se rum IL-6 and Atte ndance at Re ligious Se rvice s
(1675 persons age 65 or over living in North Carolina, USA)
Percent with IL-6 Levels >5
18
* bivariate analyses
** analyses controlled for age, sex, race, education, and physical functioning (ADLs)
16
14
12
10
8
6
Never/Almost Never
1-2/yr to 1-2/mo
Once/wk or more
Frequency of Attendance at Religious Services
Citation: International Journal of Psychiatry in Medicine
1997; 27:233-250
Cardiovascular Functions
(systematic review)
Religious involvement is related to:
Lower blood pressure
(36 of 62 studies) (58%)
Less heart disease (CAD, CVR, HRV, CRP, cardiac surg, etc.)
(35 of 54 studies overall) (65%)
(10 of 14 studies on CAD) (71%)
Re ligious Activity and Diastolic Blood Pre ssure
(n=3,632 persons aged 65 or over)
Citation: InternationalJournal of Psychiatry in Medicine
1998; 28:189-213
81
Average Diastolic Blood Pressure
* Analyses weighted & controlled for age, sex, race, smoking,
education, physical functioning, and body mass index
80
79
p<.0001*
78
77
Low Attendance
Low Prayer/Bible
High Attendance
Low Prayer/Bible
Low Attendance
High Prayer/Bible
High = weekly or more for attendance; daily or more for prayer
Low= less than weekly for attendance; less than once/day for prayer
High Attendance
High Prayer/Bible
Mortality From Heart Disease and Religious Orthodoxy
(based on 10,059 civil servants and municipal employees)
Most
Orth
od
No
Survival probability
n-B
e
ox
Differences remain significant after
controlling for blood pressure,
diabetes, cholesterol, smoking,
weight, and baseline heart disease
liev
ers
Follow-up time, years
Kaplan-Meier life table curves (adapted from Goldbourt et a l 1993. Cardiology 82:100-121)
Six-Month Mortality After Open Heart Surgery
(232 patients at D artmouth Medical Center, Lebanon, N ew H ampshire)
25
(10 of 49)
% Dead
20
15
10
(7 of 86)
(2 of 25)
5
(2 of 72)
0
H i Religion
H i Soc Support
H i Religion
Lo Soc Support
Lo Religion
H i Soc Support
Lo Religion
Lo Soc Support
Mortality (all-cause)
(systematic review)
Religious involvement related to:
• Greater longevity in 55 of 84 studies (65%)
• Shorter longevity in 2 of 84 studies (2%)
• Mixed findings in 12 of 84 studies (14%)
Standard Mortality Ratios (ages 25-99)
Males
Females
California Mormons (n=9815)*
Attend church wkly (99% M / 99% F)
+ never smoke+married+12 yr ed**
+ moderate BMI (57% M / 65% F)
0.54 (0.51-0.57)
0.61 (0.57-0.65)
0.45 (0.42-0.48)
0.55 (0.51-0.59)
0.43 (0.39-0.47)
0.52 (0.47-0.57)
** Life Expectancy age 25
84 years
86 years
US Whites (n=15,832)*
Attend church wkly (28% M / 39% F)
+ never smoke
+ married
+ 12 yr education **
+ moderate BMI (7% M / 10% F)
0.90 (0.85-0.96)
0.83 (0.79-0.88)
0.78 (0.68-0.88)
0.70 (0.62-0.79)
0.60 (0.48-0.74)
0.63 (0.55-0.74)
0.51 (0.40-0.66)
0.52 (0.42-0.66)
0.47 (0.33-0.64)
0.38 (0.28-0.52)
0.43 (0.30-0.61)
0.35 (0.24-0.50)
Life Expectancy age 25 (US Whites – all)
**Life Expectancy age 25 (extrapolated)
74 years
84 years
81 years
86 years+
*Based on a systematic sample of active Calif. Mormons followed 1980-2004, and random
sample of white US adults followed 1988-1997. Preventive Medicine 2008; 46:133-136
Theoretical Model of Causal Pathways
Handbook of Religion & Health, 2nd Ed, 2011
Public prac, rit
Positive Emotions*
Human Virtues
Private prac, rit
SOURCE
God
belief, relation,
attachment
R commit
R exp
Theological
virtues: faith,
hope, love
Forgiveness
Honesty
Courage
Self-discipline
Altruism
Humility
Gratefulness
Patience
Dependability
Social sup &
connections
Negative Emotions*
R coping
Physical Health and Longevity
faith
community
Decisions, Lifestyle Choices, Health Behaviors
Immune, Endocrine, Cardiovascular Functions
Spirituality
Genetics, Developmental Experiences, Personality
*Positiv e emotions : peace, harmony, existential well-being, happiness, hope/optimism, meaning, purpose
*Negativ e emotions : depression, anxiety, emotional distress, loneliness, low self-esteem
Further Reading
Spirituality in Patient Care (2007, Templeton Press)
Medicine, Religion and Health (2008, Templeton Press)
Faith and Mental Health (2005, Templeton Press)
Handbook of Religion and Health (2001, Oxford University Press)
Handbook of Religion and Health (2011 Oxford University Press)
The Link Between Religion and Health (2002, Oxford University Press)
Further Information
Website: Duke Center for Spirituality, Theology and Health
http://www.spiritualityandhealth.duke.edu/
Summer Research Workshops
July and August 2010
Durham, North Carolina
5-day intensive research workshops focus on what we know about the relationship between
spirituality and health, applications, how to conduct research and develop an academic career
in this area (see website: http://www.spiritualityhealthworkshops.org/). Leading
spirituality-health researchers at Duke and elsewhere will give presentations:
-Previous research on spirituality and health
-Strengths and weaknesses of previous research
-Applying findings to clinical practice
-Theological considerations and concerns
-Highest priority studies for future research
-Strengths and weaknesses of spirituality measures
-Designing different types of research projects
-Carrying out and managing a research project
-Writing a grant to NIH or private foundations
-Where to obtain funding for research in this area
-Writing a research paper for publication; getting it published
-Presenting research to professional and public audiences; working with the media
If interested, contact Harold G. Koenig: [email protected]
Discussion and Questions
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