A growing interest has been focusing on the relationship between religious coping and psychosocial adjustment among cancer patients. However, previous research mostly has not differentiated between positive and negative components of religious coping. The current cross-sectional study investigated the role of both positive religious coping, i.e., a confident and constructive turning to religion, and negative religious coping, i.e., religious struggle and doubt, in a sample of 156 German breast cancer patients. Participants were assessed upon admission to an inpatient rehabilitation program. In addition to religious coping, two basic nonreligious coping styles (depressive coping and active problem-focused coping) and psychosocial adjustment (anxiety and depression) were measured. Major research questions concerning the mediating role of nonreligious coping and the relative predictive power of positive and negative religious coping were primarily addressed using structural equation modeling. Results indicated that the relationship between religious coping and psychosocial outcomes was completely mediated by nonreligious coping, whereby only depressive coping and not active problem-focused coping proved to be a mediating variable. Positive and negative religious coping were somewhat positively related to each other; their (indirect) predictive power on psychosocial adjustment was identical though in an opposite direction. All in all, the results correspond to previous Anglo-American research. There are, however, some discrepancies which may be due to the specific religious-cultural background in Germany.
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REFERENCES
Alferi, S. M., Culver, J. L., Carver, C. S., Arena, P. L., and Antoni, M. H. (1999). Religiosity, religious coping, and distress: A prospective study of Catholic and Evangelical women in treatment for early-stage breast cancer. J. Health Psychol. 4: 343–356.
Allison, P. D. (2001). Missing Data. Sage, Thousand Oaks.
Anandarajah, G., and Hight, E. (2001). Spirituality and medical practice: Using the HOPE questions as a practical tool for spiritual assessment. Am. Fam. Physician 63: 81–89.
Ano, G. G., and Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to stress: A meta-analysis. J. Clin. Psychol. 61: 1–20.
Arbuckle, J. L., and Wothke, W. (1999). AMOS 4.0 User's Guide, Small-Waters Corporation, Chicago, IL.
Baumgartner, H., and Homburg, C. (1996). Applications of structural equation modeling in marketing and consumer research: A review. Int. J. Res. Mark. 13: 139–161.
Bagozzi, R., and Baumgartner, H. (1994). The evaluation of structural equation models and hypothesis testing. In Bagozzi, R. (Ed.), Principles of Marketing Research, Blackwell Publishers, Cambridge, MA, pp. 386–422.
Baider, L., Russak, S. M., Perry, S., Kash, K., Gronert, M., Fox, B., Holland, J. C., and Kaplan-DeNour, A. (1999). The role of religious and spiritual beliefs in coping with malignant melanoma: An Israeli sample. Psychooncology 8: 27–35.
Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychol. Bull. 107: 238–246.
Bishop, G. (1999). Poll trends. Americans’ belief in God. Public Opin. Q. 63: 421–434.
Bollen, K. A. (1989). Structural Equations with Latent Variables. Wiley, New York.
Boomsma, A. (2000). Reporting analyses of covariance structures. Struct. Equation Model. 7: 461–483.
Brady, M. J., Peterman, A. H., Fitchett, G., Mo, M., and Cella, D. (1999). A case for including spirituality in quality of life measurement in oncology. Psychooncology 8: 417–428.
Burker, E. J., Evon, D. M., Sedway, J. A., and Egan, T. (2005). Religious and non-religious coping in lung transplant candidates: Does adding God to the picture tell us more? J. Behav. Med. 28: 513–526.
Büssing, A., Ostermann, T., and Matthiessen, P. F. (2005). Search for meaningful support and the meaning of illness in German cancer patients. Anticancer Res. 25: 1449–1455.
Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., Ketcham, A. S., Moffat, F. L., Jr., and Clark, K. C. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. J. Pers. Soc. Psychol. 65: 375–390.
Cotton, S. P., Levine, E. G., Fitzpatrick, C. M., Dold, K. H., and Targ, E. (1999). Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psychooncology 8: 429–438.
Coward, D. D. (1995). Self-transcendence: Making meaning from the cancer experience. Qual. Life 4: 53–58.
