Spirituality linked with better health outcomes, patient care

by Harvard T.H. Chan School of Public Health

Credit: CC0 Public Domain

Spirituality should be incorporated into care for both serious illness and overall health, according to a study led by researchers at Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital.

31 jul 2022--"This study represents the most rigorous and comprehensive systematic analysis of the modern day literature regarding health and spirituality to date," said Tracy Balboni, lead author and senior physician at the Dana-Farber/Brigham and Women's Cancer Center and professor of radiation oncology at Harvard Medical School. "Our findings indicate that attention to spirituality in serious illness and in health should be a vital part of future whole person-centered care, and the results should stimulate more national discussion and progress on how spirituality can be incorporated into this type of value-sensitive care."

"Spirituality is important to many patients as they think about their health," said Tyler VanderWeele, the John L. Loeb and Frances Lehman Loeb Professor of Epidemiology in the Departments of Epidemiology and Biostatistics at Harvard Chan School. "Focusing on spirituality in health care means caring for the whole person, not just their disease."

The study, which was co-authored by Balboni, VanderWeele, and senior author Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School, will be published online in JAMA on July 12, 2022. Balboni, VanderWeele, and Koh are also co-chairs of the Interfaculty Initiative on Health, Spirituality, and Religion at Harvard University.

According to the International Consensus Conference on Spiritual Care in Health Care, spirituality is "the way individuals seek ultimate meaning, purpose, connection, value, or transcendence." This could include organized religion but extends well beyond to include ways of finding ultimate meaning by connecting, for example, to family, community, or nature.

In the study, Balboni, VanderWeele, Koh, and colleagues systematically identified and analyzed the highest-quality evidence on spirituality in serious illness and health published between January 2000 and April 2022. Of the 8,946 articles concerned with serious illness, 371 articles met the study's strict inclusion criteria, as did 215 of the 6,485 articles focused on health outcomes.

A structured, multidisciplinary group of experts, called a Delphi panel, then reviewed the strongest collective evidence and offered consensus implications for health and health care.

They noted that for healthy people, spiritual community participation–as exemplified by religious service attendance—is associated with healthier lives, including greater longevity, less depression and suicide, and less substance use. For many patients, spirituality is important and influences key outcomes in illness, such as quality of life and medical care decisions. Consensus implications included incorporating considerations of spirituality as part of patient-centered health care and increasing awareness among clinicians and health professionals about the protective benefits of spiritual community participation.

The 27-member panel was composed of experts in spirituality and health care, public health, or medicine, and represented a diversity of spiritual/religious views, including spiritual-not-religious, atheist, Muslim, Catholic, various Christian denominations, and Hindu.

According to the researchers, the simple act of asking about a patient's spirituality can and should be part of patient-centered, value-sensitive care. The information gleaned from the conversation can guide further medical decision-making, including but not limited to notifying a spiritual care specialist. Spiritual care specialists, such as chaplains, are trained to provide clinical pastoral care to diverse patients–whether spiritual-not-religious or from various religious traditions. Chaplains themselves represent a variety of spiritual backgrounds, including secular and religious.

"Overlooking spirituality leaves patients feeling disconnected from the health care system and the clinicians trying to care for them," said Koh. "Integrating spirituality into care can help each person have a better chance of reaching complete well-being and their highest attainable standard of health."

Other Harvard Chan co-authors include Stephanie Doan-Soares and Katelyn Long.

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More information: Spirituality in Serious Illness and Health, JAMA (2022). DOI: 10.1001/jama.2022.11086

Provided by Harvard T.H. Chan School of Public Health 

Religious affiliation linked to nearly 4-year longevity boost

Credit: The Ohio State University

A new nationwide study of obituaries has found that people with religious affiliations lived nearly four years longer than those with no ties to religion.
That four-year boost – found in an analysis of more than 1,000 obits from around the country – was calculated after taking into account the sex and marital status of those who died, two factors that have strong effects on lifespan.

17 jun 2018--The boost was slightly larger (6.48 years) in a smaller study of obituaries published in a Des Moines, Iowa, newspaper.
"Religious affiliation had nearly as strong an effect on longevity as gender does, which is a matter of years of life," said Laura Wallace, lead author of the study and a doctoral student in psychology at The Ohio State University.
The study was published online today in the journal Social Psychological and Personality Science.
The researchers found that part of the reason for the boost in longevity came from the fact that many religiously affiliated people also volunteered and belonged to social organizations, which previous research has linked to living longer.
"The study provides persuasive evidence that there is a relationship between religious participation and how long a person lives," said Baldwin Way, co-author of the study and associate professor of psychology at Ohio State.
In addition, the study showed how the effects of religion on longevity might depend in part on the personality and average religiosity of the cities where people live, Way said.
The first study involved 505 obituaries published in the Des Moines Register in January and February 2012. In addition to noting the age and any religious affiliation of those who died, the researchers also documented sex, marital status and the number of social and volunteer activities listed.
Results showed that those whose obit listed a religious affiliation lived 9.45 years longer than those who didn't. The gap shrunk to 6.48 years after gender and marital status were taken into account.
The second study included 1,096 obituaries from 42 major cities in the United States published on newspaper websites between August 2010 and August 2011.
In this study, people whose obits mentioned a religious affiliation lived an average of 5.64 years longer than those whose obits did not, which shrunk to 3.82 years after gender and marital status were considered.
Many studies have shown that people who volunteer and participate in social groups tend to live longer than others. So the researchers combined data from both studies to see if the volunteer and social opportunities that religious groups offer might explain the longevity boost.
Results showed that this was only part of the reason why religious people lived longer.
"We found that volunteerism and involvement in social organizations only accounted for a little less than one year of the longevity boost that religious affiliation provided," Wallace said. "There's still a lot of the benefit of religious affiliation that this can't explain."
So what else explains how religion helps people live longer? It may be related to the rules and norms of many religions that restrict unhealthy practices such as alcohol and drug use and having sex with many partners, Way said.
In addition, "many religions promote stress-reducing practices that may improve health, such as gratitude, prayer or meditation," he said.
The fact that the researchers had data from many cities also allowed them to investigate whether the level of religiosity in a city and a city's "personality" could affect how religious affiliation influenced longevity.
The findings showed that a key personality element related to longevity in each city was the importance placed on conformity to community values and norms.
In highly religious cities where conformity was important, religious people tended to live longer than non-religious people.
But in some cities there is a spillover effect.
"The positive health effects of religion spill over to the non-religious in some specific situations," Wallace said. "The spillover effect only occurs in highly religious cities that aren't too concerned about everyone conforming to the same norms. In those areas, non-religious people tend to live as long as do religious people."
Way said there are limitations to the study, including the fact that it could not control for important factors related to longevity such as race and health behaviors. But a potential strength was that, unlike other studies, religious affiliation was not self-reported, but was reported by the obituary writer.
Overall, the study provided additional support to the growing number of studies showing that religion does have a positive effect on health, Wallace said.

