Religion and spirituality: how clinicians in quebec and geneva cope with the issue when faced with patients suffering from chronic psychosis

Does religious faith contribute to the preservation of personal value system in patients with schizophrenia? an empirical research

Introduction

As demonstrated in previous research and clinical observations, the personal value system is subject to disintegration as a consequence of schizophrenia. Patients with schizophrenia are sometimes religious and use religious coping mechanisms. A number of studies emphasize the benefits of positive religious coping as a part of clinical treatment for patients with schizophrenia and schizoaffective disorder. However, the contribution of these patients' religious faith to the structure and composition of their personal value systems remains unexplored. The present study attempts to answer this question.

Method

The factorial design (2x2) included two conditionally independent variables: mental illness (absent/present) and religious faith (absent/present). We sampled four groups (N = 65) for the study: mentally ill believers of Orthodox Christian faith, mentally ill non-believers, healthy believers, and healthy non-believers. We analyzed the structure and composition of the participants' personal values employing the following tools underpinned by G. Kelly's personal construct theory: the triad method, Hinkle's laddering and repertory grid methods. Correlation and factor analyses were then conducted within each group to find the relationships between the personal values identified. Subsequently, we compared the personal value systems of each group with each other.

Results

The outcomes of the study reveal that personal values of healthy non-believers are less differentiated than those of healthy Orthodox believers and can be divided into two clusters of meta-values: spiritual and material. Mental illness in non-religious individuals is likely to contribute to disintegration of their personal value systems. Healthy believers have distinctly differentiated and hierarchical personal value systems, while mentally ill believers retain both the general hierarchy and key structures of their personal value systems.

Discussion

The relative stability of the personal value systems of mentally ill believers is explained by their attitude toward illness as a form of trial, which is integrated within the framework of their religious worldview grounded in the Orthodox Christian doctrine. In this way, illness is not regarded as a hindrance to achieving life goals and personal meanings inspired by religion.

Spiritual Health Support for Individuals with Serious Mental Illness in the Community

This paper presents a qualitative research project that examines the role of the spiritual health practitioner in an interprofessional Assertive Community Treatment team. The full-time spiritual health practitioner worked alongside the team to support clients with severe mental illness over a six-month period from September 2016 to March 2017. The project examined how the spiritual health needs of clients were addressed through the clinical practice of a spiritual health practitioner. Written in a narrative voice, the findings are presented and discussed, study limitations are identified, recommendations regarding the provision of spiritual health care in the community are made, and areas of future research suggested.

Quality of Life and Its Associations with Religiosity and Religious Coping among Outpatients with Psychosis in Singapore

This cross-sectional study investigated the relationship of religiosity, the use of positive and negative religious coping methods, and quality of life (QOL) among 364 outpatients with psychosis in Singapore. Positive religious coping was significantly associated with better scores on physical (β = 0.51, p = 0.02) and psychological (β = 0.64, p = 0.01) QOL domains in the regression model. Negative religious coping was related to worse QOL in all four domains: physical (β = −0.44, p = 0.03), psychological (β = −0.76, p < 0.01), social (β = −0.54, p = 0.03), and environment (β = −0.65, p < 0.01). Increased participation in organizational religious activities was positively associated with higher QOL for psychological (β = 2.47, p < 0.01), social relationships (β = 2.66, p = 0.01), and environment (β = 2.09, p = 0.01) domains. Interestingly, those with no religious affiliation were found with higher scores in the QOL domain for social relationships (β = 4.59, p = 0.02). Religious coping plays an important role for the QOL of outpatients with psychosis. Greater awareness of the importance of religion in this population may improve cultural competence in treatment. Individuals with psychosis may benefit from greater community support and collaboration between clinical and religious community-based organizations to improve social integration and QOL.

Activity participation patterns of community mental health consumers

Introduction

Previous international research indicates that people with severe mental illness often experience lower levels of activity participation and may therefore be marginalized from occupational opportunities that support recovery. This study aimed to describe activity and participation patterns of consumers of mental health services living in the community and identify significant relationships with demographic characteristics.

Method

A cross-sectional observational study design was utilized, via data mining of the Activity and Participation Questionnaires completed while receiving services from an area mental health service. Data for 282 consumers, who submitted 333 questionnaires, were included.

