Religious beliefs and well-being and distress in congestive heart failure patients

Abstract

Religiousness (typically assessed as service attendance) is often associated with well-being and psychological distress in persons with life-threatening illnesses, but little of this work has focused explicitly on religious beliefs. We examined the longitudinal relationships of religious beliefs (i.e., in God and in the afterlife) with well-being and distress (assessed 6 months later) in a sample of patients with congestive heart failure, a chronic and progressive disease. After controlling for religious service attendance, belief in God was associated with negative affect and spiritual well-being, while belief in the afterlife was associated with physical health, post-traumatic depreciation, and spiritual well-being. However, after controlling for baseline values of well-being or distress, religious beliefs were not associated with nearly all well-being or distress outcomes at follow-up. Over the 6-month duration of the study, participants increased in belief in afterlife but decreased in their belief in God. Increases in religious beliefs across time were associated with higher levels of distress. These results suggest that religious beliefs are neither positively nor negatively associated with well-being and distress independent of religious attendance among seriously ill patients with CHF. Based on these findings, healthcare providers are encouraged to assess religious belief change at the individual level to better understand and inform spiritual care for patients with late-stage CHF.

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References

  1. American Heart Association. (2018). Heart disease and stroke statistics: 2018 update. Circulation,137, 67–492.

    Google Scholar 

  2. Andersson, G. (2008). Chronic pain and praying to a higher power: useful or useless? Journal of Religion and Health,47, 176–187.

    PubMed  Article  Google Scholar 

  3. Bahrami, H., Kronmal, R., Bluemke, D. A., Olson, J., Shea, S., Liu, K., et al. (2008). Differences in the incidence of congestive heart failure by ethnicity: The multi-ethnic study of atherosclerosis. Archives of Internal Medicine,168, 2138–2145.

    PubMed  PubMed Central  Article  Google Scholar 

  4. Balboni, M. J., Sullivan, A., Enzinger, A. C., Epstein-Peterson, Z. D., Tseng, Y. D., Mitchell, C., et al. (2014). Nurse and physician barriers to spiritual care provision at the end of life. Journal of Pain and Symptom Management,48, 400–410. https://doi.org/10.1016/j.jpainsymman.2013.09.020

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bellizzi, K. M., Miller, M. F., Arora, N. K., & Rowland, J. H. (2007). Positive and negative life changes experienced by survivors of non-Hodgkin’s lymphoma. Annals of Behavioral Medicine,34, 88–199.

    Article  Google Scholar 

  6. Blaine, B., & Crocker, J. (1995). Religiousness, race, and psychological well-being: Exploring social psychological mediators. Personality and Social Psychology Bulletin,21, 1031–1041.

    Article  Google Scholar 

  7. Bollwinkel, E. M. (1994). Role of spirituality in hospice care. Annals of the Academy of Medicine, Singapore,23, 261–263.

    CAS  PubMed  Google Scholar 

  8. Cadge, W. (2018). Healthcare chaplaincy as a companion profession: Historical developments. Journal of Health Care Chaplaincy,25, 45–60. https://doi.org/10.1080/08854726.2018.1463617

    Article  PubMed  Google Scholar 

  9. Carver, C. S., & Antoni, M. H. (2004). Finding benefit in breast cancer during the year after diagnosis predicts better adjustment 5 to 8 years after diagnosis. Health Psychology,23, 595–598.

    PubMed  Article  Google Scholar 

  10. Clark, C. C., & Hunter, J. (2019). Spirituality, spiritual well-being, and spiritual coping in advanced heart failure: Review of the literature. Journal of Holistic Nursing,37, 56–73.

    PubMed  Article  Google Scholar 

  11. Contrada, R. J., Goyal, T. M., Cather, C., Rafalson, L., Idler, E. L., & Krause, T. J. (2004). Psychosocial factors in outcomes of heart surgery: The impact of religious involvement and depressive symptoms. Health Psychology,23, 227–238.

