Allowing spirituality into the healing process

A similar movement can be seen in the medical literature. A search of MedLine using the keyword “spirituality” produced 52 articles from 1960 to 1990, 90 from 1991 to 1995, and almost 200 from 1996 to 1999. A more recent search produced 554 citations from January 2000 to April 2003.

What outcomes research has shown about spirituality

Much of the focus in this area has been on what research can reveal regarding the impact of spirituality on health. The late David Larson, MD, MSPH, of the International Center for the Integration of Health and Spirituality (ICIHS) and his collaborators extensively reviewed journals and identified large numbers of studies that included spiritual indicators. They found a strong trend toward identifying spirituality as a positive factor for coping with illness, preventing illness, and aiding treatment.^3,10

Harold G. Koenig of Duke University continued the effort and recently published a Handbook of Religion and Health.¹¹ This work systematically reviewed and rated around 1600 studies related to the relationships between religion and a variety of mental and physical health conditions, starting with the earliest identified studies through 2000. The research can be broken down into 3 major categories: religion and mental health, religion and physical disorders, and religion and the use of health services. A smaller number of studies focus on research issues, spiritual development, and implications for health and religious professionals ( Table 1).

Although most studies in English have focused on “Western faiths” such as Roman Catholicism, Orthodoxy, mainline and fundamentalist Protestantism, Pentecostalism, Jehovah’s Witnesses, Judaism, and Mormonism, studies have also looked at such faiths as Baha’i, Hare Krishna, Islam, Sikhism, and Hinduism.^12,13 In some cases, especially in the area of mental health (depression and psychoses), the type of religious affiliation did seem to be a factor in outcomes, both positive and negative.¹¹

Studies have also included a variety of cultures and nations. Thirty-nine different countries are specifically listed as study locals, with many other studies listing the “world” as the local. Many studies contrast nations, cultures, or faith systems. In some cases these differences were significant, with one study focused on suicide showing opposite results depending on culture.¹⁴

Religion and mental health. Studies have looked at the impact of religion or spirituality on well-being, self-esteem, depression and suicide, as well as alcohol and drug use and abuse. Religious or spiritual people, especially those who are regularly involved with a community of faith, experience depression less often than others, are less likely to abuse drugs or alcohol, cope with life-issues and illness more effectively, and are less likely to commit suicide.¹¹

Religion and physical disorders. Studies have focused specifically on the effect of faith on heart disease, hypertension, cerebrovascular disease, immune system dysfunctions, and cancer. Other studies have looked at broader issues such as pain and mortality.¹¹ Results have shown reduced hypertension,^15,16 better lipid profiles,^17,18 improved immune function,^19,20 and lower cholesterol levels²¹ ( Table 2).

A recent article in American Psychologist notes there is more evidence that religion or spirituality impedes recovery than it improves recovery.²¹ However, the evidence cited by the article was connected to religious struggle or to negative coping (eg, “I feel God has abandoned me”). This is not surprising, and it underscores the need to support positive religious coping and to help patients move beyond negative religious coping.

Religion and use of health services. Studies looking at the use of health services focus on such matters as screening services²² and compliance.²³ One of the interesting factors here is the role of religion in noncompliance. The refusal of Jehovah’s Witnesses to receive blood products has been a highly visible example. But other issues—more subtle, but nevertheless critical—emerge when one examines the literature; these include noncompliance due to a belief that a higher power “caused” the illness, or that illness is the result of “sinful” behavior.²⁴

In general, research shows the impact of religion and spirituality is positive. Although a person’s spirituality sometimes is pathological, and spiritual beliefs can create health issues, an overwhelming number of studies show a positive benefit. Of those studies reviewed by Koenig et al,¹¹ where the impact of spirituality could be classified as positive, negative, no association, complex, or mixed, 70% showed a positive impact (68% a strong positive with P<.05) while only 5% showed a negative impact. The studies show spirituality and religion benefit patients by helping prevent illness, increasing the ability to cope, and improving outcomes.

TABLE 1
Areas of spirituality research to date