Results

Consumers were mostly engaged in home-based and unpaid work, and their participation in these tasks significantly increased over time. Significant relationships were found between activity participation and age, gender and primary language. Consumers who were older were less likely to participate in employment, education and physical activity, while female and culturally and linguistically diverse consumers were less likely to engage in activities in the community.

Conclusion

Demographic factors may have a significant impact on the ability of consumers to participate in activities. This may require targeted approaches to activity and participation interventions for specific groups of consumers.

Religiosity and Psychotic Ideation in Stable Schizophrenia: A Role for Empathic Perspective-Taking

The relationship between religiosity and different components of empathy was explored in schizophrenia patients. A total of 81 stable schizophrenia patients and 95 controls from the nearby community completed self-reported questionnaires assessing religiosity and empathy (through the Interpersonal Reactivity Index, IRI). Patients with schizophrenia showed higher religiousness than controls and they presented less perspective-taking and empathic concern but increased personal distress in IRI scores. Regression analyses unveiled an association between religiosity and perspective-taking in schizophrenics after adjusting for age, gender, and psychotic symptoms. In conclusion, religiosity in patients with schizophrenia may be linked to variations in perspective- taking as a component of empathy.

Religious and Spiritual Aspects in the Construction of Identity Modelized as a Constellation

This paper makes a case for an integrative approach to the field of psychology of religion and spirituality. Rather than relying upon or choosing one approach or theory to the detriment of all others, one can identify the construction of psychological identity, modelized as a constellation, as one of several possible « points of connection » serving as work site for the convergence, synthesis and exchange among the vast and rich variety of concepts, measures, theories and methods extant in the field. This work of integration can stimulate, and enrich our perceptions of the multiple dimensions, levels and valences of religion and spirituality.

Spirituality and Religion-Relevance and Assessment in the Clinical Setting

Background:

There has been an increasing interest in the past several decades to study the relationship between spirituality and religion with physical and mental health as well as the various quality of life measures. This trend has led to the creation of an area of study called epidemiology of religion and spirituality. The policy shifts at various levels, in the mental health field, has occurred as well to educate healthcare providers, and address patients’ spiritual /religious needs in clinical settings. Despite these advances in research and policy shift, there is still some resistance in the health care community to assess and address the spiritual needs of patients in clinical settings.

Objective:

The objective is to review the published articles on spirituality/religion and its relationship with mental and physical wellbeing and discuss limitations of such research. The review articles on assessment and interventions to address spiritual or religious needs in clinical settings were also included.

Methods:

Author conducted a literature search using books@Ovid, Journals@Ovid Full Text, Your Journals@Ovid, Ovid MEDLINE® 1946 to January week 4 2019, Ovid Medline® and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily without Revisions 2015-January 28, 2019; Ovid MD and Psychiatry Online.

Results:

A total of 1,040 articles were identified using keywords spirituality, religion, mental health, physical health, psychological well-being, healthy beliefs, psychopathological beliefs and quality of life. The search result included original research papers, review articles and commentaries.

Conclusion:

The review articles were narrowed to 100 articles based on relevance to the objectives outlined above. Seventy-five articles were referenced at the end.

Recovery stories: An anthropological exploration of moral agency in stories of mental health recovery

Moral agency has been loosely defined as the freedom to aspire to a "good life" that makes possible intimate relationships with others. This article uses ethnographic research to further the discussion of the role of moral agency in mental health recovery. This article attends to the ebb and flow of moral agency in the life stories of three people diagnosed with a serious psychiatric disability at different stages in their individual recoveries to illustrate particular aspects of moral agency relevant for recovery. From these, a more complex notion of moral agency emerges as the freedom not only to aspire to a "good life," but also to achieve a "good" life through having both the intention to aspire and access to resources that help bring one's life plans to fruition. Each storyteller describes an initial Aristotelian peripeteia, or "breach" of life plan, followed by an erosion of moral agency and sense of connection to others. The stories then diverge: some have the resources needed to preserve moral agency, and others attempt to replenish moral agency that has been eroded. In these stories, the resources for preserving and nourishing moral agency include the ability to cultivate the social bases of self-respect, autobiographical power, and peopled opportunities. These stories cumulatively suggest that without such resources one's attempts to preserve or nourish the moral agency needed for recovery after the peripeteia, which is often perpetuated by the onset and experience of serious mental illness, may fall short.

