Skip to main content

Religious struggle as a predictor of subsequent mental and physical well-being in advanced heart failure patients

Abstract

Patients with congestive heart failure (CHF) often report high levels of religiousness, which may mitigate the stressfulness of their condition. However, religious struggle, reflecting negative attitudes toward God and a strained meaning system, may be detrimental to well-being. Little is known about religious struggle in those with CHF, particularly in relation to physical health and well-being over time. We examined associations of religious struggle and subsequent mental and physical well-being in 101 endstage CHF patients who completed questionnaires twice over 3 months. Religious struggle predicted higher number of nights subsequently hospitalized, higher depression, and marginally lower life satisfaction. When controlling for baseline levels of well-being, effectively assessing change in those outcomes, religious struggle remained a significant predictor of hospitalization and also emerged as a marginally significant predictor of lower physical functioning. Struggle was unrelated to health-related quality of life. Post-hoc analyses suggest that these effects were particularly strong for those endorsing greater religious identification. Religious struggle appears to have a potentially negative impact on well-being in advanced CHF; therefore, helping patients to address issues of struggle may meaningfully lessen the personal and societal costs of CHF.

This is a preview of subscription content, access via your institution.

Notes

  1. NYHA Level III refers to cardiac disease resulting in dyspnea from even minor exertion, while Level IV refers to cardiac disease resulting in a lack of ability to carry on any physical activity without dyspnea or discomfort; symptoms may be present even at rest.

References

  • Abeles, R., Ellison, C. G., George, L. K., Idler, E. L., Krause, N., Levin, J. S., et al. (1999). Multidimensional measurement of religiousness/spirituality for use in health research. Kalamazoo, MI: John E. Fetzer Institute.

    Google Scholar 

  • Ai, L. A., Park, C. L., Huang, B., Rodgers, W., & Tice, T. N. (2007). Psychosocial mediation of religious coping styles: A study of short-term psychological distress following cardiac surgery. Personality and Psychology Bulletin, 33, 867–882.

    Google Scholar 

  • American Heart Association. (2010). Heart disease and stroke statistics2010 update. http://www.americanheart.org/presenter.jhtml?identifier=3037327.

  • Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to stress: A meta-analysis. Journal of Clinical Psychology, 61, 461–480.

    PubMed  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    PubMed  CAS  Google Scholar 

  • Beery, T., Baas, L., Fowler, C., & Allen, G. (2002). Spirituality in persons with heart failure. Journal of Holistic Nursing, 20, 5–25.

    PubMed  Google Scholar 

  • Bekelman, D., Dy, S., Becker, D., Wittstein, I., Hendricks, D., Yamashita, T., et al. (2007). Spiritual well-being and depression in patients with heart failure. Journal of General Internal Medicine, 22, 470–477.

    PubMed  Google Scholar 

  • Burker, E. J., Evon, D. M., Sedway, J. A., & Egan, T. (2004). Religious coping, psychological distress and disability among patients with end-stage pulmonary disease. Journal of Clinical Psychology in Medical Settings, 11, 179–193.

    Google Scholar 

  • Centers for Disease Control (CDC). (2010). Heart failure fact sheet. Retrieved March 14, 2010, from http://www.cdc.gov/dhdsp/library/fs_heart_failure.htm.

  • Chibnall, J., Videen, S., Duckro, P., & Miller, D. (2002). Psychosocial–spiritual correlates of death distress in patients with life-threatening medical conditions. Palliative Medicine, 16, 331–338.

    PubMed  Google Scholar 

  • Desai, M. M., Zhang, P., & Hennessy, C. H. (1999). Surveillance for morbidity and mortality among older adults—United States, 1995–1996 (Morbidity and mortality weekly report surveillance summaries No. 48(SS08); 7–25). Atlanta, GA: Centers for Disease Control and Prevention.

    Google Scholar 

  • Diener, E. (1994). Assessing subjective well-being: Progress and opportunities. Social Indicators Research, 31, 103–157.

    Google Scholar 

  • Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75.

    PubMed  CAS  Google Scholar 

  • Edmondson, D., Park, C. L., Chaudoir, S. R., & Wortmann, J. (2008). Death without god: religious struggle, death concerns, and depression in the terminally ill. Psychological Science, 19, 628–632.

    Google Scholar 

  • Exline, J. J. (in press). Spiritual struggle. In K. E. Pargament (Ed.), Handbook of the psychology of religion. Washington, DC: American Psychological Association.

  • Exline, J. J., & Rose, E. (2005). Religious and spiritual struggles. In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 315–330). New York: Guilford Press.