    PubMed  Article  Google Scholar 

  12. Durkheim, E. (1912). The elementary forms of the religious life. Oxford University Press.

  13. Edmondson, D., Park, C. L., Chaudoir, S. R., & Wortmann, J. H. (2008). Death without God: Religious struggle, death concerns, and depression in the terminally iII. Psychological Science,19, 754–758.

    PubMed  Article  Google Scholar 

  14. Edwards, A., Pang, N., Shiu, V., & Chan, C. (2010). The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: A meta-study of qualitative research. Palliative Medicine,24, 753–770.

    CAS  PubMed  Article  Google Scholar 

  15. Ellison, C. G., Boardman, J. D., Williams, D. R., & Jackson, J. S. (2001). Religious involvement, stress, and mental health: Findings from the 1995 Detroit Area Study. Social Forces,80, 215–249.

    Article  Google Scholar 

  16. Ellison, C. G., Burdette, A. M., & Hill, T. D. (2009). Blessed assurance: Religion, anxiety, and tranquility among US adults. Social Science Research,38, 656–667.

    PubMed  Article  Google Scholar 

  17. Exline, J. J., & Rose, E. (2005). Religious and spiritual struggles. Handbook of the Psychology of Religion and Spirituality,2, 380–398.

    Google Scholar 

  18. Falsetti, S. A., Resick, P. A., & Davis, J. L. (2003). Changes in religious beliefs following trauma. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies,16, 391–398.

    Article  Google Scholar 

  19. Fetzer, N. I. A. (1999). Religiousness/spirituality for use in health research: A Report of the Fetzer Institute/National Institute on Aging Working Group (pp. 31–33). Kalamazoo, MI: Fetzer.

    Google Scholar 

  20. Fitchett, G., Murphy, P. E., Kim, J., Gibbons, J. L., Cameron, J. R., & Davis, J. A. (2004). Religious struggle: Prevalence, correlates and mental health risks in diabetic, congestive heart failure, and oncology patients. The International Journal of Psychiatry in Medicine,34, 179–196.

    PubMed  Article  Google Scholar 

  21. Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault. Journal of Consulting and Clinical Psychology,69, 1048–1055.

    CAS  PubMed  Article  Google Scholar 

  22. Gandhi, S. K., Salmon, J. W., Zhao, S. Z., Lambert, B. L., Gore, P. R., & Conrad, K. (2001). Psychometric evaluation of the 12-item short-form health survey (SF-12) in osteoarthritis and rheumatoid arthritis clinical trials. Clinical Therapeutics, 23, 1080–1098.

    CAS  PubMed  Article  Google Scholar 

  23. Gardner, R. S., & McDonagh, T. A. (2014). Chronic heart failure: Epidemiology, investigation and management. Medicine,42, 562–567.

    Article  Google Scholar 

  24. Gutierrez, I. A., & Park, C. L. (2015). Emerging adulthood, evolving worldviews: How life events impact college students’ developing belief systems. Emerging Adulthood, 3, 85–97.

    Article  Google Scholar 

  25. Harding, S. R., Flannelly, K. J., Weaver, A. J., & Costa, K. G. (2005). The influence of religion on death anxiety and death acceptance. Mental Health, Religion & Culture,8, 253–261.

    Article  Google Scholar 

  26. Heflick, N. A., & Goldenberg, J. L. (2012). No atheists in foxholes: Arguments for (but not against) afterlife belief buffers mortality salience effects for atheists. British Journal of Social Psychology,51, 385–392.

    PubMed  Article  Google Scholar 

  27. Idler, E. (1999). Beliefs. Religiousness/Spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group (pp. 31–33). Kalamazoo, MI: Fetzer.

  28. Jahani, A., Rejeh, N., Heravi-Karimooi, M., Hadavi, A., Zayeri, F., & Khatooni, A. R. (2013). The relationship between spiritual health and quality of life in patients with coronary artery disease. Islamic Life Center Health,1, 17–21.

    Article  Google Scholar 

  29. Jim, H. S., Pustejovsky, J. E., Park, C. L., Danhauer, S. C., Sherman, A. C., Fitchett, G., et al. (2015). Religion, spirituality, and physical health in cancer patients: A meta-analysis. Cancer,121, 3760–3768.

