Abstract
This study assessed the predictive relationship between View of God beliefs and change in CD4-cell and Viral Load (VL) in HIV positive people over an extended period. A diverse sample of HIVseropositive participants (N = 101) undergoing comprehensive psychological assessment and blood draws over the course of 4 years completed the View of God Inventory with subscales measuring Positive View (benevolent/forgiving) and Negative View of God (harsh/judgmental/punishing). Adjusting for initial disease status, age, gender, ethnicity, education, and antiretroviral medication (at every 6-month visit), a Positive View of God predicted significantly slower disease-progression (better preservation of CD4-cells, better control of VL), whereas a Negative View of God predicted faster disease-progression over 4 years. Effect sizes were greater than those previously demonstrated for psychosocial variables known to predict HIV-disease-progression, such as depression and coping. Results remained significant even after adjusting for church attendance and psychosocial variables (health behaviors, mood, and coping). These results provide good initial evidence that spiritual beliefs may predict health outcomes.
This is a preview of subscription content, access via your institution.
References
Armstrong, K. (2004). A history of God: The 4000 year quest for Judaism, Christianity and Islam. New York, NY: Gramercy/Random House.
Ayin, N., Fischer, P., & Frey, D. (2010). Turning to God in the face of ostracism: Effects of social exclusion on religiousness. Personality and Social Psychology Bulletin, 36, 742–753. doi:10.1177/0146167210367491.
Barefoot, J. C., Dodge, K. A., Peterson, B. L., Dahlstrom, W. G., & Williams, R. B., Jr. (1989). The Cook-Medley hostility scale: Item content and ability to predict survival. Psychosomatic Medicine, 51, 46–57.
Beck, A. (1978). Beck depression inventory. Philadelphia: Center for Cognitive Therapy.
Beck, A. T., & Steer, R. A. (1984). Internal consistencies of the original and revised Beck Depression Inventory. Journal of Clinical Psychology, 40, 1365–1367. doi:10.1002/1097-4679(198411)40:6<1365:AID-JCLP2270400615>3.0.CO;2-D.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Bouvard, M., Charles, S., Guerin, J., Aimard, G., & Cottraux, J. (1992). Study of Beck’s hopelessness scale. Validation and factor analysis. L’Encephale, 18, 237–240.
Campbell, J. (2006). The many faces of God. New York, NY: W.W. Norton.
Carrico, A. W., Ironson, G., Antoni, M. H., Lechner, S. C., Duran, R. E., Kumar, M., et al. (2006). A path model of the effects of spirituality on depressive symptoms and 24-hurinary-free cortisol in HIV-positive persons. Journal of Psychosomatic Research, 61, 51–58. doi:10.1016/j.jpsychores.2006.04.005.
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267–283. doi:10.1037/0022-3514.56.2.267.
Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12, 255–266. doi:10.1080/0954012005004289.
Chida, Y., Steptoe, A., & Powell, L. H. (2009). Religiosity/Spirituality and Mortality [Special Article]. Psychotherapy and Psychosomatics, 78, 81–90. doi:10.1159/000190791.
Chopra, D. (2006). How to know God: The soul’s journey into the mystery of mysteries. New York, NY: Norton and Co.
Cole, S. W., Korin, Y. D., Fahey, J. L., & Zack, J. A. (1998). Norepinephrine accelerates HIV replication via protein kinase A-dependent effects on cytokine production. Journal of Immunology, 161, 610–616.
Costello A. B. & Osborne J. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment Research & Evaluation, 10. Available online: http://pareonline.net/getvn.asp?v=10&n=7.
Cotton, S., Tsevat, J., Szaflarski, M., Kudel, I., Sherman, S. N., Feinberg, J., et al. (2006). Changes in religiousness and spirituality attributed to HIV/AIDS: Are there sex and race differences? Journal of General Internal Medicine, 21, S14–S20. doi:10.1111/j.1525-1497.2006.00641.x.
