U.S. Department of Health and Human Services
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Cognitive and Emotional Health Project: The Healthy Brain







Demographic and Social Factors

V. RELIGION

A. Definitions

Religious commitment vs. spirituality (Matthews DA et al. 1998)

o Religious commitment = "the participation in or endorsement of practices, beliefs, attitudes, or sentiments that are associated with an organized community of faith"

o Spirituality = "personal views and behaviors that express a sense of relatedness to the transcendental dimension or to something greater than the self"

o No consensus exists among scientists on how to define spirituality

o Instruments to measure spirituality in clinical/epidemiologic contexts are not well developed

o Little empirical research on spirituality & health.

B. Measures

1. Dimensions of religiousness (Koenig 1998):

a. Religious denomination

b. Organizational religiosity (external/public), e.g. attendance at religious services

c. Nonorganizational religiosity (internal/private), e.g. private prayer, meditation, or scripture reading; or religious media consumption

d. Personal religious commitment, e.g. 'intrinsic religiosity'

o Intrinsic Religiosity Scale (Hoge 1972). 10 statements about religious beliefs or experience. Respondents mark on a 1-5 scale the extent to which they felt the statement is true or not true for them.

Items:
1. My faith involves all of my life
2. In my life, I experience the presence of the Divine (God)
3. Refuse to let religion influence everyday affairs
4. Nothing is as important as serving God

5. Faith sometimes restricts my actions
6. Religious beliefs lie behind my whole approach to life
7. Try hard to carry religion over into life's dealings
8. One should seek God's guidance when making important decisions
9. Many more important things in life than religion
10. Beliefs are less important than living a moral life

e. Religious coping, i.e. religious behaviors used to bring comfort & reduce stress

o Religious Coping Index (Koenig et al. 1992). 3-item measure. Respondent is asked an open-ended question about what enabled him or her to cope with stress of medical illness or other stressor. If religious response is given, a score of 10 is assigned; if a nonreligious response is given, a score of 0 is assigned. Second, the respondent is asked to rate on a visual analogue scale ranging from 0 to 10 the extent to which he or she used religion to cope. Finally, the interviewer engages the respondent in a conversation about how he or she used religion to cope & asked for specific examples. Based on that discussion, the interviewer rates the respondent on a scale of 0-10 on the extent to which religion is used as a coping behavior. Scores on the 3 items are summed to form an index ranging from 0-30. Koenig et al. (1992) and Koenig (1998) used this scale in a large study of medical patients, but the scale in its current form is probably not appropriate for epidemiologic settings.

o Koenig et al. (1992). 850 elderly hospitalized veterans. Using one's religious beliefs as coping resource was related to reduced likelihood of major depression. Also, association between physical disability & depression was weakest among persons who used religion as coping strategy.

2. Multidimensional indices

o EPESE battery on religion

1. What is your religious preference?
2. About how often do you go to religious services?
3. How many people in your congregation do you know personally?
4. Aside from attendance at religious services, do you consider yourself to be: deeply religious / fairly religious / only slightly religious / not at all religious / against religion
5. How much is religion a source of strength & comfort to you? None / a little / a great deal

o National Institute on Aging/Fetzer Institute Working Group Brief Measure of Religiousness and Spirituality (Idler EL, Ellison CG, George LK, Krause N, Levin JS, Ory M, Pargament KI, Powell L, Williams DR, Underwood-Gordon L, 1997). These institutes convened a working group to develop long & short forms of a standard survey instrument to tap dimensions of religious involvement that seem most germane to mental & physical health. This instrument includes items on church-based support, religious coping (based on Paragment 1997), & other functional & behavioral religious items. The short form is included in the 1998 National Opinion Research Center's General Social Survey.

See also 2 articles cited by Ellison & Levin (1998): o Krause N. Measuring religiosity in later life. Res Aging. 1993;15:170-197. o Willliams DR. The measurement of religion in epidemiologic studies: Problems and prospects. In Levin JS (ed). Religion in aging & health: Theoretical foundations & methodologic frontiers. Thousand Oaks CA: Sage, 1994. p. 125-148.

o Koenig HG, McCullough ME, Larson DB (2000).. Handbook of Religion and Health. (Available from National Institute for Healthcare Research.)

C. Epidemiologic evidence

o 95% of Americans believe in God; more than 50% pray daily; & more than 40% attend church weekly.

o North Carolina EPESE: 4162 elderly community-dwelling adults followed 6 yr

o Helm, Hays, Flint, Koenig, Blazer (2000). Among persons without ADL limitations at baseline, there was an association between infrequent ("rarely to never") participation in private religious activities such as prayer, meditation, or Bible study & greater mortality. Association persisted after controlling for numerous explanatory variables including health practices, social support, & other religious practices. Among persons with ADL limitations, however, there was no association between private religiousness & mortality.

o Koenig, Hays, Larson, George, Cohen, McCullough, Meador, Blazer (1999). Regardless of initial ADL status, persons who attended religious services less than once per week had a greater mortality risk. Association persisted after control for demographics, health conditions, social connections, & health practices.

o Koenig, George, Hays, Larson, Cohen, Blazer (1998). In cross-sectional analyses, lower blood pressure was observed among persons who attended religious services at least once/week & among persons who frequently engaged in private religious activity (prayed or studied the Bible daily or more often).

o Koenig, Cohen, George, Hays, Larson, Blazer (1997). One mechanism by which frequent religious attendance may convey better physical health is by lowering psychological stress, thereby reducing the production of interleukin-6 (an inflammatory cytokine). In this study, however, there was only a weak association between frequency of religious attendance (How often do you attend religious services or other religious meetings? 1) never/almost never, 2) once or twice a year, 3) every few months, 4) once or twice a month, 5) once a week, 6) more than once a week.) & interleukin-6 levels.

o Koenig, Hays, George, Blazer, Larson, Landerman (1997). Attendance at religious services was inversely related to depression. Private prayer/Bible reading was unrelated to depression. Religious TV/radio listening was positively associated with depression.

o New Haven EPESE: 2812 elderly community-dwelling adults followed 6-12 yr.

o Idler & Kasl (1992). Religious group membership protected elderly Christians & Jews against mortality in the month before their respective religious holidays during 6-yr follow-up.

o Colantonio et al. (1992). Persons who never or rarely attended religious services had nearly twice the stroke rate of weekly attenders during 6-yr follow-up.

o Idler & Kasl (1997). Frequent religious attendance predicted better physical function 8-12 yr later, even after controlling for baseline function.

o Strawbridge et al. (1997). Religious attendance is associated with lower 28-yr mortality risk among residents of Alameda County.

o Kark et al. (1996). Residents of religious kibbutzim had a 40% lower 16-yr mortality rate from CVD than those living on secular kibbutzim.

o Oxman et al. (1995). 6-month mortality rate following elective open heart surgery was significantly lower among patients with strong religious faith (as measured by the question "How much is religion a source of strength & comfort to you?") than among their nonreligious counterparts.

o These longitudinal studies show that lower mortality & morbidity rates for frequent religious attenders are partly but not entirely explained by improved health practices & increased social contacts occurring in conjunction with attendance, or by confounding by baseline health status (i.e. selection). Evidence from the more methodologically sound studies indicates that the health-promoting effect of private religiousness (e.g. prayer or scripture reading at home, or subjective feelings of religious commitment) is somewhat weaker than that of public religiousness (attendance at services).

o Herbert Benson & colleagues at the Mind/Body Medical Institute at Harvard Medical School have recently published a number of small-scale studies on physiologic changes (e.g. w/functional MRI) that accompany meditation (e.g. Lazar SW et al. 2000).