Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study.

BACKGROUND: Although church attendance has been associated with a reduced risk of mortality, no study has examined the impact of religious struggle with an illness on mortality. OBJECTIVE: To investigate longitudinally the relationship between religious struggle with an illness and mortality. METHODS: A longitudinal cohort study from 1996 to 1997 was conducted to assess positive religious coping and religious struggle, and demographic, physical health, and mental health measures at baseline as control variables. Mortality during the 2-year period was the main outcome measure. Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC. RESULTS: After controlling for the demographic, physical health, and mental health variables, higher religious struggle scores at baseline were predictive of greater risk of mortality (risk ratio [RR] for death, 1.06; 95% confidence interval [CI], 1.01-1.11; chi(2) = 5.89; P =.02). Two spiritual discontent items and 1 demonic reappraisal item from the religious coping measure were predictive of increased risk for mortality: "Wondered whether God had abandoned me" (RR for death, 1.28; 95% CI, 1.07-1.50; chi(2) = 5.22; P =.02), "Questioned God's love for me" (RR for death, 1.22; 95% CI, 1.02-1.43; chi(2) = 3.69; P =.05), and "Decided the devil made this happen" (RR for death, 1.19; 95% CI, 1.05-1.33; chi(2) = 5.84; P =.02). CONCLUSIONS: Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.

Religion in the home in the 1980s and 1990s: a meta-analytic review and conceptual analysis of links between religion, marriage, and parenting.

The authors reviewed 94 studies published in journals since 1980 on religion and marital or parental functioning. Meta-analytic techniques were used to quantify religion-family associations examined in at least 3 studies. Greater religiousness appeared to decrease the risk of divorce and facilitate marital functioning, but the effects were small. Greater Christian conservatism was modestly associated with greater endorsement and use of corporal punishment with preadolescents. Isolated findings suggested that greater parental religiousness relates to more positive parenting and better child adjustment. The scope, meaningfulness, and potential strength of findings were restricted because of reliance on global or single-item measures of religious and family domains. To facilitate more conceptually and methodologically sophisticated research, the authors delineated mechanisms by which the substantive and psychosocial elements of religion could benefit or harm family adjustment.

The many methods of religious coping: development and initial validation of the RCOPE.

The purpose of this study was to develop and validate a new theoretically based measure that would assess the full range of religious coping methods, including potentially helpful and harmful religious expressions. The RCOPE was tested on a large sample of college students who were coping with a significant negative life event. Factor analysis of the RCOPE in the college sample yielded factors largely consistent with the conceptualization and construction of the subscales. Confirmatory factor analysis of the RCOPE in a large sample of hospitalized elderly patients was moderately supportive of the initial factor structure. Results of regression analyses showed that religious coping accounted for significant unique variance in measures of adjustment (stress-related growth, religious outcome, physical health, mental health, and emotional distress) after controlling for the effects of demographics and global religious measures (frequency of prayer, church attendance, and religious salience). Better adjustment was related to a number of coping methods, such as benevolent religious reappraisals, religious forgiveness/purification, and seeking religious support. Poorer adjustment was associated with reappraisals of God's powers, spiritual discontent, and punishing God reappraisals. The results suggest that the RCOPE may be useful to researchers and practitioners interested in a comprehensive assessment of religious coping and in a more complete integration of religious and spiritual dimensions in the process of counseling.

Religious coping with chronic pain.

This study examined the role of religious and nonreligious cognitive-behavioral coping in a sample of 61 chronic pain patients from a midwestern pain clinic. Participants described their chronic pain and indicated their use of religious and nonreligious cognitive-behavioral coping strategies. Results supported a multidimensional conceptualization of religious coping that includes both positive and negative strategies. Positive religious coping strategies were associated significantly with positive affect and religious outcome after statistically controlling for demographic variables. In contrast, measures of negative religious coping strategies were not associated significantly with outcome variables. Several significant associations also were found between nonreligious cognitive-behavioral coping strategies and outcome variables. The results underscore the need for further research concerning the contributions of religious coping in adjustment to chronic pain. Practitioners of applied psychophysiology should assess their chronic pain patients' religious appraisals and religious coping as another important stress management strategy.

The vigil: religion and the search for control in the hospital waiting room.

