Religion, Spirituality and Health
Religion, Spirituality and Health
Belief can be a great ally in our every day lives. It has played a powerful role in our evolutionary process, particularly in our development of culture and religion over the past 12,000 years. I have long advocated that belief is a valuable ally in the absence of fact, but when fact is present, our beliefs, in this case related to our behavior and activities, need to be examined. This is particularly important when considering many of the faulty and incomplete beliefs parents, teachers and other professionals have held about children's behavior, development and problems. Throughout my work I have emphasized the importance of examining our beliefs, particularly when they guide our actions with our children. However, this statement does not diminish my equally strong opinion that belief may play a powerful protective and guiding role in our every day lives. In this month's article, I review a series of extremely interesting studies examining the relationship between religion, spirituality and our health.
In polls over the last ten years, 67 percent of Americans rated religion as very important in their lives. Ninety-six percent of them believe in God, and 42 percent attend religious services regularly. A Gallup poll in 1995 suggested that spiritual growth was increasing with 82 percent of Americans expressing such an interest in 1998 compared with only 58% expressing similar interest in 1994.
In a January, 2003 article in the American Psychologist, researchers Lynda Powell, Lila Shahabi and Carl Thoresen noted that there is little dispute "that religion and spirituality can provide psychological comfort." The proposition that such beliefs can reduce the risk of mental illness, death or disease is more controversial. Past reviews of the literature make strong claims for the broad health benefits of religion, with some researchers suggesting that when religious faith is present, wellness is triggered and health can be improved. However, others have argued strongly that limited support exits for the belief that religious activity promotes health.
In their review article, Powell and colleagues searched all published research for studies relating to religion, spirituality and health. They grouped these studies based upon their topics and scientific rigor. Studies that made little effort to control for other possible sources of explanation, used inaccurate statistical analyses or vague measures were excluded. The authors then evaluated nine hypotheses concerning the relationship between religion, spirituality and health. I will briefly review each hypothesis and the evidence generated. Please keep in mind as you read these hypotheses that the purpose of these research studies was not to question religious belief but rather to academically evaluate the influence of belief on health. No assumptions are made that a higher power does or does not exist.
Hypothesis 1: Eleven studies investigated the relationship between religious service attendance and incidence of mortality. The authors concluded that weekly religious service attendance was a vehicle for maintaining and/or improving risk factor status. However, they also noted that a 25 percent difference between attenders and non-attenders on mortality existed even after adjustment for other established risk factors. Thus, they concluded that in well-controlled studies weekly religious service attendance could not account entirely for protective benefits. It is also important to note that in contrast to the evidence for the link between religious service attendance and mortality, there was little evidence that any measure of depth of religiousness offered similar protection.
Hypothesis 2: The authors identified four well designed prospective studies examining the impact of religion or spirituality on any of the cardiovascular diseases. They concluded that in these studies some aspect of religion or spirituality, most likely weekly attendance at religious services, protected against cardiovascular disease, but that this benefit may have been mediated by the impact of religion or spirituality on the promotion of a healthy lifestyle.
Hypothesis 3: The authors found two studies examining the impact of some measure of religion or spirituality on cancer mortality. In both studies, any association between religion or spirituality and cancer mortality could not be explained by the confounding effects of prior health status. The authors suggested that the temporal relationship between religion or spirituality and health is reversed in people who are at risk for cancer mortality. That is, those who become ill are more likely to become religious or spiritual.
Hypothesis 4: Eight studies were identified testing the hypothesis that people who are deeply religious by any definition live longer. The evidence did not support this global hypothesis. However, the authors suggested that the effects of prayer and meditation may be more powerful in the prevention of mortality before the overwhelming force of functional illness sets in.
Hypothesis 5: The authors found two studies testing the relationship between religion and disability. These studies did not report a relationship between the religious variables and the development of any disability.
Hypothesis 6: Six studies examined the impact of religion or spirituality on the progression of cancer. These studies did not effectively evaluate the hypothesis that the use of religion to cope with difficulty resulted in a longer life. No conclusions could be drawn about this hypothesis.
