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Hazim Abdulkarim Khatib,1 Waleed Ahmed Alghamdi,2 Ahmed Hussein Subki,3 Nadeem Shafique Butt,4 Mohammed Saad Alsallum,5 Ahmed Salem Alsulaimani,6 Sara Faisal Alnajjar,7 Fahad Daifallah Alzaidi,8 Abdulrahman Ali Alasmari,9 Hussein Mesfer Alshamrani,10 Faten Al-Zaben,2 Harold G Koenig2,11,12 1Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia; 2Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Internal Medicine, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia; 4Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 6Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia; 7Department of Diagnostic Radiology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 8Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 9Department of Forensic Medicine, Forensic Medicine Center, Jeddah, Saudi Arabia; 10Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 11School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 12Department of Psychiatry, Duke University Medical Center, Durham, NC, USACorrespondence: Waleed Ahmed Alghamdi; Harold G Koenig, Email wagalghamdi@kau.edu.sa; harold.koenig@duke.eduIntroduction: Skin Picking Disorder (SPD) is a skin-related disease, also recognized as psychogenic excoriation, dermatillomania, or excoriation disorder. SPD is defined as a habitual picking of skin, which in turn harms skin tissue. Given the paucity of information on SPD symptoms, their prevalence, and risk factors in Saudi Arabia, the present study seeks to fill this gap by investigating these factors in a community sample from Jeddah.Methods: This descriptive cross-sectional study was conducted in the city of Jeddah. The Skin Picking Scale-Revised (SPS-R) scale was administered to a convenience sample of 520 respondents. A partial least squares path model (PLS-PM) for “impairment” and “symptoms severity” subscales was assessed by evaluating the validity of measurement and structural models.Results: Skin picking behavior was reported by 28.8% (n=150). A significant level of skin picking disorder symptoms was present in 1.2% (n=6). Skin picking visual effect, depressive symptoms, and being unmarried were the only positive independent predictors of the total SPS-R score.Conclusion: SPD symptoms are relatively common among the adult population in Jeddah, but those with threshold symptoms indicative of SPD are relatively few. Such behavior is particularly common in vulnerable groups such as those with depressive symptoms and the unmarried. More attention to this condition by clinicians will improve the quality of life of those affected, and reduce the emotional and physical health consequences of this often unrecognized condition.Keywords: skin picking disorder, dermatillomania, excoriation disorder, prevalence, risk factors, The Skin Picking Scale-Revised scale

Waleed Ahmed Alghamdi,1 Ahmed Hussein Subki,2 Hazim Abdulkarim Khatib,3 Nadeem Shafique Butt,4 Rahaf Ali Alghamdi,1 Mohammed Saad Alsallum,5 Ahmed A Alharbi,1 Mohammad Nasser Almatrafi,1 Abdullah Ahmed Alobisi,1 Faten Al-Zaben,1 Harold G Koenig1,6,7 1Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Department of Internal Medicine, King Faisal Specialist Hospital & Research center, Jeddah, Saudi Arabia; 3Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia; 4Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 5Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 6School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 7Duke University Medical Center, Durham, NC, USACorrespondence: Waleed Ahmed Alghamdi; Harold G Koenig, Email wagalghamdi@kau.edu.sa; harold.koenig@duke.eduBackground: The present study examined the prevalence of and risk factors for symptoms of body dysmorphic disorder (BDD) in the general population of Jeddah, a large port city in Saudi Arabia.Methods: This cross-sectional study surveyed a convenience sample of 520 adults. We used a validated self-screening measure to assess BDD, the body dysmorphic disorder questionnaire (BDDQ).Results: The prevalence of significant BDD symptoms among the general Saudi population was 8.8% (ie, those scoring above the cut off for BDD on the BDDQ). Over half (52%) of all respondents reported concerns about the attractiveness of their body parts, and of those expressing such concerns, 66% were preoccupied with these thoughts. Only 3% of all respondents opted for cosmetic surgery because of these concerns, and most of those individuals (69%) had only one surgery. Nearly 9% of all respondents reported that these concerns affected their relationships with family and friends. Almost 15% of all participants spent an hour or more each day thinking about these concerns. Patients who reported a history of depression were 3.8 times more likely to have BDD. Other variables included in the model predicting high BDD scores (eg, age, job status, and marital status) did not achieve statistical significance.Conclusion: Significant symptoms of BDD (based on the BDDQ) are not uncommon among the general population of Jeddah, Saudi Arabia. Risk factors for this condition were female gender, younger age, being unmarried, and in bivariate and multivariate analyses, history of depression and female gender. These findings underscore the need for increased awareness by clinicians of this disorder, particularly when treating patients with depressive disorder, particularly among women.Keywords: body dysmorphic disorder, body image, prevalence, Saudi Arabia

