La religión como afrontamiento en pacientes oncológicos: síntomas depresivos y ansiosos / Religion as coping in cancer patients: depressive and anxious symptoms

Resumen En momentos de crisis o amenaza la religión es uno de los principales recursos que utilizan las personas para hacer frente. El diagnóstico de cáncer y su tratamiento constituyen un evento especialmente demandante para cualquier persona. En concordancia con eso, el presente estudio tuvo como objetivo verificar la relación entre afrontamiento religioso por medio de RCOPE y síntomas depresivos-ansiosos por medio del DASS-21, en pacientes oncológicos y grupo no oncológico. Este estudio de carácter cuantitativo, comparativo, correlacional y transversal se llevó a cabo en una muestra de 96 pacientes oncológicos del Hospital base Valdivia, Chile y grupo control de 102 sujetos. Los principales resultados obtenidos comprueban el mayor uso del afrontamiento religioso por pacientes oncológicos en comparación a grupo control; la existencia de relación directamente proporcional entre afrontamiento religioso negativo y la presencia de síntomas depresivo-ansiosos; la ausencia de relación entre afrontamiento religioso positivo y la presencia de síntomas depresivo-ansiosos. Se concluye que la búsqueda de respaldo de medios religiosos resulta especialmente necesaria en periodos de crisis, como lo es el tratamiento de una enfermedad grave. Sin embargo, cuando hay una relación positiva con la deidad o lo religioso (afrontamiento positive), no necesariamente implicaría un efecto atenuante de síntomas ansiosos o depresivos, y más bien, el afrontamiento negativo, se puede esperar un aumento o disminución de este tipo de malestar. Por lo que resultaría conveniente en contexto de enfermedad grave enfocarse en disminuir la conflictividad religiosa como medio de atenuar síntomas depresivos y ansiosos.

Abstract In times of crisis or threat, religion is one of the primary resources that people use to cope. Cancer diagnosis and treatment are an exceptionally demanding event for anyone. By this, the present study aimed to verify the relationship between religious coping through RCOPE and depressive symptoms - anxious through DASS-21, in cancer patients. This quantitative, comparative, correlational, and cross-sectional study was carried out in a sample of 96 cancer patients from the Valdivia base Hospital, Chile, and a control group of 102 subjects. The main results obtained confirm the greater use of religious coping by cancer patients than the control group; the existence of a directly proportional relationship between negative religious coping and the presence of depressive-anxious symptoms; the absence of a relationship between positive religious coping and the presence of depressive-anxious symptoms. It is concluded that the search for support from religious media is essential in periods of crisis, such as the treatment of a severe illness. However, when there is a positive relationship with the deity or religion, it would not necessarily translate into mitigation of anxious and depressive symptoms. Instead, negative coping, an increase or decrease of this type of discomfort can be expected. Therefore, in the context of serious illness, it would be advisable to focus on reducing the religious conflict to attenuate anticipatory and anxious symptoms.

Crecimiento postraumático y variables psicosociales en víctimas de violencia política / Posttraumatic growth and psychosocial variables among victims of political violence

Resumen Antecedentes: la dictadura militar chilena (1973-1990) dejó miles de víctimas entre afectados directos y familiares, quienes pudieron desarrollar diversas secuelas en su salud mental. Objetivos: el presente estudio buscó evaluar un modelo predictivo de crecimiento postraumático (CPT) que incluía la ideología política, el afrontamiento religioso y la rumiación, en víctimas de la violencia política durante la dictadura. Método: participaron 200 personas adultas reconocidas en el Programa de Reparación y Atención Integral de Salud (PRAIS), encargada de brindar apoyo a las víctimas directas de violaciones a los derechos humanos durante la dictadura, y a sus familiares. De ellos 104 son mujeres (52%) y 96 hombres (48%), en un rango de edad entre los 30 y 91 años. Se utilizaron como instrumentos el Inventario de Crecimiento Postraumático, la Escala Breve de Afrontamiento Religioso, la Escala de Rumiación relacionada con el Evento y la Escala de Ideología Política. Resultados: los principales resultados indicaron que el afrontamiento religioso positivo y la rumiación deliberada predijeron el CPT. La rumiación deliberada media parcialmente entre el afrontamiento religioso positivo y el CPT. Conclusión: se concluye que el afrontamiento religioso positivo y el procesamiento cognitivo deliberado favorecen los cambios positivos en víctimas directas de la violencia política y sus familiares. Ante esto, se refuerza la idea que las víctimas de estas violaciones logran crecer después de estas experiencias dolorosas.

