Spirituality & Health

Metrics and Mystery

“And the prayer offered in faith will make the sick person well; the Lord will raise him up…”

James 5:15

“Can I pray for you?” Dr. Caleb Liem

Moses

“…when he looked to the bronze serpent, he lived.” Numbers 21:6-9 (NASB)

Jesus

The blind receive sight,

lame walk,

lepers are cleansed,

deaf hear,

dead are raised,

poor hear the gospel.

Luke 7:22

World Without End

“Take them to

the cathedral!”

The Church & Health

Middle Ages

• Church issued medical licenses

• Physicians were monks and priests

• Nuns were nurses

• Religious orders built & staffed first

hospitals

Wagon Trains West

Compassion & Beneficence

How We Got Started…

“Pure air, Sunlight, Abstemiousness, Rest, Exercise, Proper Diet, The use of Water, Trust in Divine Power---

These are the true remedies.”

Ellen White, Ministry of Healing

Western Health Reform Institute

• 84% of Americans believe that praying to God can cure someone

• 72% of Americans would welcome a conversation with their physician about faith

Newsweek Poll

What is Spirituality?

• “belief in a greater power”

• “sense of interconnectedness”

• “inner peace”• “touching ultimate worth”• “eternal hills & unresting

sea”• “unique for each

individual”

What is Religion?1. A system of beliefs and practices of those within a community, with

rituals designed to acknowledge, worship, communicate with, and come closer to the Sacred, Divine or ultimate Truth or Reality (i.e., God)

2. Usually has a set of scriptures or teachings that describe the meaning and purpose of the world, the individual’s place in it, and the responsibilities of individuals to one another

3. Usually has a moral code of conduct that is agreed upon by members of the community, who attempted to adhere to that code

Religion is a unique construct or domain – separate from psychology that can be measured and quantified and examined in its relationship to

health outcomes.

Religion

Community

Spirituality

Objective

Organized

Observable

Definitive

Distinctive

Individual

Subjective

Informal

Interior

Eclectic

Unifying

Research

• On average

• Across a population

• All other things being equal

Religion and Depression in Hospitalized Patients

Geriatric Depression ScaleInformation based on results from 991 consecutively admitted patients (differences significant at p<.0001)

35%

23% 22%

17%

Low Moderate High Very High

Degree of Religious Coping

Per

cen

t D

epre

ssed

0 4 8 12 16 20 24

Weeks of Followup

0

20

40

60

80

100P

roba

bili

ty o

f N

on-R

emis

sion

%

Other Patients

Highly Religious (14%)

diagnosis

845 medical inpatients > age 50 with major or minor depression

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

Church Attendance and Suicide Rates

Martin WT (1984). Religiosity and United States suicide rates. J Clinical Psychology 40:1166-1169

White Males Black Males White Females Black Females

Church Attendance

Suicide Rate

Correlation=-.85, p<.0001

Church Attendance and Anxiety Disorder(anxiety disorder within past 6 months in 2,964 adults ages 18-89)

Koenig et al (1993). Journal of Anxiety Disorders 7:321-342

Young (18-39) Middle-Aged (40-59) Elderly (60-97)

An

xiet

y D

iso

rder

Church Attendance and Alcoholism (lifetime)

Koenig et al (1994). Hospital and Community Psychiatry 45:225-231

Young Middle-Aged Elderly

Alc

oh

ol A

bu

se o

r D

epen

den

ce

Religious Attendance and Cigarette Smoking3968 Persons aged 65 or Older in North Carolina

Never 1-2/yr 3-6/yr-1-3/mo 1/wk >1/wk

Frequency of Attendance at Religious Services

5

10

15

20

25

30

Pe

rce

nt

Wh

o C

urr

en

tly

Sm

ok

e

5

10

15

20

25

30

Nu

mb

er o

f Pa

ck

-Ye

ars

Sm

ok

ed

% smoking

pack-years

Religion and Mental Health Research Summary

1. Purpose and meaning in life (15/16)2. Well-being, hope, and optimism (91/114)3. Social support (19/20)4. Marital satisfaction and stability (35/38)5. Depression and its recovery (60/93)6. Suicide (57/68)7. Anxiety and fear (35/69)8. Substance abuse (98/120)9. Delinquency (28/36)10. Summary: 478/724 quantitative studies

(based on conducted in the year 2000 or before)

Handbook of Religion and Health (Oxford University Press, 2001)

Death Rates from Cancerby Religious Group

General Hutterite SDA Mormon Amish **0

0.2

0.4

0.6

0.8

1

Sta

nd

ard

Mo

rtal

ity

Rat

io *

Population

* 1.0=average risk of dying from cancer ** Males ages 40-69 only

Mortality From Heart Disease and Religious Orthodoxy(based on 10,059 civil servants and municipal employees)

Kaplan-Meier life table curves (adapted from Goldbourt et a l 1993. Cardiology 82:100-121)