Ahmed Hussein Subki,1 Abdullah Khaled Agabawi,2 Muhab Mohammed Hindi,2 Nadeem Shafique Butt,3 Mohammed Saad Alsallum,4 Rawan Ali Alghamdi,2 Siham Hussein Subki,2 Fahad Alsallum,2 Abdulaziz Ahmed Alharbi,5 Yousif Ibrahim Lodhi,6 Sultan Alandijani,1 Faten Al-Zaben,7 Harold G Koenig,7,8 Ayman M Oraif2 1Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 2Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Biostatistics, King Abdulaziz University, Jeddah, Saudi Arabia; 4Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 5‏Department of Emergency Medicine, King Fahad General Hospital, Jeddah, Saudi Arabia; 6Department of Internal Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia; 7Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USACorrespondence: Ayman M OraifDepartment of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi ArabiaTel +966 53 806 2000Email ayman_oraif@yahoo.comBackground: The patient–doctor relationship is one of the most important factors in determining the outcome of healthcare. The first step in establishing this relationship is choosing a physician. This study sought to identify patient preferences concerning the gender of their obstetrics and gynecology (OB-GYN) physician and the effect of religion and society on these choices.Methods: A cross-sectional study was conducted at the OB-GYN outpatient clinics at King Abdulaziz University Hospital in Jeddah between February 2017 and June 2017. A total of 227 female patients were recruited. Eligible were women ages 18 years or older who had attended the clinic at least three times. A 30-item questionnaire was administered.Results: Significantly, more female doctors were preferred for pelvic examination in lower income group (p=0.003), while male doctors were preferred for surgery (p=0.010) in higher income group. Significantly more male doctors were preferred for pelvic examination and gynecological surgery in > 35-year age group (p=0.015 and p=0.017, respectively). With regard to predictors, embarrassment was the most significant factor reported for not choosing a male obstetrician/gynecologist (OB-GYN) in the younger age group. Nearly three-quarters (71.2%) of respondents with age ≤ 35 reported embarrassment as a factor for not choosing a male OB-GYN; 79.7% of this subgroup indicated that female doctors were more knowledgeable about women’s health issues.Conclusion: Participants expressed a strong preference for female providers overall, although some women preferred male providers during certain circumstances (gynecologic surgery). Despite these gender preferences, more important to women in their choice of OB-GYN provider was the doctor’s experience, qualifications, and reputation. Such trends are consistent with those culturally similar countries and in line with trends worldwide. These findings have the potential to significantly impact the personal health for women in Saudi Arabia and elsewhere in the Middle East where religious and cultural traditions are so important in decision-making.Keywords: gender, preference, obstetrics, gynecologist, patient care

Harold G Koenig,1–4 Kathleen Perno,5 Ted Hamilton5 1Department of Psychiatry, 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 4School of Public Health, Ningxia Medical University, Yinchuan, People’s Republic of China; 5Medical Mission Integration, Adventist Health System, Orlando, FL, USA Objective: We report here the impact of an educational training program on attitudes and practices of physicians (MDs) and mid-level practitioners (MLPs) toward controversial spiritual practices, such as practitioner-led prayer, sharing personal religious beliefs, and encouraging patients’ religious beliefs.Methods: In this single-group experimental study, 427 physicians and 93 MLPs affiliated with the Adventist Health System agreed to complete a questionnaire assessing demographics, practice characteristics, religiosity, and attitudes and behaviors at baseline, 1 month, and 12 months. Changes in attitudes and practices over time were examined and baseline predictors were identified using mixed-effects regression models.Results: For the most part, attitudes regarding praying with patients, sharing faith with patients, and encouraging patients’ own religious faith did not change much during the 12-month ­educational training program. However, significant increases were found in frequency of praying with patients (MDs and MLPs), willingness to pray with patients (MDs), sharing their faith with patients (MDs), and encouraging patient’s own religious faith (MDs and MLPs). Among physicians, predictors of praying with patients across time were older age, Christian affiliation, and importance of religion, and among MLPs, they were older age, non-White race, and importance of religion. No interaction between time and religiosity was found.Conclusion: Although attitudes toward these mostly controversial practices were largely unaffected, the frequency of praying with patients, sharing faith, and supporting patient’s own religious faith increased over time in both religious and nonreligious clinicians. Educational programs of this type may be important in changing clinicians’ behaviors regarding appropriate and sensitive engagement in such activities with patients. Keywords: physicians, health professionals, behavior, spirituality, religion, prayer

