Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice
2001; Elsevier BV; Volume: 76; Issue: 12 Linguagem: Inglês
10.4065/76.12.1225
ISSN1942-5546
AutoresPaul S. Mueller, David J. Plevak, Teresa A. Rummans,
Tópico(s)Religion, Society, and Development
ResumoSurveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (eg, chaplains) are available to clinicians to address the spiritual needs of patients. Surveys suggest that most patients have a spiritual life and regard their spiritual health and physical health as equally important. Furthermore, people may have greater spiritual needs during illness. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life, and other health outcomes. We also reviewed articles that provided suggestions on how clinicians might assess and support the spiritual needs of patients. Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health-related quality of life (even during terminal illness) and less anxiety, depression, and suicide. Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness. Discerning, acknowledging, and supporting the spiritual needs of patients can be done in a straightforward and noncontroversial manner. Furthermore, many sources of spiritual care (eg, chaplains) are available to clinicians to address the spiritual needs of patients. When people consult physicians to determine the cause and treatment of an illness, they may also seek answers to existential questions that medical science cannot answer (eg, "Why is this illness happening to me?").1Barnard D Dayringer R Cassel CK Toward a person-centered medicine: religious studies in the medical curriculum.Acad Med. 1995; 70: 806-813Crossref PubMed Google Scholar Many patients rely on a religious or spiritual framework and call on religious or spiritual care providers to help answer these questions. Indeed, throughout history, religion and spirituality and the practice of medicine have been intertwined. As a result, many religions embrace caring for the sick as a primary mission, and many of the world's leading medical institutions have religious and spiritual roots. The word religion is from the Latin religare, which means "to bind together."2Gove PB Merriam-Webster Editorial Staff Webster's Third New International Dictionary of the English Language, Unabridged. G & C Merriam Co, Springfield, Mass1961Google Scholar A religion organizes the collective spiritual experiences of a group of people into a system of beliefs and practices. Religious involvement or religiosity refers to the degree of participation in or adherence to the beliefs and practices of an organized religion. Spirituality is from the Latin spiritualitas, which means "breath."2Gove PB Merriam-Webster Editorial Staff Webster's Third New International Dictionary of the English Language, Unabridged. G & C Merriam Co, Springfield, Mass1961Google Scholar It is a broader concept than religion and is primarily a dynamic, personal, and experiential process. Features of spirituality include quest for meaning and purpose, transcendence (ie, the sense that being human is more than simple material existence), connectedness (eg, with others, nature, or the divine), and values (eg, love, compassion, and justice).3Emblen JD Religion and spirituality defined according to current use in nursing literature.J Prof Nurs. 1992; 8: 41-47Abstract Full Text PDF PubMed Google Scholar Even though some people who regard themselves as spiritual do not endorse a formal religion, religious involvement and spirituality are overlapping concepts.4Holland JC Kash KM Passik S et al.A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness.Psychooncology. 1998; 7: 460-469Crossref PubMed Scopus (130) Google Scholar Experientially, both may involve a search for meaning and purpose, transcendence, connectedness, and values. In this light, religious involvement is similar to spirituality. Spirituality may also have communal or group expression; when this expression is formalized, spirituality is more like an organized religion.5Fallot RD The place of spirituality and religion in mental health services.New Dir Ment Health Serv. 1998; 80: 3-12Crossref PubMed Google Scholar Because of this overlap, religious involvement and spirituality are considered together in this article. Religion and spirituality are among the most important cultural factors that give structure and meaning to human values, behaviors, and experiences.6Lukoff D Lu FG Turner R Cultural considerations in the assessment and treatment of religious and spiritual problems.Psychiatr Clin North Am. 1995; 18: 467-485PubMed Google Scholar In fact, most people report having a spiritual life. Surveys of the general population7Gallup G Religion in America: 1990. Princeton, NJ: Princeton Religious Research Center; 1990. Cited by Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status: a review of the research and implications for family medicine.Arch Fam Med. 1998; 7: 118-124Crossref PubMed Google Scholar and of patients8King DE Bushwick B Beliefs and attitudes of hospital inpatients about faith healing and prayer.J Fam Pract. 