Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer?

Original Article


Aims and objectives

To establish whether there is a correlation between spirituality and anxiety and depression in patients with advanced cancer.

Patients and methods

Patients with a diagnosis of cancer at St. Peter’s day hospice in Bristol were asked to complete three questionnaires to assess anxiety, depression and spirituality. Informed consent was obtained. Anxiety and depression are indicated by the Hospital Anxiety and Depression Scale score, and spirituality is indicated by scores on the Spiritual Well-Being Scale (SWBS) and the Royal Free Interview for Spiritual and Religious Beliefs. As will be explained, religion and spirituality are generally recognised as having different meanings—religion entailing a relationship with a higher being, while spirituality can be thought of in terms of meaning and purpose in life.


Eighty-five complete data sets were obtained. A significant negative correlation was found between both anxiety and depression scores and overall spiritual well-being scores (p<0.0001). When the SWBS subscale scores were analysed individually, a significant negative correlation was found between the existential well-being scores and the anxiety and depression scores (p<0.001). However, no correlation was found between the religious well-being scores and anxiety or depression.


This study found a significant negative correlation between spirituality (in particular, the existential aspect) and anxiety and depression in patients with advanced cancer. Religious well-being and strength of belief had no impact on psychological well-being in this study.


Spirituality Religion Anxiety Depression Cancer 



We would like to thank Christopher Foy and Rosemary Greenwood for statistical assistance and Prof. Michael King, Rev. Peter Speck, Rev. Mark Cobb, Prof. Mari Lloyd-Williams and Dr. Bill Noble for other additional assistance.


