Religion and Spirituality as Community Resources for Persons with Traumatic Brain Injury

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Religion and Spirituality as Community Resources
for Persons with Traumatic Brain Injury

• Ellen L. Idler, Ph.D.
• National Institute for Disability and
  Rehabilitation Research
• State of the Science Conference
• Washington, DC
• April 12-13, 2007

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NIH-Funded Papers with Religion Variables, 1980
- 2006
Analysis by J.McLaughlin, S. Bodnar-Deren, and
E.Idler, 2007 N1971 since 1980 when Medline
included funding acknowledgements
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Peer-reviewed Journals with Most NIH-Funded
Papers with Religion Variables

• Am J Human Genetics 94
• J Gerontology PsychSocial Sci 37
• Am J Epidemiology 36
• Am J Public Health 33
• Social Science and Medicine 33
• J Studies on Alcohol 33
• Neurology 27
• The Gerontologist 27
• Am J Psychiatry 27
• J Am Geriatrics Society 24
• J National Cancer Institute 23
• Blood 22
• Am J Medical Genetics 21
• JAMA 20
• Proc Natl Academy of Sciences 19

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Medline Papers with Religion Variables by
Primary NIH Funder, 1980-2006
Analysis by J.McLaughlin, S. Bodnar-Deren, and
E.Idler, 2007 N1971 since 1980 when Medline
included funding acknowledgements
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Outline of Talk

• I. Population-based epidemiological studies
• II. Patient-based studies (TBI and non-TBI)
• III. Translating this research to the community

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Original Insights

• Emile Durkheim, Suicide, 1898
• Religion protected individuals against suicide
• Reduced alienation and anomie
• Catholics protected more than Protestants
• Religious groups protective in the same way as
  families, occupational groups, community
  associations
• Excess regulation / integration could also lead
  to suicide

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• Population-based Epidemiological Studies
• Religion provides rules for living.

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Religion in Social Epidemiological Studies

• Alameda County, CA Tecumseh County, MI Evans
  County, GA 1979 1985
• National Health Interview Survey 1999
• Population-based samples
• include religious and nonreligious respondents
• represent diverse faiths and traditions
• Religious service attendance as type of social
  tie
• Linear association between baseline frequency of
  attendance and follow-up all-cause mortality

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Religion in Social Epidemiological Studies

• Religious attendance is the most
  frequently-studied dimension, less is known about
  other dimensions of religiousness/spirituality
• There are many possible causal pathways for the
  association
• lower smoking, alcohol use, drug use, more
  physical activity
• greater social support
• better psychological well-being
• Emphasis in interpretation is on rules for
  living, with effects on health outcomes through
  primary prevention
• The impact of religion on health is inadvertent
  religious observances are practiced as ends in
  themselves

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II. Patient-Based StudiesReligion provides
support, comfort, and hope.
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Population-Based Elderly Sample

• Idler, 1987, 1995 Idler and Kasl 1992, 1997a,b
  Idler, Kasl, and Hays, 2001
• Sample and study design
• New Haven Established Populations for
  Epidemiologic Study of the Elderly data,
  1982-1994
• N2812 aged 65
• Roman Catholic 53, Jewish 14, White Protestant
  14, Black Protestant 15
• Response rates Baseline 82, Annual
  follow-ups 94 96
• Variables
• Religion
• Affiliation, attendance (40 once a week),
  religiousness (37 deeply), strength and comfort
  (71 great deal)
• Health status measures
• Chronic conditions, angina, prescription
  medications, measured blood pressure, cognitive
  function, BMI
• Outcomes
• Functional disability (15 items ADL, Rosow,
  Nagi) depression timing of mortality

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Religion Interacts with Health StatusHeightened
Effects for Vulnerable Populations

