Spirituality As A Determinant Of Health: Emerging Policies, Practices, And Systems.

Reimagining public health's future should include explicitly considering spirituality as a social determinant of health that is linked to human goods and is deeply valued by people and their communities. Spirituality includes a sense of ultimate meaning, purpose, transcendence, and connectedness. With that end in mind, we assessed how recommendations recently issued by an expert panel for integrating spiritual factors into public health and medicine are being adopted in current practice in the United States. These recommendations emerged from a systematic review of empirical evidence on spirituality, serious illness, and population health published between 2000 and 2022. For each recommendation, we reviewed current federal, state, and local policies and practices recognizing spiritual factors, and we considered the ways in which they reflected the panel's recommendations. In this article, we highlight opportunities for broader application and scale while also noting the potential harms and benefits associated with incorporating these recommendations in various contexts. This analysis, while respecting the spiritual and religious diversity of the US population, identifies promising approaches for strengthening US public health by integrating spiritual considerations to inform person- and community-centered policy and practice.

First Decade of Supportive Services for Veteran Families Program and Homelessness, 2012-2022.

As homelessness remains an urgent public health crisis in the United States, specific programs in the US Department of Veterans Affairs (VA) system may serve as a roadmap for addressing it. We examine lessons learned from the first decade (2012-2022) of the Supportive Services for Veteran Families (SSVF) program, a cornerstone in the VA continuum of homeless services aimed at both preventing homelessness among those at risk and providing rapid rehousing for veterans and their families who are currently experiencing homelessness. Drawing on information from annual reports and other relevant literature, we have identified 3 themes of SSVF that emerged as features to comprehensively deliver support for homeless veterans and their families: (1) responsiveness and flexibility, (2) coordination and integration, and (3) social resource engagement. Using these strategies, SSVF reached nearly three quarters of a million veterans and their families in its first decade, thereby becoming one of the VA's most substantial programmatic efforts designed to address homelessness. We discuss how each feature might apply to addressing homelessness in the general population as well as future research directions. (Am J Public Health. 2024;114(6):610-618. https://doi.org/10.2105/AJPH.2024.307625).

Hope in adolescence and subsequent health and well-being in adulthood: An outcome-wide longitudinal study.

BACKGROUND: A sense of hopelessness is rising at alarming levels among adolescents in the United States. There is urgent need to understand the potential implications of being hopeful on adolescents' future health and wellbeing. METHODS: This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,038, mean age at baseline = 15 years) to prospectively examine the relationship between baseline hope and a wide range of outcomes 12 years later. Thirty-eight outcomes were examined in the domains of physical health, health behavior, mental health, psychological well-being, social factors, and civic and prosocial behavior. Regression models were used to regress each outcome on baseline hope separately. Models controlled for a wide range of factors as well as prior values of the exposure (hope) and outcomes. RESULTS: Having hope for the future in adolescence was associated with improvements in 11 subsequent outcomes after Bonferonni correction, including higher cognition and self-rated health, less physical inactivity, fewer depressive symptoms, lower perceived stress, and improvement on a number of psychological and social factors including greater happiness, more satisfaction with parenting, and increased voting and volunteering in adulthood. There were also a number of associations that were close to the null, which are equally important to explore and understand. IMPLICATIONS: The results of the study may have important implications for hope-based efforts and programs aimed at improving the lives of young people and promoting their current and future well-being.

Spirituality in Serious Illness and Health.

Importance: Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. Objective: To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. Evidence Review: Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. Findings: Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. Conclusions and Relevance: This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.

Forgiveness of others and subsequent health and well-being in mid-life: a longitudinal study on female nurses.

BACKGROUND: Forgiveness is a concept of growing interest within psychology and of potential relevance to public health. While there has been increasing evidence suggesting positive associations between forgiveness of others and a range of psychosocial well-being and mental health outcomes, its associations with health behaviors and physical health are less clear. METHODS: This study used longitudinal data from the Nurses' Health Study II (2008 Trauma Exposure and Post-traumatic Stress Supplementary Survey to 2015 questionnaire wave, N = 54,703), to conduct an outcome-wide analysis among a cohort of female nurses in the United States (age range: 43-64 years). The study prospectively examines the association between spiritually motivated forgiveness of others and a number of of subsequent psychosocial well-being, mental health, health behavior, and physical health outcomes in midlife. A set of linear, logistic, and Poisson regression models were used to regress each outcome on forgiveness in separate models. Sociodemographic factors, prior religious service attendance, and prior values of all outcome variables were controlled for wherever data were available. To account for multiple testing, we performed Bonferroni correction. RESULTS: Forgiveness was associated with subsequent improved psychosocial well-being and reduced psychological distress outcomes in a monotonic pattern. For instance, the top versus bottom level of forgiveness was associated with substantially higher levels of subsequent positive affect (ß = 0.18, 95% CI: 0.15, 0.21) and social integration (ß = 0.15, 95% CI: 0.13, 0.17), and was inversely associated with several indicators of subsequent psychological distress such as depressive symptoms (ß = - 0.16, 95% CI: - 0.19, - 0.14). However, in this sample, there was little evidence that forgiveness was associated with health behaviors or physical health outcomes. DISCUSSION: This study suggests that forgiveness may be a health asset for promoting population mental health and psychosocial well-being, and moreover may also be understood as a good in itself. Further investigation on the dynamics between forgiveness and physical health is warranted to explore the discrepancy between the results here and some past research.

