Annals of Behavioral Medicine

, Volume 41, Issue 1, pp 92–103

Spirituality and Religiosity in Patients with HIV: A Test and Expansion of a Model

  • Ian Kudel
  • Sian Cotton
  • Magda Szaflarski
  • William C. Holmes
  • Joel Tsevat
Original Article



A causal model developed by Koenig suggests that higher levels of spirituality and religiosity effect intermediary variables and eventually result in better mental health, which then positively affects physical function.


Using structural equation modeling, we tested the model and expanded versions that use self-report data of patients with HIV (n = 345).


All models demonstrated good overall fit with significant parameters. The final model found that increased spirituality/religiosity predicted increased religious coping, which influenced social support. Social support, in turn, positively influenced depressed mood (as a measure of mental health); depressed mood affected fatigue; and both variables predicted self-reported physical function. These three variables predicted health rating/utility for one’s health state. Additional analyses found that two covariates, religiosity and race, differentially predicted spirituality/religiosity and religious coping.


In patients with HIV, an expanded version of Koenig’s model found that increased spirituality/religiosity is positively associated with self-reported outcomes.


Religious beliefs Spirituality Utilities Quality of life Coping 


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Copyright information

© US Government 2010

Authors and Affiliations

  • Ian Kudel
    • 1
    • 2
  • Sian Cotton
    • 2
  • Magda Szaflarski
    • 2
  • William C. Holmes
    • 3
  • Joel Tsevat
    • 1
    • 2
    • 4
  1. 1.Health Services Research & Development, Cincinnati Veterans Affairs Medical CenterCincinnatiUSA
  2. 2.University of CincinnatiCincinnatiUSA
  3. 3.Philadelphia VA Medical Center and University of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Department of Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiUSA

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