Spiritual Meaning in Life and Values in Patients With Severe Mental Disorders

Spirituality and meaning in life are key dimensions of recovery in psychiatric disorders. The aim of this study was to explore spiritual meaning in life in relation to values and mental health among 175 patients with schizophrenia, borderline personality disorder, bipolar disorder, and anorexia nervosa. For 26% of the patients, spirituality was essential in providing meaning in life. Depending on the diagnosis, considering spirituality as essential in life was associated with better social functioning; self-esteem; psychological and social quality of life; fewer negative symptoms; higher endorsement of values such as universalism, tradition (humility, devoutness), and benevolence (helpfulness); and a more meaningful perspective in life. These results highlight the importance of spirituality for recovery-oriented care.

[The assessment of spirituality and religiousness in patients with psychosis]

OBJECTIVES

There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion.

PATIENTS AND METHODS

This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up.

RESULTS

Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months' outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective.

CONCLUSIONS

Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way.

Social support and religion: mental health service use and treatment of schizophrenia

The perceptions and religious beliefs held by family members, mental health and health care professionals, and the community may affect the treatment of individuals with schizophrenia. To better identify and understand the influence of families, professionals and community members on individual's treatment for schizophrenia, this review paper examines: (1) the religious perceptions of families, professionals, and the public towards schizophrenia; (2) religious perceptions of the etiology of schizophrenia; (3) how others perceive religion as a coping mechanism; and (4) how religion influences treatment engagement and help-seeking behaviors. MEDLINE and PsycInfo databases were systematically searched from 1980 to 2010 using the terms schizophrenia, schizoaffective, schizophreniform, psychotic disorder not otherwise specified and religion, religiosity, spirituality, and faith. Forty-three (n = 43) original research studies met the inclusion criteria. This study found that religious beliefs influence the treatment of schizophrenia in the following ways: Religious themes were positively associated with coping, treatment engagement and help-seeking behavior. Evidence of religious underpinnings was found in perceptions of etiology. The findings also indicate that there is often both a preference among family members and caregivers to utilize religious-based professionals and caution toward mental health professionals. Researchers and professionals may find avenues for improving treatment through examining the interaction of religious and schizophrenia at the social support level.

Administering a two-stage spiritual assessment in healthcare settings: a necessary component of ethical and effective care

AIM

This article delineates rationales for administering a spiritual assessment as a universal component of care.

BACKGROUND

The notion that nurses should identify and address patients' spiritual needs remains controversial, particularly in the UK where criticisms derived from secularization theory have appeared in the literature.

EVALUATION

To respond to these criticisms and to develop rationales supportive of spiritual assessment, I draw upon scholarship from a variety of disciplines including social work, sociology, and medicine.

KEY ISSUES

Five rationales are posited to support the concept of universal spiritual assessments: professional ethics, patient autonomy, knowledge of patients' worldviews, the identification of spiritual assets, and accrediting and governmental requirements. Criticisms based on secularization theory are discussed and analysed.

CONCLUSION

A two-stage spiritual assessment - consisting of a brief preliminary assessment followed, if necessary, by a comprehensive assessment - provides a mechanism to efficiently identify patients' spiritual needs.

IMPLICATIONS FOR NURSING MANAGEMENT

As key members of the healthcare team, nurse managers are ideally situated to ensure that all patients receive a spiritual assessment as a routine component of care. In so doing, they help ensure the provision of ethical and effective care to the diverse spiritual groups that will continue to populate the UK for the foreseeable future.

Spirituality and religion in outpatients with schizophrenia: a multi-site comparative study of Switzerland, Canada, and the United States

OBJECTIVE

To assess the importance of spirituality and religious coping among outpatients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder living in three countries.

METHOD

A total of 276 outpatients (92 from Geneva, Switzerland, 121 from Trois-Rivières, Canada, and 63 from Durham, North Carolina), aged 18-65, were administered a semi-structured interview on the role of spirituality and religiousness in their lives and to cope with their illness.

RESULTS

Religion is important for outpatients in each of the three country sites, and religious involvement is higher than in the general population. Religion was helpful (i.e., provided a positive sense of self and positive coping with the illness) among 87% of the participants and harmful (a source of despair and suffering) among 13%. Helpful religion was associated with better social, clinical and psychological status. The opposite was observed for the harmful aspects of religion. In addition, religion sometimes conflicted with psychiatric treatment.