    Google Scholar 

  • Exline, J. J., Yali, A. M., & Sanderson, W. C. (2000). Guilt, discord, and alienation: The role of religious strain in depression and suicidality. Journal of Clinical Psychology, 56, 1481–1496.

    PubMed  CAS  Google Scholar 

  • Fang, J., Mensah, G. A., Croft, J. B., & Keenan, N. L. (2007). Heart failure-related hospitalizations in the U.S., 1979–2004. Journal of the American College of Cardiology, 52, 428–434.

    Google Scholar 

  • Ferketich, A., & Binkley, P. (2005). Psychological distress and cardiovascular disease: Results from the 2002 National Health Interview Survey. European Heart Journal, 26, 1923–1929.

    PubMed  Google Scholar 

  • Fitchett, G., Murphy, P. E., Kim, J., Gibbons, J. L., Cameron, J. R., & Davis, J. A. (2004). Religious struggle: Prevalence, correlates and mental health risks in diabetic, congestive heart failure, and oncology patients. International Journal of Psychiatry and Medicine, 34, 179–196.

    Google Scholar 

  • Galbreath, A., Krasuski, R., Smith, B., Stajduhar, K., Kwan, M., Ellis, R., et al. (2004). Long-term healthcare and cost outcomes of disease management in a large, randomized, community-based population with heart failure. Circulation, 110, 3518–3526.

    PubMed  Google Scholar 

  • Gottlieb, S. (2003). Palliative care in heart failure. Advanced Studies in Medicine, 3, 456–463.

    Google Scholar 

  • Hills, J., Paice, J. A., Cameron, J. R., & Shott, S. (2005). Spirituality and distress in palliative care consultation. Journal of Palliative Medicine, 8, 782–788.

    PubMed  Google Scholar 

  • Jaagosild, P., Dawson, N. V., Thomas, C., Wenger, N. S., Tsevat, J., Knaus, W. A., et al. (1998). Outcomes of acute exacerbation of severe congestive heart failure: Quality of life, resource use, and survival. SUPPORT investigators. The study to understand prognosis and preferences for outcomes and risks of treatments. Archives of Internal Medicine, 158, 1081–1089.

    PubMed  CAS  Google Scholar 

  • Jerant, A. F., Azari, R., & Nesbitt, T. S. (2001). Reducing the cost of frequent hospital admissions for congestive heart failure: A randomized trial of a home telecare intervention. Medical Care, 39, 1234–1245.

    PubMed  CAS  Google Scholar 

  • Jiang, W., Alexander, J., Christopher, E., Kuchibhatla, M., Gaulden, L. H., Cuffe, M. S., et al. (2001). Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Archives of Internal Medicine, 161, 1849–1856.

    PubMed  CAS  Google Scholar 

  • Keefe, F., Affleck, G., Lefebvre, J., Underwood, L., Caldwell, D., Drew, J., et al. (2001). Living with rheumatoid arthritis: The role of daily spirituality and daily religious and spiritual coping. The Journal of Pain, 2, 101–110.

    PubMed  CAS  Google Scholar 

  • Koenig, H. G. (1998). Depression in hospitalized older patients with congestive heart failure. General Hospital Psychiatry, 20, 29–43.

    PubMed  CAS  Google Scholar 

  • Koenig, H. G. (2002). Religion, congestive heart failure, and chronic pulmonary disease. Journal of Religion and Health, 41, 263–278.

    Google Scholar 

  • Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford University Press.

    Google Scholar 

  • Konstam, V., Salem, D., Pouleur, H., Kostis, J., Gorkin, L., Shumaker, S., et al. (1996). Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. The American Journal of Cardiology, 78, 890–895.

    PubMed  CAS  Google Scholar 

  • Lee, B. Y., & Newberg, A. B. (2010). The interaction of religion and health. In B. D. Beitman (Ed.), Integrative psychiatry (pp. 408–444). New York: Oxford University Press.

    Google Scholar 

  • Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., et al. (2009). Heart disease and stroke statistics–2009 update: A report from the American Heart Association statistics committee and stroke statistics subcommittee. Circulation, 119, 121–181.

    Google Scholar 

  • McCall, D. (1994). Congestive heart failure. In J. H. Stein, J. J. Hutton, & P. O. Kohler (Eds.), Internal medicine (4th ed., pp. 116–131). St. Louis, MO: Mosby.

    Google Scholar 

  • McConnell, K. M., Pargament, K. I., Ellison, C. G., & Flannelly, K. J. (2006). Examining the links between spiritual struggles and symptoms of psychopathology in a national sample. Journal of Clinical Psychology, 62, 1469–1484.

