Invited Commentary: Religious Service Attendance and Implications for Clinical Care, Community Participation, and Public Health

Religion and survival among European older adults

There are several pathways through which religion can affect longevity. Previous research, predominately from North America, has shown decreased mortality risk for participants that attended religious services. This study aims to examine the association between religion and all-cause mortality in a large sample of older European adults, comparing religious affiliations, and using prayer frequency as well as frequency of participation in a religious organisation as measures of religiousness. To this end, a total of 16,062 participants from the Survey of Health Ageing and Retirement in Europe were employed for a survival analysis (median follow-up 11.3 years; 3790 recorded deaths). Following a religion was negatively associated with mortality regardless of demographic and socioeconomic factors (HR = 0.81; 95% CI 0.74-0.89). Large differences in the median survival of participants from different religious affiliations can be mostly attributed to demographic and socioeconomic factors. Both frequency of prayer and religious participation exhibited a significant positive dose-response relationship with survival despite adjustments, although the results for religious participation were more profound. Changes on the religiosity levels of the European population will require additional research on the subject in the future.

Guidelines for integrating spirituality into the prevention and treatment of alcohol and other substance use disorders

Alcohol and other substance use disorders are complex problems with multiple variables and determinants, requiring a multidimensional approach to prevention and treatment. A robust body of research shows that religiosity and spirituality (R/S) play a prominent role in these disorders; however, how to apply this knowledge remains unclear. We present practical guidelines on how to integrate R/S into substance use prevention and treatment in an ethical, evidence-based manner. These guidelines have been endorsed by prominent academic leaders in these topics and by health associations affiliated with the three major Brazilian religions. The integration of R/S is part of a respectful, person-centered, interdisciplinary approach, which imposes neither religious beliefs nor secular worldviews. The most critical interventions include collecting a history of spiritual and religious beliefs, practices, and experiences and evaluating how these may be used positively in treatment. It is also essential that health professionals are encouraged to value and respect the R/S of patients, and that religious groups recognize that professional and technical interventions can make a valuable contribution to preventing and treating these disorders.

Effect of religious service attendance on mortality and hospitalisations among Danish men and women: longitudinal findings from REGLINK-SHAREDK

Research suggests a protective effect of religious service attendance on various health outcomes. However, most research has been done in religious societies, raising the question of whether these associations are also prominent in secular cultures. Here we examine mortality and hospitalisations by religious service attendance among men and women in a secular society. We performed a cohort study including 2987 Danes aged 40+ interviewed in SHARE from 2004 to 2007 and followed up in the Danish registries until 2018. We used Cox regressions and negative binomial regressions to examine associations, including interactions with sex and adjusting for age, wave, socioeconomic factors, lifestyle factors, body mass index, and history of diseases. Overall, 5.0% of men and 6.6% of women reported that they had taken part in a religious organisation within the last month. Among 848 deaths, we found lower mortality for people who attended religious services (hazard ratio (HR) 0.70; 95% CI 0.50-0.99). There was evidence for an association among women (HR 0.56; 95% CI 0.35-0.89), but not among men (HR 0.95; 95% CI 0.59-1.53). In contrast, regarding hospital admissions (n = 12,010), we found lower hospitalisation rates among men who attended religious services (incidence rate ratio (IRR) 0.67; 95% CI 0.45-0.98), whereas no association was found among women (IRR 0.95; 95% CI 0.70-1.29). Sensitivity analyses with E-values were moderately robust. Our results contribute to the limited literature on possible health benefits of religious service attendance in secular societies, demonstrating lower mortality among women and fewer hospitalisations among men.

Toward a translational epidemiology of religion: challenges and applications

This paper explores the concept of translational epidemiology in the context of epidemiologic studies of religious determinants of morbidity and mortality. Despite a research literature of, by now, thousands of published studies, many in top-tier medical and public health journals, some resistance remains to full acceptance of this work. A principal reason may be the failure of investigators to make the case for real-world applications of epidemiologic findings on religious risk or protection for subsequent personal or population health, in keeping with the definition of translational epidemiology. To remedy this, a case is made for a translational epidemiology of religion. Three types of translation are proposed. The first two recall the standard definition of translational medicine as "from bench to bedside," in this instance two types of bedside encounters, pastoral and clinical. The third application is to public health practice, involving multiple public health professions and specialties. As with other substantive topics within psychosocial epidemiology, research on population-health outcomes of religious exposures provides information that can be applied to development of health promotion and disease prevention programs and formulation of health policy. But this can happen only if investigators give more attention to enumerating potential uses of their findings.

