The Biopsychosocial Religionand Health Study (BRHS)AKA Adventist Religion & Health Study

Funding from the NIH: National Institute of AgingPrimary Investigators: Gary Fraser (PI) and Jim Walters (Co-PI)Co-investigators: Denise Bellinger, Terry Butler, Jerry Lee, Kelly

Morton, Eric Walsh, Colwick Wilson, Christopher Ellison (Universityof Texas)

Consultants: Neal Krause, University of Michigan, Ann Arbor; HaroldKoenig, Duke University; William Strawbridge, University ofCalifornia, San Francisco; Arthur A Stone, State University of NewYork, Stony Brook;Teresa Seeman, University of California, LosAngeles; and David Williams, Harvard University;

Cohort Profile: The biopsychosocial religion andhealth study (BRHS) Jerry W Lee; Kelly R Morton;James Walters; Denise L Bellinger; Terry L Butler;Colwick Wilson; Eric Walsh; Christopher G Ellison;Monica M McKenzie; Gary E Fraser

(In Press) International Journal of Epidemiology

Presentation based in part on:

Advanced Access:http://ije.oxfordjournals.org/cgi/content/extract/dyn244v1

Specific AimsTo examine manifestations of religious experience and theirpossible associations with quality of life, CHD and all-causemortality in Seventh-day Adventists, a group characterizedby general good health outcomes and considerablediversity in lifestyle.

To investigate whether these manifestations of religiousexperience have different associations with quality of life,CHD and all-cause mortality in African and EuroAmericans; and

To examine the possible relationships of thesemanifestations of religious experience to biochemical andphysiological indicators of stress, immune system function,coronary artery disease and aging.

Our basic model

AllostaticLoad

Morbidity,Mortality,

and Qualityof Life

Positive

Negative

CumulativeRisk

Exposure

Positive

Negative

ReligionRelated

Behaviors,Beliefs,

andEmotions

Lifestyle,Psycho-

logical andSocial

Mediatorsof Health

Cumulative Risk Exposure

Aggregates risk exposure acrossPhysical risks such as

PovertyPoor housing qualityViolence exposure

Psychosocial risk such asPoor parental bondPoor marital bondPoor job satisfaction

Allostatic Load

Allostasis—achieving biological stabilitythrough change. May involve changes inmultiple biological and behavioral systems.Allostatic load—cumulative burden that bothacute and lifetime stress place on theorganism.Primarily assessed by a combination ofbiologic, biometric, physical performance andcognitive function measures.

Our basic model

AllostaticLoad

Morbidity,Mortality,

and Qualityof Life

Positive

Negative

CumulativeRisk

Exposure

Positive

Negative

ReligionRelated

Behaviors,Beliefs,

andEmotions

Lifestyle,Psycho-

logical andSocial

Mediatorsof Health

Two arms of the studyPsyMRS

Psychosocial Manifestations of Religion20 page questionnaire sent to a randomsample of AHS-2 participants

BioMRSBiological Manifestations of ReligionBiometric, biologic, cognitive function andphysical performance measures

Sampling plan

AHS-2100,000

PsyMRS10,000

BioMRS500

PsyMRS3,000

BioMRS400

PsyMRS2,400

BioMRS320

Year 1 Year 4

PossibleFollow-up Grant

Year 7

On-going Mortality and Morbidity monitoring by AHS-2carried out on all participants.

Note: Current year 1 enrollment is 10,988 in PsyMRS and 508 in BioMRS.

PsyMRS—Questionnaire Assessmentof

Cumulative Risk ExposureReligious/spiritual commitment, attitudes,beliefs, and behaviorsPsychosocial and lifestyle mediators of areligion/health connectionQuality of life indicatorsControl variables (including demographics)

Cumulative Risk ExposureEarly relationships

Father love & abuseMother love & abuse

Risky family (of origin)Adult relationships

Spouse or partner positiveSpouse or partner negative

Trauma HistoryLast year, 1 to 5 years ago,more than 5 years ago, totalimpact

Jobstresscontrolsatisfaction

Unfair treatment (gender,race, age, religion, other)

LifetimeEveryday discrimination

HousingGrowing upCurrent

Difficulty meetingexpenses

Under 1818 to 35Last year

Perceived Stress

Religious/spiritual commitment,attitudes, beliefs, and behaviors

Church attendanceCongregational activityPercent co-religionist contactSpouse & Children’s religionChildren’s church schoolingCongregational sense of communityReligious support

Emotional Support ReceivedEmotional Support GivenNegative InteractionAnticipated Support

PrayerConfessionHabitMeditation/Contemplative

GratitudeForgivenessSpiritual meaning in LifeIntrinsic religiosity (DUREL)Loving versus controlling God

Positive and negative religious copingControl:

Self-directedCollaborativePassive DeferralActive surrender

Meaning;Benevolent ReappraisalPunishing God ReappraisalComfort:

Seeking Spiritual SupportSpiritual Discontent

TransformationSabbath keeping

Sabbath restFrom social pressure/guiltBuilds relationship with GodSacred activitiesSecular activities

