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Research Grants

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Title: Research Grants


1
Overview of Research and Findings in Spirituality
Heath
Harold G. Koenig, MD Departments of Medicine and
Psychiatry Duke University Medical Center GRECC
VA Medical Center
2
Overview
  • What is health?
  • What is spirituality?
  • What is religion?
  • Research on religion and mental health
  • Effects of psychological stress on the body
  • Research on religion and physical health
  • Applications to clinical practice

3
What is health?
  • Physical health and vigor
  • Psychological health and well-being
  • Social health
  • Community health and thriving

4
What is Spirituality?
  • That which places a priority on seeking a
    connection with the Sacred, the transcendent,
    ultimate truth/reality, God
  • Personal, individualistic has many different
    meanings (from devout religious commitmenttoa
    nebulous kind of philosophy focused on doing
    whatever feels good)
  • Ideal term for use clinically, since inclusive
    and vague important beginning place for
    dialogue
  • Impossible to define and quantify as a distinct
    construct for research, apart from religion or
    positive psychology
  • The popular use of the word spirituality today
    has become heavily linked to humanism and
    positive psychology that often exclude religion
    and the Sacred

5
Spirituality
  • The very idea and language of spirituality,
    originally grounded in the self-disciplining
    faith practices of religious believers, including
    ascetics and monks, then becomes detached from
    its moorings in historical religious traditions
    and is redefined in terms of subjective
    self-fulfillment.
  • C. Smith and M.L. Denton, Soul Searching The
    Religious and Spiritual Lives of American
    Teenagers, p.175

Part of a presentation given by Rachel Dew, M.D.,
Duke post-doc fellow
6
What is Religion?
  • 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)
  • Usually has a set of scriptures or teachings that
    describe the meaning and purpose of the world,
    the individuals place in it, the
    responsibilities of individuals to one another,
    and the life after death
  • 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 positive psychology and distinct
    from secular humanism that can be measured,
    quantified, and examined in relationship to
    health outcomes

7
Religion and Mental Health
8
Sigmund Freud Future of an Illusion, 1927
Religion would thus be the universal obsessional
neurosis of humanity... If this view is right,
it is to be supposed that a turning-away from
religion is bound to occur with the fatal
inevitability of a process of growthIf, on the
one hand, religion brings with it obsessional
restrictions, exactly as an individual
obsessional neurosis does, on the other hand it
comprises a system of wishful illusions together
with a disavowal of reality, such as we find in
an isolated form nowhere else but amentia, in a
state of blissful hallucinatory confusion
9
Sigmund Freud Civilization and Its Discontents
The whole thing is so patently infantile, so
incongruous with reality, that to one whose
attitude to humanity is friendly it is painful to
think that the great majority of mortals will
never be able to rise above this view of life.
Part of a presentation given by Rachel Dew, M.D.,
Duke post-doc fellow
10
Religion and Coping with Illness
  • Many persons turn to religion for comfort when
    sick
  • Religion is used to cope with problems common
    among those with medical illness
  • - uncertainty
  • - fear
  • - pain and disability
  • - loss of control
  • - discouragement and loss of hope

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12
Does Religion Make a Difference?
  • Well-being
  • Depression
  • Suicide
  • Anxiety
  • Substance abuse

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Religion and Mental Health Research Summary
  • Purpose and meaning in life (15/16)
  • Well-being, hope, and optimism (91/114)
  • Social support (19/20)
  • Marital satisfaction and stability (35/38)
  • Depression and its recovery (60/93)
  • Suicide (57/68)
  • Anxiety and fear (35/69)
  • Substance abuse (98/120)
  • Delinquency (28/36)
  • Summary 478/724 quantitative studies
  • (based on studies prior to 2001)
  • Handbook of Religion and Health (Oxford
    University Press, 2001)

20
Attention Received Over the Years Religion,
Spirituality and Health
  • 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 )
  • Growing amount of research and academic articles
    on topic
  • PsycInfo 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