Spiritually Motivated Self-Forgiveness and Divine Forgiveness, and Subsequent Health and Well-Being Among Middle-Aged Female Nurses: An Outcome-Wide Longitudinal Approach.

Background: Interest in the relationship between forgiveness and health is steadily growing across disciplines within the research community. While there are multiple forms of forgiveness, past research has focused principally on studying forgiveness of others, whereas longitudinal evidence on the associations between other forms of forgiveness and health remains scarce. Methods: Using longitudinal data from the Nurses' Health Study II (from the 2008 Trauma Exposure and Post-traumatic Stress Supplementary Survey to 2015 questionnaire wave), this study employed an outcome-wide analytic approach to prospectively examine the association between two forms of religiously or spiritually motivated forgiveness, namely, self-forgiveness and divine forgiveness, and a wide array of subsequent psychosocial well-being, mental health, health behavior, and physical health outcomes among middle-aged female nurses (N = 54,703 for self-forgiveness; N = 51,661 for divine forgiveness). All models controlled for sociodemographic factors, prior religious service attendance, and prior values of all outcome variables wherever data were available. Bonferroni correction was used to account for multiple testing. Results: Self-forgiveness was strongly associated with greater psychosocial well-being (e.g., for top vs. bottom level of self-forgiveness, ß = 0.23, 95% CI: 0.20, 0.25 for positive affect) and lower psychological distress (e.g., ß = -0.21, 95% CI: -0.23, -0.18 for depressive symptoms). To a lesser extent, divine forgiveness was also associated with higher levels of psychological well-being and lower psychological distress. For both forgiveness types, there was little evidence of association with physical health or health behavior outcomes, though possible marginal evidence for an association of self-forgiveness with increased mortality. Discussion: This study provides novel evidence that religiously or spiritually motivated self-forgiveness and divine forgiveness are both positively related to several indicators of psychosocial well-being and inversely associated with psychological distress outcomes, whereas the associations with physical health and health behaviors are less clear. Further longitudinal investigation of the dynamics between these types of forgiveness and health and well-being is warranted.

Measuring coordination between women's self-help groups and local health systems in rural India: a social network analysis.

OBJECTIVES: To assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India. DESIGN: A pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups. SETTING: The study was conducted in 18 villages located in three districts in Uttar Pradesh, India. INTERVENTION: To improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation. PARTICIPANTS: A purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders). MAIN OUTCOME MEASURES: Social network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels. RESULTS: The health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members. CONCLUSIONS: The creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

A picture of Indian adolescent mental health: an analysis from three urban secondary schools.

Purpose Mental health disorders are a pressing issue among adolescents around the world, including in India. A better understanding of the factors related to poor mental health will allow for more effective and targeted interventions for Indian adolescents. Methods The Indian Adolescent Health Questionnaire (IAHQ), a validated questionnaire designed specifically for use in schools, was administered to approximately 1500 secondary students in three private urban Indian schools in 2012. The Strengths and Difficulties Questionnaire (SDQ) module assessed mental health. Linear regression was used to predict SDQ scores. The biopsychosocial framework was used as an organizing framework to understand how each explanatory variable in the final model might impact the SDQ score. Results One thousand four hundred and eight students returned IAHQ surveys (93.9% response rate); 1102 students completed questions for inclusion in the regression model (78.3% inclusion rate). Statistically significant (p < 0.05) independent variables associated with SDQ scores were gender, level of overall health, negative peer pressure, insults from peers, kindness of peers, feeling safe at home, at school, or with friends, and grades. Discussion Schools have a role to play in improving adolescent mental health. Many of the significant variables in our study can be addressed in the school environment through school-wide, long-term programs utilizing teachers and lay counselors. The IAHQ and SDQ can be used by schools to identify factors that contribute to poor mental health among students and then develop targeted programs to support improved mental health.

Development and validation of the Indian Adolescent Health Questionnaire.

The period of adolescence is a critical time of development. There is an urgent need to better assess adolescent health worldwide, particularly in India, a country with the world's largest adolescent population. Validated screening tools are needed to evaluate health-related risks and behaviors in this growing demographic. We developed, validated and administered a school-based health assessment, the Indian Adolescent Health Questionnaire, which can be used as a comprehensive health-screening tool among Indian adolescents in secondary school.