    PubMed  Google Scholar 

  • Meisenhelder, J. B., & Marcum, J. P. (2004). Responses of clergy to 9/11: Posttraumatic stress, coping, and religious outcomes. Journal for the Scientific Study of Religion, 43, 547–554.

    Google Scholar 

  • Mommersteeg, P. M. C., Denollet, J., Spertus, J. A., & Pedersen, S. S. (2009). Health status as a risk factor in cardiovascular disease: A systematic review of current evidence. American Heart Journal, 157, 208–218.

    PubMed  Google Scholar 

  • Murray, S. A., Kendall, M., Boyd, K., Worth, A., & Benton, T. F. (2004). Exploring the spiritual needs of people dying of lung cancer or heart failure: A prospective qualitative interview study of patients and their carers. Palliative Medicine, 18, 39–45.

    PubMed  Google Scholar 

  • Murray, S. A., Kendall, M., Grant, E., Boyd, K., Barclay, S., & Sheikh, A. (2007). Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34, 393–402.

    PubMed  Google Scholar 

  • Pargament, K. I. (2007). Spiritually integrated psychotherapy: Understanding and addressing the sacred. New York: Guilford Press.

    Google Scholar 

  • Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56, 519–543.

    PubMed  CAS  Google Scholar 

  • Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2001a). Religious struggle as a predictor of mortality among medically ill elderly patients: A 2-year longitudinal study. Archives of Internal Medicine, 161, 1881–1885.

    PubMed  CAS  Google Scholar 

  • Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2004). Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: A two-year longitudinal study. Journal of Health Psychology, 9, 713–730.

    PubMed  Google Scholar 

  • Pargament, K. I., Murray-Swank, N., Magyar, G., & Ano, G. (2005). Spiritual struggle: A phenomenon of interest to psychology and religion. In W. R. Miller & H. D. Delaney (Eds.), Judeo-Christian perspectives on psychology: Human nature, motivation, and change (pp. 245–268). Washington, DC: APA Press.

    Google Scholar 

  • Pargament, K. I., Tarakeshwar, N., Ellison, C. G., & Wulff, K. M. (2001b). Religious coping among the religious: The relationships between religious coping and well-being in a national sample of Presbyterian clergy, elders, and members. Journal for the Scientific Study of Religion, 40, 497–513.

    Google Scholar 

  • Park, C. L. (2008). Estimated longevity and changes in spirituality in the context of advanced congestive heart failure. Palliative and Supportive Care, 6, 3–11.

    PubMed  Google Scholar 

  • Park, C. L., Brooks, M. A., & Sussman, J. (2009). Dimensions of religion and spirituality in psychological adjustment in older adults living with congestive heart failure. In A. Ai & M. Ardelt (Eds.), The role of faith in the well-being of older adults: Linking theories with evidence in an interdisciplinary inquiry (pp. 112–134). Hauppauge, NY: Nova Science Publishers.

    Google Scholar 

  • Park, C. L., Malone, M. R., Suresh, D. P., Bliss, D., & Rosen, R. I. (2008a). Coping, meaning in life, and quality of life in congestive heart failure patients. Quality of Life Research, 17, 21–26.

    PubMed  Google Scholar 

  • Park, C. L., Moehl, B., Fenster, J. R., Suresh, D. P., & Bliss, D. (2008b). Religiousness and treatment adherence in congestive heart failure patients. Journal of Religion, Spirituality and Aging, 20, 249–266.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Google Scholar 

  • Rector, T. S. (2005). A conceptual model of quality of life in relation to heart failure. Journal of Cardiac Failure, 11, 173–176.

    PubMed  Google Scholar 

  • Rector, T. S., Anand, I. S., & Cohn, J. N. (2006). Relationships between clinical assessments and patients’ perceptions of the effects of heart failure on their quality of life. Journal of Cardiac Failure, 12, 87–92.

    PubMed  Google Scholar 

  • Rector, T. S., Kubo, S. H., & Cohn, J. N. (1987). Patients’ self assessment of their congestive heart failure: II. Content, reliability and validity of a new measure-the Minnesota Living with Heart Failure Questionnaire. Heart Failure, 3, 198–209.

    Google Scholar 

  • Rosmarin, D. H., Pargament, K. I., & Flannelly, K. J. (2009). Do spiritual struggles predict poorer physical/mental health among Jews? International Journal for the Psychology of Religion, 19, 244–258.

    Google Scholar 

  • Rutledge, T., Reis, V., Linke, S., Greenberg, B., & Mills, P. (2006). Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48, 1527–1537.