Naseem Akhtar Qureshi,1 Abdulhameed Abdullah Al-Habeeb,2 Harold G Koenig3 1General Administration for Research and Studies, 2Mental Health and Social Services, Ministry of Health, Riyadh, Saudi Arabia; 3Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA Background: There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia. Objective: We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement. Method: The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009–2010, 4 years after a baseline assessment. Results: Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society. Conclusion: This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience. Keywords: Saudi Arabia, mental health system, organization, legal issues, research, training

Objective: An increasing body of literature examines the association of religious factors with posttraumatic stress as well as posttraumatic growth. This review of selected empirical studies describes religious and spiritual factors that have been examined in their association with the consequences of trauma. A comprehensive model is proposed to explain the complex interrelationship. Method: We performed a qualitative review of empirical research in August 2006, updated in February 2008, using Medline (1950-present), PsychInfo (1806-present), Web of Science (1900-present), and PILOTS (1960-present). We searched the terms posttraumatic, posttraumatic stress, posttraumatic growth, and religion, religious, spirituality, spiritual, meditation, and forgiveness. Based on supporting data from reviewed literature, we then developed a model for key religious factors derived from this review predictive of the response to trauma over time. Results: Twenty-three studies were identified that describe religious pretrauma characteristics, religious trauma-appraisal and post-trauma adjustment factors. The association of these factors with posttraumatic stress and growth is described. Conclusions: Intrinsic religious orientation, in particular, appears to be a useful construct in measuring religiosity in the association with the consequences of trauma. There are preliminary indications that the association between intrinsic religiosity and the consequences of trauma may change depending on the time after the event. Future studies should stratify outcome by the time after trauma or use longitudinal designs. [ABSTRACT FROM AUTHOR]

Objective: We intended to develop a brief and compact scale which measures the beneficial effects of spirituality/religiosity (SpR) on several dimensions of patients' life concerns, to be used in health outcome studies. Method: To attain a short measure valid for spiritual and religious dimensions, we designed a scale based on tested items of an independent item pool of the already established SpREUK inventory, which measures SpR attitudes and convictions and holds an independent data pool addressing the support of life concerns through SpR. To validate the intended BENEFIT scale, reliability and factor analyses were performed utilizing 371 individuals with different chronic diseases recruited in various medical centers in Germany (exploratory analysis), while for the confirmatory analyses we used an independent pool of 229 patients with chronic pain conditions. Results: Six items addressed the beneficial effects of SpR of the patients' concerns, and thus were chosen for the BENEFIT scale. These items had a good internal reliability (Cronbach's alpha = 0.922). Primary factor analysis pointed to a 1-factor solution, which explained 72% of variance. Correlation analyses revealed that the BENEFIT scale correlated with both uniquely religious and spiritual attitudes. Conclusions: The data demonstrate the reliability and validity of the 6-item BENEFIT scale that captures a unique aspect of SpR that can be used in epidemiological studies and clinical trials for those who wish to assess both the external and internal dimensions of SpR. This brief instrument can be easily incorporated into almost any study of mental health, physical health, or quality of life. [ABSTRACT FROM AUTHOR]

Over 100 measures of religiousness and spirituality are used in research investigating the associations between religion and health. These measures are often used to assess "religiousness in general," but this approach lumps together widely divergent worldviews in ways that can distort religion beyond recognition. The authors suggest that the existing measures of religiousness are perhaps better understood as reverse-coded measures of "secularism." This argument suggests that the existing data regarding religiousness and health might be best interpreted as demonstrating a small, robust health liability associated with a deliberately secular worldview. If true, this conclusion might change the direction of future research, and it would imply that meaningful inferences about the health associations of religious practice will depend on developing tools that measure specific religions in their particularity. [ABSTRACT FROM AUTHOR]

