Positive and Negative Religious Coping in German Breast Cancer Patients

Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial

Purpose. The aim of this study was to investigate the role of spiritual therapy intervention in improving the spiritual well-being and quality of life (QOL) of Iranian women with breast cancer. Methods. This randomized controlled clinical trial (RCT) recruited 65 women with breast cancer, randomly assigned to a 6-week spirituality-based intervention (n = 34) or control group (n = 31). Before and after six-week spiritual therapy intervention, spiritual well-being and quality of life (QOL) were assessed using Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12) and cancer quality-of-life questionnaire (QLQ-C30), respectively. t-test, Paired t-test, pearson's correlation, and hierarchical regression analyses were used for analysis using Predictive Analytic software (PASW, version 18) for Windows. Results. After six spiritual therapy sessions, the mean spiritual well-being score from 29.76 (SD = 6.63) to 37.24 (SD = 3.52) in the intervention group (P < 0.001). There was a significant difference between arms of study (F = 22.91, P < 0.001). A significant positive correlation was detected between meaning and peace with all subscales of functional subscales on European Organization for Research and Treatment of Cancer quality of Life (EORTC QLQ-C30) (P < 0.05). Hierarchical regression analyses of participants indicated that the study arm, pain, and financial impact were significant predictors of spiritual well-being and overall QOL. Social functioning was another significant predictor of spiritual well-being. Conclusion. The results of this randomized controlled trial study suggest that participation in spiritual therapy program is associated with improvements in spiritual well-being and QOL. Targeted interventions to acknowledge and incorporate spiritual needs into conventional treatment should be considered in caring of Iranian patients with breast cancer.

Dimensional assessment of depressive severity in the elderly general population: psychometric evaluation of the PHQ-9 using Rasch Analysis

BACKGROUND

The depression module of the Patient Health questionnaire (PHQ-9) is a wide-spread self-report instrument for the assessment of depression with compelling psychometric characteristics when relying on classical test theory assumptions. This study aimed at evaluating whether the PHQ-9 may be interpreted as a dimensional scale measuring depression severity in the elderly general population using Rasch analysis with special emphasis on its unidimensional structure and differential item functioning (DIF) due to gender, age, and the presence of somatic multimorbidity.

METHODS

A representative sample of the elderly German general population (N=1631; age 60-85 years, 53.5% female) filled in the PHQ-9, a questionnaire about chronic medical conditions and a demographic data sheet. Unidimensionality and psychometric properties of the PHQ-9 were ascertained applying confirmatory factor analysis (CFA) and Rasch analysis.

RESULTS

Results revealed substantial violations of the unidimensionality of the scale: item 8 (retardation or agitation) had to be eliminated and multiple residual correlations were added. Gender-related DIF emerged for two items, and three items showed insufficient Rasch model fit.

LIMITATIONS

The large sample leads to high statistical power that might technically increase the probability of detecting model misfit or DIF. The sampling procedure leads to a possible underestimation of morbidity due to the exclusion of those elderly patients living in nursing homes.

CONCLUSIONS

Results suggest that - when applied in the elderly general population - the PHQ-9 should be interpreted in terms of a diagnostic algorithm for classificatory decisions about a DSM-IV based probable diagnosis of depression rather than as a dimensional scale.

Struggle with the divine in Swiss patients visited by chaplains: prevalence and correlates

A body of evidence is developing that describes harmful effects of religious struggle that includes struggle with the divine (e.g. feeling abandoned or punished by God). We examined the prevalence and correlates of divine struggle among 540 Swiss hospital patients. Some divine struggle was reported by 46 percent of the sample. Unexpected hospital admission and scores on a measure of faith were associated with a greater likelihood of reporting any divine struggle. Higher levels of anxiety and depression were also associated with divine struggle. Screening for divine struggle or other forms of religious struggle will permit, where indicated, appropriate religious assessment and care to mitigate the harmful effects that may accompany religious struggle.