Exline, J. J., and Rose, E. (2005). Religious and spiritual struggles. In Paloutzian, R. F., and Park, C. L. (Eds.), Handbook of the Psychology of Religion and Spirituality, Guilford, New York, pp. 315–330.
Feher, S., and Maly, R. C. (1999). Coping with breast cancer in later life: The role of religious faith. Psychooncology 8: 408–416.
Ferring, D., Filipp, S.-H., and Klauer, T. (1994). Korrelate der Überlebenszeit bei Krebspatienten: Ergebnisse einer follow-back-Studie [Correlates of survival time in cancer patients: results of a follow-back study]. In Heim, E., and Perrez, M. (Eds.), Krankheitsverarbeitung, Hogrefe, Göttingen, pp. 63–73.
Filipp, S.-H., Klauer, T., Freudenberg, E., and Ferring, D. (1990). The regulation of subjective well-being in cancer patients: An analysis of coping effectiveness. Psychol. Health 4: 305–317.
Fitchett, G., Murphy, P. E., Kim, J., Gibbons, J. L., Cameron, J. R., and Davis, J. A. (2004). Religious struggle: Prevalence, correlates, and mental health risks in diabetic, congestive heart failure, and oncology patients. Int. J. Psychiatry Med. 34: 179–196.
Flannelly, L. T., Flannelly, K. J., and Weaver, A. J. (2002). Religious and spiritual variables in three major oncology nursing journals: 1990–1999. Oncol. Nurs. Forum 29: 679–685.
Fornell, C., and Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. J. Marketing Res. 18: 39–50.
Frick, E., Riedner, C., Fegg, M., Hauf, S., and Borasio, G. D. (2006). A clinical interview assessing cancer patients’ spiritual needs and preferences. Eur. J. Cancer Care (Engl.) 15: 238–243.
Gall, T. L. (2000). Integrating religious resources within a general model of stress and coping: Long-term adjustment to breast cancer. J. Religion Health 39: 167–182.
Gall, T. L., Charbonneau, C., Clarke, N. H., Grant, K., Joseph, A., and Shouldice, L. (2005). Understanding the nature and role of spirituality in relation to coping and health: Conceptual framework. Can. Psychol. 46: 88–104.
Gioiella, M. E., Berkman, B., and Robinson, M. (1998). Spirituality and quality of life in gynecologic oncology patients. Cancer Pract. 6: 333–338.
Graham, J. W., Cumsille, P. E., and Elek-Fisk, E. (2003). Methods for handling missing data. In Schinka, J. A., and Velicer, W. F. (Eds.), Research Methods in Psychology, Wiley, New York, pp. 87–114.
Hair, J. F., Anderson, R. E., Tatham, R. L., and Black, W. C. (2004). Multivariate Data Analysis. Prentice Hall, Upper Saddle River, NJ.
Hardt, J., Petrak, F., Egle, U. T., Kappis, B., Schulz, G., and Küstner, E. (2003). Was misst der FKV? Eine Überprüfung des Freiburger Fragebogens zur Krankheitsverarbeitung bei Patienten mit unterschiedlichen Erkrankungen [What does the FQCI measure? An examination of the Freiburg Questionnaire of Coping with Illness in patients with various diseases]. Z. Klin. Psychol. Psychother. 32: 41–50.
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale—A review of validation data and clinical results. J. Psychosom. Res. 42: 17–41.
Herrmann, C., Buss, U., and Snaith, R. P. (1995). HADS-D—Hospital Anxiety and Depression Scale—Deutsche Version [HADS-D—German version]. Huber, Bern.
Holland, J. C., Passik, S., Kash, K. M., Russak, S. M., Gronert, M. K., Sision, A., Lederberg, M., Fox, B., and Baider, L. (1999). The role of religious and spiritual beliefs in coping with malignant melanoma. Psychooncology 8: 14–26.
Homburg, C., and Giering, A. (2001). Personal characteristics as moderators of the relationship between customer satisfaction and loyalty—An empirical analysis. Psychol. Marketing 18: 43–66.
