Alexander Moreira-Almeida

Religiousness and mental health: a review

OBJETIVO: A relacao entre religiosidade e saude mental tem sido uma perene fonte de controversias. O presente artigo revisa a evidencia cientifica disponivel sobre a relacao entre religiao e saude mental. METODO: Os autores apresentam os principais estudos e as conclusoes de uma revisao sistematica abrangente dos estudos sobre a relacao religiao-saude mental. Utilizando-se de varias bases de dados, a revisao identificou 850 artigos publicados ao longo do seculo XX. O presente artigo tambem inclui uma breve contextualizacao historica e metodologica, alem de uma atualizacao com artigos publicados apos 2000 e a descricao de pesquisas conduzidas no Brasil. DISCUSSAO: A ampla maioria dos estudos de boa qualidade encontrou que maiores niveis de envolvimento religioso estao associados positivamente a indicadores de bem estar psicologico (satisfacao com a vida, felicidade, afeto positivo e moral mais elevado) e a menos depressao, pensamentos e comportamentos suicidas, uso/abuso de alcool/drogas. Habitualmente, o impacto positivo do envolvimento religioso na saude mental e mais intenso entre pessoas sob estresse (idosos, e aqueles com deficiencias e doencas clinicas). Mecanismos teoricos da conexao religiosidade-saude mental e as implicacoes clinicas destes achados sao discutidos. CONCLUSOES: Ha evidencia suficiente disponivel para se afirmar que o envolvimento religioso habitualmente esta associado a melhor saude mental. Atualmente, duas areas necessitam de maior investimento: compreensao dos fatores mediadores desta associacao e a aplicacao deste conhecimento na pratica clinica.

Spirituality and Resilience in Trauma Victims

The way people process stressors is critical in determining whether or not trauma will be experienced. Some clinical and neuroimaging findings suggest that posttraumatic stress disorder patients experience difficulty in synthesizing the traumatic experience in a comprehensive narrative. Religiousness and spirituality are strongly based on a personal quest for understanding of questions about life and meaning. Building narratives based on healthy perspectives may facilitate the integration of traumatic sensorial fragments in a new cognitive synthesis, thus working to decrease post-traumatic symptoms. Given the potential effects of spiritual and religious beliefs on coping with traumatic events, the study of the role of spirituality in fostering resilience in trauma survivors may advance our understanding of human adaptation to trauma.

Validation of the Duke Religion Index: DUREL (Portuguese version).

The purpose of the current study was to examine the psychometric properties of the Portuguese version of the Duke Religion Index (PDUREL) in a community setting. PDUREL was translated and adapted for administration to 383 individuals from a population-based study of low-income community-dwelling adults. The PDUREL intrinsic subscale and total scores demonstrated high internal consistency (alphas ranging from 0.733 for the total scale score to 0.758 for the intrinsic subscale). Correlations among the DUREL subscales were also examined for evidence of discriminant validity. Correlations were ranging from 0.36 to 0.46, indicating significant overlap between the scales without marked redundancy. PDUREL is a reliable and valid scale. The availability of a comprehensive, but brief measure of religiousness can help to study the role of religiousness in health by researchers from countries that speak the Portuguese language.

Envolvimento religioso e fatores sociodemográficos: resultados de um levantamento nacional no Brasil

CONTEXTO: As relacoes entre envolvimento religioso e saude tem sido objeto de crescente interesse, mas ha carencia de estudos fora dos Estados Unidos e da Europa. OBJETIVOS: O presente estudo descreve o envolvimento religioso na populacao brasileira e sua relacao com variaveis sociodemograficas. METODOS: Numa amostra probabilistica da populacao brasileira (n = 3.007), variaveis sociodemograficas e de envolvimento religioso foram avaliadas. RESULTADOS: Cinco por cento dos brasileiros declararam nao ter religiao, 83% consideraram religiao muito importante para sua vida e 37% frequentavam um servico religioso pelo menos uma vez por semana. As filiacoes religiosas mais frequentes foram Catolicismo (68%), Protestante/Evangelica (23%) e Espiritismo Kardecista (2,5%). Dez por cento referiram frequentar mais de uma religiao. De modo semelhante a estudos em outros paises, maior idade e sexo feminino se associaram a maiores niveis de religiosidade subjetiva e organizacional, mesmo apos o controle para outras variaveis sociodemograficas. Entretanto, nivel educacional, renda e raca negra nao se associaram de modo independente a indicadores de religiosidade. CONCLUSAO: Este estudo mostra altos niveis de religiosidade entre os brasileiros e sugere que religiosidade, em diferentes culturas, pode relacionar-se de modo diferente com outras variaveis. Para uma melhor compreensao da influencia da religiosidade na saude, e necessario expandir esse tipo de estudo para outras culturas.

Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.

OBJECTIVES To evaluate the relationship between religiousness and mental health, hospitalization, pain, disability and quality of life in older adults from an outpatient rehabilitation setting in Sao Paulo, Brazil. DESIGN Cross-sectional study. SUBJECTS/PATIENTS A total of 110 patients aged 60 years or older were interviewed during attendance at an outpatient rehabilitation service. METHODS Researchers administered a standardized questionnaire that assessed socio-demographic data, religiousness, self-reported quality of life, anxiety, physical activity limitation, depression, pain and cognition. Predictors were included in each model analysis, and a backward conditional method was used for variable selection using logistic regression (categorical outcomes) or linear regression (continuous outcomes). RESULTS Thirty-one patients (28.2%) fulfilled criteria for significant depressive symptoms, 27 (24.5%) for anxiety, and 10 (9.6%) for cognitive impairment. Pain was present in 89 (80.7%) patients. Limited depressive symptoms (as assessed by the Geriatric Depression Scale), and greater self-reported quality of life were related to greater self-reported religiousness, as were scores on the Mini-Mental State Examination (less cognitive impairment), and lower ratings of pain. CONCLUSION Religiousness is related to significantly less depressive symptoms, better quality of life, less cognitive impairment, and less perceived pain. Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings.

