Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?
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Anxiety and depression are common in seriously ill patients and may be associated with spiritual concerns. Little research has examined how concerns in different domains of spirituality are related to anxiety and depression.
To examine the association of spiritual history and current spiritual well-being with symptoms of anxiety and depression in patients with advanced illness.
Cross-sectional cohort study
Two hundred and ten patients with advanced illness, of whom 1/3 were diagnosed with cancer, 1/3 COPD, and 1/3 CHF. The mean age of the sample was 66 years, and 91% were Christian.
Outcome measures were the Profile of Mood States’ Anxiety Subscale (POMS) and 10-item Center for Epidemiologic Studies Depression Scale (CESD). Predictors were three subscales of the Spiritual History Scale measuring past religious help-seeking and support, past religious participation, and past negative religious experiences and two subscales of the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale measuring the role of faith in illness and meaning, peace, and purpose in life. We conducted multiple regression analyses, controlling for demographics, disease type and severity, self-rated religiousness/spirituality, and frequency of religious attendance and devotion.
In adjusted analyses, greater spiritual well-being, including both beliefs about the role of faith in illness and meaning, peace, and purpose in life were associated with fewer symptoms of anxiety (P ≤ 0.001) and depression (P < 0.001). Greater past negative religious experiences were associated with more symptoms of anxiety (P = 0.04) and depression (P = 0.004). No other measures of spiritual history were associated with the outcomes.
In this diverse sample of seriously ill patients, current spiritual well-being and past negative religious experiences were associated with symptoms of anxiety and depression. Healthcare providers should consider asking about current spiritual well-being and past negative religious experiences in their assessment of seriously ill patients with symptoms of anxiety and depression.
- Noorani NH, Montagnini M. Recognizing depression in palliative care patients. J Palliat Med. 2007;10:458-64. CrossRef
- Wilson KG, Chochinov HM, Skiro MG, et al. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage. 2007;33:118-29. CrossRef
- Barraclough J. ABC of palliative care: Depression, anxiety, and confusion. BMJ. 1997;315:1365-68.
- Tarakewshwar N, Vancerwerker LC, Palk E, Pearce MJ, Kasi SV, Prigerson HG. Religious coping is associated with the quality of life of patients with advanced cancer. J Palliat Med. 2006;9:646-57. CrossRef
- Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. Religious coping methods as predictors of psychological, physical, and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study. J Health Psychol. 2004;9:713-30. CrossRef
- Yi MS, Mrus JM, Wade TJ, et al. Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. J Gen Intern Med. 2006;21 Suppl 5:S21-27. CrossRef
- Whitford HS, Olver IN, Peterson MJ. Spirituality as a core domain in the assessment of quality of life in oncology. Psycho-Oncology. 2008;17:1121-28. CrossRef
- McCoubrie RC, Davies AN. Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Support Care Cancer. 2006;14:379-85. CrossRef
- McConnell KM, Pargament KI, Ellison CG, Flannelly KJ. Examining the links between spiritual struggles and symptoms of psychopathology in a national sample. J Clin Psychol. 2006;62:1469-84. CrossRef
- Phelps AC, Maciejewski PK, Nilsson M, et al. Religious coping and use of life-prolonging care near death in patients with advanced cancer. JAMA. 2009;301:1140-47. CrossRef
- Balboni TA, Vanderwerker LC, Block SD, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25:555-60. CrossRef
- Silvestri GA, Knittig S, Zoller JS, Nietert PJ. Importance of faith on medical decisions regarding cancer care. J Clin Oncol. 2003;2:1379-82. CrossRef
- Puchalski C, Ferrell B, Virani R, et al. Improving the quality of spiritual care as a dimension of palliative care: the report of the consensus conference. J Palliat Med 2009;12:885-904. CrossRef
- National Consensus Project for Quality Palliative Care (2009). Clinical Practice Guidelines for Quality Palliative Care, Second Edition. http://www.nationalconsensusproject.org. Accessed January 25, 2010.
- Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals. In Standards Frequently Asked Questions. Provision of Care, Treatment, Services--Spiritual Assessment. Revised November 24, 2008. Available at: http://www.jointcommission.org/AccreditationPrograms/Hospitals/Standards/09_FAQs/PC/Spiritual_Assessment.htm. Accessed January 25, 2010.
- Puchalski CM, Romer AL. Taking a spiritual history allows clinicians to understand patients more fully. J Palliat Med. 2000;3:129-37. CrossRef
- Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flashchen J. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159:1803-06. CrossRef
- Daaleman TP, Nease DE. Patient attitudes regarding physician inquiry into spiritual and religious issues. J Fam Pract. 1994;39:564-68.