Is religious coping related to better quality of life following acute myocardial infarction?

Although few studies have examined the extent to which religiousness is related to better well-being following acute myocardial infarction (AMI), studies from the broader literature suggest that positive religious coping may be helpful while more negative forms of religious coping may be related to poorer well-being. To assess the relationship between positive and negative religious coping and depressive symptoms in patients with AMI, we collected data twice over a 1-month period from 56 patients hospitalized with a first AMI. Controlling for demographic variables and social support, both positive and negative religious coping were independently related to higher levels of depressive symptoms both in hospital and at a one-month follow-up. Further, even when controlling for baseline depressive symptoms, religious coping predicted higher subsequent depressive symptoms. These results suggest that religious coping appears to be maladaptive in dealing with acute MI, perhaps because this type of recovery requires more active forms of coping.

Belief in divine control, coping, and race/ethnicity among older women with breast cancer

BACKGROUND

Belief in divine control is often assumed to be fatalistic. However, the assumption has rarely been investigated in racial/ethnic minorities.

OBJECTIVES

This study aims to examine the association between belief in divine control and coping and how the association was moderated by ethnicity/acculturation in a multi-ethnic sample of breast cancer patients.

METHODS

Latina, African American, and non-Hispanic White older women with newly diagnosed breast cancer (N=257) from a population-based survey completed the scale of Belief in Divine Control and the Brief COPE.

RESULTS

Belief in divine control was positively related to approach coping (i.e., positive reframing, active coping, and planning) in all ethnic groups. Belief in divine control was positively related to acceptance and negatively related to avoidance coping (i.e., denial and behavioral disengagement) among low-acculturated Latinas.

CONCLUSIONS

Negative presumptions about fatalistic implications of belief in divine control should be critically reappraised, especially when such skepticism is applied to racial/ethnic minority patients.

Screening for spiritual distress in the oncology inpatient: a quality improvement pilot project between nurses and chaplains

AIMS

A quality improvement initiative of nursing/chaplain collaboration on the early identification and referral of oncology patients at risk of spiritual distress.

BACKGROUND

Research shows that spiritual distress may compromise patient health outcomes. These patients are often under-identified, and chaplaincy staffing is not sufficient to assess every patient. The current nursing admission form with a question of 'Any spiritual practices that may affect your care?' is ineffective in screening for spiritual distress.

METHOD(S)

Ten nurses on the oncology unit were recruited and trained in a two-question screening tool to be utilized upon admission.

RESULTS

Six nurses made referrals; a total of 14 patients. Four (28%) were at risk of spiritual distress and were assessed by the chaplains.

CONCLUSIONS

Nurses are interested in the spiritual well-being of their patients and observe spiritual distress. They appreciate terminology/procedures by which they can assess more productively the spiritual needs of their patients and make appropriate chaplain referrals.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of a brief spiritual screening protocol can improve nursing referrals to chaplains. The better utilization of chaplains that this enables can improve patient trust and satisfaction with their overall care and potentially reduce the harmful effects of spiritual distress.

Screening for religious/spiritual struggle in blood and marrow transplant patients

PURPOSE

A growing body of research documents the harmful effects of religious/spiritual (R/S) struggle (e.g., feeling abandoned or punished by God) among patients with a wide variety of diagnoses. Documented effects include poorer quality of life, greater emotional distress, poorer recovery, and increased disability. This study reports the use of a screening protocol that identified patients who may have been experiencing R/S struggle. We also examined the prevalence and correlates of possible R/S struggle, its association with quality of life, pain, and depressive symptoms and compared the results from the screening protocol with social workers' assessments.

METHODS

One hundred seventy-eight blood and marrow transplant patients completed the Electronic Self-Report Assessment--Cancer (ESRA-C) which included the Rush Religious Struggle Screening Protocol and other measures of quality of life, pain, and depressive symptoms prior to transplant therapy. All participants were assessed by a social worker, 90 % within 2 weeks of the ESRA-C assessment.