1994; 39: 349-352PubMed Google Scholar, 9Maugans TA Wadland WC Religion and family medicine: a survey of physicians and patients.J Fam Pract. 1991; 32: 210-213PubMed Google Scholar have consistently found that more than 90% of people believe in a Higher Being. Another survey8King DE Bushwick B Beliefs and attitudes of hospital inpatients about faith healing and prayer.J Fam Pract. 1994; 39: 349-352PubMed Google Scholar found that 94% of patients regard their spiritual health and their physical health as equally important. Most patients want their spiritual needs met and would welcome an inquiry regarding their religious and spiritual needs.8King DE Bushwick B Beliefs and attitudes of hospital inpatients about faith healing and prayer.J Fam Pract. 1994; 39: 349-352PubMed Google Scholar, 10Ehman JW Ott BB Short TH Ciampa RC Hansen-Flaschen J Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?.Arch Intern Med. 1999; 159: 1803-1806Crossref PubMed Scopus (209) Google Scholar, 11Daaleman TP Nease Jr, DE Patient attitudes regarding physician inquiry into spiritual and religious issues.J Fam Pract. 1994; 39: 564-568PubMed Google Scholar Finally, a survey of family physicians found that 96% believe spiritual well-being is an important factor in health.12Ellis MR Vinson DC Ewigman B Addressing spiritual concerns of patients: family physicians' attitudes and practices.J Fam Pract. 1999; 48: 105-109PubMed Google Scholar Despite these findings, the spiritual needs of patients are often ignored or not satisfied8King DE Bushwick B Beliefs and attitudes of hospital inpatients about faith healing and prayer.J Fam Pract. 1994; 39: 349-352PubMed Google Scholar, 9Maugans TA Wadland WC Religion and family medicine: a survey of physicians and patients.J Fam Pract. 1991; 32: 210-213PubMed Google Scholar, 13Fitchett G Burton LA Sivan AB The religious needs and resources of psychiatric inpatients.J Nerv Ment Dis. 1997; 185: 320-326Crossref PubMed Scopus (58) Google Scholar (unpublished data, Mayo Patient Expectations Survey, 1994). Physician interest in patient spirituality has increased because of a growing number of studies that have shown an association between increased religious involvement and spirituality and better health outcomes.14Gundersen L Faith and healing.Ann Intern Med. 2000; 132: 169-172Crossref PubMed Google Scholar In this article, we review these studies and provide suggestions on how clinicians may assess and support the spiritual needs of patients. We reviewed published studies, meta-analyses, systematic reviews, and subject reviews that examined the association between religious involvement and spirituality and physical health, mental health, health-related quality of life (HRQOL), and other outcomes. Studies selected used validated measures of religious involvement (eg, attendance at religious services) and spirituality (eg, scales of spiritual well-being) and statistical testing for significance. In addition, we reviewed articles that provided suggestions on how clinicians might ethically assess and support the spiritual needs of patients. Relevant articles were identified by conducting a MEDLINE search (1970–2000) and by using the following search terms: religion, religiosity, and spirituality each alone and each with epidemiology, mortality, cardiovascular disease, cancer, depression, anxiety, substance abuse, suicide, coping, and quality of life. The reference lists of identified articles were also reviewed for additional relevant studies, articles, textbooks, annotated bibliographies, and other sources. Religious and spiritual variables are not widely used in medical research. For example, a review15Larson DB Pattison EM Blazer DG Omran AR Kaplan BH Systematic analysis of research on religious variables in four major psychiatric journals, 1978–1982.Am J Psychiatry. 1986; 143: 329-334PubMed Google Scholar of 2348 studies published in 4 major psychiatry journals between 1978 and 1982 revealed that only 59 (2.5%) used a religious or spiritual variable. A later review16Weaver AJ Samford JA Larson DB Lucas LA Koenig HG Patrick V A systematic review of research on religion in four major psychiatric journals: 1991–1995.J Nerv Ment Dis. 1998; 186: 187-190Crossref PubMed Scopus (36) Google Scholar of the same journals for 1991 to 1995 revealed that only 1.2% of studies used such a variable. Similar reviews have shown that only 3.5% of family practice studies,17Craigie Jr, FC Liu IY Larson DB Lyons JS A systematic analysis of religious variables in the Journal of Family Practice, 1976-1986.J Fam Pract. 