Spirituality in Serious Illness and Health

IMPORTANCE

Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed.

OBJECTIVE

To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes.

EVIDENCE REVIEW

Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority.

FINDINGS

Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation.

CONCLUSIONS AND RELEVANCE

This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.

Variables associated with religious practice in Brazilian adults and older adults aged 50 and over: ELSI-Brazil

Abstract Objective To identify variables associated with religious practice in Brazilian adults and older adults aged 50 and over. Method In this observational and cross-sectional study, the participants included 7,171 individuals aged 50 and over from a representative national sample (N=9,412), interviewed in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), on frequency of participation in religious services, religious affiliation, self-rated health, sex, age, education, living arrangements, region of residence, and race. The Poisson regression model was used to investigate crude and adjusted associations between variables. Results Fifty-seven percent of the sample was female, the mean age was 62.5±9.4 years old, the majority had 5 to 8 years of education and lived with 3 or more people, 42% resided in the Southeast region, and 48% self-declared as Pardo [mixed race], 66% were Catholic, 76% attended religious services once or more times a week, and 45% rated their health as fair. The most frequent participants in religious services were Black (PR=1.06, 95%CI 1.00-1.12)and mixed race (PR=1.07, 95%CI 1.03-1.11), Evangelical (PR =1.26, 95%CI 1.22-1.30), and self-rated their health as fair (PR=1.07, 95%CI 1.02-1.11). In contrast, the least frequent were male (PR=0.87, 95%CI 0.84-0.90), with 5 to 8 years of education (PR=0.92, 95%CI 0.88-0.97), residing in the Southeast (PR=0.91, 95%CI 0.86-0.95) and South (PR=0.90, 95%CI 0.82-0.99) regions. Conclusion Self-declaration as Black and mixed race, Evangelical religion, and self-rated health as fair were associated with higher attendance at religious services among Brazilians aged 50 and over.

Variáveis associadas com a prática religiosa em adultos e idosos brasileiros com 50 anos ou mais: ELSI-Brasil

Resumo Objetivo Identificar variáveis associadas à prática religiosa em adultos e idosos brasileiros de 50 anos e mais. Método Neste estudo observacional e transversal, participaram 7.171 indivíduos de 50 anos e mais, integrantes de amostra nacional representativa (N=9.412), entrevistados na 1ª onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), sobre frequência de participação em serviços religiosos, afiliação religiosa, autoavaliação de saúde, sexo, idade, escolaridade, arranjo de moradia, região de residência e raça. O modelo de regressão de Poisson foi usado para investigar associações brutas e ajustadas entre as variáveis. Resultados Cinquenta e sete por cento da amostra eram mulheres; a média de idade foi 62,5±9,4 anos; a maior parte tinha 5 a 8 anos de escolaridade e morava com 3 ou mais pessoas; 42% residiam na região Sudeste e 48% declararam-se pardos; 66% eram católicos e 76% participavam de cerimônias religiosas uma ou mais vezes por semana; 45% avaliaram a própria saúde como regular. Os mais assíduos em serviços religiosos foram os participantes pretos (RP=1,06, IC95% 1,00-1,12), pardos (RP=1,07, IC95% 1,03-1,11), evangélicos (RP=1,26, IC95% 1,22-1,30) e com autoavaliação da saúde como regular (RP=1,07, IC95% 1,02-1,11). Os menos assíduos eram do sexo masculino (RP=0,87, IC95% 0,84-0,90), com 5 a 8 anos de escolaridade (RP=0,92, IC95% 0,88-0,97) e residiam nas regiões Sudeste (RP=0,91, IC95% 0,86-0,95) e Sul (RP=0,90, IC95% 0,82-0,99). Conclusão Cor de pele preta e parda, religião evangélica e autoavaliação de saúde como regular estão associadas à maior assiduidade em serviços religiosos entre brasileiros de 50 anos e mais.