Spirituality is increasingly being examined as a construct related to mental and physical health. The definition of spirituality, however, has been changing. Traditionally, spirituality was used to describe the deeply religious person, but it has now expanded to include the superficially religious person, the religious seeker, the seeker of well-being and happiness, and the completely secular person. Instruments used to measure spirituality reflect this trend. These measures are heavily contaminated with questions assessing positive character traits or mental health: optimism, forgiveness, gratitude, meaning and purpose in life, peacefulness, harmony, and general well-being. Spirituality, measured by indicators of good mental health, is found to be correlated with good mental health. This research has been reported in some of the world's top medical journals. Such associations are meaningless and tautological. Either spirituality should be defined and measured in traditional terms as a unique, uncontaminated construct, or it should be eliminated from use in academic research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe religious affiliation, importance of religion, and the relationship between religion and self-rated health in persons aged 60 or older living in Latin America or the Caribbean. METHOD: We used data from seven cities (n = 10,587). Multivariate models were used to analyze the associations between religious affiliation and importance of religion with sociodemographic or health factors and self-rated health. RESULTS: Overall, 92% of the total study population had a religious affiliation; among those who are religious, 80% considered religion to be important in their lives. Half of the population (51%) reported fair or poor health. In multivariate models, older age increased odds of having a religious affiliation and religion being important. Women were about four times more likely to have a religious affiliation and over twice as likely as men to indicate that religion was important. Although religious affiliation was associated with poor health, this association was no longer significant after controlling for functional status. Older adults who considered religion as very important were less likely to report fair or poor health compared to those who were less religious (somewhat important, not very important). CONCLUSIONS: These older adults have a high prevalence of religious affiliation and most of them consider religion to be important. Better self-rated health was associated with higher self-rated religiosity. [ABSTRACT FROM AUTHOR]

Objective: This study compared the religious characteristics of psychiatrists with those of other physicians and explored whether nonpsychiatrist physicians who are religious are less willing than their colleagues to refer patients to psychiatrists and psychologists.Methods: Surveys were mailed to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. Physicians were queried about their religious characteristics. They also read a brief vignette about a patient with ambiguous psychiatric symptoms and were asked whether they would refer the patient to a clergy member or religious counselor, or to a psychiatrist or a psychologist.Results: A total of 1,144 physicians completed the survey, including 100 psychiatrists. Compared with other physicians, psychiatrists were more likely to be Jewish (29% versus 13%) or without a religious affiliation (17% versus 10%), less likely to be Protestant (27% versus 39%) or Catholic (10% versus 22%), less likely to be religious in general, and more likely to consider themselves spiritual but not religious (33% versus 19%). Nonpsychiatrist physicians who were religious were more willing to refer patients to clergy members or religious counselors (multivariate odds ratios from 2.9 to 5.7) and less willing to refer patients to psychiatrists or psychologists (multivariate odds ratios from .4 to .6).Conclusions: Psychiatrists are less religious than other physicians, and religious physicians are less willing than nonreligious physicians to refer patients to psychiatrists. These findings suggest that historic tensions between religion and psychiatry continue to shape the care that patients receive for mental health concerns. [ABSTRACT FROM AUTHOR]

The impact of religious involvement on time to remission of depression was examined in older medical inpatients with heart failure and/or chronic pulmonary disease (CHF/CPD). Inpatients older than 50 years with CHF/CPD were systematically diagnosed with depressive disorder using a structured psychiatric interview. Cox proportional hazards regression was used to examine the effects of religious involvement on time to remission, controlling for covariates. Of 1000 depressed patients identified at baseline, follow-up data on depression course were obtained on 87%. Patients involved in group-related religious activities experienced a shorter time to remission. Although numerous religious measures were unrelated by themselves to depression outcome, the combination of frequent religious attendance, prayer, Bible study, and high intrinsic religiosity, predicted a 53% increase in speed of remission (HR 1.53, 95% CI 1.20-1.94, p = 0.0005, n = 839) after controls. Patients highly religious by multiple indicators, particularly those involved in community religious activities, remit faster from depression. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Many American patients depend on religion to cope, but less is known about the spiritual/religious (SpR) characteristics of medical patients in Europe, a more secular environment. We examined self-categorizations of SpR (spiritual, religious, both, neither), patients' search for meaningful support, trust in higher source, positive interpretation of disease, and support in relations of life through SpR, as measured with the SpREUK questionnaire, in German medical patients. METHOD: We analyzed data on 710 West-German patients with a mean age of 54. Forty-two percent had chronic pain diseases, 25% cancer, 10% multiple sclerosis, 21% other chronic diseases, and 3% acute diseases. RESULTS: The general interest in search for meaningful support was moderate. Trust in a higher source and support in life through SpR were rated higher, while almost all patients had a positive interpretation of their diseases, i.e, hint to change life. The interest in SpR issues was highest in cancer patients and lowest in patients with multiple sclerosis. Univariate analyses confirmed that the SpR self-categorization was the strongest predictor of all four factors, while trust in a higher source was also affected by religious affiliation and age. Positive interpretations of disease correlated well with search for meaningful support. CONCLUSIONS: Patients with chronic diseases differ with respect to their SpR self-categorizations and may thus utilize different aspects of SpR. Cancer patients, in particular, often depend on their trust in a higher power and in conventional religious activities to help them to cope with their illness. [ABSTRACT FROM AUTHOR]