    PubMed  Google Scholar 

  • Selman, L., Beynon, T., Higginson, I., & Harding, R. (2007). Psychological, social and spiritual distress at the end of life in heart failure patients. Current Opinion in Supportive and Palliative Care, 1, 260–266.

    PubMed  Google Scholar 

  • Sherman, A. C., Plante, T. G., Simonton, S., Latif, U., & Anaissie, E. J. (2009). Prospective study of religious coping among patients undergoing autologous stem cell transplantation. Journal of Behavioral Medicine, 32, 118–128.

    PubMed  Google Scholar 

  • Sherman, A. C., Simonton, S., Latif, U., Tricot, G., & Spohn, R. (2005). Religious struggle and religious comfort in response to illness: Health outcomes among stem cell transplant patients. Journal of Behavioral Medicine, 28, 359–367.

    PubMed  Google Scholar 

  • Sherwood, A., Blumenthal, J. A., Trivedi, R., Johnson, K. S., O’Connor, C. M., Adams, K. F., Jr., et al. (2007). Relationship of depression to death or hospitalization in patients with heart failure. Archives of Internal Medicine, 167, 367–373.

    PubMed  Google Scholar 

  • Smith, B., Hughes-Cromwick, P., Forkner, E., & Galbreath, A. (2008). Cost-effectiveness of telephonic disease management in heart failure. The American Journal of Managed Care, 14, 106–115.

    PubMed  Google Scholar 

  • Strawbridge, W. J., Shema, S. J., Cohen, R. D., Roberts, R. E., & Kaplan, G. A. (1998). Religiosity buffers effects of some stressors on depression but exacerbates others. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 53B, S118–S126.

    Google Scholar 

  • Sullivan, M., Wood, L., Brantley, T. J., et al. (2009). The support, education, and research in chronic heart failure study (SEARCH): A mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. American Heart Journal, 157, 84–90.

    PubMed  Google Scholar 

  • Tarakeshwar, N., & Pargament, K. I. (2001). Religious coping in families of children with autism. Focus on Autism and Other Developmental Disabilities, 16, 247–260.

    Google Scholar 

  • Tarakeshwar, N., Vanderwerker, L. C., Paulk, M. J., Kasl, S. V., & Prigerson, H. G. (2006). Religious coping is associated with the quality of life of patients with advanced cancer. Journal of Palliative Medicine, 9, 646–657.

    PubMed  Google Scholar 

  • Tibaldi, V., Isaia, G., Scarafiotti, C., Gariglio, F., Zanocchi, M., Bo, M., et al. (2009). Hospital at home for elderly patients with acute decompensation of chronic heart failure: A prospective randomized controlled trial. Archives of Internal Medicine, 169, 1569–1575.

    PubMed  Google Scholar 

  • Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary test of reliability and validity. Medical Care, 34, 220–226.

    PubMed  Google Scholar 

  • Williams, D. R., Larson, D. B., Buckler, R. E., & Heckmann, R. C. (1991). Religion and psychological distress in a community sample. Social Science and Medicine, 32, 1257–1262.

    PubMed  CAS  Google Scholar 

  • Wood, B. T., Worthington, E. L., Jr., Exline, J. J., Yali, A. M., Aten, J. D., & McMinn, M. R. (2010). Development, refinement, and psychometric properties of the attitudes toward God scale (ATGS-9). Psychology of Religion and Spirituality, 2, 148–167.

    Google Scholar 

  • Yi, M. S., Mrus, J. M., Wade, T. J., Ho, M. L., Hornung, R. W., Cotton, S., et al. (2006). Religion, spirituality, and depressive symptoms in patients with HIV/AIDS. Journal of General Internal Medicine, 21, S21–S27.

    PubMed  Google Scholar 

  • Zwingmann, C., Wirtz, M., Muller, C., Korber, J., & Murken, S. (2006). Positive and negative religious coping in German breast cancer patients. Journal of Behavioral Medicine, 29, 533–547.

    PubMed  Google Scholar 

Download references

Acknowledgments

This study was generously supported by the Fetzer Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Crystal L. Park.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Park, C.L., Wortmann, J.H. & Edmondson, D. Religious struggle as a predictor of subsequent mental and physical well-being in advanced heart failure patients. J Behav Med 34, 426–436 (2011). https://doi.org/10.1007/s10865-011-9315-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-011-9315-y

Keywords

  • Religious struggle
  • Spirituality
  • Congestive heart failure
  • Depression
  • Quality of life
  • Hospitalization