- Chibnall JT, Brooks CA. Religion in the clinic: the role of physician beliefs. South Med J. 2001;94:374-79.
- Ellis MR, Vinson DC, Ewigman B. Addressing spiritual concerns of patients. J Fam Pract. 1999;48:105-09.
- Maugans TA, Wadland WC. Religion and family medicine: a survey of physicians and patients. J Fam Pract. 1991;32:210-13.
- Curlin FA, Chin MH, Sellergren SA, Roach CJ, Lantos JD. The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Med Care. 2006;44:446-53. CrossRef
- Sulmasy DP. A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist. 2002;42:24-33.
- Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. New York, NY, Oxford University Press, 2001.
- Idler EL, Kasl SV, Hays JC. Patterns of religious practice and belief in the last year of life. J Gerontol B Psychol Sci Soc Sci. 2001;56(6):S326-34.
- Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000;284(19):2476-82 CrossRef
- Hays JC, Meador KG, Branch PS, George LK. The spiritual history scale in four dimensions (SHS-4): Validity and reliability. Gerontologist. 2001;41:239-49.
- Steinhauser KE, Clipp EC, Hays JC, et al. Identifying, recruiting, and retaining seriously-ill patients and their caregivers in longitudinal research. Palliat Med. 2006;20:745-54. CrossRef
- Cella D. Manual of the Functional Assessment of Chronic Illness Therapy (FACIT Scales) -- Version 4. Evanston, Ill.: Center on Outcomes Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University, IL; November 1997.
- Cella DF, Bonomi AE, Lloyd SR, Tulsky DS, Kaplan E, Bonomi P. Reliability and validity of the Functional Assessment of Cancer Therapy- Lung (FACT-L) quality of life instrument. Lung Cancer. 1995;12(3):199-220. CrossRef
- Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570-79.
- Cella DF, Jacobsen PB, Orav EJ, Holland JC, Silberfarb PM, Rafla S. A brief POMS measure of distress for cancer patients. J Chronic Dis. 1987;40(10):939-42. CrossRef
- Radloff L. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psych Meas. 1977;1:385-401. CrossRef
- McClain CS, Rosenfeld B, Breibart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361:1603-07. CrossRef
- Fehring RJ, Miller JF, Shaw C. Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncol Nurs Forum. 1997;24:663-71.
- Rodin G, Lo C, Mikulincer M, Donner A, Gagliese L, Zimmermann C. Pathways to distress: the multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Soc Sci Med. 2009;68:562-69. CrossRef
- Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality influences health-related quality of life in mean with prostate cancer. Psycho-Oncology. 2006;15:121-131. CrossRef
- McClain-Jacobson C, Rosenfeld B, Kosinski A, Pessin H, Cimino JE, Breitbart W. Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer. Gen Hosp Psychiatry. 2004;26:484-86. CrossRef
- Bekelman DB, Dy SM, Becker DM, et al. Spiritual well-being and depression in patients with heart failure. J Gen Intern Med. 2007;22:470-77. CrossRef
- Griffin MT, Lee YH, Salman A, et al. Spirituality and well-being among elders: differences between elders with heart failure and those without heart failure. Clin Interv Aging. 2007;2:669-75.
- Nelson CJ, Rosenfeld B, Breibart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomantics. 2002;43:213-20. CrossRef
- Boscaglia N, Clark DM, Jobling TW, Quinn MA. The contribution of spirituality and spiritual coping to anxiety and depression in women with a recent diagnosis of gynecological cancer. Int J Gynecol Cancer. 2005;15:755-61. CrossRef
- Anandarajah G, Hight E. Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician. 2001;63:81-89.
- Maugans TA. The SPIRITual History. Arch Fam Med. 1997; 5:11-16. CrossRef
- Steinhauser KE, Voils CI, Clipp EC, Bosworth HB, Christakis NA, Tulsky JA. Are you at peace? One item to probe spiritual concerns at the end of life. Arch Intern Med. 2006;166:101-05. CrossRef
- Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?
Journal of General Internal Medicine
Volume 26, Issue 7 , pp 751-758
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- end-of-life care
- terminal illness
- Industry Sectors
- Author Affiliations
- 1. Division of Geriatrics, Duke University School of Medicine, DUMC Box 3003, Durham, NC, 27710, USA
- 2. Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- 3. Center for Palliative Care, Duke University, Durham, NC, USA
- 7. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- 4. School of Nursing, Duke University, Durham, NC, USA
- 6. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- 5. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA