While several previous studies have demonstrated a reduced risk of death with more frequent church attendance, this is the first study to look closely at certain negative forms of religiousness as predictors of mortality. Feelings of "being abandoned or punished by God," "believing the devil caused their illnesses" or "feeling abandoned by one's faith community" were identified as key factors in risk of death among elderly participants, said Dr. Harold G. Koenig, one of the authors of the study and an associate professor of psychiatry at Duke University Medical Center.
The results of the study appear in the Aug. 13, 2001 issue of the Archives of Internal Medicine. "This study reminds us that religion is a rich, complex process, one that represents a potent resource for people facing problems and one that can, at times, be a source of problems in itself," said Kenneth Pargament, professor of psychology at Bowling Green State University and lead author of the study. "The finding of a link between religious struggles and increased risk of mortality was, in some ways, surprising to us," Pargament said. "Preliminary analyses among the survivors of this cohort suggest that patients who 'stay stuck' in their struggles over time may be more likely to suffer declines in their physical and mental health than those who are able to resolve their struggles more quickly."
The study sample consisted of 595 people aged 55 or older who were hospitalized at either Duke Hospital or the VA Medical Center in Durham between January 1996 and March 1997. The group was almost entirely Christian (about 95 percent), with a majority of patients representing conservative or mainline Protestant denominations.
Patients who reported they felt alienated from God or who attributed their illness to the devil were associated with a 19 percent to 28 percent increase in risk of dying during the approximately two-year follow-up period. Gender, race, diagnosis, cognitive functioning, independence in daily activities, depressed mood or quality of life did not predict risk of mortality. Details of physical and mental health, as well as reports of religiosity and religious struggle were collected through interviews with study participants.
"Whenever anyone becomes suddenly ill with a disease that threatens life, or a way of life, they ask 'why?' or 'why me?'" said Koenig, who has conducted several studies on the link between health and religion. "It's not so much a question as it is a release of frustration. Some people experience anger at God for not protecting them or not answering their prayers for healing. Some feel as though God is punishing them and they question God's love for them, and sometimes they feel like others have deserted them as well."
Koenig said this is a normal and expected stage of grief and that most people are able to reconnect with God and their spiritual community and utilize those resources for support and growth. Others, however, remain in that state and block themselves off from anything spiritual.
"Those people are in trouble -- and doctors need to know about it," he added. "This study is important because it identifies specific religious conflicts that may lead to poorer health and greater risk of death," Koenig said.
According to Pargament, the study findings underscore the need for spiritual assessment and pastoral interventions for patients experiencing chronic religious struggle in the face of major medical illnesses. Physicians are beginning to understand the correlation between spiritual belief and health. For example, doctors are now being asked to take a patient's spiritual history, and more than two-thirds of medical schools in the United States now have courses that train students on how to take such a history, according to Koenig.
Patients who indicate religious struggle during a spiritual history may be at particularly high risk for poor medical outcomes. Referral to clergy is helpful for patients needing to work through their religious struggle.
"These feelings by patients that God has deserted them or that they are not loved are normal responses, but if people get stuck there that can lead to worse health outcomes and therefore it's important that either doctors or chaplains address these issues so that people can work through them," Koenig said. "Doctors need to be assessing their patients for these kinds of feelings and beliefs." The research was funded by a grant from the Retirement Research Foundation. Additional authors on the study included Nalini Tarakeshwar of Bowling Green State University and June Hahn of Proctor & Gamble.
Teri Sharp, Bowling Green