RESULTS

Using the Rush Protocol, 18 % of the patients were identified as potentially experiencing R/S struggle. R/S struggle was not reported in any social work assessments. In a multivariable model, potential R/S struggle was more likely in patients who were more recently diagnosed, male, and Asian/Pacific Islanders. There were no significant associations between potential R/S struggle and quality of life, pain, or depressive symptoms.

CONCLUSIONS

Early identification of patients with R/S struggle will facilitate their referral for further assessment and appropriate intervention. Further research is needed to identify the best methods of screening patients for R/S struggle.

Religious and spiritual practices among patients with cancer

The aim of this study was to investigate the frequency with which cancer patients engage in religious and spiritual practices, the methods used, the reasons for such a search, and the levels of depression and hopelessness in patients who seek spiritual assistance. One hundred and ten radiation oncology patients, who gave voluntary informed consent were included in this study. Questionnaires about religious and spiritual practices were administered, along with the Beck Depression and Beck Hopelessness scales. Twenty percent of the patients preferred spiritual practices. Female gender, lower education levels, and higher depression and hopelessness scores were associated with this preference. The frequency of depression was 18.2%, and the frequency of hopelessness was 20.9%. A significant number of cancer patients engaged in religious and spiritual practices. We recommend that practitioners offer their patients brief but sufficient information about religious and spiritual support and determine their patients' depression and hopelessness levels.

The effect of spiritual therapy for improving the quality of life of women with breast cancer: a randomized controlled trial

Diagnosis of breast cancer is a devastating psychological experience for a woman. Also, treatments such as radiation therapy may cause psychosocial distress in these patients and threaten their quality of life (QOL). Among several approaches, spirituality has been shown to be significantly associated with improving the QOL. The aim of this study was to assess the role of spiritual therapy intervention in improving the QOL of patients with breast cancer undergoing radiation therapy. This was a randomized controlled trial study undertaken in a radiotherapy clinic, Isfahan, Iran. Between October 2010 and February 2011, 68 patients under radiation therapy were randomized to either spiritual therapy intervention group or control group who received routine management and educational programs. Before and after six weeks of spiritual therapy sessions, the QOL was evaluated using Cancer quality-of-life questionnaire (QLQ)-C30 and breast cancer-specific questionnaire (BR-23). Multivariate, repeated-measures ANOVA, t-test, and Paired t-test were used for analysis using Predictive Analytic Soft Ware (PASW, version 18) for windows. In all, 65 patients actually completed the six-week intervention and were evaluated for the outcome. The mean Global health status score/QOL reached from 44.37 (SD = 13.03) to 68.63 (SD = 10.86), (p = 0.00). There was a statistically significant difference in all functional scales of QLQ-C30 after intervention (p < 0.05). The results of this trial showed that the spiritual therapy program can improve the overall QOL of women with breast cancer; therefore, it could be adopted in comprehensive care programs for women with breast cancer.

Religion, Spirituality, and Cancer

It has often been noted that people with a severe illness endeavor to deepen their religious and spiritual practice and knowledge. It is generally accepted that spiritual and religious factors help sick people confront their suffering. The authors conducted a qualitative research on the role of religious and spiritual practices and knowledge among 10 cancer patients in Québec, Canada. Individual interviews focused on their illness experience confirmed that religion and spirituality can be present and contribute to coping when life is threatened. More precisely, the analyses of the place and use of these resources during the patient’s illness showed that these resources contributed to an individual empowerment process that was undertaken in response to a biographic and existential disruption induced by the illness diagnosis. The sick people took advantage of religious and spiritual content in their quest for meaning and a cure, progressing from a stage of despair and powerlessness to a stage of hope, a critical analysis of the disease, and a better management and control of it and its evolution. This article describes how people suffering from cancer use and participate in religious and spiritual content. It demonstrates the contribution of this content to an individual empowerment process. The use of religion and spirituality constitutes a quest for self-mastery, an acquiring of power and control. We understand that religious and spiritual phenomena do not always prevent people from fighting against their suffering, limit their freedom, or systematically reduce people’s viewpoints and worldviews.