1988; 27: 509-513PubMed Google Scholar 1.1% of internal medicine studies,18Orr RD Isaac G Religious variables are infrequently reported in clinical research.Fam Med. 1992; 24: 602-606PubMed Google Scholar 11.8% of adolescent health studies,19Weaver AJ Samford JA Morgan VJ Lichton AI Larson DB Garbarino J Research on religious variables in five major adolescent research journals: 1992 to 1996.J Nerv Ment Dis. 2000; 188: 36-44Crossref PubMed Scopus (28) Google Scholar 10% of nursing mental health studies,20Weaver AJ Flannelly LT Flannelly KJ Koenig HG Larson DB An analysis of research on religious and spiritual variables in three major mental health nursing journals, 1991–1995.Issues Ment Health Nurs. 1998; 19: 263-276Crossref PubMed Google Scholar and 3.6% of gerontology studies21Sherrill KA Larson DB Greenwold M Is religion taboo in gerontology? systematic review of research on religion in three major gerontology journals.Am J Geriatr Psychiatry. 1993; 1: 109-117Abstract Full Text Full Text PDF Google Scholar used religious or spiritual variables. Neglect of religious and spiritual variables in medical research may be due, in part, to the reliance on the biomedical model in which physical evidence is paramount. While the biomedical model is excellent for describing certain disease mechanisms (eg, viral illnesses), it is reductionistic and has difficulty accounting for psychological, sociological, and spiritual factors that influence most, if not all, illnesses.22Engel GL The clinical application of the biopsychosocial model.Am J Psychiatry. 1980; 137: 535-544PubMed Google Scholar Of the studies that have considered the effects of religious or spiritual factors on health, most have used measures of religious involvement (eg, frequency of attendance at religious services and scales of religiosity), not measures of spirituality. The main reason for this practice is the greater consensus on how to define and measure religious involvement as opposed to spirituality. A majority of the nearly 350 studies of physical health and 850 studies of mental health that have used religious and spiritual variables have found that religious involvement and spirituality are associated with better health outcomes.23Koenig HG Religion, spirituality, and medicine: application to clinical practice.JAMA. 2000; 284: 1708Crossref PubMed Google Scholar During the past 3 decades, at least 18 prospective studies have shown that religiously involved persons live longer.24Comstock GW Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic characteristics.Am J Epidemiol. 1971; 94: 1-10Crossref PubMed Google Scholar, 25Comstock GW Partridge KB Church attendance and health.J Chronic Dis. 1972; 25: 665-672Abstract Full Text PDF PubMed Google Scholar, 26Comstock GW Tonascia JA Education and mortality in Washington County, Maryland.J Health Soc Behav. 1977; 18: 54-61Crossref Google Scholar, 27Berkman LF Syme SL Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.Am J Epidemiol. 1979; 109: 186-204Crossref PubMed Google Scholar, 28House JS Robbins C Metzner HL The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study.Am J Epidemiol. 1982; 116: 123-140PubMed Google Scholar, 29Wingard DL The sex differential in mortality rates: demographic and behavioral factors.Am J Epidemiol. 1982; 115: 205-216PubMed Google Scholar, 30Zuckerman DM Kasl SV Ostfeld AM Psychosocial predictors of mortality among the elderly poor: the role of religion, well-being, and social contacts.Am J Epidemiol. 1984; 119: 410-423PubMed Google Scholar, 31Schoenbach VJ Kaplan BH Fredman L Kleinbaum DG Social ties and mortality in Evans County, Georgia.Am J Epidemiol. 1986; 123: 577-591PubMed Google Scholar, 32Seeman TE Kaplan GA Knudsen L Cohen R Guralnik J Social network ties and mortality among the elderly in the Alameda County Study.Am J Epidemiol. 1987; 126: 714-723PubMed Google Scholar, 33Bryant S Rakowski W Predictors of mortality among elderly African-Americans.Res Aging. 1992; 14: 50-67Crossref Google Scholar, 34Goldman N Korenman S Weinstein R Marital status and health among the elderly.Soc Sci Med. 1995; 40: 1717-1730Crossref PubMed Scopus (183) Google Scholar, 35Kark JD Shemi G Friedlander Y Martin O Manor O Blondheim SH Does religious observance promote health? mortality in secular vs religious kubbutzim in Israel.Am J Public Health. 