An evaluation of the quantity and quality of empirical research in three pastoral care and counseling journals, 1990-1999: has anything changed?

This article summarizes a review of all articles published in Pastoral Psychology, The Journal of Rleigion and Health, and The Journal of Pastoral Care between 1900 and 1999, identifying a total of 737 scholarly articles, of which 165 (22.4%) were research studies. The proportion of research studies, especially quantitative studies, increased significantly between the first and second half of the study period (p < .05). There was a significant positive correlation between compliance with three out of four criteria of internal validity. Three of five criteria of external validity were also positively related to one another. Compared to previous research using identical criteria to assess quantitative studies in the same journals in 1980-1989, the 1990-1999 sample showed improved compliance with respect to specifying the sampling method (p < .001), reporting the response rate (p < .05), and discussing the limitations of research studies (p < .001). However, the overall findings suggest that many researchers in the field do not have a sophisticated knowledge of statistical sampling, statistical analysis, or research design. Several recommendations for increasing the quality of quantitative research are offered.

Religion, senescence, and mental health: the end of life is not the end of hope

The authors review epidemiological and survey research relevant to the relationships between religiousness/spirituality and mental health in people at the end of life, with the end of helping psychiatrists, psychologists, and other mental health professionals dealing with older Americans. They give special attention to well-being, religious coping, cognitive dysfunction, anxiety, depression, and suicide, and consider the extent to which hope is a mediator of the purported salutary effects of religiousness. Studies were selected from the comprehensive and systematic review of 20th-century scientific literature concerning religion and health. Authors also review current studies relevant to religion and end-of-life issues. Religious persons reported generally higher levels of well-being. The review also found fairly consistent inverse associations of religiousness with rates of depression and suicide. There was some negative association between religious participation and cognitive dysfunction, but the association with anxiety was inconsistent, with some studies showing a correlation between higher levels of religion and anxiety. Religion's effects on mental health are generally protective in direction but modest in strength.

Canadian psychiatric inpatient religious commitment: an association with mental health

BACKGROUND

Research indicates that religion may have a positive effect on coping and possibly enhance clinical outcomes. This study aims to determine the level of religious interest of psychiatric inpatients and to assess whether religious commitment has an impact on selected outcome variables.

METHODS

There were 88 consecutive adult patients (50% men) who were admitted to a Canadian tertiary care psychiatry inpatient unit and were interviewed about their religious beliefs and practices. Patients with a Beck Depression score of 12 or more were included for outcome analysis.

RESULTS

A total of 59% believed in a God who rewards and punishes, 27% had a high frequency of worship attendance, and 35% prayed once or more daily. More frequent worship attenders had less severe depressive symptoms, shorter current length of stay, higher satisfaction with life, and lower rates of current and lifetime alcohol abuse (P < 0.05), when compared with those with less frequent or no worship attendance. In contrast, private spirituality was associated with lower depressive symptoms and current alcohol use only (P < 0.05), and prayer frequency had no significant associations.

DISCUSSION

This study indicates that certain religious practices may protect against severity of symptoms, hospital use, and enhance life satisfaction among psychiatric inpatients. This is the first known Canadian study that examines religious commitment among psychiatric inpatients.

Mental health issues among clergy and other religious professionals: a review of research

The authors reviewed the literature on mental health issues among clergy and other religious professionals, using electronic searches of databases of medical (Medline), nursing (CINAHL), psychology (PsycINFO), religious (ATLA), and sociological research (Sociofile). The existing research indicates the Protestant clergy report higher levels of occupational stress than Catholic priests, brothers, or sisters. Catholic sisters repeatedly reported the lowest work-related stress, whereas women rabbis reported the highest stress levels in various studies. Occupational stress appears to be a source of family stress among Protestant clergy--a factor which clergy and their spouses believe the denominational leadership should address. High levels of stress also have been found to be associated with sexual misconduct among clergy. The authors make several recommendations based on these and other findings they report in their review.

Religion and coping with serious medical illness

OBJECTIVE

To review and discuss some of the research published in the last several decades that has addressed the role that religion plays in helping patients cope with serious medical illness.

DATA SOURCES

Although this is not a systematic review of the literature, it provides a sampling of the studies that have examined the relationship between religious involvement, coping with illness, and health outcomes. This sampling of studies reflects the findings of a much larger systematic review of research (MEDLINE, Current Contents, Psychlit, Soclit, HealthStar, Cancerlit, CINAHL, and others) during the past century that was recently completed by the authors.

