Health and Spirituality

Health and Spirituality. By Tyler J. VanderWeele, PhD; Tracy A. Balboni, MD, MPH; Howard K. Koh, MD, MPH
JAMA. Published online July 27, 2017. doi:10.1001/jama.2017.8136

Recent studies suggest a broad protective relationship between religious participation and population health. A report from the Nurses’ Health Study, which followed up more than 74 000 study participants for 16 years, found that women who attended weekly religious services had a lower mortality rate compared with those who had never attended religious services (actual rates of 845 vs 1229 per 100 000/y, respectively; adjusted hazard ratio, 0.74),4 and those who attended religious services more than once per week had an even lower mortality rate (actual rates of 740 vs 1229 per 100 000/y; adjusted hazard ratio, 0.67), suggesting a possible dose-response relationship.

Multivariable adjustment for extensive confounders did not substantially attenuate the association, suggesting that some of the association might be causal. Although the findings may still be subject to unmeasured factors and residual confounding4 (eg, personal, social, psychological, and socioeconomic characteristics), sensitivity analysis suggested that the association was moderately robust to such unmeasured confounding. Another report from the Nurses’ Health Study noted that attendance at religious services was associated with a reduction in depression risk (adjusted relative risk, 0.71) and a 6-fold reduction in suicide risk (from 6.5 to 1.0 per 100 000/y).5

Possible mechanisms include that religious service participation may enhance the social integration that promotes healthy (eg, tobacco-free) behaviors and provides social support, optimism, or purpose. A recent meta-analysis of 10 prospective studies with more than 136 000 participants showed having higher purpose in life was associated with a reduction (relative risk, 0.83) in all-cause mortality and cardiovascular events.6 Because randomized trials are not possible (assignment of behaviors such as service attendance and life purpose is infeasible), these population-based studies represent the strongest available evidence.

Additional investigations suggest the value of spiritual approaches to medical care within the clinical realm, particularly in the end-of-life setting. In a multisite, prospective study7 of 343 patients with advanced cancer, those whose medical teams (eg, clinicians, chaplains) attended to their spiritual needs had quality-of-life scores at life’s end that were 28% greater on average than those who did not receive such spiritual care (20.3 vs 15.8; highest possible score, 30). In addition, patients reporting high support of their spiritual needs by their medical teams (26%) compared with the large majority who did not receive such care (74%) had a higher odds of transitioning to hospice care (adjusted odds ratio, 3.5).

In contrast, when religious communities supplied spiritual care in the absence of the medical team (43%), patients with terminal illness had a lower odds of receiving hospice services (adjusted odds ratio, 0.37) together with a higher odds of receiving aggressive medical interventions (eg, resuscitation and ventilation) during the last week of life (adjusted odds ratio, 2.6).7 Other studies indicate that most patients with serious illness experience spiritual struggles, such as feeling punished or abandoned by God, associated with decrements in patient well-being.7 All these findings suggest the need for clinicians to integrate spiritual care into end-of-life settings for patients who wish to receive it.

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>>> Interesting data for those of you who are spiritual.