Follow-up time, years

Su

rviv

al p

rob

abil

ity

Differences remain significant aftercontrolling for blood pressure, diabetes, cholesterol, smoking,weight, and baseline heart disease

Six-Month Mortality After Open Heart Surgery

Citation: Psychosomatic Medicine 1995; 57:5-15

0

5

10

15

20

25

% D

ead

(2 of 72)

(7 of 86) (2 of 25)

(10 of 49)

(232 patients at Dartmouth Medical Center, Lebanon, New Hampshire)

Hi ReligionHi Soc Support

Hi ReligionLo Soc Support

Lo ReligionHi Soc Support

Lo ReligionLo Soc Support

Hi ReligionHi Soc Support

Mortality data from Alameda County, California, 1974-19873 Lifestyle practices: smoking; exercise; 7-8 hours of sleep

n=2290 all white All Attend Attend Church Weekly Weekly+3

Practices

SMR for all cancer mortality 89 52 13

SMR = Standardized Mortality Ratio (compared to 100 in US population)

Enstrom (1989). Journal of the National Cancer Institute, 81:1807-1814.

Predicting Cancer Mortality

Seven Healthy Practices

• Adequate sleep

• Eating breakfast

• Not eating between meals

• Ideal weight

• Never smoking

• Avoiding alcohol

• Physical activity

Religion and Physical Health Research Summary

Handbook of Religion and Health (Oxford University Press, 2001)

• Better immune/endocrine function (5 of 5)• Lower mortality from cancer (5 of 7)• Lower blood pressure (14 of 23)• Less heart disease (7 of 11)• Less stroke (1 of 1)• Lower cholesterol (3 of 3)• Less cigarette smoking (23 of 25)• More likely to exercise (3 of 5)• Lower mortality (11 of 14) (1995-2000)• Clergy mortality (12 of 13)

(summary of research in year 2000 or before)

Many new studies since 2000

Attention Received Over the YearsReligion, Spirituality and Health

1. Growing interest – entire or partial journal issues on topic (J Personality, J Family Psychotherapy, American Behavioral Scientist, Public Policy and

Aging Report, Psychiatric Annals, American J of Psychotherapy [partial], Psycho-Oncology, International Review of Psychiatry, Death Studies, Twin Studies, J of Managerial Psychology,J of Adult Development, J of Family Psychology, Advanced Development, Counseling & Values, J of Marital & Family Therapy, J of Individual Psychology, American Psychologist, Mind/Body Medicine, Journal of Social Issues, J of Health Psychology, Health Education & Behavior, J Contemporary Criminal Justice, Journal of Family Practice, Southern Med J )

2. Growing amount of research-related articles on topicPsycInfo 2001-2005 = 5187 articles (2757 spirituality, 3170 religion) [11198 psychotherapy] 46%PsycInfo 1996-2000 = 3512 articles (1711 spirituality, 2204 religion) [10438 psychotherapy] 34%PsycInfo 1991-1995 = 2236 articles ( 807 spirituality, 1564 religion) [9284 psychotherapy] 24%PsycInfo 1981-1985 = 936 articles ( 71 spirituality, 880 religion) [5233 psychotherapy] 18%PsycInfo 1971-1975 = 776 articles ( 9 spirituality, 770 religion) [3197 psychotherapy] 24%

Seven Principles

• Religious affiliation

• Religious fellowship

• Worship and Prayer

• Religious beliefs

• Faith

• Mystical experiences

• Prayer for others

Religion

MentalHealth

SocialSupport

HealthBehaviors

StressHormones

ImmuneSystem

Autonomic Nervous System

DiseaseDetection &TreatmentCompliance

Smoking High Risk Behaviors Alcohol & Drug Use

Infection

Cancer

Heart Disease

Hypertension

Stomach &Bowel Dis.

Accidents& STDs*

Gen

etic

su

scep

tib

ility

, Gen

der

, Age

, Rac

e, E

du

cati

on, I

nco

me

Liver & Lung Disease

Stroke

Chi

ldho

od T

rain

ing

Adu

lt D

ecis

ions

Val

ues

and

Cha

ract

er

Adu

lt D

ecis

ions

* Sexually Transmitted Diseases

Model of Religion's Effects on HealthHandbook of Religion and Health (Oxford University Press, 2001)

Religion is associated with lower rates of disease and death.

• Does research support it? Yes

• Does it work for everyone? No

• Are there exceptions? Yes

• Is religion always healthful? No

• Controversial? Yes

Science and Faith

“If there is a God that influences our health in ways that transcend all possible natural forces, no study can ever prove or disprove that fact. The best that we can do in relation to such works of grace is either to accept them on faith or reject their possibility.”

Levin, Jeff PhD. God, Faith and Health: Exploring the Spirituality-Healing Connection. John Wiley & Sons, 2001, pg 184.

“If we ask anything according to his will, He hears us.” I John 5:14

“I have never seen laryngeal edema clear so rapidly.” Dr. John Hodgkin