Religious/spiritual struggles and whole person functioning among Colombian university students: Longitudinal evidence of mutual influence

This prospective study examined the primary, secondary and complex conceptual models of religious/spiritual struggles with 18 indicators of whole person functioning across five domains: psychological well-being, psychological distress, social well-being, physical well-being and character. We used three waves of longitudinal data (Wave 1: August/September 2021, Wave 2: October/November 2021, Wave 3: February 2022) from Colombian university students (N = 2878, Mage = 20.88 ± 4.05 years). Adjusting for covariates assessed in Wave 1, our primary analysis applied the analytic templates for outcome-wide and lagged exposure-wide designs to estimate two sets of lagged linear regression models. Religious/spiritual struggles in Wave 2 were associated with a small-to-medium-sized decline in subsequent functioning on 17/18 indicators in Wave 3, and worse functioning on 16/18 indicators in Wave 2 was associated with very small-to-medium-sized increases in subsequent religious/spiritual struggles in Wave 3. The results provided evidence in favour of the complex conceptual model for 16/18 indicators of whole person functioning. Our findings extend existing evidence on the reciprocal association between religious/spiritual struggles and individual functioning to a wide range of indicators, reinforcing the need for practitioners to consider the dynamic interplay between religious/spiritual struggles and individual functioning as they work with younger populations.

Divine struggles and whole person functioning: a 9-year longitudinal study of middle-aged U.S. adults

OBJECTIVE

This longitudinal study examined the associations of divine struggles with 25 psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior outcomes assessed approximately nine years later.

METHODS

We used three waves of data from the National Survey of Midlife Development in the United States (N = 4041): M1 (1995-1996), M2 (2004-2006), and M3 (2013-2014). Following the analytic template for outcome-wide longitudinal designs, our primary analysis employed a series of regression models to estimate the associations between a continuous measure of divine struggles assessed at M2 with each outcome assessed at M3. All models adjusted for a rich set of covariates, including prior values of all outcomes.

RESULTS

There was modest evidence suggesting that divine struggles were associated with worse subsequent functioning on one or more outcomes for each domain except health behaviors (effect sizes were generally very small).

CONCLUSIONS

Divine struggles have the potential to degrade long-term functioning across multiple domains of life. Practitioners should attend to and address divine struggles in their clinical work.

R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health

OBJECTIVE

Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014.

DESIGN

An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018.

RESULTS

Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data).

CONCLUSIONS

R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.

Religious/spiritual struggles and psychological distress: A test of three models in a longitudinal study of adults with chronic health conditions

OBJECTIVE

This study tested three conceptual explanatory models that have been theorized to account for the linkages between religious/spiritual (R/S) struggles and psychological distress: the primary model (i.e., R/S struggles lead to psychological distress), the secondary model (i.e., psychological distress leads to R/S struggles), and the complex model (i.e., R/S struggles and psychological distress reciprocally exacerbate each other).

METHODS

Using prospective data from a sample of US adults living with chronic health conditions (n = 302), we performed a cross-lagged panel analysis with three timepoints to test for evidence of potential causal relations between R/S struggles and psychological distress.

RESULTS

Consistent with the complex conceptual model of R/S struggles, we found evidence of positive reciprocal associations between R/S struggles and psychological distress.

CONCLUSION

The findings highlight the importance of attending to the dynamic interplay between R/S struggles and psychological distress when working with adults who have chronic health conditions.

The Relevance of Religion and Spirituality to Mental Health: A National Survey of Current Clients' Views

Despite a growing interest in the relationship between religion and spirituality (RS) and mental health across helping professions, less is known about clients' perceived relevance of these areas. This article describes the development and validation of the Relevance of Religion and Spirituality to Mental Health (RRSMH) scale, and responses to the first national survey of clients' perceived relevance of RS to mental health. Specifically, a sample of 989 U.S. adults who saw a mental health care provider in the last month responded to an online survey that included 27 new items to measure clients' perceptions of the relevance of RS to mental health, both positive and negative. A confirmatory factor analysis revealed that the sample's data had an adequate fit to the final 12-item model, and the instrument's overall reliability was very good (α = .96). Descriptive analyses indicated that clients view RS as both supportive and relevant to their mental health. The RRSMH scale may be used in mental health research and practice settings. Authors recommend that RS be assessed and included in treatment planning, where appropriate, and addressed in training for mental health professionals.

