Spirituality/Religion & Health Research:
A Few Introductory Points
Chaplain John W. Ehman
Penn Presbyterian Medical Center
Philadelphia, PA
6/3/14
Number of Medline-Indexed English Articles by Year, with
Keywords: RELIGION and SPIRITUALITY
11
10
20
20
09
08
20
07
20
06
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05
20
20
04
03
20
02
20
01
20
00
20
20
99
98
[ Includes the variations: religious, religiosity, religiousness, and spiritual ]
19
97
19
96
19
95
19
19
94
93
19
92
19
91
19
90
19
19
89
88
19
87
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86
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85
19
19
84
83
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82
19
81
19
19
19
80
2200
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1800
1600
1400
1200
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600
400
200
0
John Ehman, 2012
Number of Medline-Indexed English Articles by Year, with
Keywords: RELIGION and SPIRITUALITY
11
10
20
20
09
08
20
07
20
06
20
05
20
20
04
03
20
02
20
01
20
00
20
20
99
98
[ Includes the variations: religious, religiosity, religiousness, and spiritual ]
19
97
19
96
19
95
19
19
94
93
19
92
19
91
19
90
19
19
89
88
19
87
19
86
19
85
19
19
84
83
19
82
19
81
19
19
19
80
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0
John Ehman, 2012
Number of Medline-Indexed English
Articles by Year, with Keywords
SPIRITUAL or SPIRITUALITY
800
700
600
500
400
300
200
100
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
John Ehman, 6/30/09
Number of Medline-Indexed English
Articles by Year, with Keywords
SPIRITUAL or SPIRITUALITY
800
700
600
500
400
300
200
100
20
06
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
John Ehman, 6/30/09
Among the factors in the mid-1990s affecting
the study of spirituality/religion & health:
• Greater attention paid to religious values, beliefs, and
practices as key aspects of patient diversity (e.g., new
emphasis by the Joint Commission)
• Growing sense among health care providers and researchers
of religion’s role in health-pertinent behaviors and health
care decision-making -- important for “knowing your patient”
• Research begins accumulating significant data that patients’
spirituality/religiosity may be important to medical outcomes
and thus to the process of “healing your patient”
Two things to keep in mind about the
modern field of Spirituality & Health:
1) It is still nascent in the current form
2) It has somewhat fluid terminology
In the health care literature, religion is associated
with institutional systems of beliefs and practices,
whereas spirituality is associated with personal
experiences and an individual quest for meaning.
Spirituality is generally seen as a broad concept,
going beyond the “limits” of religion.
The Two Most Common Views of the
Relationship of Spirituality to Religion
in the Current Health Care Literature
Spirituality
Spirituality
Religion
Religion
A New and Important Definition of Spirituality:
‘‘Spirituality is a dynamic and intrinsic aspect of
humanity through which persons seek ultimate
meaning, purpose, and transcendence, and
experience relationship to self, family, others,
community, society, nature, and the significant
or sacred. Spirituality is expressed through
beliefs, values, traditions, and practices.’’
— p. 646 of Puchalski, C. M., et al., "Improving the Spiritual Dimension of
Whole Person Care: Reaching National and International Consensus,"
Journal of Palliative Medicine 17, no. 6 (June 2014): 642-656
While the broad concept of spirituality holds
strong appeal in the practice of health care and
is prominent in the literature, religion tends to
be favored as the focus of research because
the concept highlights factors that can be more
easily specified, observed, and quantified.
While the broad concept of spirituality holds
strong appeal in the practice of health care and
is prominent in the literature, religion tends to
be favored as the focus of research because
the concept highlights factors that can be more
easily specified, observed, and quantified.
However, a growing problem with religionfocused research is that Americans are
increasingly less likely to see themselves
and fit themselves in traditional categories
of religion.
Americans and Religious Affiliation
A 2012 Pew Research Center survey found that one-fifth of
the U.S. public – and a third of adults under 30 years old –
now describe themselves as “religiously unaffiliated.” This
is partly due to an increasing trend to drop all sense of
connection to a specific religious tradition when there is not
an active social involvement in a congregation.
Moreover, 18% of American adults describe themselves
now as “spiritual but not religious.”
Pew Research Center’s Forum on Religion & Public Life,
"'Nones' on the Rise…,” report issued October 9, 2012
Polls re: Religion/Spirituality in the US
• 90-96% of adults in the US say they “believe in God”
• over 40% say they attend religious services regularly, usually
at least once a week
• 50-75% say religion is “very important” in their lives
• 90% say they pray, and most (54-75%) say they pray at least
once a day
• over 80% say that “God answers prayers”
• 79-84% say they believe in “miracles” and that “God answers
prayers for healing someone with an incurable illness”
--These percentages are summary characterizations of numerous
national surveys showing fairly consistent results across time
Religion-focused research remains the driving force
in the overall field of “Spirituality & Health” because
it is conducive to drawing practical connections
with health issues.
For example:
• fewer dangerous behaviors (e.g., less substance abuse,
unsafe sex, or neglect of health screenings)
• less suicide and generally greater aversion to suicide
• less depression and faster recovery from depression
• greater sense of meaning/purpose in life, hopefulness
--See: Koenig, H.G, et al., Handbook of Religion and Health, 2001/2011;
and Koenig, H.G., Testimony to the US House of Representatives
Subcommittee on Research and Science Education, 9/18/08
• lower rates of coronary artery disease
• lower cardiovascular reactivity
• greater heart rate variability
• lower blood pressure and generally less hypertension
• tendency for better outcomes after cardiac surgery
• better endocrine function
• better immune function
• lower cancer rate and better outcomes
• lower mortality and longer survival generally
--ibid.
Theoretical Model of How Religion Affects Physical Health
--adapted from Koenig, et al., Handbook of Religion and Health, 2001
Stress
Hormones
R
E
L
I
G
I
O
N
Mental
Health
Social
Support
Health
Behaviors
Religion also affects Childhood Training,
Adult Decisions, and Values & Character;
which then in turn affect mental health,
social support, and health behaviors.
Infection
Cancer
Immune
System
Autonomic
Nervous
System
Disease Detection
and Treatment
Compliance
High Risk
Behaviors
(smoking, drugs)
Heart
Disease
Hypertension
Stroke
Stomach
& Bowel
Liver
& Lung
Accidents
& STDs
Recent health care literature largely
addresses religion/spirituality as…
… a ground for “religious” social support
… a value basis for personal meaning-making
(and therefore understanding illness and
coping with crises) and decision-making
… a context for behavior that can influence the
way the body works (e.g., meditation that
can affect physiological reactions to stress)