1996; 86: 341-346Crossref PubMed Google Scholar, 36Strawbridge WJ Cohen RD Shema SJ Kaplan GA Frequent attendance at religious services and mortality over 28 years.Am J Public Health. 1997; 87: 957-961Crossref PubMed Google Scholar, 37Oman D Reed D Religion and mortality among the community-dwelling elderly.Am J Public Health. 1998; 88: 1469-1475Crossref PubMed Google Scholar, 38Glass TA de Leon CM Morottoli RA Berkman LF Population based study of social and productive activities as predictors of survival among elderly Americans.BMJ. 1999; 319: 478-483Crossref PubMed Google Scholar, 39Hummer RA Rogers RG Nam CB Ellison CG Religious involvement and U.S. adult mortality.Demography. 1999; 36: 273-285Crossref PubMed Google Scholar, 40Koenig HG Hays JC Larson DB et al.Does religious attendance prolong survival? a six-year follow-up study of 3,968 older adults.J Gerontol A Biol Sci Med Sci. 1999; 54A: M370-M376Crossref Google Scholar, 41Clark KM Friedman HS Martin LR A longitudinal study of religiosity and mortality risk.J Health Psychol. 1999; 4: 381-391Crossref PubMed Google Scholar The populations examined in these studies include not only entire communities but also specific groups. The religious and spiritual variables used in these studies include membership in a religious congregation,27Berkman LF Syme SL Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents.Am J Epidemiol. 1979; 109: 186-204Crossref PubMed Google Scholar, 29Wingard DL The sex differential in mortality rates: demographic and behavioral factors.Am J Epidemiol. 1982; 115: 205-216PubMed Google Scholar, 32Seeman TE Kaplan GA Knudsen L Cohen R Guralnik J Social network ties and mortality among the elderly in the Alameda County Study.Am J Epidemiol. 1987; 126: 714-723PubMed Google Scholar attendance at religious services,24Comstock GW Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic characteristics.Am J Epidemiol. 1971; 94: 1-10Crossref PubMed Google Scholar, 25Comstock GW Partridge KB Church attendance and health.J Chronic Dis. 1972; 25: 665-672Abstract Full Text PDF PubMed Google Scholar, 26Comstock GW Tonascia JA Education and mortality in Washington County, Maryland.J Health Soc Behav. 1977; 18: 54-61Crossref Google Scholar, 28House JS Robbins C Metzner HL The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study.Am J Epidemiol. 1982; 116: 123-140PubMed Google Scholar, 30Zuckerman DM Kasl SV Ostfeld AM Psychosocial predictors of mortality among the elderly poor: the role of religion, well-being, and social contacts.Am J Epidemiol. 1984; 119: 410-423PubMed Google Scholar, 31Schoenbach VJ Kaplan BH Fredman L Kleinbaum DG Social ties and mortality in Evans County, Georgia.Am J Epidemiol. 1986; 123: 577-591PubMed Google Scholar, 33Bryant S Rakowski W Predictors of mortality among elderly African-Americans.Res Aging. 1992; 14: 50-67Crossref Google Scholar, 34Goldman N Korenman S Weinstein R Marital status and health among the elderly.Soc Sci Med. 1995; 40: 1717-1730Crossref PubMed Scopus (183) Google Scholar, 36Strawbridge WJ Cohen RD Shema SJ Kaplan GA Frequent attendance at religious services and mortality over 28 years.Am J Public Health. 1997; 87: 957-961Crossref PubMed Google Scholar, 37Oman D Reed D Religion and mortality among the community-dwelling elderly.Am J Public Health. 1998; 88: 1469-1475Crossref PubMed Google Scholar, 38Glass TA de Leon CM Morottoli RA Berkman LF Population based study of social and productive activities as predictors of survival among elderly Americans.BMJ. 1999; 319: 478-483Crossref PubMed Google Scholar, 39Hummer RA Rogers RG Nam CB Ellison CG Religious involvement and U.S. adult mortality.Demography. 1999; 36: 273-285Crossref PubMed Google Scholar, 40Koenig HG Hays JC Larson DB et al.Does religious attendance prolong survival? a six-year follow-up study of 3,968 older adults.J Gerontol A Biol Sci Med Sci. 1999; 54A: M370-M376Crossref Google Scholar living within a religious community,35Kark JD Shemi G Friedlander Y Martin O Manor O Blondheim SH Does religious observance promote health? mortality in secular vs religious kubbutzim in Israel.Am J Public Health. 1996; 86: 341-346Crossref PubMed Google Scholar and self-reported religiosity.41Clark KM Friedman HS Martin LR A longitudinal study of religiosity and mortality risk.J Health Psychol. 1999; 4: 381-391Crossref PubMed Google Scholar One study42Koenig HG Larson DB Hays JC et al.Religion and the survival of 1010 hospitalized veterans.J Religion Health. 