CONCLUSIONS

These results indicate that outpatients with schizophrenia or schizoaffective disorder often use spirituality and religion to cope with their illness, basically positively, yet sometimes negatively. These results underscore the importance of clinicians taking into account the spiritual and religious lives of patients with schizophrenia.

Struggling and enduring with God, religious support, and recovery from severe mental illness

OBJECTIVES

People with severe mental illnesses may achieve varying degrees of recovery, including symptom reduction and community integration. Research also indicates that religiosity facilitates coping with psychological disorders. In this study, we assessed the relationship between religiosity and recovery from severe mental illnesses.

DESIGN

Self-report data were collected from 81 participants with severe mental illnesses. We measured recovery, religious support, and participants' struggle or endurance with faith.

RESULTS

Religious support and enduring with faith were positively associated with recovery. Struggling was negatively associated with recovery, and that relationship was mediated by religious support.

CONCLUSIONS

Religious variables, including religious support and spiritual struggle, might affect recovery from severe mental illnesses.

Spirituality and religiousness as predictive factors of outcome in schizophrenia and schizo-affective disorders

Spirituality and religiousness have been shown to be highly prevalent in patients with schizophrenia. This study assesses the predictive value of helpful vs. harmful use of religion to cope with schizophrenia or schizo-affective disorder at 3 years. From an initial cohort of 115 outpatients, 80% were reassessed for positive, negative and general symptoms, clinical global impression, social adaptation and quality of life. For patients with helpful religion at baseline, the importance of spirituality was predictive of fewer negative symptoms, better clinical global impression, social functioning and quality of life. The frequencies of religious practices in community and support from religious community had no effect on outcome. For patients with harmful religion at baseline, no relationships were elicited. This result may be due to sample size. Indeed, helpful spiritual/religious coping concerns 83% of patients, whereas harmful spiritual/religious coping concerns only 14% of patients. Our study shows that helpful use of spirituality is predictive of a better outcome. Spirituality may facilitate recovery by providing resources for coping with symptoms. In some cases, however, spirituality and religiousness are a source of suffering. Helpful vs. harmful spiritual/religious coping appears to be of clinical significance.

Prevalence and predictors of poor medication adherence among out-patients at a psychiatric hospital in Benin City, Nigeria

OBJECTIVE

To determine the prevalence and predictors of poor or non-compliance with medications among respondents attending an adult psychiatry out-patient clinic in Benin City, Nigeria.

METHODS

Respondents (n = 137) were randomly selected over a 3-month period using a cross-sectional study design. They were administered a questionnaire adapting the Factors Influencing Neuroleptic Medication Taking Scale as well as the Brief Psychiatric Rating Scale (BPRS) to ascertain medication, illness-related and psychosocial variables. Medication adherence was determined by self report and for the purpose of the study confined to the week prior to interview.

RESULTS

Almost half (42.3%) were poorly adherent to medications. Most admitted to good psychosocial support, but believed that their illness had a spiritual aetiology. Stigma, higher frequency of medication dosing as well as illness severity as measured by their BPRS scores were significant predictors of poor medication adherence.

CONCLUSION

The prevalence of poor medication adherence in this environment is higher than in studies from Western cultures, and replicates rates from previously published reports in this environment. Factors responsible for poor adherence can form the template for intervention studies and programs to improve compliance.

The case for more effective relationships between psychiatry, religion and spirituality

PURPOSE OF REVIEW

The purpose of this review is to highlight that the indifferent, undecided, and rarely positive attitude of psychiatrists toward the relationship between psychiatry, religion and spirituality stands in contradiction to extensive data.

RECENT FINDINGS

The evidence reveals a largely positive relationship between religiosity/spirituality and different indices of health. Despite the attitude of psychiatrists in general, the neglect of this fact is difficult to justify. However, religious and spiritual beliefs are powerful forces and may impart harmful as well as beneficial effects.

SUMMARY

Whatever disagreements there might be on definition and use, spirituality and religion are concerned with the core beliefs, values and experiences of human beings. A consideration of their relevance should, therefore, be a central part of clinical and academic psychiatry.