Spiritual intimacy, spiritual one-upmanship, and marital conflict across the transition to parenthood

Dyadic discussions that directly tap into spouses' views on spirituality and religiousness (S/R) represent an understudied but important facet of marital functioning that may be tied, for better or worse, to marital conflict and resolution processes. This study used longitudinal data gathered from 164 married couples across the transition to parenthood (TtP) to address this possibility. Specifically, during late pregnancy and when their infant was 3, 6, and 12 months old, husbands and wives completed measures about both spouses' spiritual intimacy (i.e., self-disclosure and support of partner's disclosures about spirituality) and spiritual one-upmanship (i.e., relying on spiritual and religious [dis]beliefs and opinions to assert superiority in conflicts). Criterion variables were the frequency of marital conflict and both partners' use of collaborative, hostile, and stalemating communication strategies during marital conflicts. Using fixed-effects regression models with both predictors entered, we found that greater spiritual intimacy by wives and husbands predicted less frequent conflict (p < .01), more collaborative communication by husbands (p < .01) and less stalemating (p < .01) by both spouses. Wives' spiritual intimacy also predicted more collaboration and less verbal hostility by wives (p < .01). By contrast, greater spiritual one-upmanship by both spouses predicted greater stalemating by both spouses (p < .05) and verbal hostility by husbands (p < .05). The findings indicate that 2 contrasting types of S/R dialogues are differentially linked to disagreements and conflict-resolution skills after accounting for stable aspects of the couples across the TtP (e.g., personality traits). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health

Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.

The Decoding of the Human Spirit: A Synergy of Spirituality and Character Strengths Toward Wholeness

Little attention has been given to the integral relationship between character strengths and spirituality (the search for or communing with the sacred to derive meaning and purpose). The science of character strengths has surged in recent years with hundreds of studies, yet with minimal attention to spirituality or the literature thereof. At the same time, the science of spirituality has steadily unfolded over the last few decades and has offered only occasional attention to select strengths of character (e.g., humility, love, and forgiveness) or the universal typology of the VIA classification of character strengths and virtues. In this exploration, we argue that there is a robust synergy of these sciences and practices revealing that spirituality is vitally concerned with promoting character strengths. At the same time, character strengths can enhance and deepen spiritual practices, rituals, and experiences. We elaborate on how character strengths and spirituality come together in the context of the psycho-spiritual journey toward wholeness. By wholeness, we are referring to a way of being in the world that involves a life-affirming view of oneself and the world, a capacity to see and approach life with breadth and depth and the ability to organize the life journey into a cohesive whole. We further discuss six levels by which spirituality can be integrated within the VIA Classification, including a meta-perspective in which wholeness represents a meta-strength or superordinate virtue. We frame two pathways of integration: the grounding path, in which character strengths offer tangibility and thereby deepen and enhance spirituality, and the sanctification path, in which spirituality elevates character strengths. Finally, we turn to research-based practices and examine how character strengths might facilitate and contribute to spiritual practices and, conversely, how spirituality might enhance character strength practices. Such multifaceted integration offers insight and wisdom to both areas of study and opens up new directions for psycho-spiritual research and practices to deepen and broaden our understanding of what it means to be human.

The impact of social support and morally injurious events on PTSD symptoms in Veterans

Potentially morally injurious events (PMIEs), including committing transgressions (Transgressions-Self) and perceiving betrayals, have been positively associated with posttraumatic stress disorder (PTSD). A proposed mechanism for the association between PMIEs and PTSD symptoms is social disconnection. However, research on PMIEs and social disconnection is limited. Secondary data analysis from a larger study examined the moderating role of different sources of perceived social support (Family, Friends, and Significant Other) on the relation between PMIEs (Transgressions-Self and Betrayal) and PTSD. The interaction of Transgressions-Self and perceived social support subscales did not predict PTSD symptoms. However, the interaction of Betrayals and perceived social support (Significant Other and Family) predicted PTSD symptoms. Results suggest that perceived social support provides a protective effect for low to mean levels of perceived betrayals; however, for Veterans reporting high levels of betrayal, perceived social support did not attenuate PTSD symptom severity. Additional research on perceived betrayals and the association with PTSD is needed, especially for Veterans who experience high levels of perceived betrayals.