Religious coping and psychological distress in military veteran cancer survivors

Research on the relationship between religious coping and psychological well-being in cancer survivors is limited. Forty-eight veteran cancer survivors completed measures of psychological distress, posttraumatic growth, and positive and negative religious coping. Negative religious coping was associated with greater distress and growth. Positive religious coping was associated with greater growth. Gender, race, and religious affiliation were significant predictors of positive and negative religious coping. Veteran cancer survivors who utilize negative religious coping may benefit from referral to clergy or a mental health professional. Assessment of religious coping may be particularly important for female, non-White, and Christian cancer survivors.

Entwicklung, Validierung und Normierung des Rasch-basierten Depressionsscreenings

Zusammenfassung. Theoretischer Hintergrund: Vor dem Hintergrund hoher Prävalenzraten für depressive Störungen bei somatisch Erkrankten sowie artifizieller Effekte bei wiederholten Messungen wurde das Rasch-basierte Depressionsscreening (DESC) entwickelt. Fragestellung: Der Entwicklungs-, Validierungs- und Normierungsprozess des Verfahrens wird zusammengefasst und die Nützlichkeit für die klinische Praxis diskutiert. Methoden: Ausgehend von der Aachener Depressionsitembank ( Forkmann et al., 2009 ) wurde das DESC anhand von N = 333 psychisch/somatisch erkrankten Patienten (Alter M = 43,6 Jahre; 46,2% Frauen) mittels Strukturmodellierung und Rasch-Analyse entwickelt, an verschiedenen klinischen Stichproben überprüft und bevölkerungsrepräsentativ normiert (N = 2 .509). Ergebnisse: Eindimensionalität und Rasch-Modellkonformität der Parallelformen wurden bestätigt und Cut-Off-Werte mit guter Sensitivität und Spezifität bestimmt. Die Paralleltestreliabilität war in allen Stichproben >0.9. Schlussfolgerungen: Mit dem DESC steht ein neues Verfahren mit guten psychometrischen Eigenschaften zur Verfügung, das das Instrumentarium zur Depressionsdiagnostik sinnvoll ergänzt.

Twenty-five years later--what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review

INTRODUCTION

A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors' psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.

METHODS

MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985-March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.

RESULTS

Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.

DISCUSSION/CONCLUSIONS

Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.

IMPLICATIONS FOR CANCER SURVIVORS

The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through "turning to God" for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one's belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.

Psychometric properties of the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M)

BACKGROUND

From a management perspective, it is necessary to examine how a hospital's top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M) has the same psychometric properties as the HSOPS for hospital employees does.

METHODS

In 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA). Additionally, we proved construct validity and internal consistency.

RESULTS

A total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbach's alpha indicated that the dimensions had an acceptable level of reliability.

CONCLUSION

The analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital management's points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.

Religious struggle as a predictor of subsequent mental and physical well-being in advanced heart failure patients

Patients with congestive heart failure (CHF) often report high levels of religiousness, which may mitigate the stressfulness of their condition. However, religious struggle, reflecting negative attitudes toward God and a strained meaning system, may be detrimental to well-being. Little is known about religious struggle in those with CHF, particularly in relation to physical health and well-being over time. We examined associations of religious struggle and subsequent mental and physical well-being in 101 endstage CHF patients who completed questionnaires twice over 3 months. Religious struggle predicted higher number of nights subsequently hospitalized, higher depression, and marginally lower life satisfaction. When controlling for baseline levels of well-being, effectively assessing change in those outcomes, religious struggle remained a significant predictor of hospitalization and also emerged as a marginally significant predictor of lower physical functioning. Struggle was unrelated to health-related quality of life. Post-hoc analyses suggest that these effects were particularly strong for those endorsing greater religious identification. Religious struggle appears to have a potentially negative impact on well-being in advanced CHF; therefore, helping patients to address issues of struggle may meaningfully lessen the personal and societal costs of CHF.