This study examined how religion is involved in achieving a sense of personal control in a situation that evokes feelings of distress and vulnerability. One hundred and fifty family members, waiting in the hospital while their relative underwent coronary artery bypass surgery, completed a survey about their methods of coping, event-specific outcomes, and adjustment (depression and anxiety). As predicted, religious methods of coping designed to achieve control predicted outcomes and adjustment beyond the effects of non-religious coping measures and traditional general measures of religiousness. A collaborative approach to religious coping, in which the individual shares the responsibility for coping with God, was particularly associated with better outcomes. However, the religious coping measures were also associated with higher self-reported levels of depression and anxiety. Exploratory path analyses suggested that anxiety and depression may be stressors in themselves, eliciting religious coping responses which, in turn, lead to specific outcomes. These findings underscore the practical and empirical value of a closer, more detailed analysis of the roles of religion in coping with uncontrollable life stressors.

Religious coping and health status in medically ill hospitalized older adults.

Associations between specific religious coping (RC) behaviors and health status in medically ill hospitalized older patients were examined and compared with associations between nonreligious coping (NRC) behaviors and health status. The sample consisted of 577 patients age 55 or over consecutively admitted to the general medical inpatient services of Duke University Medical Center (78%) or the Durham VA Medical Center (22%). Information was gathered on 21 types of RC, 11 types of NRC, and 3 global indicators of religious activity (GIRA). Health measures included multiple domains of physical health, depressive symptoms, quality of life, stress-related growth, cooperativeness, and spiritual growth. Demographic factors, education, and admitting hospital were control variables. "Negative" and "positive" types of religious coping were identified. Negative RC behaviors related to poorer physical health, worse quality of life, and greater depression were reappraisals of God as punishing, reappraisals involving demonic forces, pleading for direct intercession, and expression of spiritual discontent. Coping that was self-directed (excluding God's help) or involved expressions reflecting negative attitudes toward God, clergy, or church members were also related to greater depression and poorer quality of life. Positive RC behaviors related to better mental health were reappraisal of God as benevolent, collaboration with God, seeking a connection with God, seeking support from clergy/church members, and giving religious help to others. Of 21 RC behaviors, 16 were positively related to stress-related growth, 15 were related to greater cooperativeness, and 16 were related to greater spiritual growth. These relationships were both more frequent and stronger than those found for NRC behaviors. Certain types of RC are more strongly related to better health status than other RC types. Associations between RC behaviors and mental health status are at least as strong, if not stronger, than those observed with NRC behaviors.

Red flags and religious coping: identifying some religious warning signs among people in crisis.

This study attempts to identify some of the signs of ineffective religious involvement in coping. Drawing from a process/integration model of efficacious coping, three broad types of religious warning signs were defined and 11 subscales were developed. These subscales were administered to a group of Roman Catholic church members and two groups of college undergraduates who had experienced different types of negative life events in the past two years. Statistical analyses were conducted to determine the relationship between these subscales and measures of general mental health and event specific outcome. The theoretical and practical implications of these results are considered.

God and the search for meaning among hospice caregivers.

The purposes of this study were (1) to describe both religious and nonreligious appraisals of caregiving for a terminally ill patient and (2) to explore the relationship between these appraisals with situational outcomes, mental health outcomes, and spiritual health outcomes in the caregivers. Ninety-two caregivers completed a questionnaire consisting of religious and nonreligious appraisals, general and religious outcomes, depression, anxiety, and purpose in life. Caregivers who appraised their situation as part of God's plan or as a means of gaining strength or understanding from God reported positive outcomes while caregivers who viewed their situation as unjust, as unfair punishment from God, or as desertion from God had low scores on mental and spiritual health outcomes. Religious appraisals made a significant and unique contribution to the prediction of situational outcomes and mental and spiritual health outcomes above and beyond the effects of nonreligious appraisals.

A quantitative and qualitative analysis of suicidal preadolescent children and their families.

This study identified a sample of suicidal preadolescent children who also were depressed, aggressive, and socially isolated. The study explored the dimensions of cohesion and control associated with the families of these children. Two hypotheses were suggested: 1) the families have a deficit in emotional bonding and 2) the families have a chaotic disciplinary style. It also seems likely that children learn suicidal behavior through observation of others in their family and social contexts.

Cognitive appraisals in cancer patients.

Coping with cancer was examined using interviews with outpatient subjects in a correlational design. Specific attention was given to the relationships between cognitive appraisals and various aspects of adjustment. Appraisals were selected in accord with Lazarus' (1980) model of coping. The primary appraisal of perceived life threat appeared negatively related to adjustment. The primary appraisal process also appeared to involve multiple, simultaneous appraisals. Several secondary appraisals emerged as correlates of adjustment: perceived personal control, God-control, and chance-control, along with perceived control over emotional reactions. Overall, cognitive appraisals appeared to be modest predictors of adjustment.