Positive and negative eschatologicalattitudes

Psychosocial and lifestyle mediators of areligion/health connection (Based on Ellison & Levin, 1998)

Health behaviors & lifestyleExerciseDietSleep HoursAll AHS-2 lifestyle indicators

Healthy & Unhealthy BeliefsOptimismPessimism

Positive (& negative) emotionsPositive & negative affectHostilityDepression

Self-esteem & Personal efficacySelf-esteemMastery

Social integration & supportInformational supportInstrumental supportEmotional supportCompanionshipUnwanted advice orintrusionFailure to provide helpUnsympathetic orinsensitive behaviorRejection or neglect

Coping resources & behaviorsThese are included underreligious coping and prayer

Quality of life indicators

Physical & Mental Health(SF-12)

Physical functioningRole physical (Also SF-36)

Role emotionalBodily painGeneral health (Also SF-36)

VitalitySocial functioningMental Health

SF-12 Composite scoresPhysical HealthMental Health

Life satisfactionMedical History

Diagnosed medicalconditionsPhysical symptomsInfluenzaUpper respiratory infectionSleep problems

Control variablesGenderAgeIncomeOther demographicsBalanced Inventory of DesirabilityResponding

Self-deceptionImpression Management

Neuroticism

The Questionnaire

BioMRS Clinical assessment ofBiometrics

height, weight, body fat (bioimpedance), waist/hip, B/PPhysical performance including

gait, balance, grip strengthCognitive performance

California Verbal Learning Test—over 20 indicators includingShort and long-delay recall, semantic clustering, primacy andrecency, total learning slope, total response bias, intrusions

Independent Activities of Daily Living (IADLs)Blood, Saliva and urine including:

Stress—Waking salivary cortisol, urinary norepinephrine &epinephrineMetabolism—HbA1c, Plasma AlbuminInflammation Markers—Plasma IL-6 & C-reactive proteinLipid Profile —Total and LDL cholesterol, TriglyceridesCreatinine clearanceAdditional blood and urine samples frozen in liquid nitrogen

AHS-2 linked dataAHS-2 questionnaire (collectedup to 3 years before PsyMRS)

EthnicityEducation: self & parentsOccupationDietExercise & Napping: Week day,Saturday, & Sunday“Female History”Sun exposureAge at baptism, mother’s &fathers religionRearing history (who did it &why)

BiennialhospitalizationquestionnaireMortality

Samples of possible analyses

Proposed in grant application

The lifestyle/stress model

HealthyHealthyLifestyleLifestyle

PhysicalPhysicalQuality ofQuality of

LifeLife

ReligiousReligiousAttendanceAttendance

PerceivedPerceivedStressStress

+ +

+

– –

Prayer and Quality of Life

LifeLifeEventsEvents

+

+

–

–

ComCom--passionatepassionate

PetitionPetition

PetitionPetitionfor selffor self

ConfessionConfession

Meditation/Meditation/ImprovementImprovement

OptimismOptimism

PerceivedPerceivedStressStress

PhysicalPhysicalQuality ofQuality of

LifeLife

Interactions:Interactions:Habit withHabit with

CompassionateCompassionatePetition &Petition &PetitionPetition

Interactions:Interactions:Habit withHabit with

ConfessionConfession& Meditation/& Meditation/ImprovementImprovement

+ +

+

+

+

+

––

Some possible biological associationsPhysicalPhysical

PerformancePerformance

AllostaticAllostaticLoadLoad

CongregationalCongregationalSupportSupport

PerceivedPerceivedStressStress

++

+

–

–

CortisolCortisol

HgA1cHgA1c

MentalMentalPerformancePerformance–

––

LifetimeLifetimetraumatrauma

+++

ILIL--66CC--reactivereactiveProteinProtein

Characteristics of the Sample

Compared to the General Social SurveyDavis, J. A., Smith, T. W., & Marsden, P. V. (2007).

General Social Surveys, 1972-2006. Chicago, IL:National Opinion Research Center.

Gender & Ethnicity

Education

Marital Status

Age

Church Attendance

Prayer Frequency

Physical and Mental Health

Compared to national norms for theSF-12 version 2

Composite Physical Health (SF-12)Self Report

35

40

45

50

55

60

35 - 44 45 - 54 55 - 64 65 - 74 > 74

Age of Female

Scal

e Sc

ore

35 - 44 45 - 54 55 - 64 65 - 74 > 74

Age of Male

U.S. Norm (n = 2,298)Black SDA (n = 819)White SDA (n = 2,043)

U.S. Norm (n = 3,343)Black SDA (n = 2,231)White SDA (n = 3,544)

Composite Mental Health (SF-12)Self-Report

3535 - 44 45 - 54 55 - 64 65 - 74 > 74

Age of Female

40

45

50

55

60

Scal

e Sc

ore

35 - 44 45 - 54 55 - 64 65 - 74 > 74Age of Male

U.S. Norm (n = 3,347)Black SDA (n = 2,231)White SDA (n = 3,544)

U.S. Norm (n = 2,297)Black SDA (n = 819)White SDA (n = 2,043)