In the Shadow of Death: Religious Hope as a Moderator of the Effects of Age on Death Anxiety

Objectives

The purpose of this study is to see whether feelings of death anxiety are lower among older than among younger people. In addition, an effort is made to see whether religious hope explains this relationship. It is proposed that the inverse relationship between a religiously oriented sense of hope and death anxiety increases across successively older age-groups. In contrast, it is hypothesized that the relationship between a generalized sense of hope and death anxiety will not vary across successively older age-groups.

Method

Data on religious hope, a general sense of hope, and death anxiety were obtained from a recent nationwide survey of people aged 18 and older (N = 2,783).

Results

The findings suggest that, compared with older adults, feelings of death anxiety are higher among younger and middle-aged people. The results further reveal that a religious sense of hope, but not a general sense of hope, reduces feelings of death anxiety across successively older age-groups.

Discussion

These findings suggest that a previously unexamined dimension of religion (i.e., religious hope) may help people cope with feelings of death anxiety.

Religious and spiritual struggles, religiousness, and alcohol problems among undergraduates

Theoretically, religion/spirituality may protect against alcohol problems or facilitate recovery. However, challenges can arise in religious/spiritual life that may contribute to or complicate alcohol problems. Emerging adults often experience difficult transitions from family environments to independent membership in academic communities straddling the legal drinking age boundary. Among underage undergraduates, we hypothesized that religious/spiritual struggles predict more alcohol problems independently of distress and religiousness, and religiousness independently predicts fewer alcohol problems. Our survey of two U.S. universities (total N = 2525) supported these hypotheses. Structural equation models revealed positive correlations between alcohol problems and all six religious/spiritual struggles (divine, demonic, interpersonal, moral, ultimate meaning, doubt), but only moral struggle predicted alcohol problems moderately and independently of religiousness, distress, gender, and non/white ethnicity. Evidence also emerged for negative correlations between religious/spiritual struggles and drinking as it varies independently of alcohol problems. We recommend that alcoholism counselors address clients' religious/spiritual struggles.

Positive and negative religious coping as predictors of distress among minority older adults

OBJECTIVES

The study replicated and extended previous findings by investigating relationships between positive and negative religious coping and psychological distress in minority older adults.

METHODS

Older adults were evaluated during screening and baseline procedures of a psychotherapy clinical trial for late-life worry and anxiety. Participants were age 50 years or older and recruited from low-income and predominantly minority neighborhoods. Participants screening positive for worry (PSWQ-A ≥ 23) with no significant cognitive impairment (Six-Item Screener for cognitive impairment ≤2) completed a diagnostic interview and baseline assessments. Positive and negative religious coping were assessed with the positive and negative coping subscales of the Brief Religious Coping scale. Psychological distress was assessed with measures of depression, anxiety, and worry. A set of multiple linear regression models were used to evaluate the relationship between religious coping and each measure of psychological distress.

RESULTS

Negative religious coping was associated with greater anxiety, worry, and depression. Positive and negative religious coping interacted such that positive religious coping buffered the effects of negative religious coping on anxiety and depression. Significant main effects and interactions remained after controlling for age, gender, race, years of education, and study.

CONCLUSIONS

The findings of this study are consistent with prior work showing that negative religious coping is associated with greater psychological distress. This study replicates previous findings that positive religious coping may buffer the harmful effects of negative religious coping and extends understandings of the specific psychological impacts that positive and negative religious coping may have on older, minority adults.

Reading the Bible, Stressful Life Events, and Hope: Assessing an Overlooked Coping Resource

Many people rely on religion to deal with the stressors in their lives. The purpose of this study is to examine a religious coping resource that has received relatively little attention-reading the Bible. We evaluated three hypotheses: (1) reading the Bible moderates the relationship between stress and hope; (2) people who read the Bible more often are more likely to rely on benevolent religious reappraisal coping responses; and (3) individuals who rely on benevolent religious reappraisals will be more hopeful about the future. Support was found for all three hypotheses in our analyses.