Abstract Background: The Chilean military dictatorship (1973-1990) left thousands of victims among those directly affected and their families, who were able to develop various mental health sequelae. Objective: The present study sought to evaluate a predictive model of posttraumatic growth (PTG) that included political ideology, religious coping and rumination in victims of political violence during the dictatorship. Method: The study involved 200 adults recognised in the Programme for Reparation and Integral Health Care (PRAIS), which is responsible for providing support to direct victims of human rights violations and their family members during the dictatorship. Out of these, 104 were women (52%) and 96 were men (48%) ranging in age from 30 to 91 years. The Posttraumatic Growth Inventory, the Brief Religious Coping Scale, the Event-Related Rumination Scale and the Political Ideology Scale were used as instruments. Results: The main results indicated that positive religious coping and deliberate rumination predicted PTG. Deliberate rumination partially mediates between positive religious coping and PTG. Conclusion: It is concluded that positive religious coping and deliberate cognitive processing favour positive change in those directly affected by political violence and their family members. This reinforces the idea that victims of these violations manage to grow after these painful experiences.

Enfrentamento religioso-espiritual de mães com bebê em Unidade de Terapia Intensiva Neonatal / Mothers' spiritual-religious coping with baby in Neonatal Intensive Care Unit / Afrontamiento religioso y espiritual de las madres con bebé en la Unidad de Cuidados Intensivos Neonatales

A Teoria Motivacional do Coping (TMC) define o enfrentamento como a forma com que as pessoas regulam o comportamento, a emoção e a orientação motivacional frente ao estressor. A internação do filho em Unidade de Terapia Intensiva Neonatal (UTIN) é uma condição estressante, sendo frequente o uso do coping religioso-espiritual. Analisou-se o processo de enfrentamento de 20 mães (17-39 anos), com bebês internados em UTIN (M =10 dias). Foi aplicada a versão brasileira da RCOPE Scale (Religious Coping Questionnaire), denominada Escala de Coping Religioso-Espiritual - CRE (87 itens), organizados em 8 fatores de CREP (positivo) e 4 de CREN (negativo). Analisaram-se suas relações com categorias de enfrentamento adaptativas (Autoconfiança, Busca de suporte, Resolução de problemas, Busca de Informações, Acomodação, Negociação) e mal adaptativas (Delegação, Isolamento, Desamparo, Fuga, Submissão e Oposição). Os índices da Escala CRE ficaram na média, com predomínio de CREN e maior frequência de Posicionamento Negativo frente a Deus, e de estratégias mal adaptativas, como Submissão, Fuga e Oposição. Houve correlações entre CREP e famílias adaptativas; e entre CREN e famílias mal adaptativas. Foi possível identificar o uso do coping religioso-espiritual nesta amostra e analisar suas relações com o processo adaptativo, ampliando as possibilidades de análise da Escala CRE.

The Motivational Theory of Coping (MTC) defines coping as how people regulate behavior, emotion and motivational orientation against the stressor. The child's hospitalization in the Neonatal Intensive Care Units (NICU) is a stressful condition, with frequent use of spiritual and religious coping. It was analyzed the 20 mothers (17-39 years) coping process with babies admitted to NICU (M = 10 days). The Brazilian version of RCOPE, the Spiritual/Religious Coping Scale (SRCOPE) was applied (87 items), organized into 8 factors of SRCOPE-P (positive) and 4 SRCOPE-N (negative). Their relations with adaptive coping categories (Self-reliance, Support Seeking, Problem Solving, Information Seeking, Accommodation, Negotiation) and maladaptive (Delegation, Isolation, Helplessness, Escape, Submission and Opposition) were analyzed. The indices of SRCOPE were on average, with a predominance of SRCOPE-N and higher frequency of Negative Positioning front of God, and prevalence of maladaptive strategies such as Submission, Escape and Opposition. There were correlations between SRCOPE-P and adaptive families; and between SRCOPE-N and maladaptive families. It was possible identify the use of spiritual and religious coping in this sample, and analyze its relations with adaptive process, expanding the possibilities of analysis of SRCOPE Scale.