Depression following open-heart surgery: a path model involving interleukin-6, spiritual struggle, and hope under preoperative distress

Faith factors (i.e., factors pertaining to religion/spirituality) have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle. Based on the multidisciplinary literature and on previous findings, the study's analysis estimated parallel psychophysiological pathways from preoperative distress to postoperative depression in patients undergoing open heart surgery. Plasma samples for interleukin(IL)-6 were obtained before surgery. The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of preoperative anxiety on postoperative depression. Avoidant coping also mediated the influence of anxiety on postoperative maladjustment. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on postoperative mental health attributes.

Religious coping and hospital admissions among adults with sickle cell disease

Although a well-established literature implicates religiosity as a central element of the African American experience, little is known about how individuals from this group utilize religion to cope with specific health-related stressors. The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease-a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (β = -.29, P < .05). These results indicate a need for further investigation of the roles that religion and spirituality play in adjustment to sickle cell disease and their influence on health care utilization patterns and health outcomes.

Religious coping and posttraumatic growth among family caregivers of cancer patients in India

Growing attention has focused on relationships between religious coping and health outcomes among cancer patients. However, surprisingly little is known about religious coping among family caregivers. Moreover, few studies have been conducted outside of Western developed nations. This investigation evaluated family caregivers in Pune, India. The authors examined discrete dimensions of cancer-specific religious coping, and their associations with posttraumatic growth, among families at a similar phase of treatment. As hypothesized, posttraumatic growth was associated with increased use of positive religious coping strategies and diminished use of negative coping strategies. In multivariate analyses, the strongest predictors were benevolent religious reappraisals and punishing God reappraisals. Findings underscore the importance of meaning-focused religious coping.

Pathways to postoperative hostility in cardiac patients: mediation of coping, spiritual struggle and interleukin-6

Using structural equation modeling, we estimated major pathways from preoperative distress, indicated by anxiety and other factors, to postoperative hostility in cardiac patients. Sequential interviews were conducted before and after surgery. Standardized medical and surgical indices were selected from a national database. Results showed that preoperative spiritual struggle mediated indirect effects of anxiety and anger coping on Interleukin-6 (IL-6) immediately before surgery. The link between spiritual struggle and IL-6 further mediated the indirect effects of anxiety and anger coping on postoperative hostility. Anger coping mediated the harmful influence of anxiety and counteracted the protection of positive religious coping on adjustment.

The trajectory of religious coping across time in response to the diagnosis of breast cancer

OBJECTIVES

This study investigates the mobilization of religious coping in women's response to breast cancer.

METHODS

Ninety-three breast cancer patients and 160 women with a benign diagnosis participated. Breast cancer patients were assessed on their use of religious coping strategies and their level of emotional distress and well-being at pre-diagnosis, 1 week pre-surgery, and 1 month, 6 months, 1 year, and 2 years post-surgery.

RESULTS

In general, breast cancer patients used religious strategies more frequently than women with a benign diagnosis; however, the patterns of use were similar across time for the majority of strategies. Results showed that religious coping strategies are mobilized early on in the process of adjustment to breast cancer. Breast cancer patients' use of support or comfort-related strategies peaked around surgery and then declined, while the use of strategies that reflected more a process of meaning-making remained elevated or increased into the long-term. Positive and negative forms of religious coping were predictive of concurrent distress and emotional well-being. As well, there was evidence that the mobilization of religious coping was predictive of changes in distress and well-being across time. For example, women's increased use of active surrender coping from 1 to 6 months post-surgery was related to a concomitant decrease in emotional distress and increase in emotional well-being.