The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress

Inflammation, often measured by C-reactive protein (CRP), is thought to be related to a number of debilitating illnesses as we age, including cardiovascular disease, cancer and diabetes. Stress has also been implicated in these processes. This study examines potential protective effects of spirituality and religion in older adults who have experienced stressful life events. As part of the nationwide Landmark Study of Spirituality and Health, a subsample of 643 middle-aged and older adults (age ≥ 50) who were at or above the median in number of life stressors (≥ 2) was included in this analysis. Psychospiritual and religious (PS/R) variables included: religious service attendance, prayer, religious meaning, religious hope, general meaning, general hope and sense of peace. Control variables included: age, gender, education, BMI, smoking, alcohol use, social support. Only church attendance predicted significantly lower CRP after controlling for covariates, even above the other PS/R variables (standardized β = - 0.14, t = - 3.23 p = 0.001). Those with frequent religious service attendance were 38% less likely to have clinically elevated CRP than those who attend rarely or never. Religious service attendance may confer protection in older adults experiencing stressful events as it was significantly associated with lower CRP, an inflammatory marker associated with illness.

Spiritual Struggles and Problem Drinking: Are Younger Adults at Greater Risk than Older Adults?

BACKGROUND

Although a good deal of research has assessed the positive effects that involvement in religion has on alcohol use, there is relatively little research on the negative aspects of religious life and alcohol problems.

OBJECTIVES

This study has two objectives. The first is to see if spiritual struggles are associated with problem drinking. The second is to see if the relationship between spiritual struggles and problem drinking is stronger for younger than for older adults.

METHODS

The data come from a recent nationwide survey of adults of all ages who reside in the United States (N = 2142).The study was conducted in 2014. Problem drinking is assessed with the CAGE questionnaire.

RESULTS

The findings indicate that people who encounter more spiritual struggles are more likely to experience problem drinking. The relationship between spiritual struggles and problem drinking was stronger than the relationship between three other frequently used measures of religion and problem drinking (i.e., attendance at worship services, private prayer, and affiliation with Evangelical denominations). The results further reveal that spiritual struggles are associated with a greater risk of drinking problems among younger than among older individuals. Conclusions/Importance: Although many studies show that various facets of religion are associated with a lower risk of experiencing problems with alcohol the findings from the current study show that there are negative aspects of religious life that may be associated with a greater risk of having problems with alcohol.

Moral disapproval and perceived addiction to internet pornography: a longitudinal examination

BACKGROUND AND AIMS

Internet pornography use is an increasingly common, yet controversial, behavior. Whereas mental health communities are divided about potentially problematic use patterns, many lay people identify as feeling dysregulated or compulsive in their use. Prior work has labeled this tendency perceived addiction to internet pornography (PA). This study's aims were to (1) assess the association between PA at baseline and other factors, including actual levels of average daily pornography use and personality factors and (2) assess the associations between baseline variables and PA 1 year later.

DESIGN

Two large-scale community samples were assessed using online survey methods, with subsets of each sample being recruited for follow-up surveys 1 year later.

SETTING

United States.

PARTICIPANTS

Participants were adults who had used pornography within the past 6 months recruited in two samples. Sample 1 (n = 1507) involved undergraduate students from three US universities and sample 2 (n = 782) involved web-using adults. Subsets of each sample (sample 1, n = 146; sample 2, n = 211) were surveyed again 1 year later.

MEASUREMENTS

At baseline, we assessed average daily pornography use, PA and relevant predictors (e.g. trait neuroticism, trait self-control, trait entitlement, religiousness, moral disapproval of pornography use). One year later, we assessed PA.

FINDINGS

Cross-sectionally, PA was correlated strongly with moral disapproval of pornography use [sample 1, Pearson's correlation: r = 0.68 (0.65, 0.70); sample 2, r = 0.58 (0.53, 0.63)]. Baseline moral disapproval [sample 1, r = 0.46 (0.33, 0.56); sample 2, r = 0.61 (0.51, 0.69)] and perceived addiction demonstrated relationships with perceived addiction 1 year later. We found inconclusive evidence of a substantial or significant association between pornography use and perceived addiction over time [sample 1, r = 0.13 (-0.02, 0.28); sample 2, r = 0.11 (-0.04, 0.25)].

CONCLUSIONS

Perceived addiction to internet pornography appears to be related strongly to moral scruples around pornography use, both concurrently and over time, rather than with the amount of daily pornography use itself.