Teoría Motivacional de Afrontamiento (TMC) define afrontamiento cómo forma de regular comportamiento, emociones y orientación motivacional frente al factor estresante. La hospitalización de un hijo en la unidad de cuidados intensivos neonatales (UCIN) es una condición estresante, con uso frecuente del afrontamiento religioso-espiritual. Se analizó el proceso de afrontamiento del 20 madres (17-39 años), con bebés hospitalizados en la UCIN (M = 10 días). Se aplicó la Escala de Adaptación Religiosa-Espiritual - CRE (87 ítems), dispuestos en 8 factores de CREP (positivo) y 4 CREN (negativo). Analizamos sus relaciones con categorias adaptativas de afrontamiento (autoconfianza, búsqueda de apoyo, solución de problemas, búsqueda de información, alojamiento, negociación) y desadaptativas (Delegación, aislamiento, desamparo, la fuga, la sumisión y la oposición) propuestas por el TMC. Los índices de Escala CRE eran, en promedio, con un predominio de CREN y mayor frecuencia de posicionamiento negativo delante de Dios, y prevalencia de las estrategias desadaptativas como presentación, Escape y Oposición. Hubo correlaciones entre CREP y familias de adaptación; y entre CREN y familias desadaptativas. Fue posible no solo identificar el uso del afrontamiento religioso y espiritual en esta muestra, pero también analizar sus relaciones con proceso de adaptación, expandiendo las posibilidades de análisis de Escala CRE.

Coping religioso/espiritual positivo em mulheres com câncer de mama: um estudo qualitativo / Positive religious/spiritual coping in women with breast cancer: a qualitative study / Afrontamiento religioso/espiritual positivo en mujeres con cáncer de mama: un estudio cualitativo

Objetivou-se compreender, em mulheres com câncer de mama com altos índices de coping religioso/espiritual positivo, o lugar que a religiosidade/espiritualidade ocupa em suas vidas, as formas de coping utilizadas durante o diagnóstico e tratamento e as possíveis mudanças ocorridas durante a doença. Sete mulheres vinculadas a dois grupos de apoio participaram de dois grupos focais. A idade média foi de 51,5 anos (DP=7,2) e as pacientes haviam recebido o diagnóstico de câncer de mama, em média, há 43,4 meses (DP=14,6). Os resultados revelaram a presença de uma relação positiva com Deus, capaz de mobilizar força, esperança e conforto. Mudanças na personalidade das participantes foram mencionadas, decorrentes de um processo de reflexão quando do diagnóstico. Os resultados reafirmam a necessidade de uma abordagem na qual os profissionais da saúde contemplem as crenças religiosas/espirituais das pacientes, visando o estímulo das estratégias de coping positivas e a reavaliação daquelas negativas...

The aim in this research was to understand the place that religiousness/spirituality has in the lives of female breast cancer patients with high rates of positive religious/spiritual coping, the coping styles used during diagnosis and treatment, and possible changes occurred during the illness. Seven women linked to two support groups participated intwo focal groups. The average age was 51.5 years (SD=7.2) and the patients had received their breast cancer diagnosis, on average, 43.4 months earlier (SD=14.6). The results revealed a positive relationship with God, which was capable of fostering strength, hope and comfort. Personality changes in the participants were mentioned, which were a result of a reflection process at the time of the diagnosis. Results reaffirm the need for of an approach in which healthcare professionals embrace the religious/spiritual beliefs of the patients, aiming to encourage positive coping strategies and the reevaluation of the negative ones...