Hypothesis 7: One study was found examining whether in the face of difficulty the use of God or religion to cope will lengthen life. Using data from a nationwide survey, this 1998 study tested religious coping and mortality over a four year period after adjustment for complicating variables. The data was inadequate to evaluate the hypothesis that the use of religion to cope with difficulty resulted in a longer life. Interaction between religious coping and stress appeared to be more significant for the more subjective outcome of self-reported health but non-significant for the more objective outcome of functional disability.
Hypothesis 8: Five well designed investigations were reviewed examining the role of some aspect of religion or spirituality on physical recovery from acute illness. In general, there was consistent failure to support the hypothesis that religion or spirituality improved recovery from acute illness. Only one study suggested this as a possibility. In contrast, the authors concluded that there was some evidence to support the hypothesis that religion or spirituality could impede recovery. The authors suggested more research concerning this hypothesis was needed.
Hypothesis 9: Three studies were assessed questioning the impact of distant, intercessory prayer by healers on the recovery of patients with acute illness. These three studies examined whether human intention can affect the physical world at a distance. In all three of these studies, the strongest findings were for the variables that were evaluated most subjectively. This raised concern about the possible inadvertent, unmasking of the outcome's assessors. Nonetheless, the authors concluded that there was some evidence to support the hypothesis that being prayed for improved recovery from acute illness. They suggested further study was needed.
In a world in which religious differences fuel multiple conflicts between groups of individuals, countries and political ideologies, the benefits of religion and the strong belief in a higher power are increasingly difficult to discern. Religion and/or spirituality, not the hate or destruction of others because they are different or hold different beliefs, but the belief that a higher empathic, guiding force helps and supports us could certainly be considered to have a protective impact on physical health. This could be a resource that prevents the development of disease in healthy individuals and/or as a coping resource that buffers the impact of disease or mental illness in affected individuals. These studies, though limited and certainly in need of much greater investigation, provide the strongest and most consistent evidence for a protective effect in healthy people.
It is likely that this support centers largely on the hypothesis that religious service attendance protects against death. In the studies reviewed by Powell and colleagues, seven independent studies, most of which drew on large representative populations, found that healthy religious service attenders had approximately a 30% reduction in risk after adjustment for important confounders and a 25% reduction in risk after further adjustment for established risk/protective factors. However, when cause specific mortality was examined the authors noted that the association was largely but not totally accounted for by established risk/protective factors.
What exactly does all this mean? Dr. Robert Brooks and I, in our multiple works concerning resilience and in our upcoming edited scientific volume (Handbook of Resilience in Children, Kluwer, 2005) offer evidence that in multiple longitudinal and retrospective studies throughout the world affiliation with an organized religion is a resilience factor. Such affiliation affords connections to others, assistance in time of need and perhaps, as the studies reviewed by Powell and colleagues suggests, belief in a higher power brings with it a generalized type of protection against physical and mental illness.
However, much more research is needed. Does affiliation with an organized religion encourage meaningful social roles that provide a sense of self-worth and purpose in which participants not only receive but give help as well? Religious social support, because of its affiliation with a "higher power" may provide a deeper and broader perception of psychological safety among participants. Participation in an organized religion may afford, as Powell and colleagues point out, "opportunity to observe vicariously yet consistently those who model a variety of positive, hopeful, compassionate and caring behaviors, attitudes and beliefs that are highly conducive to living a healthy life style." This is precisely the basis of our assertion concerning the power of resilience. This social modeling may be especially influential in trying times.
These studies lay a foundation to suggest that religion or spirituality is more powerful as a coping, resilience resource, one that buffers the impact of mental or physical illness, more so than as a resistance resource in healthy individuals. A relationship between religion or spirituality and physical and mental health certainly exists but it may be more limited and more complex than suggested by others. Further, well-controlled research is needed. Finally, it is not for me to question nor assert the existence of a higher power in this context. It is, I believe, reasonable to state that though neither necessary nor sufficient in and of itself, such a belief provides a protective or resilient resource in our daily lives.
