Wellness Check: Spirituality

2 Minute Medicine is pleased to announce that we are launching Wellness Check, a new series dedicated to exploring new research evidence focused on wellness. Each week, we will report on articles examining different aspects of wellness, including (but not limited to) nutrition, sleep, reproductive health, substance use and mental health. This week, we explore the latest evidence-based updates in spirituality.

Spirituality and religiosity may be associated with higher quality of life

1. In this systematic review, spirituality was associated with a higher quality of life.

2. The aspects of religiosity and spirituality that most determined quality of life outcomes included components such as hope, optimism, and the meaning of life.

Evidence Rating Level: 1 (Excellent)

Many reports have suggested that spirituality and religiosity are among factors that help determine coping strategies. Currently, there are several articles that report positive associations between spirituality and religiosity (S/R) with quality of life (QoL) among individuals with severe disease. However, there is limited data exploring this association among individuals with no comorbidities. As a result, the objective of the present systematic review was to investigate the relationship between S/R and QoL among healthy adult individuals. This study also examined the role of S/R in mental health as a secondary objective.

Out of 1952 studies, 10 met the inclusion criteria (n=4337). Articles were included if they were composed of individuals aged 18-64 with no illness. Studies also had to assess S/R and QoL using quantitative instruments. Studies were excluded if they composed of children or adolescents (age <18 years old) or elderly individuals (>65 years old), had physical or mental conditions, or used a qualitative approach. The studies’ quality was assessed using the Critical Appraisal Checklist for Analytical Cross Sectional studies and Critical Appraisal Checklist for Cohort studies.

With the exception of one study, there was an overall positive association between S/R and QoL outcomes. Among the components of S/R that most determined QoL outcomes, these included: hope, optimism, meaning of life, inner peace, wholeness, and integration, spiritual strength, faith, and high self-control. S/R decreased stress, anxiety, and an increased ability to cope with environmental challenges. However, this study was limited by the fact that only observational studies were selected. Nonetheless, this study is the first to examine the relationship between S/R and QoL and demonstrate that S/R plays a role in healthy individuals, not just those suffering from illness.

The current understanding of spirituality in healthcare may be unclear

1. In this study, 24 dimensions of spirituality were identified, with the most common being related to the connectedness and meaning of life.

2. Overall, a new spiritual framework was created, such that spirituality was defined as being composed of three axes/domains.

Evidence Rating Level: 2 (Good)

Spirituality has been included as part of the concept of health by the World Health Organization in part for its influence on both mental and physical health outcomes. However, recent articles on the topic have introduced new dimensions to the term, preventing a thorough understanding of which dimensions have a greater influence on health. As a result, the present systematic review sought to identify the main dimensions of spirituality and propose a framework that would operationalize the understanding of spirituality.

From 441 screened articles, 166 studies up to October 2020 were included. Studies in any language were included if they addressed the meaning, concept or definition of spirituality. Exclusion criteria consisted of studies that were not related to the definition of spirituality or that did not present a new concept or operational definition about spirituality. The resulting studies were analyzed to identify which dimensions were presented and were further operationalized.

After data synthesis, there were 24 dimensions of spirituality identified with the most common being meaning/purpose (51.80%). These dimensions were used to create a new spirituality framework incorporating beliefs, practices, experiences, the ways in which individuals express them, and how it leads to the development of values and positive inner feelings. The present study was limited by the inclusion of only one database which limited the comprehensiveness of the search strategy. Nonetheless, the study results allowed for a more comprehensive framework for spirituality that may facilitate future research to be less prone to subjective interpretation.

Physician religiosity positively correlated with spirituality in clinical practice

1. There is a significant association between religiosity and/or spirituality and spirituality in clinical practice, independent of culture.

2. Psychiatrists reported a higher degree of spirituality in clinical practice compared to non-psychiatrists.

Evidence Rating Level: 1 (Excellent)

Physicians who describe themselves to be religious or spiritual have been shown to have a higher likelihood to discuss patients’ religiosity and/or spirituality (R/S) issues and cooperate with clergy/pastoral professionals. However, prior studies have not controlled for known confounders. As a result, the present meta-analysis seeks to investigate the association between physician’s religious characteristics and their self-reported behavior regarding these in clinical practice. A secondary analysis was performed to compare the behaviors of psychiatrists and non-psychiatrists.

From 7323 identified health professionals in the Network for Research in Spirituality and Health (NERSH) database and literature search, 3159 physicians were identified from 2002 to 2018. Inclusion criteria required physicians to have measures for R/S and spirituality in clinical practice (R/S-B) described in previous research. Non-physicians were excluded from the analysis. Statistical analysis was performed using a two-stage individual participant data meta-analysis (IPDMA) using R/S coefficients. Meta analyses were performed using a random-effects inverse-variance model with DerSimonian-Laird estimate of tau.

The results demonstrated a significant association between R/S and R/S-B independent of culture. Furthermore, psychiatrists reported a higher degree of R/S-B compared to non-psychiatrists despite an equal effect of R/S on R/S-B for both groups. However, this study was limited by heterogeneity with respect to the definition of religiosity and spirituality, and missing relevant potential confounders such as duration of work experience and level of academic degree. Nonetheless, these results demonstrate a cultural independent effect of R/S on R/S-B which has not been previously documented.

Image: PD

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