Dobson, K. S. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414–419. doi:10.1037/0022-006X.57.3.414.
Fitzpatrick, A. L., Standish, L. J., Berger, J., & Kim, J. G. (2007). Survival in hiv-1-positive adults practicing psychological or spiritual activities for one year. Alternative Therapies in Health and Medicine, 13, 18.
Freud, S. (1957). The future of an illusion (W. D. Robson-Scott, Trans.). London, England: Doubleday & Company, Inc.
Gallup, G., & Lindsay, D. M. (1999). Surveying the religious landscape: Trends in the U.S. beliefs. Harrisburg, PA: Morehouse.
Gore-Felton, C., & Koopman, C. (2008). Behavioral mediation of the relationship between psychosocial factors and HIV disease progression. Psychosomatic Medicine, 70, 569–574. doi:10.1097/PSY.0b013e318177353e.
Hawkins, D. R. (2002). Power vs. force: The hidden determinants of human behavior. Carlsbad, CA: Hayhouse.
Hill, P. C., & Hood, R. W. (1999). Measures of religiosity. Birmingham, AL: Religious Education Press.
Ironson, G., Balbin, E., Stieren, E., Detz, K., Fletcher, M. A., Schneiderman, N., et al. (2008). Perceived stress and norepinephrine predict the effectiveness of response to protease inhibitors in HIV. International Journal of Behavioral Medicine, 15, 221–226. doi:10.1080/10705500802219606.
Ironson, G., Friedman, A., Klimas, N., Antoni, M., Fletcher, M. A., Laperriere, A., et al. (1994). Distress, denial, and low adherence to behavioral interventions predict faster disease-progression in gay men infected with human immunodeficiency virus. International Journal of Behavioral Medicine, 1, 90–105. doi:10.1207/s15327558ijbm0101_6.
Ironson, G., & Kremer, H. (2009). Spiritual transformation, psychological well-being, health, and survival in people with HIV. The International Journal of Psychiatry in Medicine, 39, 263–281.
Ironson, G., & Kremer, H. (2011). Coping, spirituality, and health in HIV. In S. Folkman (Ed.), The oxford handbook of stress, health, and coping (pp. 289–318). New York: Oxford University Press.
Ironson, G., Kremer, H., & Ironson, D. (2006a). Spirituality, spiritual experiences, and spiritual transformations in the face of HIV. In J. D. Koss & P. Hefner (Eds.), Spiritual transformation and healing: Anthropological, theological, neuroscientific, and clinical perspectives (1st ed., pp. 241–262). Lanham, MD: AltaMira Press.
Ironson, G., O’Cleirigh, C., Fletcher, M. A., Laurenceau, J. P., Balbin, E., Klimas, N., et al. (2005). Psychosocial factors predict CD4 and VL change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosomatic Medicine, 67, 1013–1021.
Ironson, G., Solomon, G. F., Balbin, E. G., O’Cleirigh, C., George, A., Kumar, M., et al. (2002). The Ironson-Woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS. Annals of Behavioral Medicine, 24, 34–48.
Ironson, G., Stuetzle, R., & Fletcher, M. A. (2006b). An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. Journal of General Internal Medicine. doi:10.1111/j.1525-1497.2006.00648.x.
Kirkpatrick, L. A. (2005). Attachment, evolution and the psychology of religion. New York, NY: The Guilford Press.
Koenig, H. G. (2000). Psychoneuroimmunology and the faith factor. The Journal of Gender-Specific Medicine, 3, 37–44. doi:10.1097/NMD.0b013e31816ff796.
Kremer, H., Ironson, G., & Porr, M. (2009). Spiritual and mind-body beliefs as barriers and motivators to HIV-treatment decision-making and medication adherence? A qualitative study. AIDS Patient Care and STDs, 23, 127–134. doi:10.1089/apc.2008.0131.