Church attendance is associated with improved health and well-being among older adults, but older adults with functional limitations may have difficulty attending church services. This article examines differences in the association between functional limitations and church attendance in a sample of 987 elderly African American and white individuals. African American and white elderly people without limitations attended church at virtually the same rate (69 percent). Despite their higher scores on religiousness measures, elderly African Americans with one or more limitations were significantly less likely to attend church regularly than were white counterparts. Health status measures did not help explain older African Americans' lower attendance rates. Differences in attendance were associated primarily with educational attainment and cognitive functioning. The article recommends social work intervention to reduce barriers to church attendance for older adults who want to attend services. [ABSTRACT FROM AUTHOR]

A total of 268 medically ill, elderly, hospitalized patients responded to measures of religious coping and spiritual, psychological and physical functioning at baseline and follow-up two years later. After controlling for relevant variables, religious coping was significantly predictive of spiritual outcome, and changes in mental and physical health. Generally, positive methods of religious coping (e.g. seeking spiritual support, benevolent religious reappraisals) were associated with improvements in health. Negative methods of religious coping (e.g. punishing God reappraisal, interpersonal religious discontent) were predictive of declines in health. Patients who continue to struggle with religious issues over time may be particularly at risk for health-related problems. © 2004 SAGE Publications Ltd. [ABSTRACT FROM AUTHOR]

This research examined the extent to which religiosity was predictive of level of depression, even after controlling for race, gender, social support, income sufficiency, and physical health. Data were collected using in-home interviews conducted from 1999 to 2001 with 1,000 adults age 65 to 106. Subjects were recruited from a stratified, random sample of Medicare beneficiaries age 65 and older in five central Alabama counties (three rural and two urban). The sample was stratified by county, race, and sex and included balanced numbers of African American males and females and White males and females. Highly religious persons had lower levels of depression, even when controlling for other known covariates, beta = -.16, t(972) p<.001. Females reported higher levels of depression, beta = .07, t(972) p<.05. Although race was unrelated to depression in the model including gender and religiosity only, African Americans reported fewer symptoms of depression than did Whites when social support, income sufficiency, and physical health were added to the model, beta = -.08, t(972) p<.01. Results suggest the importance of health and social service professionals' drawing upon older adults' positive spirituality in professional interventions to prevent and treat depression. [ABSTRACT FROM AUTHOR]

The prevalence of major depression declines with age, but depressive symptoms become more common. Never normal, these are eminently treatable with antidepressants taken in adequate dosages for an appropriate length of time. [ABSTRACT FROM AUTHOR]

Methods: A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986 1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model.Results: During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.434).59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.554-.76, p<.0001) and men (RH 0.83, 95% CI 0.69-1.00, p=.05).Conclusions: Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently. [ABSTRACT FROM AUTHOR]

A review of quantitative research studies published between 1991 and 1995 in 3 major mental health nursing journals revealed that approximately 10% (31 of 311) included a measure of religion or spirituality. This percentage (10%) is 3 to 8 times higher than that found in previous reviews of empirical research in psychological and psychiatric journals, suggesting that mental health nursing research is more sensitive to the role of religious-spiritual factors on mental health than research in related disciplines. The results are discussed in the context of the history and philosophy of nursing and in comparison to related disciplines. Methodological aspects of the research, especially the importance of multiple measures, are discussed, as are other salient findings. [ABSTRACT FROM AUTHOR]