El objetivo del estudio fue compreender, en mujeres con cáncer de mama con altos niveles de afrontamiento religioso/espiritual positivo, el lugar que la religiosidad/espiritualidad tiene en sus vidas, las formas de afrontamiento utilizadas durante el diagnóstico y tratamiento y los posibles cambios ocurridos durante la enfermedad. Siete mujeres participantesde dos grupos de apoyo hicieron parte de dos grupos focales. La edad media fue de 51,5 años (DP=7,2) y las pacientes habían recibido el diagnóstico de cáncer de mama, en media, desde hace 43,4 meses (DP=14,16). Los resultados mostraron la presencia de una relación positiva con Dios, capaz de generar fuerza, esperanza y conforto. Cambios enla personalidad de las participantes fueron mencionadas, ocurridas a partir de un proceso de reflexión en el momentodel diagnóstico. Los resultados confirman la necesidad de un abordaje en el cual el personal sanitario valorize lascreencias religiosas/espirituales de los pacientes para estimular el uso de estrategias de afrontamiento positivas y la reevaluación de las negativas...

La salud en el marco de la psicología de la religión y la espiritualidad / The health in the mark of the psychology of the religion and the spirituality

El siguiente trabajo tiene como objetivo presentar una descripción del impacto que ha tenido en la salud "la psicología de la religión y la espiritualidad". Se muestra la evolución histórica de este constructo a lo largo del siglo XX, hasta llegar a las investigaciones basadas en la evidencia de las relaciones de la religión y la espiritualidad con la salud mental y física, y de investigaciones sobre los procesos de intervención en salud, enfocadas desde la espiritualidad. En conclusión, son muchas las investigaciones que plantean que la religión y la espiritualidad son variables moderadoras y amortiguadoras ante eventos traumáticos de la vida como lo es una enfermedad.

The present work has as aim present a review of the impact that has had in the health "the psychology of the religion and the spirituality". There are examined the historical precedents of this concept from its origins up to coming in the middle of the 20th century where it begins and one gives increasing summit in the researches based on the evidence of the relations of the religion and the spirituality in the mental and physical health, equally an approximation is done to the researches on the processes of intervention in health focused from the spirituality. In conclusion, there are great the researches that raise that the religion and the spirituality are moderating and buffering variables before traumatic events of the life like it is a disease.

