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Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?

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Abstract

Background

Anxiety and depression are common in seriously ill patients and may be associated with spiritual concerns. Little research has examined how concerns in different domains of spirituality are related to anxiety and depression.

Objective

To examine the association of spiritual history and current spiritual well-being with symptoms of anxiety and depression in patients with advanced illness.

Design

Cross-sectional cohort study

Participants

Two hundred and ten patients with advanced illness, of whom 1/3 were diagnosed with cancer, 1/3 COPD, and 1/3 CHF. The mean age of the sample was 66 years, and 91% were Christian.

Measurements

Outcome measures were the Profile of Mood States’ Anxiety Subscale (POMS) and 10-item Center for Epidemiologic Studies Depression Scale (CESD). Predictors were three subscales of the Spiritual History Scale measuring past religious help-seeking and support, past religious participation, and past negative religious experiences and two subscales of the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale measuring the role of faith in illness and meaning, peace, and purpose in life. We conducted multiple regression analyses, controlling for demographics, disease type and severity, self-rated religiousness/spirituality, and frequency of religious attendance and devotion.

Results

In adjusted analyses, greater spiritual well-being, including both beliefs about the role of faith in illness and meaning, peace, and purpose in life were associated with fewer symptoms of anxiety (P ≤ 0.001) and depression (P < 0.001). Greater past negative religious experiences were associated with more symptoms of anxiety (P = 0.04) and depression (P = 0.004). No other measures of spiritual history were associated with the outcomes.

Conclusions

In this diverse sample of seriously ill patients, current spiritual well-being and past negative religious experiences were associated with symptoms of anxiety and depression. Healthcare providers should consider asking about current spiritual well-being and past negative religious experiences in their assessment of seriously ill patients with symptoms of anxiety and depression.

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Acknowledgements

Contributors

No additional contributors.

Funders

Paul B. Beeson Career Development Award in Aging Research: NIA 5K08AG028975

Pathways Study

NINR P01 – RFA – NR-08-001

Prior Presentations

Johnson KS, Olsen MK, Lindquist JH, Tulsky JA, Steinhauser K. Which dimensions of spirituality are associated with anxiety and depression in patients with advanced serious illness? Poster Presentation, National Palliative Care Research Center Annual Retreat and Research Symposium, October 2009, Atlanta Georgia.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Division of Geriatrics, Duke University School of Medicine, DUMC Box 3003, Durham, NC, 27710, USA

    Kimberly S. Johnson MD, MHS

  2. Department of Medicine, Duke University School of Medicine, Durham, NC, USA

    Kimberly S. Johnson MD, MHS & James A. Tulsky MD

  3. Center for Palliative Care, Duke University, Durham, NC, USA

    Kimberly S. Johnson MD, MHS, James A. Tulsky MD & Karen E. Steinhauser PhD

  4. School of Nursing, Duke University, Durham, NC, USA

    Judith C. Hays PhD, RN

  5. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Maren K. Olsen PhD

  6. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Robert M. Arnold MD

  7. Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA

    James A. Tulsky MD, Maren K. Olsen PhD, Jennifer H. Lindquist MS & Karen E. Steinhauser PhD

Authors
  1. Kimberly S. Johnson MD, MHS
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  2. James A. Tulsky MD
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  7. Karen E. Steinhauser PhD
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Corresponding author

Correspondence to Kimberly S. Johnson MD, MHS.

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Johnson, K.S., Tulsky, J.A., Hays, J.C. et al. Which Domains of Spirituality are Associated with Anxiety and Depression in Patients with Advanced Illness?. J GEN INTERN MED 26, 751–758 (2011). https://doi.org/10.1007/s11606-011-1656-2

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  • DOI: https://doi.org/10.1007/s11606-011-1656-2

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