Recent years have seen increasing recognition paid to the relation of religiousness/spirituality (R/S) to health care and research. This has led to the development of more inclusive and trans-culturally validated measurements of R/S. This paper comments on the WHOQOL SRPB Group's 'A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life' (62: 6, 2005, 1486-1497), a recently published paper in Social Science & Medicine, and illustrates a possible problem in the measurement of R/S, especially as related to the study of mental health outcomes. Some scales have included questions about psychological well-being, satisfaction, connectedness with others, hopefulness, meaning and purpose in life, or altruistic values as part of their measure of R/S. These questions are really tapping indicators of mental health, and should not be included in the definition of R/S itself. Otherwise, tautology is the result, and it should not be surprising that such measures of R/S (defined by questions tapping mental health) are related to mental health outcomes. [ABSTRACT FROM AUTHOR]

The need to take account of spirituality in research and health services provision is assuming ever greater importance. However the field has long been hampered by a lack of conceptual clarity about the nature of spirituality itself. We do not agree with the sceptical claim that it is impossible to conceptualize spirituality within a scientific paradigm. Our aims are to 1) provide a brief over-view of critical thinking that might form the basis for a useful definition of spirituality for research and clinical work and 2) demystify the language of spirituality for clinical practice and research. [ABSTRACT FROM AUTHOR]

Background: Previous studies have linked higher religious attendance and longer survival. In this study, we examine the relationship between survival and private religious activity.Methods: A probability sample of elderly community-dwelling adults in North Carolina was assembled in 1986 and followed for 6 years. Level of participation in private religious activities such as prayer, meditation, or Bible study was assessed by self-report at baseline, along with a wide variety of sociodemographic and health variables. The main outcome was time (days) to death or censoring.Results: During a median 6.3-year follow-up period, 1,137 subjects (29.5%) died. Those reporting rarely to never participating in private religious activity had an increased relative hazard of dying over more frequent participants, but this hazard did not remain significant for the sample as a whole after adjustment for demographic and health variables. When the sample was divided into activity of daily living (ADL) impaired and unimpaired, the effect did not remain significant for the ADL impaired group after controlling for demographic variables (hazard ratio [RH] 1.11, 95% confidence interval [CI] 0.91-1.35). However, the increased hazard remained significant for the ADL unimpaired group even after controlling for demographic and health variables (RH 1.63, 95% CI 1.20-2.21), and this effect persisted despite controlling for numerous explanatory variables including health practices, social support, and other religious practices (RH 1.47, 95% CI 1.07-2.03).Conclusions: Older adults who participate in private religious activity before the onset of ADL impairment appear to have a survival advantage over those who do not. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites. METHODS: We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs. RESULTS: The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites. DISCUSSION: The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated. [ABSTRACT FROM AUTHOR]

Few investigations of the social correlates of depressive symptomatology have addressed variation in the correlates across multiple dimensions of depression scales. We examined the relationships of selected social, clinical, and demographic correlates with four dimensions of the Center for Epidemiologic Studies--Depression (CES-D) scale in 3,401 community-dwellinng elders in the Piedmont area of North Carolina. These correlates explained significant variation in somatic complaints and depressed affect, effects of chronic disability and recent negative events were particularly robust Having a confidant explained reduced symptomatology for all four dimensions, but particularly for low positive affect and interpersonal problems. Positive affect was also buttressed by helping others. These patterns have particular relevance where treatment for depression is divorced from considerations of the social environment of the elderly patient. [ABSTRACT FROM AUTHOR]

Objectives: Mental health remains an unmet need among Chinese Americans. This study aims to identify specific needs and strategies that may address the needs., Design: A total of 55 Chinese Americans consented and participated in online focus groups conducted in either Chinese or English using nominal group technique. Participants discussed the following questions, achieved themes, and provided ranking of themes in importance for each: (1) In general, what do people in the Chinese American community think about mental health or emotional well-being? (2) What have you found to be helpful for accessing mental health or emotional well-being services or care in the Chinese American population? And (3) What actions would you suggest to improve mental health and emotional well-being in the Chinese American population?, Results: Across the focus groups, we observed high consistency of top ranked themes including lack of knowledge and awareness, negative impression, lack of Chinese-speaking providers, and that the most helpful factor toward access to care was education and increased awareness. Seminars and trainings was the top actionable suggestion., Conclusion: The findings are consistent with previous findings and continue to show that Chinese Americans need more education and training and that providers who can speak the language and understand the culture would be very helpful to increase access to care. This study emphasizes addressing mental health disparities in the Chinese American community through awareness, tailored interventions, and barrier removal. Promoting equal access also underscores the need for ongoing assessment and responsive strategies.

