Harvard research: How are spirituality and health related?

Spirituality improves medical care for those coping with serious illnesses. And it improves overall health outcomes, even at the population level.

These claims are based on a review of more than two decades of high-quality studies showing the benefits of seeing and nurturing a patient’s spirituality as part of medical care or public health.

The findings, which were led by researchers from Harvard University’s Human Flourishing Program and colleagues at the university’s Initiative on Health, Religion and Spirituality, among others, were published earlier this month in JAMA, the Journal of the American Medical Association.

According to Dr. Tracy A. Balboni, co-director of the Harvard Initiative and professor of radiation oncology and lead author of the study, is not a new discovery. She said the link is particularly well known between community forms of spirituality and key outcomes such as reductions in all-cause mortality, suicide, depression and substance abuse, and better recovery from substance use disorders.

“There is actually a body of research in both health – healthy populations – and serious disease that shows clear ways that spirituality is related to well-being and shows many notable associations with very rigorously conducted research,” Balboni said. who also directs the Harvard radiation oncology program.

“Spirituality in Serious Illness and Health” is a detailed look at hundreds of studies involving thousands of patients to see what research has shown about the connection between spirituality and health. Expert panels then analyzed the results to produce recommendations on how to harness this relationship for the benefit of both critically ill individuals and public health.

The goal, they said, is “person-centered, values-sensitive care.”

Clinicians, public health experts, researchers, healthcare system leaders and medical ethicists made up the panels. Top priorities in treating people with serious illnesses identified by the panel include:

  • Regularly include pastoral care in medical care.
  • Incorporating Spiritual Care Education into the training of interdisciplinary medical team members.
  • Including specialized spiritual practitioners such as chaplains in patient care.

In the area of ​​public health, they suggest:

  • That clinicians consider useful connections between religious/spiritual community and health to provide better person-centred care.
  • Improving the knowledge of public health professionals on evidence that participation in religious/spiritual communities is associated with health protection.
  • Recognize spirituality as a social factor linked to health.

Balboni said spirituality can manifest itself in many ways, not just as a religion. “At the very least, early data suggests that a community where there is a shared purpose, value, and connection might have something similar. It’s just that religious communities tend to — that’s the crux of what they generally do. I think those are the most common forms.”

She added, “Finding that community that helps nurture and maintain a framework of meaning, purpose, and value is critical to our health, well-being, and thriving as human beings.”

define need

Blogging about the research in Psychology Today and in the Human Flourishing newsletter, Tyler J. VanderWeele, director of that program, noted “strong evidence that church attendance was associated with a reduced risk of mortality; less smoking, alcohol and drug use; better mental health; better quality of life; less subsequent depressive symptoms and less frequent suicidal behavior.”

He wrote that deep insight into longitudinal studies suggests those who attend church services often have a 27% reduced risk of dying in aftercare and a 33% reduced chance of developing depression later.

“So spirituality or spiritual community seemed to be important in both sickness and health,” VanderWeele said.

The researchers considered high-quality studies published since 2000. The criteria for “high quality” included large sample sizes and validated measures. For health outcomes, the studies also needed a longitudinal design. They excluded studies with “serious or critical” risk of bias.

The panels discussed the health care implications based on the evidence in the studies, rating them from inconclusive to the strongest evidence to agree on the recommendations.

By the time they went through the elimination process, they had narrowed down nearly 9,000 items to 371 on serious diseases. Out of almost 6,500 articles on health outcomes, 215 were among them.

They found clear evidence that spirituality is important to most patients and that spiritual needs are common, but spiritual care is not. They also found that patients often desire spiritual care, but spiritual needs are rarely addressed as part of medical care—although spirituality often influences the medical decisions patients make.

Finally, the research report showed that patients’ quality of life is not as good when spiritual needs are not addressed, while providing spiritual care provides better end-of-life outcomes.

In real life

Rev. Amy Ziettlow has often experienced the interplay of faith and medicine in her role as pastor of Holy Cross Lutheran Church in Decatur, Illinois. She said the JAMA study “consistent with my day-to-day experience of community service.”

Every congregation has homebound members who are critically ill, said Rev. Ziettlow, who was not involved with the study. “They live with chronic or acute pain, suffer from memory loss and physical mobility, and are vulnerable to infections, particularly COVID-19, flu and pneumonia. “Homebound” by definition means they are separated from their denominations, and my role as pastor aims to remind them that they are still connected to their church homes and to God’s presence,” she told Deseret News E-mail.

Her example is Mary, who at age 96 had difficulty walking and was living in a memory ward when she started hospice last April. Amid the COVID-19 restrictions, only family members and Rev. Ziettlow were allowed to visit.

During weekly, then daily, visits as death neared, “I was a bridge between her isolated room and our bustling haven of worshipers, between her life ruled by medication, doctor visits, and physical limitations, and her life that determined by their relationship with God.” Rev. Ziettlow said. “I wore a spiritual collar, my worship uniform, which signaled to her and the care center staff that ritual acts and words would occur that would connect Mary to her ultimate meaning, the story of God’s love and grace.”

Despite her failing memory, Mary still knew the liturgical elements that had nourished her spirit throughout her life, Rev. Ziettlow said. “She recited the Lord’s Prayer, the Apostles’ Creed, and sang along to favorite songs like ‘Jesus Loves Me’ and ‘Amazing Grace.'”

Each visit ended with the Sacrament of Communion. “Mary kept a special plate and napkin that I was happy to use as we marked this ritual meal together. We ate, drank and remembered that God’s presence is truly with us always,” the pastor recalled. “Her last words to me were, ‘God bless you.'”

Baldoni hopes the medical community, public health workers and all they serve will pay attention to the connection between spirituality and health.

Spirituality, she said, “can actually nourish the very soul of medicine. I believe that when we better embrace the spiritual aspects of our patients, we embrace the spiritual aspects of what it means to be caregivers.”

Speaking on the public health side, she said: “As health systems at all levels recognize that people are spiritual beings and that this is an important aspect of thriving, we can unlock better care for human populations or communities by drawing on the resources of the community spirituality.”

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