David B. Larson

Modeling the Cross-Sectional Relationships Between Religion, Physical Health, Social Support, and Depressive Symptoms

The authors examined models of the relationships between religious activities, physical health, social support, and depressive symptoms in a sample of 4,000 persons age 65 and over. Religious activity was examined first as a single composite construct and then split into three component variables that were examined individually. Religious activity as a single construct was correlated with both social support and good physical health but was unrelated to depression. Split into the three components, model fit was significantly increased. Frequency of church attendance was positively related to physical health and negatively related to depression, but was surprisingly unrelated to social support. Frequent churchgoers were about half as likely to be depressed. Private prayer/Bible reading was negatively correlated with physical health and positively correlated with social support, but unrelated to depression. Religious TV/radio listening was unrelated to social support, negatively related to good physical health, and, unexpectedly, positively associated with depression.

Religion and Coping with Serious Medical Illness

OBJECTIVE: To review and discuss some of the research published in the last several decades that has addressed the role that religion plays in helping patients cope with serious medical illness. DATA SOURCES: Although this is not a systematic review of the literature, it provides a sampling of the studies that have examined the relationship between religious involvement, coping with illness, and health outcomes. This sampling of studies reflects the findings of a much larger systematic review of research (MEDLINE, Current Contents, Psychlit, Soclit, HealthStar, Cancerlit, CINAHL, and others) during the past century that was recently completed by the authors. DATA EXTRACTION: Epidemiologic studies published in the English-language literature were reviewed and discussed. DATA SYNTHESIS: A number of well-designed cross-sectional and prospective studies have examined the relationship between religious beliefs and activities and adaptation to physical illness in patients with general medical conditions, neurologic disorders, heart disease, renal failure, AIDS, and a host of other physical disorders. This review demonstrates the widespread use of religion in coping with medical illness and provides circumstantial evidence for the possible benefits of this lifestyle factor. CONCLUSIONS: When people become physically ill, many rely heavily on religious beliefs and practices to relieve stress, retain a sense of control, and maintain hope and their sense of meaning and purpose in life. Religious involvement appears to enable the sick, particularly those with serious and disabling medical illness, to cope better and experience psychological growth from their negative health experiences, rather than be defeated or overcome by them.

The relationship between religious activities and blood pressure in older adults

Objective: To examine the relationship between religious activities and blood pressure in community-dwelling older adults. Method: Blood pressure and religious activities were assessed in a probability sample of 3,963 persons age sixty-five years or older participating in the Duke EPESE survey. Participants were asked if their doctor had ever informed them that they had high blood pressure and if they were currently taking medication for high blood pressure. After the interview, systolic and diastolic blood pressures were measured following a standardized protocol. Data were available for three waves of the survey (1986, 1989–90, and 1993–94). Analyses were stratified by age (65–74 vs. over 75) and by race (Whites vs. Blacks) and were controlled for age, race, gender, education, physical functioning, body mass index, and, in longitudinal analyses, blood pressure from the previous wave. Results: Cross-sectional analyses revealed small (1–4 mm Hg) but consistent differences in measured systolic and diastolic blood pressures between frequent (once/wk) and infrequent (< once/wk) religious service attenders. Lower blood pressures were also observed among those who frequently prayed or studied the Bible (daily or more often). Blood pressure differences were particularly notable in Black and younger elderly, in whom religious activity at one wave predicted blood pressures three years later. Among participants who both attended religious services and prayed or studied the Bible frequently, the likelihood of having a diastolic blood pressure of 90 mm Hg or higher was 40 percent lower than found in participants who attended religious services infrequently and prayed or studied the Bible infrequently (OR 0.60, 95% CI, 0.48–0.75, p < .0001). Among participants told they had high blood pressure, religiously active persons were more likely to be taking their blood pressure medication; this could not, however, explain the differences in blood pressure observed. While most religious activity was associated with lower blood pressure, those who frequently watched religious TV or listened to religious radio actually had higher blood pressures. Conclusions: Religiously active older adults tend to have lower blood pressures than those who are less active. This applies to attendance at religious services and private religious activities, but not to religious media. Physiological mechanisms are discussed.

Attendance at Religious Services, Interleukin-6, and other Biological Parameters of Immune Function in Older Adults