21
Mind-Body Relationship
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Effects of Negative Emotions on Health
  • Rosenkranz et al. Proc Nat Acad Sci 2003
    100(19)11148-11152
  • experimental evidence that negative affect
    influences immune function
  •   Kiecolt-Glaser et al. Proc Nat Acad Sci 2003
    100(15) 9090-9095
  • stress of caregiving affects IL-6 levels for
    as long as 2-3 yrs after death of patient
  •   Blumenthal et al. Lancet 2003 362604-609
  • 817 undergoing CABG followed-up up for 12
    years controlling grafts, diabetes,
  • smoking, LVEF, previous MI, depressed pts
    had double the mortality
  • Brown KW et al. Psychosomatic Medicine 2003
    65636643
  • depressive symptoms predicted cancer
    survival over 10 years
  • Epel et al. Proc Nat Acad Sci 2004 101
    17312-17315
  • psychological stress associated with
    shorter telomere length, a determinant of cell
  • senescence/ longevity women with highest
    stress level experienced telomere
  • shortening suggesting they were aging at
    least 10 yrs faster than low stress women

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Replication
Lutgendorf SK, et al. Religious participation,
interleukin-6, and mortality in older adults.
Health Psychology 2004 23(5)465-475 Prospective
study examines relationship between religious
attendance, IL-6 levels, and mortality rates in a
community-based sample of 557 older adults.
Attending religious services more than once
weekly was a significant predictor of lower
subsequent 12-year mortality and elevated IL-6
levels ( 3.19 pg/mL), with a mortality ratio
of.32 (95 CI 0.15,0.72 p ratio for elevated IL-6 of.34 (95 CI 0.16,
0.73, p religious services. Structural equation modeling
indicated religious attendance was significantly
related to lower mortality rates and IL-6 levels,
and IL-6 levels mediated the prospective
relationship between religious attendance and
mortality. Results were independent of covariates
including age, sex, health behaviors, chronic
illness, social support, and depression.
27
Predicting Cancer Mortality
Mortality data from Alameda County, California,
1974-1987 3 Lifestyle practices smoking
exercise 7-8 hours of sleep n2290 all
white All Attend Attend Church
Weekly Weekly3 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, 811807-1814.
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Religion and Physical Health Research Summary
  • 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

Handbook of Religion and Health (Oxford
University Press, 2001)
33
New Research
  • Religious behaviors associated with slower
    progression of Alzheimers dis.
  • Kaufman et al. American Academic of Neurology,
    Miami, April 13, 2005
  • Religious attendance and cognitive functioning
    among older Mexican Americans.
  • Hill TD et al. Journal of Gerontology 2006
    61(1)P3-9
  • Fewer surgical complications following cardiac
    surgery
  • Contrada et al. Health Psychology 200423227-38
  • Greater longevity if live in a religiously
    affiliated neighborhood
  • Jaffe et al. Annals of Epidemiology
    200515(10)804-810
  • Religious attendance associated with 90
    reduction in meningococcal disease in teenagers,
    equal to or greater than meningococcal
    vaccination
  • Tully et al. British Medical Journal 2006
    332(7539)445-450
  • Church-based giving support related to lower
    mortality, not support received
  • Krause. Journal of Gerontology 61(3)S140-6,
    2006

34
New Research (continued)
  • Higher church attendance predicts lower fear of
    falling in older Mexican-Americans
  • Reyes-Ortiz et al. Aging Mental Health 2006
    1013-18
  • Religion and survival in a secular region. A
    twenty year follow-up of 734 Danish adults born
    in 1914.
  • la Cour P, et al. Social Science Medicine 2006
    62 157-164
  • Oncologist assisted spiritual intervention study
    (OASIS) Patient acceptability and initial
    evidence of effects.
  • Kristeller et al. Intl J Psychiatry in Med
    2005 35329-347

35
Many Theological Concerns About What These
Research Results Mean
  • 1. Is science validating religion?
  • 2. If so, could it just as well disprove
    religion?
  • 3. Is there a risk here? (Harvard study)
  • 4. Is it appropriate to use religion to
    achieve better health?
  • 5. Are we caving into the demands of a
    therapeutic culture that
  • is seeking to eliminate all suffering?
  • 6. Is suffering always bad?

