Marilyn Baetz

Clinical Implications of Research on Religion, Spirituality, and Mental Health

The relation between religion and (or) spirituality (RS), and mental health has shown generally positive associations; however, it is a complex and often emotion-laden field of study. We attempt to examine potential mechanisms that have been proposed as mediators for the RS and mental health relation. We also examine more philosophical areas including patient and physician opinions about inclusion of RS in patient care, and ethical issues that may arise. We review suggested guidelines for sensitive patient inquiry, and opportunities and challenges for education of psychiatrists and trainees. We also study practical ways to incorporate psychospiritual interventions into patient treatment, with specific reference to more common spiritual issues such as forgiveness, gratitude, and altruism.

How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population.

Objective: Research into risk and protective factors for psychiatric disorders may help reduce the burden of these conditions. Spirituality and religion are 2 such factors, but research remains limited. Using a representative national sample of respondents, this study examines the relation between worship frequency and the importance of spiritual values and DSM-IV psychiatric and substance use disorders. Method: In 2002, the Canadian Community Health Survey obtained data from about 37 000 individuals aged 15 years or older. While controlling for demographic characteristics, we determined odds ratios for lifetime, 1-year, and past psychiatric disorders, with worship frequency and spiritual values as predictors. Results: Higher worship frequency was associated with lower odds of psychiatric disorders. In contrast, those who considered higher spiritual values important (in a search for meaning, in giving strength, and in understanding lifes difficulties) had higher odds of most psychiatric disorders. Conclusion: This study confirms an association between higher worship frequency and lower odds of depression and it expands that finding to other psychiatric disorders. The association between spiritual values and mood, anxiety, and addictive disorders is complex and may reflect the use of spirituality to reframe life difficulties, including mental disorders.

The association between spiritual and religious involvement and depressive symptoms in a Canadian population.

Data from a large epidemiologic survey were examined to determine the relationship of religious practice (worship service attendance), spiritual and religious self-perception, and importance (salience) to depressive symptoms. Data were obtained from 70,884 respondents older than 15 years from the Canadian National Population Health Survey (Wave II, 1996–1997). Logistic regression was used to examine the relationship of the religious/spiritual variables to depressive symptoms while controlling for demographic, social, and health variables. More frequent worship service attendees had significantly fewer depressive symptoms. In contrast, those who stated spiritual values or faith were important or perceived themselves to be spiritual/religious had higher levels of depressive symptoms, even after controlling for potential mediating and confounding factors. It is evident that spirituality/religion has an important effect on depressive symptoms, but this study underscores the complexity of this relationship. Longitudinal studies are needed to help elucidate mechanisms and the order and direction of effects.

Efficacy of Divalproex Sodium in Patients with Panic Disorder and Mood Instability Who Have Not Responded to Conventional Therapy

Objective: To determine the efficacy of divalproex sodium in the treatment of psychiatric outpatients with treatment refractory panic disorder and comorbid mood instability. Method: This was an 8-week, open-trial, flexible-dose outcome study conducted at a tertiary care referral centre. Individuals with panic disorder who failed to respond to a cognitive behavioural treatment program and standard antipanic medication, who also suffered from mood instability, were chosen to participate in the study. Divalproex sodium was administered at a flexible dose to reach serum levels of 300 to 600 umol/L (45 to 90 ug/ml) unless limited by tolerance. Patients were rated by self- and rater-administered questionnaires that measured the number of panic attacks, the degree of agoraphobic avoidance, the levels of depression, anxiety, and mood swings, and the perceived sense of well being. Results: Thirteen subjects were enrolled in the study, and 10 subjects completed it. Two dropped out early because of the medications side effects, and 1 was lost within the first month of follow-up. All 10 subjects showed significant improvement in depressive and anxiety symptoms and mood instability. There was also a statistically and clinically significant improvement in panic attacks and measures of quality of life. Conclusions: These findings suggest that divalproex sodium is useful in the treatment of patients with panic disorder and concomitant mood instability, who are refractory to conventional treatment. Double-blind trials will be required to verify these findings.

Canadian Psychiatric Inpatient Religious Commitment: An Association With Mental Health

Background: Research indicates that religion may have a positive effect on coping and possibly enhance clinical outcomes. This study aims to de ter mine the level of religious interest of psychiatric in patients and to assess whether religious commitment has an impact on selected outcome variables. Methods: There were 88 consecutive adult patients (50% men) who were admitted to a Canadian tertiary care psychiatry in patient unit and were in ter viewed about their religious beliefs and practices. Patients with a Beck Depression score of 12 or more were included for out come analysis. Results: A total of 59% believed in a God who re wards and punishes, 27% had a high frequency of worship at ten dance, and 35% prayed once or more daily. More frequent worship at tenders had less severe depressive symptoms, shorter cur rent length of stay, higher sat is faction with life, and lower rates of cur rent and life time al cohol abuse (P < 0.05), when com pared with those with less frequent or no worship at ten dance. In contrast, private spirituality was as sociated with lower depressive symptoms and cur rent al co hol use only (P < 0.05), and prayer frequency had no significant as sociations. Discussion: This study indicates that certain religious practices may protect against se verity of symptoms, hospital use, and enhance life sat is faction among psychiatric in patients. This is the first known Canadian study that examines religious commitment among psychiatric in patients.

Chronic pain and fatigue: Associations with religion and spirituality.