Social Desirability Bias in Pornography-Related Self-Reports: The Role of Religion

In a large online survey of undergraduates, we examined the degree to which social desirability concerns might bias pornography-related self-reports and whether these biases are stronger among highly religious participants than among less-religious ones. Recent state-level analyses have put forward a controversial suggestion that religious individuals tend to search for pornography more than their less-religious peers, despite self-reports to the contrary. Such results could be explained by a social-desirability bias against reporting the consumption of pornography, one that applies specifically to religious individuals. Though our findings are limited to undergraduates in the U.S. Midwest, we found some evidence that the desire to positively self-present (as measured by the Marlowe-Crowne social desirability scale) may bias reports of pornography consumption and perceptions of pornography's effects (e.g., perceptions of addictiveness). However, contrary to popular sentiment-and our own hypotheses-we found no evidence for and much evidence against the suggestion that religious individuals have a more pronounced social desirability bias against the reporting of pornography consumption than the irreligious. Interaction terms assessing that possibility were either nonsignificant or significant in the reverse direction.

Morally injurious events and psychological distress among veterans: Examining the mediating role of religious and spiritual struggles

OBJECTIVE

Potentially morally injurious events (PMIEs)-violations (perpetrated or witnessed) of one's deeply held beliefs or values-have been associated with several forms of psychological distress. The values violated by PMIEs are often influenced by one's religion/spirituality (r/s). Struggles with one's r/s beliefs and/or practices may also contribute to elevated psychological distress. To further develop a framework for understanding and treating the sequelae of PMIE exposure, we examined the role of r/s struggles in the relation between PMIE exposure and psychological distress.

METHOD

A diverse sample of 155 veterans at a large Veterans Affairs medical center completed questionnaires assessing PMIE exposure, r/s struggles, and psychological distress.

RESULTS

Findings revealed greater PMIE exposure predicted elevated r/s struggles as well as elevated symptoms of anxiety and posttraumatic stress disorder (PTSD). Likewise, greater r/s struggles predicted elevated anxiety, PTSD, and depression symptoms. Regression analyses revealed r/s struggles fully mediated the relation between PMIE exposure and anxiety as well as PTSD, and a significant indirect effect of PMIE exposure on depression symptoms through r/s struggles was observed. Follow-up analyses revealed that no specific domain of r/s struggles accounted for the relation between PMIE exposure and psychological distress; rather, the overarching construct of r/s struggles accounted for this relation.

CONCLUSION

These findings advance the evolving theoretical framework of moral injury, elucidating the salience of r/s struggles in the development of distress. Implications for moral injury intervention call for attention to potential dissonance between actions (witnessed or perpetrated) and r/s underpinnings of the individual's moral framework. (PsycINFO Database Record

Religious/Spiritual Struggle in Young Adult Hematopoietic Cell Transplant Survivors

PURPOSE

This study describes the prevalence of religious and/or spiritual (R/S) struggle in long-term young adult (YA) survivors following hematopoietic cell transplantation (HCT) as well as existential concerns (EC), social support, and demographic, medical, and emotional correlates of R/S struggle.

METHODS

Data were collected as part of an annual survey of survivors of HCT aged 18-39 years at survey completion; age at HCT was 1-39 years. Study measures included measures of R/S struggle (defined as any non-zero response on the negative religious coping subscale from Brief RCOPE), quality of life (QOL), and depression. Factors associated with R/S struggle were identified using multivariable logistic regression models.

RESULTS

Fifty-two of the 172 respondents (30%), who ranged from less than a year to 33 years after HCT, had some R/S struggle. In bivariate analysis, depression was associated with R/S struggle. In a multivariable logistic regression model, individuals with greater EC were nearly five times more likely to report R/S struggle. R/S struggle was not associated with age at transplant, time since transplant, gender, race, R/S self-identification, or medical variables.

CONCLUSION

R/S struggle is common among YA HCT survivors, even many years after HCT. There is a strong correlation between EC and R/S struggle. Given the prevalence of R/S struggle and its associations with EC, survivors should be screened and referred to professionals with expertise in EC and R/S struggle as appropriate. Further study is needed to determine longitudinal trajectory, impact of struggle intensity, causal relationships, and effects of R/S struggle on health, mood, and QOL for YA HCT survivors.