    PubMed  PubMed Central  Article  Google Scholar 

  30. Jonas, E., & Fischer, P. (2006). Terror management and religion: evidence that intrinsic religiousness mitigates worldview defense following mortality salience. Journal of Personality and Social Psychology,91, 553–567.

    PubMed  Article  Google Scholar 

  31. Jong, J., Halberstadt, J., & Bluemke, M. (2012). Foxhole atheism, revisited: The effects of mortality salience on explicit and implicit religious belief. Journal of Experimental Social Psychology,48, 983–989.

    Article  Google Scholar 

  32. Jong, J., Ross, R., Philip, T., Chang, S., Simons, N., & Halberstadt, J. (2018). The religious correlates of death anxiety: A systematic review and meta-analysis. Religion, Brain & Behavior,8, 4–20. https://doi.org/10.1080/2153599X.2016.1238844

    Article  Google Scholar 

  33. Koenig, H. G., King, D. A., & Carson, V. B. (2012). Handbook of religion and health (2nd ed.). New York: Oxford University Press.

    Google Scholar 

  34. Krause, N., Liang, J., Shaw, B. A., Sugisawa, H., Kim, H. K., & Sugihara, Y. (2002). Religion, death of a loved one, and hypertension among older adults in Japan. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences,57, S96–S107.

    PubMed  Article  Google Scholar 

  35. Lavery, M. E., & O’Hea, E. L. (2010). Religious/spiritual coping and adjustment in individuals with cancer: Unanswered questions, important trends, and future directions. Mental Health, Religion and Culture, 13(1), 55–65.

    Article  Google Scholar 

  36. Li, S., Stampfer, M. J., Williams, D. R., & VanderWeele, T. J. (2016). Association of religious service attendance with mortality among women. JAMA Internal Medicine,176, 777–785.

    PubMed  Article  Google Scholar 

  37. Macavei, B., & Miclea, M. (2008). An empirical investigation of the relationship between religious beliefs, irrational beliefs, and negative emotions. Journal of Cognitive & Behavioral Psychotherapies,8, 1–16.

    Google Scholar 

  38. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., et al. (2016). Heart disease and stroke statistics—2016 update: A report from the American Heart Association. Circulation,133, 38–360.

    Google Scholar 

  39. Oman, D. (2013). Defining religion and spirituality. Handbook of the Psychology of Religion and Spirituality,2, 23–47.

    Google Scholar 

  40. Park, C. L. (2007). Religiousness/spirituality and health: A meaning systems perspective. Journal of Behavioral Medicine,30, 319–328.

    PubMed  Article  Google Scholar 

  41. Park, C. L. (2017). Religious cognitions and well-being: A meaning perspective. In M. D. Robinson & M. Eid (Eds.), The happy mind: Cognitive contributions to well-being (pp. 443–458). New York: Springer.

    Google Scholar 

  42. Park, C. L., Aldwin, C. M., Choun, S., Suresh, D. P., & Bliss, D. (2016). Spiritual peace predicts 5-year mortality in congestive heart failure patients. Health Psychology, 35, 203–210.

    PubMed  Article  Google Scholar 

  43. Park, C. L., & Carney, L. M. (2018). The role of spirituality and mindfulness in supporting a patient’s cancer journey. Expert Review of Quality of Life in Cancer Care. https://doi.org/10.1080/23809000.2018.1519371

    Article  Google Scholar 

  44. Park, C. L., & Folkman, S. (1997). The role of meaning in the context of stress and coping. Review of General Psychology,1, 115–144.

    Article  Google Scholar 

  45. Park, C. L., Lim, H., Newlon, M., Suresh, D. P., & Bliss, D. (2014). Dimensions of religiousness and spirituality as predictors of well-being in advanced CHF patients. Religion and Health,53, 579–590.