• Higher levels of reported strength and comfort
  from religion for those with more disability,
  more prescription medications, more chronic
  conditions at baseline (sicker people more
  subjectively religious)
• Religious involvement increases positive affect
  and celebrating holidays for disabled respondents
  only (no effect for those with no disability)
• Stronger effect of religious attendance on later
  disability for those with moderate and severe
  disability at baseline (no effect for those with
  no prior disability)
• Increasing feelings of strength and comfort from
  religion for those in last year of life
  (compared with their own responses three years
  earlier)
• Last year of life respondents with more religious
  involvement have higher quality of life (compared
  with the non-religiously involved)

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Spirituality in TBI Patients

• McColl, Bickenbach, Johnston et al. 2000.
  Spiritual issues associated with traumatic-onset
  disability Disability and Rehabilitation
  22(12)555-564 (Canada, N16)
• Qualitative description of spirituality themes
  TBI patients expressed more religious ideas about
  their injury than spinal cord injury patients
• Herrmann, Curio, Petz et al. 2000. Coping with
  illness after brain diseases a comparison
  between patients with malignant brain tumors,
  stroke, Parkinsons disease and traumatic brain
  injury Disability and Rehabilitation
  22(12)539-546 (Germany, N163)
• TBI patients were less likely to use
  religious/spiritual coping strategies than
  Parkinsons patients, but more likely than cancer
  patients
• Kalpakjian, Lam, Toussaint, et al. 2004.
  Describing quality of life and psychosocial
  outcomes after traumatic brain injury American
  Journal of Physical Medicine and Rehabilitation
  83255-265 (US, N50)
• Social support, community integration, and
  spirituality predicted higher quality of life
  (QOL) among TBI patients

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Summary of Patient (TBI and non-TBI) Studies

• Emphasis on subjective aspects of religion /
  spirituality
• Emphasis on social support, helping hands, and
  hope, more than rules for living
• Emphasis on psychological well-being and quality
  of life outcomes, rather than mortality or
  morbidity

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III. Translating this Research to the Community
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Congregations

• A very special social institution
• Social groups with common purposes
• Affiliation by choice
• Strong and weak social ties
• Histories
• Opportunities for giving and receiving social
  support
• The setting for worship music, architecture,
  word
• Rituals unite the mind and body through the
  senses
• Age-integrated

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Hillsborough Reformed Church, Millstone, NJ
Founded 1766
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Religion/Spirituality as Influences on Public
Attitudes to TBI Patients

• Linden, Rauch, Crothers, 2005. Public attitudes
  towards survivors of brain injury Brain Injury
  19(12)1011-1017 (Ireland, N179)
• Protestant males had more positive attitudes
  toward TBI patients than Catholic males
• Minnes, Buell, Nolte et al., 2001. Defining
  community integration of persons with brain
  injuries as acculturation A Canadian
  perspective NeuroRehabilitation 163-10
  (Canada, N63 TBI patients and 63 caregivers)
• Most TBI patients did not see themselves as
  spiritual, but nearly all of those who did were
  integrated or assimilated into a religious
  community

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Conclusion
I. Impact of religion/spirituality on health and
well-being

• Religiousness / spirituality is multidimensional,
  and different dimensions may have different, even
  conflicting relationships with health
• Religious attendance is associated with more
  potential mediating mechanisms (health behaviors,
  social support, meaning provision, physiological
  effects) than subjective measures of
  religiousness/spirituality, and therefore may
  have stronger measurable effects on health in
  large, representative samples
• Vulnerable populations such as the disabled, or
  chronic pain populations, or those at the end of
  life may show positive effects of subjective
  measures of religiousness/spirituality on higher
  levels of well-being, even if there are no
  measurable improvements in pain or disability

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Conclusion
II. Policy implications for clinicians

• Health care institutions should facilitate
  patients usual religious observances.
• Physicians should be aware of patients
  religiously-motivated treatment preferences.
• Physicians and other health care workers should
  make appropriate referrals to hospital chaplains
  and/or local religious congregations to
  facilitate community integration.