Objective: First, to examine and explain the relationship between religious service attendance and plasma Interleukin-6 (IL-6) levels, and second, to examine the relationship between religious attendance and other immune-system regulators and inflammatory substances. Methods: During the third in-person interview (1992) of the Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE) project, Duke site, 1718 subjects age sixty-five or over had blood drawn for analysis of immune regulators and inflammatory factors, including IL-6 measurements. IL-6 was examined both as a continuous variable and at a cutoff of 5 pg/ml. Information on attendance at religious services was available from the 1992 interview and two prior interviews (1986 and 1989). Results: Religious attendance was inversely related to high IL-6 levels (> 5 pg/ml), but not to IL-6 measured as a continuous variable. Bivariate analyses revealed that high religious attendance in 1989 predicted a lower proportion of subjects with high IL-6 in 1992 (beta −.10, p = .01). High religious attendance in 1992 also predicted a lower proportion of subjects with high IL-6 levels in 1992 (beta −.14, p = .0005). When age, sex, race, education, chronic illnesses, and physical functioning were controlled, 1989 religious attendance weakened as a predictor of high IL-6 (beta −.07, p = .10), but 1992 religious attendance retained its effect (beta = −.10, p = .02). When religious attenders were compared to non- attenders, they were only about one-half as likely to have IL-6 levels greater than 5 ng/ml (OR 0.58, 95% CI 0.40–0.84, p < .005). Religious attendance was also related to lower levels of the immune-inflammatory markers alpha-2 globulin, fibrin d-dimers, polymorphonuclear leukocytes, and lymphocytes. While controlling for covariates weakened most of these relationships, adjusting analyses for depression and negative life events had little effect. Conclusions: There is a weak relationship between religious attendance and high IL-6 levels that could not be explained by other covariates, depression, or negative life events. This finding provides some support for the hypothesis that older adults who frequently attend religious services have healthier immune systems, although mechanism of effect remains unknown.

Spirituality's Potential Relevance to Physical and Emotional Health: A Brief Review of Quantitative Research

Longitudinal studies of community samples consistently find links between active spiritual/religious involvement and increased chances for living longer, pointing to the relevance of spirituality/religion as a potential health factor. For a large proportion of either medically ill or mental health patients, spirituality/religion may provide coping resources, enhance pain management, improve surgical outcomes, protect against depression, and reduce risk of substance abuse and suicide. However, study findings also show patient spirituality/religion may serve as a source of conflict linked with poorer health outcomes. Whether identifying helps or harms, research elucidates the potential relevance of patients’ spirituality/religion, with potential for collaboration with trained chaplains as part of the healthcare team to provide spiritual support or deal with spiritual distress for particular patient needs.

Religious programs, institutional adjustment, and recidivism among former inmates in prison fellowship programs

This study examines the impact of religious programs on institutional adjustment and recidivism rates in two matched groups of inmates from four adult male prisons in New York State. One group had participated in programs sponsored by Prison Fellowship (PF); the other had no involvement with PF. PF and non-PF inmates are similar on measures of institutional adjustment, as measured by both general and serious prison infractions, and recidivism, as measured by arrests during a one-year follow-up period. However, after controlling for level of involvement in PF-sponsored programs, inmates who were most active in Bible studies were significantly less likely to be rearrested during the follow-up period.

Spirituality in Physical Health and Aging

A variety of research has documented the association between various measures of religion/spirituality and physical health outcomes. The purpose of this paper is to review the literature on this topic. The paper also discusses the mechanisms that are thought to underlie the associations found in the literature. Further, the paper presents several avenues along which future research might proceed in order to advance our understanding of these issues. The paper concludes by making a case for the need for empirical examinations of these issues in countries other than the United States. Particular focus is paid here to religion among older adults in Japan.

Escaping from the crime of inner cities: Church attendance and religious salience among disadvantaged youth

With the theoretical backdrop of social disorganization and “resilient youth” perspectives, we hypothesize that individual religiosity is protective in helping at-risk youths such as those living in poor inner-city areas to escape from drug use and other illegal activities. To test this hypothesis, we draw data from an interview survey of 2,358 youth black males from tracts in poverty in Boston, Chicago, and Philadelphia, conducted in 1979 and 1980. Results from a series of multilevel analyses indicate that church attendance (the frequency of attending religious services) has significant inverse effects on nondrug illegal activities, drug use, and drug selling among disadvantaged youths. Religious salience (the perceived importance of religion in ones life), however, is not significantly linked to reductions in juvenile delinquency. We discuss the implications of our findings, focusing on individual religiosity as a potentially important protective factor for disadvantaged youths.

Editorial: Religion, Spirituality, and Medicine: A Rebuttal to Skeptics

A recent article by Sloan et al. in the Lancet has presented the skeptical side in the scientific debate on the religion-health relationship [1]. The interest in this topic and its relevance to medicine is underscored by the fact over 60 of 126 medical schools in the United States have initiated courses on religion/spirituality, and more are planning to do so. While we agree with Sloan et al. that the

AN ANALYSIS OF RESEARCH ON RELIGIOUS AND SPIRITUAL VARIABLES IN THREE MAJOR MENTAL HEALTH NURSING JOURNALS, 1991-1995

A review of quantitative research studies published between 1991 and 1995 in 3 major mental health nursing journals revealed that approximately 10% (31 of 311) included a measure of religion or spirituality. This percentage (10%) is 3 to 8 times higher than that found in previous reviews of empirical research in psychological and psychiatric journals, suggesting that mental health nursing research is more sensitive to the role of religious-spiritual factors on mental health than research in related disciplines. The results are discussed in the context of the history and philosophy of nursing and in comparison to related disciplines. Methodological aspects of the research, especially the importance of multiple measures, are discussed, as are other salient findings.