BACKGROUND Conditions with chronic, non-life-threatening pain and fatigue remain a challenge to treat, and are associated with high health care use. Understanding psychological and psychosocial contributing and coping factors, and working with patients to modify them, is one goal of management. An individuals spirituality and/or religion may be one such factor that can influence the experience of chronic pain or fatigue. METHODS The Canadian Community Health Survey (2002) obtained data from 37,000 individuals 15 years of age or older. From these data, four conditions with chronic pain and fatigue were analyzed together -- fibromyalgia, back pain, migraine headaches and chronic fatigue syndrome. Additional data from the survey were used to determine how religion and spirituality affect psychological well-being, as well as the use of various coping methods. RESULTS Religious persons were less likely to have chronic pain and fatigue, while those who were spiritual but not affiliated with regular worship attendance were more likely to have those conditions. Individuals with chronic pain and fatigue were more likely to use prayer and seek spiritual support as a coping method than the general population. Furthermore, chronic pain and fatigue sufferers who were both religious and spiritual were more likely to have better psychological well-being and use positive coping strategies. INTERPRETATION Consideration of an individuals spirituality and/or religion, and how it may be used in coping may be an additional component to the overall management of chronic pain and fatigue.

Mood swings in patients with anxiety disorders compared with normal controls

BACKGROUND About 70-80% of patients with anxiety syndromes suffer from depression. Mood variability including hypomania, cyclothymia and hyperthymia have been described in 40-50% of patients with depression. There is an emerging literature that such variability could also characterize anxiety disorders. The aim of this study was to visually document and quantify mood variability in patients with anxiety disorders. METHODS Twenty patients with anxiety disorders and 22 normal control subjects completed two visual analogue scales (VAS) on depressed mood and high mood, twice per day for 14 days. The Beck Depression Inventory and the Altman Self-Rating Mood Scale were used for concurrent validity. RESULTS On the VAS, patients showed higher levels of depressed and high moods, and greater mood variability than the controls. Variability of depressed and high moods was highly correlated. LIMITATIONS This was a relatively small sample from a single center. Patients were selected by convenience and were under treatment. The control subjects were not interviewed. CONCLUSIONS Subsyndromal mood variability in patients with anxiety disorders can be visually depicted and quantified. The mood variability of patients with anxiety disorders who also complain of mood swings is greater than the mood fluctuations described by normal subjects.

Antenatal depression in socially high-risk women in Canada

Background: Antenatal depression is potentially deleterious to the mother and baby. Canadian Aboriginal women have an increased risk for living in poverty, family violence, and substance use; however, little is known about antenatal depression in this group. The aim of this study was to determine the prevalence and correlates of depression in socially high-risk, mostly Aboriginal pregnant women. Methods: Women (Aboriginal and non-Aboriginal), in two prenatal outreach programmes were approached and depressive symptoms between the two groups were compared, using the Edinburgh Postnatal Depression Scale (EPDS). Results: Sixty per cent (n = 402) of potential participants were recruited for the study. The prevalence of depression was 29.5% (n = 402). Depression was associated with a history of depression, mood swings, increased stressors, current smoker, and lack of social support. Aboriginal women were more likely to be depressed, but this was not significantly higher than non-Aboriginal women; however, they did experience significantly more self-harm thoughts. Exercise was a significant mediator for depression. Conclusion: The prevalence of antenatal depression confirms rates in other high-risk, ethnic minority groups of women. A previous history of depression and mood problems were associated with depression, thus prenatal care should include a careful mental health assessment. On a positive note, the present study suggests that exercise may mediate antenatal depression.

Religious Attendance, Spirituality, and Major Depression in Canada: A 14-Year Follow-up Study

Objective: Although there have been numerous studies on the relation of religion or spirituality and major depression, few used a longitudinal, nationally representative sample. Our study sought to examine the effect of religious attendance, self-declared importance of spiritual values, and self-identification as a spiritual person on major depression. Method: Data coming from 8 waves (1994 to 2008) of the longitudinal Canadian National Population Health Survey were used. People (n = 12 583) who were not depressed at baseline (1994) were followed during 14 years. Depression at each cycle was assessed using the Composite International Interview—Short Form for Major Depression. Weibull proportional hazards regression was used to model longitudinal risk of depression, with religious attendance or spirituality as a predictor. Results: At baseline, monthly religious attenders tended to be older, female, and married, compared with occasional and nonattenders. The Weibull regression model revealed a 22% lower risk of depression for monthly attenders (hazard ratio 0.78, 95% CI 0.63 to 0.95), compared with nonattenders, after controlling for age, household income, family and personal history of depression, marital status, education, and perceived social support. Neither self-reported importance of spiritual values nor identification as a spiritual person was related to major depressive episodes. Conclusion: Attending religious services at least monthly has a protective effect against major depression.

The effect of religiosity and spirituality on psychological well-being among forensic psychiatric patients in Canada

All patients in a multilevel secure forensic psychiatric centre were surveyed to determine the relationship between religiosity and spirituality, and depression, anxiety and satisfaction with life. Of the whole population, 90% responded; 5% were females and 47% aboriginal. The mean anxiety and depression scores using the Beck anxiety and depression inventories were low at 11.4 and 17, respectively. Weekly attendance at worship and the private intrinsic religiosity scores were higher than comparable samples of Canadians and general mental-health inpatients. Satisfaction with life score was positively correlated with all religiosity and spirituality variables. There was an inverse relationship between the Existential Well-Being scale and depression scores. The Existential Well-Being scale also correlated positively with satisfaction with life. Weekly worship attendance was inversely correlated with depression scores. These results point to some important differences between this patient population and the general population.