Kremer, H., Ironson, G., Schneiderman, N., & Hautzinger, M. (2006). To take or not to take: Decision-making about antiretroviral treatment in people living with HIV/AIDS. AIDS Patient Care and STDs, 20, 335–349. doi:10.1089/apc.2006.20.335.
Kristeller, J. L., Rhodes, M., Cripe, L. D., & Sheets, V. (2005). Oncologist Assisted Spiritual Intervention Study (OASIS): Patient acceptability and initial evidence of effects. International Journal of Psychiatry in Medicine, 35, 329–347.
Lawrence, R. T. (1997). Measuring the image of God: The God image inventory and the God image scales. Journal of Psychology and Theology, 25, 214–226.
Leserman, J. (2008). Role of depression, stress, and trauma in HIV disease-progression. Psychosomatic Medicine, 70, 539–545. doi:10.1097/PSY.0b013e3181777a5f.
Leserman, J., Petitto, J. M., Gu, H., Gaynes, B. N., Barroso, J., Golden, R. N., et al. (2002). Progression to AIDS, a clinical AIDS condition and mortality: Psychosocial and physiological predictors. Psychological Medicine, 32, 1059–1073.
Levin, J. (2002). Is depressed affect a function of one’s relationship with God? Findings from a study of primary care patients. International Journal of Psychiatry in Medicine, 32, 379–393.
Mackenzie, E. R., Rajagopal, D. E., Meibohm, M., & Lavizzo-Mourey, R. (2000). Spiritual support and psychological well-being: Older adults’ perceptions of the religion and health connection. Alternative Therapies in Health and Medicine, 6, 37–45.
McCullough, M. E., Enders, C. K., Brion, S. L., & Jain, A. R. (2005). The varieties of religious development in adulthood: A longitudinal investigation of religion and rational choice. Journal of Personality and Social Psychology, 89, 78–89. doi:10.1037/0022-3514.89.1.78.
McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: a meta-analytic review. Health Psychology, 19, 211–222. doi:10.1037/0278-6133.19.3.211.
Mitchell, P. H., Powell, L., Blumenthal, J., Norten, J., Ironson, G., Pitula, C. R., et al. (2003). A short social support measure for patients recovering from myocardial infarction: The ENRICHD Social Support Inventory. Journal of Cardiopulmonary Rehabilitation, 23, 398–403.
O’Cleirigh, C., Ironson, G., & Smits, J. (2007). Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV? Behavior Therapy, 38, 314–323.
Palmer, N., Salcedo, J., Miller, A., Winiarski, M., & Arno, P. (2003). Psychiatric and social barriers to HIV medication adherence in a triply diagnosed methadone population. AIDS Patient Care and STD’s, 17, 635–644. doi:10.1089/108729103771928690.
Pargament, K. (2011). Religion and coping: The current state of knowledge. In S. Folkman (Ed.), The oxford handbook of stress, health, and coping (pp. 269–288). New York: Oxford University Press.
Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2001). Religious struggle as a predictor of mortality among medically ill elderly patients: A 2-year longitudinal study. Archives of Internal Medicine, 161, 1881–1885.
Pargament, K. I., Smith, B., Koenig, H. G., & Perez, L. (1998). Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion, 37, 710–724.
Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health. The American Psychologist, 58, 36–52. doi:10.1037/0003-066X.58.1.36.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Newbury Park, CA: Sage.
Rowatt, W. C., & Kirkpatrick, L. A. (2002). Two dimensions of attachment to God and their relation to affect, religiosity, and personality constructs. Journal for the Scientific Study of Religion, 41, 637–651. doi:10.1111/1468-5906.00143.
Salsman, J. M., Brown, T. L., Brechting, E. H., & Carlson, C. R. (2005). The link between religion and spirituality and psychological adjustment: The mediating role of optimism and social support. Personality and Social Psychology Bulletin, 31, 522–535. doi:10.1177/0146167204271563.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247. doi:10.1037-0278-6133.4.3.219.
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.
Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. I., Marshall, G. N., Elliott, M. N., et al. (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. New England Journal of Medicine, 345, 1507–1512.