State of the Science of Spirituality and Palliative Care Research Part II: Screening, Assessment, and Interventions

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part II of the SOS-SPC report addresses the state of extant research and identifies critical research priorities pertaining to the following questions: 1) How do we assess spirituality? 2) How do we intervene on spirituality in palliative care? And 3) How do we train health professionals to address spirituality in palliative care? Findings from this report point to the need for screening and assessment tools that are rigorously developed, clinically relevant, and adapted to a diversity of clinical and cultural settings. Chaplaincy research is needed to form professional spiritual care provision in a variety of settings, and outcomes assessed to ascertain impact on key patient, family, and clinical staff outcomes. Intervention research requires rigorous conceptualization and assessments. Intervention development must be attentive to clinical feasibility, incorporate perspectives and needs of patients, families, and clinicians, and be targeted to diverse populations with spiritual needs. Finally, spiritual care competencies for various clinical care team members should be refined. Reflecting those competencies, training curricula and evaluation tools should be developed, and the impact of education on patient, family, and clinician outcomes should be systematically assessed.

State of the Science of Spirituality and Palliative Care Research Part I: Definitions, Measurement, and Outcomes

The State of the Science in Spirituality and Palliative Care was convened to address the current landscape of research at the intersection of spirituality and palliative care and to identify critical next steps to advance this field of inquiry. Part I of the SOS-SPC two-part series focuses on questions of 1) What is spirituality? 2) What methodological and measurement issues are most salient for research in palliative care? And 3) What is the evidence relating spirituality and health outcomes? After describing current evidence we make recommendations for future research in each of the three areas of focus. Results show wide variance in the ways spirituality is operationalized and the need for definition and conceptual clarity in research in spirituality. Furthermore, the field would benefit from hypothesis-driven outcomes research based on a priori specification of the spiritual dimensions under investigation and their longitudinal relationship with key palliative outcomes, the use of validated measures of predictors and outcomes, and rigorous assessment of potential confounding variables. Finally, results highlight the need for research in more diverse populations.

Internet Pornography Use, Perceived Addiction, and Religious/Spiritual Struggles

Prior work has demonstrated that religious beliefs and moral attitudes are often related to sexual functioning. The present work sought to examine another possibility: Do sexual attitudes and behaviors have a relationship with religious and spiritual functioning? More specifically, do pornography use and perceived addiction to Internet pornography predict the experience of religious and spiritual struggle? It was expected that feelings of perceived addiction to Internet pornography would indeed predict such struggles, both cross-sectionally and over time, but that actual pornography use would not. To test these ideas, two studies were conducted using a sample of undergraduate students (N = 1519) and a sample of adult Internet users in the U.S. (N = 713). Cross-sectional analyses in both samples found that elements of perceived addiction were related to the experience of religious and spiritual struggle. Additionally, longitudinal analyses over a 1-year time span with a subset of undergraduates (N = 156) and a subset of adult web users (N = 366) revealed that perceived addiction to Internet pornography predicted unique variance in struggle over time, even when baseline levels of struggle and other related variables were held constant. Collectively, these findings identify perceived addiction to Internet pornography as a reliable predictor of religious and spiritual struggle.

Healthcare Engagement as a Potential Source of Psychological Distress among People without Religious Beliefs: A Systematic Review

Research into religion and mental health is increasing, but nonbelievers in terms of religion are often overlooked. Research has shown that nonbelievers experience various forms of psychological distress and that the negative perception of nonbelievers by others is a potential source of distress. This review builds on that research by identifying another potential source of psychological distress for nonbelievers: engagement with the healthcare system. Poor understanding of nonbelievers by healthcare professionals may lead to impaired communication in the healthcare setting, resulting in distress. Attempts by nonbelievers to avoid distress may result in different patterns of healthcare utilization. Awareness of these concerns may help healthcare providers to minimize distress among their nonbelieving patients.

Assessing the role of race/ethnicity in the relationships among spiritual struggles, health, and well-being

A growing body of research suggests that greater exposure to spiritual struggles is associated with more physical and mental health problems. Spiritual struggles involve difficulties that a person may encounter with his or her faith, which may include having a troubled relationship with God, encountering difficulties with religious others, or being unable to find a sense of meaning in life. However, little is known about the way in which spiritual struggles may differ across racial/ethnic groups. The purpose of this study was to assess variations in spiritual struggles, health, and well-being among Whites, Blacks, and Hispanics. We examined two ways in which race/ethnic variations may arise. First, the differential-exposure perspective suggests that some groups may experience more spiritual struggles than others. Findings from a recent nationwide survey suggest that Blacks experience more spiritual struggles than either Whites or Hispanics. Second, the differential-impact perspective suggests that the relationship between spiritual struggles, health, and well-being varies across racial/ethnic groups. Findings from the current study suggest that when spiritual struggles arise, Blacks experience fewer symptoms of physical illness, less anxiety, and they tend to be happier than Whites or Hispanics. The theoretical implication of these findings is discussed. (PsycINFO Database Record