1998; 37: 15-29Crossref Google Scholar of hospitalized veterans, however, found no relationship between religious involvement, religious coping, and mortality. Recent prospective studies have carefully controlled for potential confounding variables.43Koenig HG Idler E Kasl S et al.Religion, spirituality, and medicine: a rebuttal to skeptics.Int J Psychiatry Med. 1999; 29: 123-131Crossref PubMed Scopus (51) Google Scholar A 28-year study36Strawbridge WJ Cohen RD Shema SJ Kaplan GA Frequent attendance at religious services and mortality over 28 years.Am J Public Health. 1997; 87: 957-961Crossref PubMed Google Scholar of 5286 adults (age, 21–65 years) found that frequent (=once a week) attenders of religious services were 23% less likely than nonattenders to die during the follow-up period (relative hazard, 0.77 [95% confidence interval (CI), 0.64-0.93]) adjusted for age, sex, ethnicity, education, baseline health status, body mass index, health practices, and social connections. Notably, this study also found that mobility-impaired persons were more likely to be frequent attenders than nonattenders. A 5-year study37Oman D Reed D Religion and mortality among the community-dwelling elderly.Am J Public Health. 1998; 88: 1469-1475Crossref PubMed Google Scholar examined the same relationship in 1931 adults (age, =55 years). Frequent attenders were 24% less likely to die than nonattenders during the follow-up period (relative hazard, 0.76 [95% CI, 0.62–0.94]) adjusted for age, sex, marital status, income, education, employment status, ethnicity, baseline health status, physical functioning, health habits (eg, exercise, smoking), social functioning and support, and mental health status. A 6-year study40Koenig HG Hays JC Larson DB et al.Does religious attendance prolong survival? a six-year follow-up study of 3,968 older adults.J Gerontol A Biol Sci Med Sci. 1999; 54A: M370-M376Crossref Google Scholar examined the same relationship in 3968 adults (age, =65 years). Frequent attenders were 28% less likely than infrequent (=once a week) to die during the follow-up period (relative hazard, 0.72 [95% CI, 0.64–0.81]) adjusted for demographic factors, health conditions, social connections, and health practices. Finally, a 9-year study39Hummer RA Rogers RG Nam CB Ellison CG Religious involvement and U.S. adult mortality.Demography. 1999; 36: 273-285Crossref PubMed Google Scholar of a nationally representative sample of 22,080 US adults (age, =20 years) found the risk of death for nonattenders to be 1.87 times the risk of death for frequent attenders (P<.01) after controlling for numerous demographic, baseline health, behavioral, social, and economic variables. A recent meta-analysis44McCullough ME Hoyt WT Larson DB Koenig HG Thoresen C Religious involvement and mortality: a meta-analytic review.Health Psychol. 2000; 19: 211-222Crossref PubMed Google Scholar of 42 studies of nearly 126,000 persons found that highly religious persons had a 29% higher odds of survival compared with less religious persons (odds ratio [OR],1.29 [95% CI, 1.20–1.39]). The authors could not attribute the association to confounding variables or to publication bias. Studies have found that religious involvement is associated with less cardiovascular disease. A case-control study45Friedlander Y Kark JD Stein Y Religious orthodoxy and myocardial infarction in Jerusalem—a case control study.Int J Cardiol. 1986; 10: 33-41Abstract Full Text PDF PubMed Google Scholar found that secular Jewish persons had significantly higher odds of first myocardial infarction compared with Orthodox Jewish patients (OR, 4.2 [95% CI, 2.6–6.6] for men, 7.3 [95% CI, 2.3–23.0] for women) adjusted for age, ethnicity, education, smoking, physical activity, and body mass index. A 23-year prospective study46Goldbourt U Yaari S Medalie JH Factors predictive of long-term coronary heart disease mortality among 10,059 male Israeli civil servants and municipal employees: a 23-year mortality follow-up in the Israeli Ischemic Heart Disease Study.Cardiology. 1993; 82: 100-121Crossref PubMed Google Scholar of 10,059 male Israeli civil servants and municipal employees found that Orthodox Jewish men had a 20% decreased risk of fatal coronary heart disease (CHD) compared with nonreligious men adjusted for age, blood pressure, lipids, smoking, diabetes, body mass index, and baseline CHD. A prospective study47Oxman TE Freeman Jr, DH Manheimer ED Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly.Psychosom Med. 1995; 57: 5-15PubMed Google Scholar of 232 people (age, =55 years) undergoing elective heart surgery found that lack of participation in social groups and lack of strength or comfort from religion were the most consistent predictors of death adjusted for age, previous cardiac surgery, and preoperative functional status. Finally, of 16 studies examined in a recent review,48Koenig HG McCullough ME Larson DB