Police officers under attack: Resilience implications of an fMRI study

OBJECTIVE Crime is now a top-priority public-health issue in many urban areas. Sao Paulos state police force was the target of gunfire attack on an unprecedented scale. Several officers were killed or wounded, and many more were affected by psychological trauma. We investigated the brain activity underlying trauma, the coping effect of psychotherapy, and resilience in a highly homogenous sample that experienced the same traumatic event. The design applied was a between-group comparison of cerebral blood-oxygenation-level-dependent signals and symptom scores of police officers with and without partial Posttraumatic Stress Disorder (pPTSD). METHOD We used functional magnetic resonance imaging (fMRI) to investigate the retrieval of traumatic memories of 36 volunteers divided in three groups: (1) pPTSD policemen submitted to psychotherapy; (2) pPTSD policemen on the wait list; and (3) symptom-free (resilient) policemen. All participants were given a baseline fMRI scan and a follow-up scan some 40 days later. Not given psychotherapy, groups 2 and 3 were controls. RESULTS Group 1 showed 37% fewer PTSD symptoms post-psychotherapy and their scores and neural expressions were comparable to Group 3 resilient policemen. A marked increased in medial prefrontal cortex (mPFC) activity was concomitant with decreased amygdala activity during traumatic memory retrieval in both resilient and pPTSD participants (after psychotherapy) and these findings were associated with symptom attenuation. CONCLUSIONS Our results provide neurophysiological evidence of resilience in a high-risk group for PTSD. Psychotherapy may help to build narratives and resilient integrated translations of fragmented traumatic memories via mPFC, and thus weaken their sensory content while strengthening them cognitively.

Clinical implications of spirituality to mental health: review of evidence and practical guidelines

OBJECTIVE Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. METHODS PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. RESULTS The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. CONCLUSIONS This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.

History of ‘Spiritist madness’ in Brazil

Spiritism is widely accepted in Brazil and influences psychiatric practice, especially through religious-oriented hospitals. However, during the first half of the twentieth century it was considered an important cause of mental illness. This paper first reviews opinions on ‘Spiritist madness’, written by the most eminent psychiatrists of the time, and then discusses the epistemological factors that have contributed to the conflict between medicine and Spiritism. We critically examine the appropriateness of the methods used in the debates, and how this has led to inferences about associations and causal relationships.

Comparison of Brazilian Spiritist mediumship and dissociative identity disorder

We studied the similarities and differences between Brazilian Spiritistic mediums and North American dissociative identity disorder (DID) patients. Twenty-four mediums selected among different Spiritistic organizations in São Paulo, Brazil, were interviewed using the Dissociative Disorder Interview Schedule, and their responses were compared with those of DID patients described in the literature. The results from Spiritistic mediums were similar to published data on DID patients only with respect to female prevalence and high frequency of Schneiderian first-rank symptoms. As compared with individuals with DID, the mediums differed in having better social adjustment, lower prevalence of mental disorders, lower use of mental health services, no use of antipsychotics, and lower prevalence of histories of physical or sexual childhood abuse, sleepwalking, secondary features of DID, and symptoms of borderline personality. Thus, mediumship differed from DID in having better mental health and social adjustment, and a different clinical profile.

Dissociative and Psychotic Experiences in Brazilian Spiritist Mediums

Spiritism is a French offshoot of the spiritualistic movement that developed in the 19th century. In Brazil it is the fourth largest religion and its practices are deeply connected to mediumistic activity. This is not reimbursed but considered charitable voluntary work [8]. We examined the socio-demographic profile, social adjustment and mental health in Spiritist mediums as well as the clinical and socio-demographic characteristics that help distinguish the dissociative and psychotic experiences of a pathological from a non-pathological character. One hundred and fifteen mediums were randomly selected from different Kardecist Spiritist centers in São Paulo, Brazil. In the early phase of the study, all participants signed a consent form and completed socio-demographic and mediumistic activity questionnaires, the Self-Report Psychiatric Screening Questionnaire (SRQ) [9] as well as the Social Adjustment Scale (SAS) [10]. Those mediums identified by the SRQ as probably having MD (n = 12) and a control group (12 subjects randomly selected among the remaining 103 mediums) were interviewed using the Disso-ciative Disorders Interview Schedule [11] and the Schedules for Clinical Assessment in Neuropsychiatry [12]. The types of mediumship were coded according to the Spirit-ist classification: embodiment/incorporation (the medium says that the spirit controls his/her whole body), psychophony (a feeling that the mediums speech has an external origin, considered to be a disembodied spirit), hearing (hear the spirits), seeing (seeing the spirits) and psychography (the spirit writes through the mediums hand) [13]. The t test for independent samples, ␹ 2 for categorical variables and the Pearson test for correlation coefficients were used. The main results are presented in table 1. The sample had a high educational level, low unemployment rate and was predominantly female; a profile similar to other samples of mediums [14, 15]. The average SAS score was within the range of the general population and better than psychiatric patients [10]. SRQ results suggest a low prevalence of common mental disorders in the sample , lower than in other Brazilian studies using SRQ in non-clinical populations [16, 17]. Unlike patients with dissociative and psychotic disorders [2, 18] , these mediums had not experienced a high prevalence of childhood abuse. Incorporation was linked to better scores of social adjustment and fewer psychiatric symptoms; hearing and psychography were also associated with better social adjustment. Surveys performed over the last decade have shown that dissociative, hallucinatory and purported extrasensory experiences are common in the general population and often not associated with MD …