Existential or spirituality-based interventions may yield important clinical benefits
Nelson CJ, Rosenfeld B, Breitbart W, Galietta M;
Commented by , 13 Jun 2002
Background
Recent attention has turned towards spirituality as an important factor in helping patients cope with terminal illness. Despite numerous previous studies, the relationship between religion and depression remains unclear, owing to poor research methodology.
In contrast, few studies have addressed the relationship between spirituality and depression, independent of one’s religious beliefs and practices. Using more sophisticated methodology, the impact of spirituality and religiosity on depressive symptoms in a group of terminally ill patients is explored.
Methods
162 patients with cancer or AIDS, and a life expectancy < 6 months were recruited from palliative-care facilities. The primary independent variable was the Functional Assessment of Cancer Therapy (FACIT) Spiritual Well-Being Scale, with an overall measure of spirituality and two subscales. The "meaning/peace" subscale relates to the more existential aspects of spirituality, and the "faith" subscale corresponds more closely to religiosity. Religiosity was also measured using an index similar to those used in previous research.
The primary dependent variable was the clinician-rated Hamilton Depression Rating Scale (HDRS). Physical well-being was evaluated using the Memorial Symptom Assessment Scale (MSAS), and physical functioning using the Karnofsky Performance Rating Scale.
The Duke-UNC Functional Social Support Questionnaire assessed social support. To eliminate potential bias, clinician depression ratings were completed prior to the self-report questionnaires. Pearson correlation coefficients were used to assess the relationship between HDRS scores and the FACIT and religion questionnaire scores. Multiple regression analyses were used to determine the relationships among spirituality, religiosity, physical well-being and depression.
Results
There was a moderate negative correlation (r = -0.40) between the HDRS and FACIT total scores. The correlation was substantially greater for the meaning/peace subscale (r = -0.51), whereas no relationship was found with the faith scale (r = -0.13). Similarly, there was no relationship between religiosity and depression (r = 0.04). Multiple regression analyses yielded significant models, accounting for 46% and 47% of the variance in HDRS scores (depending on the analysis).
There was a strong negative association between both the FACIT total and meaning/peace subscale with HDRS scores. Conversely, there was a positive association between both the FACIT faith subscale (nonsignificant) and the religiosity index with depression. There were significant positive associations between number of symptoms endorsed on the MSAS and depression. Otherwise, there was no association between social support or physical functioning and depression.
Discussion
These findings suggest that the healing nature of religion may relate to spiritual or existential aspects rather than one’s specific religious practices and beliefs. In fact, religiosity was found to have a small positive association with depression. The most notable limitation of the study is the cross-sectional nature of the data, preventing definitive conclusions about the potential protective or exacerbating role of spirituality and religiosity.
Despite this limitation, the results suggest existential or spirituality-based interventions may yield important clinical benefits in the terminally ill. Clergy may benefit from focusing on the more "spiritual" rather than the ritual aspects of religion. Future longitudinal studies are warranted to further evaluate the interrelationship between spirituality, religiosity and depression, along with the clinical value of spiritual interventions.