Hoogland, J. J., and Boomsma, A. (1998). Robustness studies in covariance structure modeling: An overview and a meta-analysis. Sociol. Methods Res. 26: 329–367.
Jagodzinski, W., and Dobbelaere, K. (1995). Secularization and church religiosity. In van Deth, J. W., and Scarbrough, E. (Eds.), The Impact of Values, Oxford University Press, Oxford, pp. 76–119.
Kline, R. B. (2005). Principles and Practice of Structural Equation Modeling, 2nd ed. Guilford, New York.
Koenig, H. G., McCullough, M. E., and Larson, D. B. (Eds.) (2001). Handbook of Religion and Health, Oxford University Press, Oxford.
Levin, J. S. (1996). How religion influences morbidity and health: Reflections on natural history, salutogenesis and host resistence. Soc. Sci. Med. 43: 849–864.
MacLean, C. D., Susi, B., Phifer, N., Bynum, D., Franco, M., Klioze, A., Monroe, M., Garrett, J., and Cykert, S. (2003). Patient preference for physician discussion and practice of spirituality. Results from a multicenter patient survey. J. Gen. Intern. Med. 18: 38–43.
Mehnert, A., Rieß, S., and Koch, U. (2003). Die Rolle religiöser Glaubensüberzeugungen bei der Krankheitsbewältigung Maligner Melanome [The role of religious beliefs in coping with malignant melanoma]. Verhaltenstherapie und Verhaltensmedizin 24: 147–166.
Moadel, A., Morgan, C., Fatone, A., Grennan, J., Carter, J., Laruffa, G., Skummy, A., and Dutcher, J. (1999). Seeking meaning and hope: Self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psychooncology 8: 378–385.
Muthny, F. A. (1989). Freiburger Fragebogen zur Krankheitsverarbeitung (FKV). Manual [Freiburg Questionnaire of Coping with Illness (FQCI). Manual]. Beltz Test, Weinheim.
Muthny, F. A., Bechtel, M., and Spaete, M. (1992). Laienätiologien und Krankheitsverarbeitung bei schweren körperlichen Erkrankungen [Lay theories and coping with severe somatic diseases]. Psychother. Psych. Med. 42: 41–53.
Nairn, R. C., and Merluzzi, T. V. (2003). The role of religious coping in adjustment to cancer. Psychooncology 12: 428–441.
Pargament, K. I. (1997). The Psychology of Religion and Coping: Theory, Research, Practice. Guilford, New York.
Pargament, K. I. (2002). Is religion nothing but…?: Explaining religion versus explaining religion away. Psychol. Inq. 13: 239–244.
Pargament, K. I., Ano, G. G., and Wachholtz, A. B. (2005). The religious dimension of coping: Advances in theory, research, and practice. In Paloutzian, R. F., and Park, C. L. (Eds.), Handbook of the Psychology of Religion and Spirituality, Guilford, New York, pp. 479–495.
Pargament, K. I., Ensing, D. S., Falgout, K., Olsen, H., Reilly, B., Van Haitsma, K., Warren, R. (1990). God help me: (I): Religious coping efforts as predictors of the outcomes to significant negative life events. Am. J. Community Psychol. 56: 519–543.
Pargament, K. I., Koenig, H. G., and Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. J. Clin. Psychol. 56: 519–543.
Pargament, K. I., Smith, B. W., Koenig, H. G., and Perez, L. M. (1998). Patterns of positive and negative religious coping with major life stressors. J. Sci. Study Relig. 37: 710–724.
Plante, T. G., and Sherman, A. C. (Eds.) (2001). Faith and Health. Psychological Perspectives. Guilford, New York.
Puchalski, C. M., and Romer, A. L. (2000). Taking a spiritual history allows clinicians to understand patients more fully. J. Palliat. Med. 3: 129–137.
Rifkin, A., Doddi, S., Karagji, B., and Pollack, S. (1999). Religious and other predictors of psychosocial adjustment in cancer patients. Psychosomatics 40: 251–256.
