September 2009 Article of the Month
Murphy, P. E. and Fitchett, G. "Belief in a concerned God predicts response to treatment for adults with clinical depression." Journal of Clinical Psychology 65, no. 9 (September 2009): 1000-1008.
SUMMARY and COMMENT: This month's article is a collaboration between Patricia E. Murphy and George Fitchett from the Research Division of the Department of Religion, Health and Human Values at the Rush University College of Health Sciences and the Rush University Medical Center. They write: "Our study was interested in whether or not turning to religious belief in a concerned God effects response to treatment for those diagnosed with clinical depression" [p. 1001]. They build upon a 2000 study [Murphy, P. E., et al., "The relation of religious belief and practices, depression, and hopelessness in persons with clinical depression," noted below in Related Items of Interest, #1] to hypothesize both "that greater baseline belief in a concerned and supportive God would be positively associated with greater likelihood of response to treatment for depression" and "that hopelessness would mediate the impact of these religious beliefs on response to treatment" [p. 1001] --and the data here supports the former, though not the latter. What may be of particular interest to chaplains is the conceptualization of "belief in a concerned God," as assessed by the Religious Well-Being (RWB) subscale of the (Paloutzian & Ellison) Spiritual Well-Being Scale (SWBS).
This is "one of a few studies with participants diagnosed with clinical depression with a longitudinal outcome indicating the impact of religion" [p. 1006], and 136 patients provided information at baseline (shortly after admission for treatment) and eight weeks later. In addition to the Religious Well-Being (RWB) subscale of the Spiritual Well-Being Scale, patients were asked to complete the Beck Hopelessness Scale and the Beck Depression Inventory. Response to treatment was defined as "at least a 50% reduction in symptoms" [p. 1002]. Among the results, "those with strong beliefs in a personal and concerned God have an increased likelihood of response to treatment for depression" [p. 1004]. According to one model in the analysis,
The odds ratio for RWB...indicates that for a unit increase in RWB, there is a 5% greater likelihood of responding to treatment. Compared to those with scores in the lower third for RWB, persons in the upper third of RWB were 75% more likely to respond to treatment. [p. 1004]The authors speculate:
Perhaps...belief in an understanding being who accepts us unconditionally provides healing and support for those locked in the isolation of depression. There is evidence that symptoms of depression are related to social support.... The measure of religious belief in our current study includes an aspect of support from a concerned God. [p. 1004]They further note: "Another perspective on the results of our study is that low RWB scores might indicate a loss of belief or religious struggle...in the face of symptoms, which would add to a patientís distress" [p. 1006]. (Fitchett, Murphy, and others authored an important study on religious struggle that was featured as our November 2004 Article of the Month.)
This research did not find that baseline hopelessness mediated belief in a caring God, "because it was not a significant predictor of response to treatment." [p. 1004]. The authors suggest that this may have been due to the sample size, and they encourage more research in this area [--see p. 1006].
Of special interest for chaplains is the use of the RWB subscale of the SWBS to measure "belief in a concerned God." The SWBS has 20 items, 10 of which contain the word God and constitute the RWB subscale. In these instances, the formulations of the items either explicitly or implicitly suggest a dynamic of personal and active relationship with God, with 7 items phrased positively (e.g., "I believe that God is concerned about my problems") and 3 negatively (e.g., "I believe that God is impersonal and not interested in my daily situations"). Validation testing of the RWB subscale has indicated "a positive correlation with intrinsic religious orientation...and a negative association with a loneliness scale" [--see p. 1003]. The SWBS is well established in the religion & health literature, and it deserves continued attention not only by researchers but by clinical chaplains exploring religious/spiritual assessment strategies. [Note: The other subscale in the SWBS is intended to measure Existential Well-Being and includes items that need not necessarily apply to theists (e.g., "I feel that life is a positive experience" and "I feel unsettled about my future").]
Murphy and Fitchett are as careful in their writing as they are in their research, and they point out that the results here "support, but do not prove that belief in a caring and concerned God plays a role in response to treatment for people diagnosed with depression" [p. 1006]; yet their work makes another persuasive case for clinicians' attention to patients' religious/spiritual beliefs. Chaplains may find this study useful in engaging physicians treating depressed patients.
Suggestions for the Use of the Article for Discussion in CPE:
This month's article may be suited more to students experienced in reading research than to those new to the literature -- the Data Analysis section, for instance, is highly technical -- but the introductory material and the basic findings should provide ample material for general discussion. What are the possible health implications of a patient's belief in a concerned God? What might be the underlying associations between such a belief and one's sense of self, relationship with others, and view of the nature of life? Some religious traditions emphasize a personal relationship with God more than others do, so how might that dynamic affect the importance of a belief in a personal God in health care situations? The article could lead to a wider discussion of how belief in a concerned God may play into the concept of Religious Well-Being, and students might want to explore further the (Paloutzian & Ellison) Spiritual Well-Being Scale. [For other studies using the SWBS, see the March 2004 Articles-of-the-Month page.
Related Items of Interest:
I. The 2000 study which served as a basis for the present research is:
II. In addition to the very good bibliography of this month's article, see the following recent articles on spirituality and depression that also use the (Paloutzian & Ellison) Spiritual Well-Being Scale:
III. Regarding the Spiritual Well-Being Scale itself, visit www.lifeadvance.com. Other articles using this scale (thought not necessarily in studies of depression) can be found on our March 2004 Articles-of-the-Month page.
IV. For more on spirituality and depression in general (not necessarily involving measures of well-being), see our August 2007 Articles-of-the-Month page.
V. For more on research conducted by Patricia E. Murphy, George Fitchett, and others in the Research Division of the Rush University College of Health Sciences and the Rush University Medical Center, see the Areas of Research section of the department's website.
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