    Article  Google Scholar 

  46. Park, C. L., & Sacco, S. J. (2017). Heart failure patients’ desires for spiritual care, perceived constraints, and unmet spiritual needs: Relations with well-being and health-related quality of life. Psychology, Health & Medicine, 22, 1011–1020.

    Article  Google Scholar 

  47. Park, C. L., Wortmann, J. H., & Edmondson, D. (2011). Religious struggle as a predictor of subsequent mental and physical well-being in heart failure patients. Journal of Behavioral Medicine,6, 426–436.

    Article  Google Scholar 

  48. Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: The functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine,24, 49–58.

    PubMed  Article  Google Scholar 

  49. Puchalski, C., Ferrell, B., Virani, R., Otis-Green, S., Biard, P., Bull, J., et al. (2009). Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine,12, 885–904. https://doi.org/10.1089/jpm.2009.0142

    Article  PubMed  Google Scholar 

  50. Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement,1, 385–401.

    Article  Google Scholar 

  51. Rohrbaugh, J., & Jessor, R. (1975). Religiosity in youth: A personal control against deviant behavior. Journal of Personality,43, 136–155.

    CAS  PubMed  Article  Google Scholar 

  52. Schuetz, B. (1995). Spirituality and palliative care. Australian Family Physician, 24, 775–777.

    CAS  PubMed  Google Scholar 

  53. Selman, L., Harding, R., Beynon, T., Hodson, F., Coady, E., Hazeldine, C., et al. (2007). Improving end-of-life care for patients with chronic heart failure: “Let’s hope it’ll get better, when I know in my heart of hearts it won’t”. Heart,93, 963–967.

    PubMed  PubMed Central  Article  Google Scholar 

  54. Vail, K. E., III, Arndt, J., & Abdollahi, A. (2012). Exploring the existential function of religion and supernatural agent beliefs among Christians, Muslims, atheists, and agnostics. Personality and Social Psychology Bulletin,38, 1288–1300.

    PubMed  Article  Google Scholar 

  55. Vail, K. E., III, Rothschild, Z. K., Weise, D. R., Solomon, S., Pyszczynski, T., & Greenberg, J. (2010). A terror management analysis of the psychological functions of religion. Personality and Social Psychology Review,14, 84–94.

    PubMed  Article  Google Scholar 

  56. VanderWeele, T. J. (2017). Religious communities and human flourishing. Current Directions in Psychological Science,26, 476–481.

    PubMed  PubMed Central  Article  Google Scholar 

  57. Ware, J. E., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care,34, 220–233.

    PubMed  Article  Google Scholar 

  58. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology,54, 1063–1070.

    CAS  PubMed  Article  Google Scholar 

  59. Willer, R. (2009). No atheists in foxholes: Motivated reasoning and religious belief. In J. T. Jost, A. C. Kay, & H. Thorisdottir (Eds.), Social and psychological bases of ideology and system justification (pp. 241–264). New York, NY: Oxford University Press.

    Google Scholar 

  60. World Health Organization. (2004). Palliative care: Symptom management and end-of-life care: Integrated management of adolescent and adult illness. Retrieved September, 2016 from https://www.who.int/hiv/pub/imai/genericpalliativecare082004.pdf.

  61. Yaghoobzadeh, A., Soleimani, M. A., Allen, K. A., Chan, Y. H., & Herth, K. A. (2018). Relationship between spiritual well-being and hope in patients with cardiovascular disease. Journal of Religion and Health, 57, 938–950.

    PubMed  Article  Google Scholar 

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Correspondence to Lauren M. Carney.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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This study was funded by a Grant from by the American Heart Association-Ohio Valley through a Scientist Development Grant (#1 R03 AG 023883). The study was approved by the University of Connecticut Institutional Review Board.

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Carney, L.M., Park, C.L. & Gutierrez, I.A. Religious beliefs and well-being and distress in congestive heart failure patients. J Behav Med 43, 437–447 (2020). https://doi.org/10.1007/s10865-019-00115-3

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Keywords

  • Illness
  • Religious beliefs
  • Heart failure
  • Religiousness
  • Spirituality
  • God
  • Afterlife