DATA EXTRACTION

Epidemiologic studies published in the English-language literature were reviewed and discussed.

DATA SYNTHESIS

A number of well-designed cross-sectional and prospective studies have examined the relationship between religious beliefs and activities and adaptation to physical illness in patients with general medical conditions, neurologic disorders, heart disease, renal failure, AIDS, and a host of other physical disorders. This review demonstrates the widespread use of religion in coping with medical illness and provides circumstantial evidence for the possible benefits of this lifestyle factor.

CONCLUSIONS

When people become physically ill, many rely heavily on religious beliefs and practices to relieve stress, retain a sense of control, and maintain hope and their sense of meaning and purpose in life. Religious involvement appears to enable the sick, particularly those with serious and disabling medical illness, to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them.

Is gratitude a moral affect?

Gratitude is conceptualized as a moral affect that is analogous to other moral emotions such as empathy and guilt. Gratitude has 3 functions that can be conceptualized as morally relevant: (a) a moral barometer function (i.e., it is a response to the perception that one has been the beneficiary of another person's moral actions); (b) a moral motive function (i.e., it motivates the grateful person to behave prosocially toward the benefactor and other people); and (c) a moral reinforcer function (i.e., when expressed, it encourages benefactors to behave morally in the future). The personality and social factors that are associated with gratitude are also consistent with a conceptualization of gratitude as an affect that is relevant to people's cognitions and behaviors in the moral domain.

Religious involvement and mortality: a meta-analytic review

A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20-1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement-mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias.

Depressive symptoms and nine-year survival of 1,001 male veterans hospitalized with medical illness

Authors examined effects of depressive symptoms on after-discharge survival of hospitalized medically ill male veterans. Psychosocial and physical health evaluations were performed on a consecutive sample of 1,001 patients ages 20-39 (16%) and 65-102 years (84%). Subjects or surviving family members were later contacted by telephone, and Cox proportional-hazards regression modeled the effects of depressive symptoms on time-to-death, controlling for demographics and social, psychiatric, and physical health. Follow-up was obtained on all 1,001 patients (average observation time, 9 years), during which 667 patients died (67%). Patients with depressive symptoms were significantly less likely to survive. For every 1-point increase on the 12-item Brief Carroll Depression Rating Scale (BCDRS), the hazard of dying increased by 10% (P<0. 0001). Age did not significantly affect the association between depressive symptoms and mortality. Depressive symptoms during acute hospitalization are a predictor of shortened survival.

Religious involvement and mortality: a meta-analytic review

A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20-1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement-mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias.

Physicians and patient spirituality: professional boundaries, competency, and ethics

Clinical studies are beginning to clarify how spirituality and religion can contribute to the coping strategies of many patients with severe, chronic, and terminal conditions. The ethical aspects of physician attention to the spiritual and religious dimensions of patients' experiences of illness require review and discussion. Should the physician discuss spiritual issues with his or her patients? What are the boundaries between the physician and patient regarding these issues? What are the professional boundaries between the physician and the chaplain? This article examines the physician-patient relationship and medical ethics at a time when researchers are beginning to appreciate the spiritual aspects of coping with illness.

Is God good for your health? The role of spirituality in medical care

Many studies have found that religious belief and practice have a positive effect on physical and mental health, although the topic needs more research. As religious beliefs may affect both health and health-promoting behavior, physicians should try to understand their patients' beliefs.

Research on religious variables in five major adolescent research journals: 1992 to 1996

A review of quantitative research studies published between 1992 and 1996 in five major adolescent journals revealed that 11.8% (109 of 922) included a measure of religion. This percentage (11.8%) is 3 to 10 times higher than that found in previous reviews of empirical research in psychological and psychiatric journals, suggesting that adolescent research journals are more sensitive to the role of religious factors on mental health than research in related disciplines. The results are discussed in the context and philosophy of the adolescent research and in comparison with related disciplines.

Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults

METHODS

A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986 1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model.

RESULTS

During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.434).59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.554-.76, p<.0001) and men (RH 0.83, 95% CI 0.69-1.00, p=.05).

CONCLUSIONS

Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.