Sherman, A., & Simonton, S. (2007). Spirituality and cancer. In T. G. Plante & C. E. Thorensen (Eds.), Spirit, science, and health: How the spiritual mind fuels physical wellness (pp. 157–175). New York: Praeger.
Simoni, J. M., & Ortiz, M. Z. (2003). Mediational models of spirituality and depressive symptomatology among HIV-positive Puerto Rican women. Cultural Diversity & Ethnic Minority Psychology, 9, 3–15. doi:10.1037/1099-9809.9.1.3.
Smith, H. (1991). The world’s religions:Our great wisdom traditions. San Francisco, CA: Harper.
Smith, T. B., McCullough, M. E., & Poll, J. (2003). Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events. Psychological Bulletin, 129, 614–636.
Sperry, L. (2006). Spirituality in clinical practice: Guidelines for assessing and managing religious and spiritual issues. [Special issue]. Psychiatric Annals, 36, 137–204.
Stefanek, M., McDonald, P. G., & Hess, S. A. (2005). Religion, spirituality and cancer: Current status and methodological challenges. Psycho-Oncology, 14, 450–463. doi:10.1002/pon.861.
Tennen, H., & Affleck, G. (2002). Benefit-finding & benefit reminding. In C. R. Snyder & S. R. Lopez (Eds.), Handbook of positive psychology. Oxford: Oxford University Press.
Trevino, K. M., Pargament, K. I., Cotton, S., Leonard, A. C., Hahn, J., Caprini-Faigin, C. A., et al. (2007). Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: Cross-sectional and longitudinal findings. AIDS and Behavior, 14, 379–389. doi:10.1007/s10461-007-9332-6.
Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28, 369–384. doi:10.1007/s10865-005-9008-5.
Woods, T. E., & Ironson, G. (1999). Religion and spirituality in the face of illness: How cancer, cardiac, and HIV patients describe their spirituality/religiosity. Journal of Health Psychology, 4, 393–412. doi:10.1177/135910539900400308.
Acknowledgments
This research was graciously supported by the Metanexus/Templeton Foundation, and by the National Institute of Mental Health Grant (R01MH53791, and R01MH066697) Principal Investigator: Gail Ironson. Special thanks to our research participants for sharing their experiences with us, and to Dr. Sol Katz, the Director of the Metanexus Spiritual Transformation Project. Additional appreciation goes to Vanessa Cutler for her help in editing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
View of God scale
Please indicate how much you agree or disagree with each statement by circling your response. SD Strongly disagree, D Disagree, N Neutral, A Agree, SA Strongly agree.
1. I see God as merciful | SD | D | N | A | SA |
2. I feel I will be forgiven for what I have done | SD | D | N | A | SA |
3. I see God as a harsh judge | SD | D | N | A | SA |
4. I am afraid God will judge me harshly for what I have done | SD | D | N | A | SA |
5. I believe God is all forgiving | SD | D | N | A | SA |
6. Despite my shortcomings, I feel I will be forgiven | SD | D | N | A | SA |
7. Some people will go to hell when this life is over | SD | D | N | A | SA |
8. I think God will punish me for what I have done | SD | D | N | A | SA |
9. I believe God is all mercifu | SD | D | N | A | SA |
10. My beliefs help me believe God will forgive my shortcomings | SD | D | N | A | SA |
11. God will condemn those who do wrong someday | SD | D | N | A | SA |
12. God will judge me harshly one day | SD | D | N | A | SA |
Rights and permissions
About this article
Cite this article
Ironson, G., Stuetzle, R., Ironson, D. et al. View of God as benevolent and forgiving or punishing and judgmental predicts HIV disease progression. J Behav Med 34, 414–425 (2011). https://doi.org/10.1007/s10865-011-9314-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-011-9314-z
Keywords
- Spirituality
- Beliefs
- God
- Health
- HIV/AIDS
- Disease progression
- Religion