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November 2014 Article of the Month
This month's article selection is by Chaplain John Ehman,
University of Pennsylvania Medical Center-Penn Presbyterian, Philadelphia PA.


Weber, S. R. and Pargament, K. I. "The role of religion and spirituality in mental health." Current Opinion in Psychiatry 27, no. 5 (September 2014): 358-363.


SUMMARY and COMMENT:   The healthcare literature pertaining to spirituality/religion is presently increasing at a rate of over 2,000 articles per year. It may be a function of this deluge of publications that chaplains seem to express strong interest in review articles. This month's feature is a succinct review focused on mental health that offers to experienced chaplains a quick refresher on the state of activity and thought in the field and to CPE students an introductory picture providing context for research literacy. The article is also especially well-suited for group discussions.

The structure is straightforward:

[It] begins by briefly reviewing the historical tension between religion and psychiatry. We then review the mental health benefits associated with religion and spirituality, followed by the negative aspects of religion and spirituality. We conclude by reviewing what this literature means for the assessment and treatment of psychiatric patients. [p. 358]
The brief sections that follow constitute listings of research findings that connect to a very rich bibliography of 73 references. To give a sense, substantive points and citations in the single-paragraph-long sections may be counted as follows:
  • on Positive Religious Coping: roughly 8 points supported by 9 citations
  • on Community and Support: roughly 6 points supported by 8 citations
  • on Positive Beliefs: roughly 14 points supported by 6 citations
  • on Negative Religious Coping: roughly 11 points supported by 20 citations
  • on Miscommunication and Misunderstanding: roughly 5 points supported by citations
  • on Negative Beliefs: roughly 11 points supported by 6 citations
What is more, the authors have highlighted those references that they consider "of special interest" and "of outstanding interest" [p. 362].

The overall and constructive perspective of the authors on the relationship between religion/spirituality and mental health is most apparent in their section on Considerations for Psychiatric Practice.

Religion and spirituality are part of the cultural context in which mental illness occurs. Assessing religiosity or spirituality is essential in order to achieve an understanding of the whole person, including their needs and struggles. However, mental health clinicians need to consider their own inherent religious biases and how they may result in the minimizing or pathologizing of a patient’s religiosity or spirituality. Clinicians would benefit from learning about different religious and spiritual traditions and asking about patients’ religious ideals, practices, and faith communities in order to better understand the nuanced differences between religion and disease…. A clinical framework informed on religion and spirituality allows the providers to be open to their patients’ sacred experiences. This can promote more positive self-representation and improve the patient-provider relationship…. …Although not all clinicians have to incorporate religious and spiritual experiences in their practice, all should have the capacity to provide spiritually conscious care and maintain a respectful interest in their patients’ religiosity or spirituality…. [pp. 360-361]
Weber and Pargament offer some practical guidance on Assessment and Treatment [--see pp. 360-361]. They also go on to suggest that attention to patients' spirituality could also "potentially prove a boon to providers struggling to maintain hope in their own work with despairing clients" as a function of "focusing on the sacred aspects of their work and their patients’ lives" [p. 361].

Some general limits to the research literature are covered in conclusion, especially how "[m]uch of the current research on religion and spirituality focuses on Christianity" [p. 362]. A few basic areas for future research hint at the trajectory of the field.


Suggestions for the Use of the Article for Discussion in CPE: 

This month's article, more than most short reviews, may be an excellent stepping stone for students developing basic research literacy. The clarity and concentration of substantive points and references on which they are based makes this an easy gateway to the larger literature. The brevity of the article also makes feasible an assignment for students to read the piece, then select one point of interest and read an associated article. This should encourage them to see references not as background information but as leads to the dynamic interplay and dialogue of the literature (and should give practice in the process of obtaining articles as well). There are conveniently 6 subsections to the sections on positive and negative aspects of religion, plus 2 subsections on psychiatric practice, which could be divvied up among CPE groups of 6-8 students to fully cover the article. One particular advantage of this article is that it covers both positive and negative effects of religion/spirituality, though it does so in a highly constructive approach that students should appreciate. While the authors are writing to a psychiatric audience, the material seems very accessible to chaplains, and students may want to talk about what religion/spirituality may look like to psychiatrists. To that end, a psychiatrist might be invited to be a guest of the discussion. Yet another way to engage the article for students or for staff chaplains could be to use it for a "journal club" discussion with a group of clinical staff -- nurses or a unit staff -- where the dialogue might be very different from a typical CPE group but potentially invigorating. The article could be especially conducive to open discussion across disciplines, bringing clinicians/nurses and chaplains together to consider each other's perspectives. Weber & Pargament use the language of "spiritually conscious care" and "respectful interest" in patients’ religiosity or spirituality.