Schafer, J. L., and Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychol. Methods 7: 147–177.
Schnoll, R. A., Harlow, L. L., and Brower, L. (2000). Spirituality, demographic and disease factors, and adjustment to cancer. Cancer Pract. 8: 298–304.
Sherman, A. C., and Simonton, S. (2001). Assessment of religiousness and spirituality in health research. In Plante, T. G., and Sherman, A. C. (Eds.), Faith and Health: Psychological Perspectives, Guilford, New York, pp. 139–163.
Sherman, A. C., Simonton, S., Adams, D. C., Vural, E., and Hanna, E. (2000). Coping with head and neck cancer during different phases of treatment. Head Neck 22: 787–793.
Sherman, A. C., Simonton, S., Latif, U., Spohn, R., and Tricot, G. (2005). Religious struggle and religious comfort in response to illness: Health outcomes among stem cell transplant patients. J. Behav. Med. 28: 359–367.
Siegel, K., Anderman, S. J., and Schrimshaw, E. W. (2001). Religion and coping with health-related stress. Psychol. Health 16: 631–653.
Silberfarb, P. M., Anderson, K. M., Rundle, A. C., Holland, J. C., Cooper, M. R., and McIntyre, O. R. (1991). Mood and clinical status in patients with multiple myeloma. J. Clin. Oncol. 9: 2219–2224.
Stefanek, M., McDonald, P. G., and Hess, S. A. (2005). Religion, spirituality and cancer: Current status and methodological challenges. Psychooncology 14: 450–463.
Tabachnik, B. G., and Fidell, L. S. (1996). Using Multivariate Statistics. Harper Collins, New York.
Tate, D. G., and Forchheimer, M. (2002). Quality of life, life satisfaction, and spirituality—comparing outcomes between rehabilitation and cancer patients. Am. J. Phys. Med. Rehabil. 8: 400–410.
Taylor, E. J. (1995). Whys and wherefores: Adult patient perspectives of the meaning of cancer. Semin. Oncol. Nurs. 11: 32–40.
Terwey, M. (2003). Kirchen weiter auf der Verliererstraße—Inferno und Aberglauben im Aufwind? [Churches disappearing furthermore—inferno and superstition coming?]. ZA-Information (52): 93–119.
Thuné-Boyle, I. C., Stygall, J. A., Keshtgar, M. R., and Newman, S. P. (2006). Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Soc. Sci. Med. 63: 151–164.
Tix, A. P., and Frazier, P. A. (1998). The use of religious coping during stressful life events. Main effects, moderation, and mediation. J. Consult. Clin. Psychol. 66: 411–422.
Zwingmann, C. (1991). Religiosität und Lebenszufriedenheit. Empirische Untersuchungen unter besonderer Berücksichtigung der religiösen Orientierung [Religiousness and life satisfaction. Empirical studies with special regard to religious orientation]. Roderer, Regensburg.
Zwingmann, C. (2005a). Erfassung von Spiritualität/Religiosität im Kontext der gesundheitsbezogenen Lebensqualität [Assessment of spirituality/religiosity in the context of health-related quality of life]. Psychother. Psych. Med. 55: 241–246.
Zwingmann, C. (2005b). Spiritualität/Religiosität als Komponente der gesundheitsbezogenen Lebensqualität? [Spirituality/religiosity as a component of health-related quality of life?]. Wege zum Menschen 57: 68–80.
Zwingmann, C., and Murken, S. (2000). Coping with an uncertain future: Religiosity and millenarianism. Archiv für Religions-psychologie 23: 11–28.
ACKNOWLEDGMENTS
This research was supported by a grant from the Volkswagen Foundation (Germany) to Sebastian Murken.
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Zwingmann, C., Wirtz, M., Müller, C. et al. Positive and Negative Religious Coping in German Breast Cancer Patients. J Behav Med 29, 533–547 (2006). https://doi.org/10.1007/s10865-006-9074-3
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DOI: https://doi.org/10.1007/s10865-006-9074-3