Medidas de afrontamiento religioso y espiritualidad en adultos mayores mexicanos

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Summary: Spiritual life seems to play an important role in coping with stress in older adults. Spiritual life has been documented to have a positive effect on the sense of personal wellbeing in seniors and it has been inversely related to depression, to low levels of loneliness and psychopathology measured by MMPI-2. It has been documented that, when spirituality forms part of the subject's personality it tends to be expressed in his/her religious coping strategies and to have a positive impact on his/her health when these strategies are effectively used against stress during hospitalization and illness and against losses common in older age that are associated with depression. Two general approaches to the study of religious coping have been emphasized: a) the specific ways of coping, in which religious coping is a multidimensional phenomenon, which may include forgiveness, purification and confession, spiritual support, etc.; b) the study of coping patterns. The second approach includes religious coping methods and the patterns of interrelation they involve. Pargament et al. have distinguished between positive religious coping and negative religious coping; the former leads the individual towards productive and efficient spiritual coping associated with better health indicators than the negative coping strategy. According to the authors above mentioned, positive religious coping includes methods such as benevolent religious appraisal, collaborative religious coping and seeking spiritual support, seeking the support of clergy and church members, religious help and religious forgiveness. Negative religious coping includes methods such as punishing religious reappraisal, demonic religious appraisal, the reappraisal of the power of God, spiritual discontent, self directed religious coping, and interpersonal religious discontent. Pargament et al. have included these coping patterns in the Scale of Positive and Negative Patterns of Religious Coping Methods (Brief-RCOPE). Our research was aimed at identifying the validity and reliability of the religious coping scale (Brief-RCOPE) proposed by Pargament et al. in two samples of older adults living in Mexico City and selected according to availability in two health clinics. Additionally, with the objective of gaining greater knowledge of the characteristics of religious coping and the spiritual life of older Mexican adults, our research explored the possible existence of significant differences in the above mentioned variables regarding sex, age, education and religious denomination, marital and employment status. The subjects answered a questionnaire containing 37 questions with dichotomic multiple choice answers (likert type) which included: 1) demographic information; 2) the Positive and Negative Methods of Religious Coping Scale, Brief- RCOPE, with two subscales (positive religious coping and negative religious coping); 3) the subscale of Religious Coping when Confronting Loneliness, ARS, from the Loneliness Multiphase Inventory, IMSOL; and 4) the subscale of the Relationship with God from the Spiritual Wellbeing Scale, EBE. The results obtained allowed us to conclude that the tools that were used have adequate internal consistency which we obtained by calculating Cronbach's alpha coefficient; however, the negative religious coping subscale gave conservative results that may indicate the need for further investigation. A significant association between the positive Brief-RCOPE, Religious Coping when confronted with loneliness and the subscale of Relationship with God was found, which supports the convergent validity of the first subscale. On the contrary, and in a way consistent with the results of the authors negative Brief-RCOPE was not significantly associated with the other scales, but had a conservative association with regard to a measurement consisting of two items in the Relationship with God subscale. These items seem to specifically evaluate the dissatisfaction of the individual in his/her relationship with God. We calculated the factorial structure of the tools through the analysis of major components with varimax rotation of eigenvalues greater than 1: For Brief-RCOPE it was only possible to confirm a well defined structure representing 49.5% of the variance explained with an internal consistency of α=.82 and which corresponded to positive religious coping. The Scale of Religious Coping when confronted with loneliness maintained a solid structure based on only one component which explained the 70.2% variance, according to the expectations of the author, with an internal consistency of α=.91. The EBE subscale of the Relationship with God presented two clearly defined components, which explained the 59.3% variance. The first component seems to evaluate a satisfactory relationship with God, whereas the second one seems to indicate an unsatisfactory one. In analyzing the socio-demographic variables, we found that the tendency to cope with feelings of loneliness through greater closeness with God was more frequent among women ( X=18.46) than among men ( X=16.47; t=2.04, p=.04). On the other hand, Religious Coping, when confronted with loneliness, seems so show a relationship that changes with the number of years of schooling: the higher the educational level, the less this coping strategy was used (elementary school, =18.66; middle school, X=17.71; high school, X=17.55; college, X=14.61; F=3.252, p=.024). Meanwhile, those subjects who were in a relationship (either married or living with their partner) tended to resort to religious coping to a lesser extent (Positive Brief-RCOPE, =19.29, ARS, X=16.72), than single people (single, widowed, separated or divorced) did (Positive Brief-RCOPE, =21.44, t=2.203, p=.030; ARS, =18.85, t=2.249, p=.026.) Finally, we compared the largest religious groups -Catholics and Christians- and we found that the latter turn more frequently to religious coping when confronted with loneliness ( X=20.45) than Catholics do ( X=17.30; t=2.667, p=.017). On the other hand, traditional christian denominations relate to God more frequently ( X=40.27) than Catholics do ( X=37.35; t=2.345, p=.032). Results reported here significantly attest to the psychometric qualities of the tools utilized. However, the negative coping subscale appears to call for further research. The IMSOL Religious Coping subscale proved to have the best psychometric properties, as regards internal consistency, validity and factorial structure for its use in research protocols dealing with older Mexican adults. Although EBE's Relationship with God subscale resulted in two clearly defined components instead of one, it was also shown to have psychometric qualities that make it useful for research. The analysis of the significant differences that exist in sociodemographic variables shows findings that are consistent with other research carried out in the Mexican context. The results obtained give empirical evidence on the way older Mexican adults live their spiritual life. Although the results described herein cannot be generalized, since they are not based on a random sample they contribute data that is consistent with other research.