Related Items of Interest:

I.  For other recent, broad reviews, see the following. (Note the co-authorship of Harold G. Koenig.)

Dein, S., Cook, C. C. and Koenig, H. "Religion, spirituality, and mental health: current controversies and future directions." Journal of Nervous & Mental Disease 200, no. 10 (October 2012): 852-855. [(Abstrct:) Although studies examining religion, spirituality, and mental health generally indicate positive associations, there is a need for more sophisticated methodology, greater discrimination between different cultures and traditions, more focus on situated experiences of individuals belonging to particular traditions, and, in particular, greater integration of theological contributions to this area. We suggest priorities for future research based on these considerations.]

Moreira-Almeida, A., Koenig, H. G. and Lucchetti, G. "Clinical implications of spirituality to mental health: review of evidence and practical guidelines." Revista Brasileira de Psiquiatria 36, no. 2 (April-June 2014): 176-182. [(Abstrct:) OBJECTIVE: Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. METHODS: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. RESULTS: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. CONCLUSIONS: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.]


II.  For a broad yet detailed review of research on religion and mental health, see Part III (pp. 121-314) of the 2nd edition of the Handbook of Religion and Health, by Harold G. Koenig, Dana E. King, and Verna Benner Carson (New York: Oxford University Press, 2012). The chapters of the section are:

  • Well-Being and Positive Emotions (pp. 123-144)
  • Depression (pp. 145-173)
  • Suicide (pp. 174-190)
  • Anxiety Disorders (pp. 191-206)
  • Psychotic Disorders (pp. 207-223)
  • Alcohol and Drug Use (224-242)
  • Delinquency and Crime (pp. 243-255)
  • Marital Instability (pp. 256-271)
  • Personality and Personality Disorder (pp. 272-297)
  • Understanding Religions Effects on Mental Health (pp. 298-314)
The last chapter of the section may be especially useful for chaplains. The book overall is an excellent resource, even though it is growing slightly dated as a 2012 publication. (This is, however, the update to the original 2001 first edition.)


III.  While not a review but rather an original study, the following new article should be of special interest as involving a broad perspective on religion and mental health and as coming from chaplaincy researchers.

Galek, K., Flannelly, K. J., Ellison, C. G., Silton, N. R. and Jankowski, K. R. B. "Religion, Meaning and Purpose, and Mental Health." Psychology of Religion & Spirituality online ahead of print as of November 4, 2014. [(Abstract): The present study was specifically designed to examine the associations among religious commitment, belief in meaning and purpose in life, and psychiatric symptoms among the general public using data from the 2010 Baylor Religion Survey (BRS). The BRS obtained data from a nationwide sample of 1,714 U.S. adults, 1,450 of which are included in the current analyses. The central hypothesis of the study, based on identity theory, was that religious commitment would interact with belief in meaning and purpose in their net associations on psychiatric symptoms: general anxiety, social anxiety, paranoia, obsession, and compulsion. Specifically, it was hypothesized that believing life lacks meaning and purpose will have a more pernicious association among highly religious individuals, than it will among individuals who are less religious. Other hypotheses derived from previous research were also tested. The results confirm the central hypothesis of the study for 4 of the 5 classes of psychiatric symptoms. The results are discussed with respect to identity theory, evolutionary threat assessment systems (ETAS) theory, and the hostile world scenario.]


IV.  In April 2014, the journal Issues in Mental Health Nursing (vol. 35, no. 4) published a theme issue on Spirituality and Mental Health, with a brief introduction by Inez Tuck [pp. 236-237] that gives a sense of both the state of the research and the political playing field of the subject within health care and nursing. This recent collection of articles may be of use if a CPE group invites a mental health nurse to participate in a discussion. The included article titles are:

  • Gash, J., Washington, O. G. M., Moxley, D. P. and Feen-Calligan, H., "The relationship between spiritual resources and life attitudes of African American homeless women," pp. 238-250.
  • Brewer-Smyth, K. and Koenig, H. G., "Could spirituality and religion promote stress resilience in survivors of childhood trauma?" pp. 251-256.
  • Phoenix, B., "Promoting resilience and recovery in a Buddhist mental health support group," pp. 257-264.
  • Louie, L., "The effectiveness of yoga for depression: a critical literature review," pp. 265-276.
  • Tuck, I. and Anderson, L., "Forgiveness, flourishing, and resilience: the influences of expressions of spirituality on mental health recovery," pp. 277-282.
  • Mefford, L. Thomas, S. P., Callen, B. and Groer, M., "Religiousness/spirituality and anger management in community-dwelling older persons," pp. 283-291.
  • Lynne Wilson, R. L., "Mental health recovery and quilting: evaluation of a grass-roots project in a small, rural, Australian Christian church," pp. 292-298.
  • Shores, C. I., "Spiritual interventions and the impact of a faith community nursing program," pp. 299-305.
  • Moore, A. and Cross, W., "Understanding the unconscious mind: Jungian psychology and mental health nursing," pp. 306-313.



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