CONCLUSIONS

Notably the nature of the relationship between religious coping and emotional adjustment depended on the type of religious coping strategy as well as the specific time of assessment. Specificity of information in the use of religious coping can allow health-care professionals to better identify resources and address potential points of difficulty during the process of women's adjustment to breast cancer.

Life satisfaction in chronic pain patients: the stress-buffering role of the centrality of religion

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

Positive and negative religious coping and well-being in women with breast cancer

BACKGROUND

Although religions is important to many people with cancer, few studies have explored the relationship between religious coping and well-being in a prospective manner, using validated measures, while controlling for important covariates.

METHODS

One hundred ninety-eight women with stage I or II and 86 women with stage IV stage breast cancer were recruited. Standardized assessment instruments and structured questions were used to collect data at study entry and 8 to 12 months later. Religious coping was measured with validated measures of positive and negative religious coping. Linear regression models were used to explore the relationships between positive and negative religious coping and overall physical and mental well-being, depression, and life satisfaction.

RESULTS

The percentage of women who used positive religious coping (i.e., partnering with God or looking to God for strength, support, or guidance) "a moderate amount" or "a lot" was 76%. Negative religious coping (i.e., feeling abandoned by or anger at God) was much less prevalent; 15% of women reported feeling abandoned by or angry at God at least "a little." Positive religious coping was not associated with any measures of well-being. Negative religious coping predicted worse overall mental health, depressive symptoms, and lower life satisfaction after controlling for sociodemographics and other covariates. In addition, changes in negative religious coping from study entry to follow-up predicted changes in these well-being measures over the same time period. Cancer stage did not moderate the relationships between religious coping and well-being.

CONCLUSIONS

Negative religious coping methods predict worse mental heath and life satisfaction in women with breast cancer.

Development and validation of the Rasch-based Depression Screening (DESC) using Rasch analysis and structural equation modelling

Questionnaires for the assessment of depression benefit from modern test construction like item-response-modelling. We developed two parallel 10 item depression questionnaires, the Rasch-based Depression Screening version 1 (DESC-I) and 2 (DESC-II), by combining Rasch analysis and structural equation modelling on patient samples suffering primarily from a mental disorder or from somatic diseases. Both scales base upon a Rasch homogeneous item bank and proved unidimensionality and good model fit. Cut-off scores with good sensitivity and specificity were developed using ROC analyses. Results suggest that DESC may be appropriately used to screen for depression and may be beneficial for repeated measurements.

Relevance of religion and spirituality in German patients with chronic diseases

OBJECTIVE

Many American patients depend on religion to cope, but less is known about the spiritual/religious (SpR) characteristics of medical patients in Europe, a more secular environment. We examined self-categorizations of SpR (spiritual, religious, both, neither), patients' search for meaningful support, trust in higher source, positive interpretation of disease, and support in relations of life through SpR, as measured with the SpREUK questionnaire, in German medical patients.

METHOD

We analyzed data on 710 West-German patients with a mean age of 54. Forty-two percent had chronic pain diseases, 25% cancer, 10% multiple sclerosis, 21% other chronic diseases, and 3% acute diseases.

RESULTS

The general interest in search for meaningful support was moderate. Trust in a higher source and support in life through SpR were rated higher, while almost all patients had a positive interpretation of their diseases, i.e, hint to change life. The interest in SpR issues was highest in cancer patients and lowest in patients with multiple sclerosis. Univariate analyses confirmed that the SpR self-categorization was the strongest predictor of all four factors, while trust in a higher source was also affected by religious affiliation and age. Positive interpretations of disease correlated well with search for meaningful support.

CONCLUSIONS

Patients with chronic diseases differ with respect to their SpR self-categorizations and may thus utilize different aspects of SpR. Cancer patients, in particular, often depend on their trust in a higher power and in conventional religious activities to help them to cope with their illness.