Religious Involvement, Financial Strain, and Poly-Drug Use: Exploring the Moderating Role of Meaning in Life

BACKGROUND

Research indicates that greater involvement in religion is associated with lower rates of substance use and misuse. However, religion is a complex construct that can be assessed in many ways. The purpose of this study is to explore a dimension of religion that has not been evaluated in previous research on poly-drug use: a religious sense of meaning in life.

OBJECTIVES

It is hypothesized that a religious sense of meaning in life will offset (i.e., moderate) the effects of chronic financial strain on poly-drug use. In order to instill greater confidence in the findings, the moderating role of a religious sense of meaning in life is compared and contrasted with a general sense of meaning in life.

METHODS

The data are provided by a recent nationwide survey of adults of all ages in the United States (N = 2,622). The relationships among the core study constructs are evaluated with ordinary least squares multiple regression.

RESULTS

The results indicate that a greater religious sense of meaning in life buffers the effects of financial strain on poly-drug use. In contrast, a general sense of meaning in life does not appear to perform a similar stress-buffering function. Conclusions/Importance: The findings from this study are important because they provide greater insight into the potentially important ways in which involvement in religion may be associated with poly-drug use.

Spiritual Struggles and Interleukin-6: Assessing Potential Benefits and Potential Risks

The purpose of this study is to evaluate the relationship between spiritual struggles and levels of interleukin-6 (IL-6) with a subsample (N = 943) of participants who took part in a nationwide survey. This study, which was completed in 2014, was conducted in the United States. Spiritual struggles refer to difficulties that a person may encounter with his or her faith and include having a troubled relationship with God, encountering difficulties with religious others, and being unable to find a sense of ultimate meaning in life. Based on the notion that spiritual struggles may be associated with personal growth as well physical health problems, it was hypothesized that there is a nonlinear relationship between the two: levels of IL-6 will decline at relatively low levels of spiritual struggles, but levels of IL-6 will increase as spiritual struggles become more severe. The findings support this hypothesis and suggest there is a quadratic relationship between spiritual struggles and IL-6. The clinical implications of these findings are discussed.

The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life

BACKGROUND

The B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated.

METHODS

The B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated.

RESULTS

The Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach's alphas were 0.91-0.96 and 0.77-0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility.

CONCLUSIONS

These findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.

Effect of Different Meditation Types on Migraine Headache Medication Use

Spiritual meditation has been found to reduce the frequency of migraines and physiological reactivity to stress. However, little is known about how introducing a spirituality component into a meditation intervention impacts analgesic medication usage. In this study, 92 meditation-naïve participants were randomly assigned to one of four groups: (1) Spiritual Meditation, (n = 25), (2) Internally Focused Secular Meditation (n = 23), (3) Externally Focused Secular Meditation (n = 22), or (4) Progressive Muscle Relaxation (n = 22); and practiced their technique for 20 min/day over 30 days while completing daily diaries. Headache frequency, headache severity, and pain medication use were assessed. Migraine frequency decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Headache severity ratings did not differ across groups (p = ns). After adjusting for headache frequency, migraine medication usage decreased in the Spiritual Meditation group compared to other groups (p < 0.05). Spiritual Meditation was found to not affect pain sensitivity, but it does improve pain tolerance with reduced headache related analgesic medication usage.

Patterns of Attribution of Control and Individual Psychosocial Competence

This study examined the relationships among a variety of loci of control and individual psychosocial competence measures through nomothetic and idiographic methods. 133 congregation members drawn from 12 suburban congregations participated in the study. Correlational analyses pointed to considerable independence among the loci of control. However, through a cluster analysis, groups of members manifesting different patterns of attribution of control were identified. The patterns themselves were conceptually meaningful. Furthermore, members of the clusters held significantly different characteristics of psychosocial competence. Yet, as elements of the cluster, neither internal nor external loci themselves had consistently positive or negative implications for members' competence. Rather the significance of the loci appeared to lie in their configuration with each other. Thus, this study highlights the relevance of examining individual frameworks of causal attribution whose elements operate interactively as well as independently.