The relationship between mild cognitive impairment (MCI), religiosity and/or spirituality (R/S), and all-cause mortality among older adults has yet to be clarified. The current study aims to examine this relationship using a longitudinal cohort from ethnic minority communities in mainland China. The Cox proportional hazards regression modeling revealed that MCI predicted an increased risk of all-cause mortality, and high R/S buffered this association. Those findings suggest that a religious-spiritual integrated community intervention program may reduce the mortality risk in older adults with MCI in ethnically disadvantaged populations., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In the year of the Olympics (Paris, 2024), this issue of JORH explores nutrition and chronic care, offers a caution regarding the use of religiosity and spiritual measurement scales, and revisits the topic of COVID-19. While the latter has been rapidly declining in terms of its global impact, each of these areas of inquiry generate a great deal of research from which humanity still has much to learn., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The relationship between religiosity, spirituality and health has received increasing attention in the academic literature. Studies involving quantitative measurement of religiosity and/or spirituality (R/S) and health have reported many positive associations between these constructs. The quality of various measures, however, is very important in this field, given concerns that some measures of R/S have been contaminated with indicators of mental health. When this occurs, that is when R/S is defined and measured a priori, this subsequently guarantees a positive association between R/S and health (especially mental health). Such associations are called tautological, which involves correlating a construct with itself, thus producing associations that are uninterpretable and misleading. In this article, concerns about the measurement of R/S are discussed, examples of contaminated and potentially probelmatic measures of R/S are noted, and recommendations are made regarding uncontaminated measures of R/S that should be used in future studies of R/S and health., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: The aim of this study was to evaluate the impact of social support and religiosity/spirituality (R/S) on the recovery from an acute cardiac event or cardiac surgery during cardiac rehabilitation (CR)., Methods: In this prospective study, a convenience sample of 159 patients participating in a CR program were enrolled. Religiosity/spirituality, social support, anxiety, depression, health related quality of life (QoL), and exercise capacity (6-min walk test, cycle ergometer test) were assessed., Results: Social support was significantly associated with less anxiety ( p < .01), less depression ( p < .01), and better QoL ( p < .05) on admission. After adjustment for age, gender, education level, and morbidity, social support remained significantly associated with less depression ( p < .001). Religiosity/spirituality was significantly associated with less depression ( p < .05), better QoL ( p < .05), and better exercise capacity ( p < .05) at admission. After adjustment for covariates, however, significance was lost. There were no significant impact of either social support or R/S on the course of CR measured by change in QoL or exercise capacity., Conclusion: Social support may be a protective factor against depression in the recovery from cardiac events or surgery. Neither social support nor R/S had a significant impact on the course of the 3-week CR program., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Most effective interventions to control coronary heart disease (CHD) and prevent negative outcomes involve behavioral modification. This study examined how such modification based on the Health Belief Model (HBM) might improve lifestyle and clinical outcomes., Methods: A total of 120 people with CHD seeking help at a general hospital in Iran were randomly assigned to either the intervention or control group. Information was collected using an HBM-specific questionnaire and the Health Promoting Lifestyle II (HPLP-II) scale. Clinical outcomes (blood pressure, body mass index, and fasting blood sugar) were also measured. The intervention group received a tailored education based on HBM principles plus routine care, while those in the control group received only routine care. Three months after the intervention, both groups were reassessed using Student's t test and analysis of covariance., Results: All HBM subscale scores indicated significant improvements in the intervention group, in contrast to the control group, where scores worsened or stayed the same. Perceived severity and susceptibility were the dimensions that changed most. Total score on the HPLP-II improved significantly in the intervention group (p < 0.001, F = 747.5); however, subscale scores on spiritual growth and interpersonal relationships did not demonstrate significant between-group differences at follow-up. After adjustment for baseline scores, significant improvements in lifestyle subscales were also accompanied by significant improvements in clinical measures., Conclusions: This HBM-based behavior modification program improved both lifestyle and clinical measures in patients with CHD. Utilizing this program in patients with other cardiovascular diseases may in the future demonstrate similar results., (© 2023. International Society of Behavioral Medicine.)

This issue of JORH focuses upon faith and health within three nations that have contributed a great deal in terms of religion and health research during this century-namely Israel, Türkiye and the USA., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)