36
Many Health Care System Concerns
  • Resistance against integration remains strong
    among health professionals, especially physicians
  • Time and short-term costs involved hospitals
    resistant
  • The majority of patients want health
    professionals to address spiritual issues, but a
    significant minority dont
  • There are challenges to sensitively addressing
    spiritual needs in pluralistic health care
    setting

37
Reasons Why Health Professionals Should Address
Spirituality
  • Many patients are religious and the majority
    would like it to be addressed in their health
    care
  • Religion/spirituality influences coping with
    illness
  • Religion likely affects health outcomes
  • JCAHO requires that a spiritual history be taken
  • Religion affects medical decisions, disease
    detection
  • Religion influences health care in the community

38
Recommendations for Patient Care
  • Take a spiritual history -- talk with pts about
    these issues
  • Respect, value, support beliefs and practices of
    the patient
  • Identify the spiritual needs of the patient
  • Ensure that someone meets those spiritual needs
    (pastoral care)
  • Establish working partnerships with the faith
    community
  • Pray with patients?

From Spirituality in Patient Care
(Templeton Foundation Press, 2002)
39
Taking a Spiritual History
  • Introduction is necessary (why asking these
    questions)
  • Do religious/spiritual beliefs provide comfort or
    cause stress?
  • How might beliefs influence medical decisions?
  • Are there beliefs that might interfere/conflict
    with medical care?
  • Member of a religious/spiritual community is it
    supportive?
  • Any other spiritual needs that someone should
    address?
  •  JAMA 288 (4) 487- 493 (July 24, 2002)

40
What Health Professionals Should Not Do
  • Prescribe religion to non-religious patients
  • Force a spiritual history if patient not
    religious
  • Coerce patients in any way to believe or practice
  • Pray with a patient before taking an in-depth
    spiritual hx
  • Spiritually counsel patients (always refer to
    trained spiritual caregivers)
  • Any activity that is not patient-centered
  • Argue with patients over religious matters
  • (even when it conflicts with medical
    care/treatment)

41
Summary
  • 1. Differences between religion and
    spirituality are important
  • minimal requirements to call something
    spiritual also import
  • 2. Research shows that religious involvement in
    general is related
  • to better mental health, better social health,
    and better physical
  • health, although no research has tried to
    distinguish healthy vs. unhealthy religion
  • 3. Learning about (via spiritual history),
    supporting a patients
  • own religious beliefs, praying with
    patients (if requested), and
  • referral to pastoral care experts is
    appropriate for health
  • professionals
  • 4. But there are boundaries on what health
    professionals can do,
  • and there is some danger in non-theologically
    trained health addressing spiritual issues

42
Further Resources
  • Spirituality in Patient Care (Templeton Press,
    2002)
  • Handbook of Religion and Health (Oxford
    University Press, 2001)
  • Healing Power of Faith (Simon Schuster, 2001)
  • Faith and Mental Health Religious Resources for
    Healing (Templeton Press, 2005)
  • The Link Between Religion Health
    Psychoneuroimmunology the Faith Factor (Oxford
    University Press, 2002)
  • Handbook of Religion and Mental Health (Academic
    Press, 1998)
  • In the Wake of Disaster Religious Responses to
    Terrorism and Catastrophe (Templeton Press, 2006)
  • Faith in the Future Religion, Aging Healthcare
    in 21st Century (Templeton Press, 2004)
  • The Healing Connection (Templeton Press, 2004)
  • Kindness and Joy (Templeton Press, Fall-Winter
    2006)
  • Duke website http//www.dukespiritualityandhealt
    h.org

43
Summer Research Workshop July and August
2007 Durham, North Carolina
5-day intensive workshops focus on what we know
about the relationship between religion and
health, applications, how to conduct research and
develop an academic career in this area. Leading
religion-health researchers at Duke and UNC will
give presentations -Previous research on
religion, 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 religion/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 koenig_at_geri.duke.edu
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