Handbook of Religion and Health. Oxford University Press, New York, NY2001Crossref Google Scholar 12 found that religious involvement was associated with less cardiovascular disease or cardiovascular mortality. Studies have found that religious involvement is associated with lower blood pressure and less hypertension. A recent study49Koenig HG George LK Hays JC Larson DB Cohen HJ Blazer DG The relationship between religious activities and blood pressure in older adults.Int J Psychiatry Med. 1998; 28: 189-213Crossref PubMed Google Scholar examined the relationship between religious activities and blood pressure in a sample of 3963 community-dwelling adults (age, =65 years) using data from 3 time periods. Adjusted for age, ethnicity, sex, education, functional status, body mass index, and previous blood pressure, frequent (=once a week) attenders of religious services had consistently lower systolic and diastolic blood pressures compared with infrequent attenders. Furthermore, frequent attenders who engaged in private religious activities (eg, prayer) were 40% less likely to have diastolic hypertension (>90 mm Hg) compared with infrequent attenders or those who did not engage in private religious activities (OR, 0.60 [95% CI, 0.48–0.75]). Religiously involved persons were also more likely to be compliant with their medicines. However, this difference did not account for the observed differences in blood pressures. Other recent studies50Walsh A Religion and hypertension: testing alternative explanations among immigrants.Behav Med. 1998; 24: 122-130Crossref PubMed Google Scholar, 51Hixson KA Gruchow HW Morgan DW The relation between religiosity, selected health behaviors, and blood pressure among adult females.Prev Med. 1998; 27: 545-552Crossref PubMed Scopus (31) Google Scholar have found that, after adjusting for known risk factors for hypertension, self-rated importance of religion, intrinsic religiosity, and religious coping were associated with reduced blood pressure and hypertension. Finally, of 16 studies examined in a recent review,48Koenig HG McCullough ME Larson DB Handbook of Religion and Health. Oxford University Press, New York, NY2001Crossref Google Scholar 14 found that religious involvement was associated with lower blood pressure. The same review also examined 13 clinical trials of the effects of religious or spiritual practices (eg, meditation) on blood pressure. Of these, 9 found that these practices significantly reduce blood pressure. Studies have shown that religious involvement is associated with health-promoting behaviors such as more exercise,52Oleckno WA Blacconiere MJ Relationship of religiosity to wellness and other health-related behaviors and outcomes.Psychol Rep. 1991; 68: 819-826Crossref PubMed Google Scholar, 53Wallace Jr, JM Forman TA Religion's role in promoting health and reducing risk among American youth.Health Educ Behav. 1998; 25: 721-741Crossref PubMed Google Scholar, 54Strawbridge WJ Shema SJ Cohen RD Kaplan GA Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships.Ann Behav Med. 2001; 23: 68-74Crossref PubMed Google Scholar proper nutrition,52Oleckno WA Blacconiere MJ Relationship of religiosity to wellness and other health-related behaviors and outcomes.Psychol Rep. 1991; 68: 819-826Crossref PubMed Google Scholar, 53Wallace Jr, JM Forman TA Religion's role in promoting health and reducing risk among American youth.Health Educ Behav. 1998; 25: 721-741Crossref PubMed Google Scholar more seat belt use,52Oleckno WA Blacconiere MJ Relationship of religiosity to wellness and other health-related behaviors and outcomes.Psychol Rep. 1991; 68: 819-826Crossref PubMed Google Scholar smoking cessation,54Strawbridge WJ Shema SJ Cohen RD Kaplan GA Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships.Ann Behav Med. 2001; 23: 68-74Crossref PubMed Google Scholar and greater use of preventive services.25Comstock GW Partridge KB Church attendance and health.J Chronic Dis. 1972; 25: 665-672Abstract Full Text PDF PubMed Google Scholar In addition, religious involvement predicts greater functioning among disabled persons.55Idler EL Kasl SV Religion among disabled and nondisabled persons, II: attendance at religious services as a predictor of the course of disability.J Gerontol B Psychol Sci Soc Sci. 1997; 52: S306-S316Crossref PubMed Google Scholar Finally, religious involvement is associated with fewer hospitalizations and shorter hospital stays.56Koenig HG Larson DB Use of hospital services, religious attendance, and religious affiliation.South Med J. 1998; 91: 925-932Crossref PubMed Google Scholar Only a few inconclusive studi
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