  1. 1.
    Anandarajah G, Hight E (2001) Spirituality and medical practice: using the HOPE questions as a practical tool for spiritual assessment. Am Fam Physician 63(1):81–88PubMedGoogle Scholar
  2. 2.
    Boivin MJ, Kirby AL, Underwood LK, Silva H (1999) Spiritual well-being scale. In: Hill PC, Hood RW (eds) Measures of religiosity. Religious Education Press, Birmingham, AL, pp 382–385. ISBN 089135106XGoogle Scholar
  3. 3.
    Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284(22):2907–2911PubMedCrossRefGoogle Scholar
  4. 4.
    Burton LA (1998) The spiritual dimension of palliative care. Semin Oncol Nurs 14(2):121–128PubMedCrossRefGoogle Scholar
  5. 5.
    Cassileth BR, Lusk EJ, Hutter R, Strouse TB, Brown LI (1984) Concordance of depression and anxiety in patients with cancer. Psychol Rep 54:588–590PubMedGoogle Scholar
  6. 6.
    Chibnall JT, Videen SD, Duckro PN, Miller DK (2002) Psychosocial–spiritual correlates of death distress in patients with life-threatening medical conditions. Palliat Med 16:331–338PubMedCrossRefGoogle Scholar
  7. 7.
    Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E (1999) Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psychooncology 8:429–438PubMedCrossRefGoogle Scholar
  8. 8.
    Daaleman TP, VandeCreek L (2000) Placing religion and spirituality in end-of-life care. JAMA 284(19):2514–2517PubMedCrossRefGoogle Scholar
  9. 9.
    Dom H (1999) Spiritual care, need and pain—recognition and response. Eur J Palliat Care 6(3):87–90Google Scholar
  10. 10.
    Dyson J, Cobb M, Forman D (1997) The meaning of spirituality: a literature review. J Adv Nurs 26:1183–1188PubMedCrossRefGoogle Scholar
  11. 11.
    Encarta (1999) World English dictionary, Microsoft CorporationGoogle Scholar
  12. 12.
    Fehring RJ, Miller JF, Shaw C (1997) Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncol Nurs Forum 24(4):663–671PubMedGoogle Scholar
  13. 13.
    Fryback PB, Reinert BR (1999) Spirituality and people with potentially fatal diagnoses. Nurs Forum 34(1):13–22PubMedCrossRefGoogle Scholar
  14. 14.
    Gartner J, Larson DB, Allen GD (1994) Religious commitment and mental health: a review of the empirical literature. J Psychol Theol 19(1):6–25Google Scholar
  15. 15.
    Gioiella ME, Berkman B, Robinson M (1998) Spirituality and quality of life in gynaecologic oncology patients. Cancer Pract 6(6):333–338PubMedCrossRefGoogle Scholar
  16. 16.
    Grey A (1994) The spiritual component of palliative care. Palliat Med 8:215–221PubMedCrossRefGoogle Scholar
  17. 17.
    Hassad CS (2000) Depression: dispirited or spiritually deprived? Med J Aust 173:545–547Google Scholar
  18. 18.
    Hermann CP (2001) Spiritual needs of dying patients: a qualitative study. Oncol Nurs Forum 28(1):67–72PubMedGoogle Scholar
  19. 19.
    Herrmann C (1997) International experiences with the hospital anxiety and depression scale—a review of validation data and clinical results. J Psychosom Res 42(1):17–41PubMedCrossRefGoogle Scholar
  20. 20.
    Holtom N, Barraclough J (2000) Is the hospital anxiety and depression scale (HADS) useful in assessing depression in palliative care? Palliat Med 14:219–220PubMedCrossRefGoogle Scholar
  21. 21.
    Hotopf M, Chidgey J, Addington-Hall J, Lan Ly K (2002) Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding. Palliat Med 16:81–97PubMedCrossRefGoogle Scholar
  22. 22.
    House A, Stark D (2002) ABC of psychological medicine: anxiety in medical patients. BMJ 325:207–209PubMedCrossRefGoogle Scholar
  23. 23.
    Johnston M, Pollard B, Hennessey P (2000) Construct validation of the hospital anxiety and depression scale with clinical populations. J Psychosom Res 48:579–584PubMedCrossRefGoogle Scholar
  24. 24.
    Kaczorowski J (1989) Spiritual well-being and anxiety in adults diagnosed with cancer. Hosp J 5:105–116PubMedCrossRefGoogle Scholar
  25. 25.
    Kellehear A (2000) Spirituality and palliative care: a model of needs. Palliat Med 14:149–155PubMedCrossRefGoogle Scholar
  26. 26.
    King M, Speck P, Thomas A (1995) The royal free interview for religious and spiritual beliefs: development and standardization. Psychol Med 25:1125–1134PubMedGoogle Scholar
  27. 27.
    King M, Speck P, Thomas A (2001) The royal free interview for spiritual and religious beliefs: development and validation of a self-report version. Psychol Med 31:1015–1023PubMedCrossRefGoogle Scholar
  28. 28.
    Koenig HG, Larson DB, Weaver AJ (1998) Research on religion and serious mental illness. New Dir Ment Health Serv 80:81–95PubMedCrossRefGoogle Scholar
  29. 29.
    Lloyd-Williams M, Spiller J, Ward J (2003) Which depression screening tool should be used in palliative care? Palliat Med 17:40–43PubMedCrossRefGoogle Scholar
  30. 30.
    McClain CS, Rosenfeld B, Breitbart W (2003) Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 361:1603–1607PubMedCrossRefGoogle Scholar
  31. 31.
    Mickley JR, Soeken K, Belcher A (1992) Spiritual well-being, religiousness and hope among women with breast cancer. Image J Nurs Scholarsh 24(4):267–272CrossRefGoogle Scholar
  32. 32.
    Moberg DO, Brusek PM (1978) Spiritual well-being: a neglected subject in quality of life research. Soc Indic Res 5:303–323CrossRefGoogle Scholar
  33. 33.
    Moorey S, Greer S, Watson M, Gorman C, Rowden L, Tunmore R, Robertson B, Bliss J (1991) The factor structure and factor stability of the hospital anxiety and depression scale in patients with cancer. Br J Psychiatry 158:255–259PubMedCrossRefGoogle Scholar
  34. 34.
    Mytko JJ, Knight SJ (1999) Body, mind and spirit: towards the integration of religiosity and spirituality in cancer quality of life research. Psychooncology 8:439–450PubMedCrossRefGoogle Scholar
  35. 35.
    Paloutzian RF, Ellison CW (1982) Loneliness, spiritual well-being and the quality of life. In: Peplau LA, Perlman D (eds) Loneliness: a source book of current theory, research and therapy. Wiley, New York, pp 224–237Google Scholar
  36. 36.
    Razavi D, Delvaux N, Farvacques C, Robaye E (1990) Screening for adjustment disorders and major depressive disorders in cancer inpatients. Br J Psychiatry 156:79–83PubMedGoogle Scholar
  37. 37.
    Reed PG (1987) Spirituality and well-being in terminally ill hospitalised adults. Res Nurs Health 10:335–344PubMedCrossRefGoogle Scholar
  38. 38.
    Rousseau P (2000) Spirituality and the dying patient. J Clin Oncol 18(9):2000–2002PubMedGoogle Scholar
  39. 39.
    Sloan RP, Bagiella E, Powell T (1999) Religion, spirituality and medicine. Lancet 353:664–667PubMedCrossRefGoogle Scholar
  40. 40.
    Speck P (1998) Spiritual issues in palliative care. In: Doyle D, Hanks GW, MacDonald N (eds) Oxford textbook of palliative medicine, 2nd edn. Oxford University Press, Oxford, pp 805–814Google Scholar
  41. 41.
    Thomson J (2000) The place of spiritual well-being in hospice patients’ overall quality of life. Hosp J 15(2):13–27PubMedCrossRefGoogle Scholar
  42. 42.
    Walter T (2002) Spirituality in palliative care: opportunity or burden? Palliat Med 16:133–139PubMedCrossRefGoogle Scholar
  43. 43.
    Wright MC (2001) Spirituality: a developing concept within palliative care? Prog Palliat Care 9(4):143–147Google Scholar
  44. 44.
    Yates JW, Chalmer BJ, St James P, Follansbee M, McKegney FP (1981) Religion in patients with advanced cancer. Med Pediatr Oncol 9(2):121–128PubMedCrossRefGoogle Scholar
  45. 45.
    Zigmund A, Snaith R (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of Palliative Medicine, Elgar HouseSouthmead HospitalBristolUK
  2. 2.Department of Palliative MedicineRoyal Marsden HospitalSuttonUK

Personalised recommendations