Spirituality and Aging

Helen Lavretsky

Disclosures

Aging Health. 2010;6(6):749-769. 

In This Article

Spirituality & Mental Health: Coping & Adaptation

The impact of religion and spirituality on mental health has been studied more extensively than the impact on physical health. Much of the research on spirituality and aging has looked at the relationship between spiritual or religious coping and health. Musick and colleagues identified approximately 370 studies dealing with the association between religion and physical/mental health.[94] A large number of writers would like a greater understanding of spirituality and meaning in old age,[95] or religious coping and life outcomes.[37] Spiritual health is closely related to mental health and psychological coping.[96,97] Providers of clinical services have a responsibility to take the 'whole' person into their work with clients[98] and integrate spiritual issues into the psychological or medical care of older adults.[2,69]

There is abundant evidence that spirituality and religious participation are associated with positive mental health outcomes. Koenig and coleagues reviewed 325 studies, and found a significant relationship between religious involvement and better mental health, physical health and the use of health services.[1] Williams concluded that religious attendance buffered the effects of stress on mental health.[99] In Coward's study of 107 women with advanced breast cancer, spirituality appeared to improve emotional wellbeing.[100] Studies have demonstrated religiosity to be related to wellbeing in white Americans, Mexican–Americans,[101] African–Americans[102] and in different age groups.[103] Intrinsically religious people internalize their faith, and have higher self-esteem, better personality functioning, less paranoia and lower rates of depression or anxiety, while extrinsically religious people use religion to obtain status, security, sociability or health.[73,104] Findings are mixed about whether religion increases or decreases anxiety.[52] Religious coping is inversely related to depressive symptom severity in the veterans.[105,106] However, only two-thirds of the US population consider religion to be an important influence in their life.[104]

Most studies find that higher religiousness and spirituality are associated with lower levels of death, anxiety or alcoholism, with better marriages, reduced loneliness lesser distress among dementia caregivers, and better mental health.[3] Data drawn from the first and second results of the Duke Established Populations for Epidemiologic Studies of the Elderly demonstrated that religious attendance may offer mental stimulation, which helps to maintain cognitive functioning in later life, particularly among older depressed women.[107] A few studies have addressed differences between religions. One study in older women in Hong Kong showed that Catholics and Buddhists enjoyed a better mental health status than Protestants.[108]

A number of studies examine the association of religion with depression. Prospective cohort studies have shown religious activity to be associated with remission of depression in Protestants, Catholic Netherlanders[109] and in ill older adults.[87] In total, 24 studies in the research literature have found that religiously involved people had fewer depressive symptoms and less depression[93] or less anxiety.[54] Approxiately 80% of existing research has also suggested an inverse correlation between religiosity and suicide.[110–112] Suicide may be less acceptable to people with high religious devotion and religious beliefs. Several randomized controlled trials demonstrated the benefits of religion-based cognitive therapy on Christian patients with clinical depression.[113] Three randomized controlled trials suggest that Islamic-based religious psychotherapy accelerated recovery from anxiety and depression in Muslim Malays, but did not control for the use of antidepressants and benzodiazepines.[114–116] Religious commitment also has been found to moderate the relationship between functional disability and depression.[117]

Religious and spiritual themes can be present in the context of mental illness, such as schizophrenia or bipolar disorder. On another note, highly stressful life events can transform normative religious beliefs into excessive preoccupations that involve delusional guilt. Richards and Bergin advise to restrict spiritual interventions and explorations to less-disturbed patients; that is, outpatients without psychotic or severe mood disorders.[11,104]

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