More information: Does Religion Stave Off the Grave? Religious Affiliation in One's Obituary and Longevity. Social Psychological and Personality Science. doi.org/10.1177/1948550618779820


Provided by The Ohio State University

Study shows link between regular attendance at religious services and health and longevity

Researchers from the Emory Rollins School of Public Health have published a paper in PLOS ONE that links regular attendance at religious services with improved health and lowered mortality.
The researchers conducted an empirical study on data collected 2004-2014 through the University of Michigan's Health and Retirement Study (HRS), which surveyed social and economic determinants of mortality in middle-aged and older adults, including religious factors.

12 jan 2018--"We wanted to link the research on religion—especially religious attendance—into the social determinants of health framework," says Idler.
This was an idea the paper's authors also examined in their book, Religion as a Social Determinant of Public Health (Oxford University Press, 2014), edited by Idler and featuring chapters by Blevins, Kiser, and Hogue, in addition to numerous additional Emory faculty.
"With this paper, we were able to take a theory and a conceptual framework to real data and came back with some dramatic findings. "
They found that there is a substantial amount of protection against mortality from all causes for people who attend religious services once a week or more often. Even those who attended less frequently had a greater protection against mortality than those who didn't attend at all. There were no differences by religious affiliation.
Part of this may be due to the positive health behaviors shown among those who attend religious services more often. For instance, those who attended services more often were less likely to smoke or drink alcohol than those who never attended, and they were more likely to exercise and get health screenings. Those frequenting religious services also experienced social benefits linked to health, like being part of a socially supportive community or volunteering to help others.
The findings showed that the protective effect of frequent attendance at services was very comparable to the effects of higher levels of income and wealth, economic factors that were especially well measured in the HRS.

More information: Ellen Idler et al. Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study, PLOS ONE (2017). DOI: 10.1371/journal.pone.0189134


Provided by Emory University

Negative spiritual beliefs associated with more pain and worse physical, mental health

Individuals who blame karma for their poor health have more pain and worse physical and mental health, according to a new study from University of Missouri researchers. Targeted interventions to counteract negative spiritual beliefs could help some individuals decrease pain and improve their overall health, the researchers said.

26 sept 2015--"In general, the more religious or spiritual you are, the healthier you are, which makes sense," said Brick Johnstone, a neuropsychologist and professor of health psychology in the MU School of Health Professions. "But for some individuals, even if they have even the smallest degree of negative spirituality – basically, when individuals believe they're ill because they've done something wrong and God is punishing them – their health is worse."
Johnstone and his colleagues studied nearly 200 individuals to find out how their spiritual beliefs affected their health outcomes. Individuals in the study had a range of health conditions, such as cancer, traumatic brain injury or chronic pain, and others were healthy. The researchers divided the individuals into two groups: a negative spirituality group that consisted of those who reported feeling abandoned or punished by a higher power, and a no negative spirituality group that consisted of people who didn't feel abandoned or punished by a higher power. Participants answered questions about their emotional and physical health, including physical pain.
Those in the negative spirituality group reported significantly worse pain as well as worse physical and mental health while those with positive spirituality reported better mental health. However, even if individuals reported positive spiritual beliefs, having any degree of negative spiritual belief contributed to poorer health outcomes, the researchers found.
"Previous research has shown that about 10 percent of people have negative spiritual beliefs; for example, believing that if they don't do something right, God won't love them," Johnstone said. "That's a negative aspect of religion when people believe, 'God is not supportive of me. What kind of hope do I have?' However, when people firmly believe God loves and forgives them despite their shortcomings, they had significantly better mental health."
Individuals with negative spiritual beliefs also reported participating in religious practices less frequently and having lower levels of positive spirituality and forgiveness. Interventions that help combat negative spiritual beliefs and promote positive spiritual beliefs could help some individuals improve their pain and their mental health, Johnstone said.
The study, "Relationships Between Negative Spiritual Beliefs and Health Outcomes for Individuals With Heterogeneous Medical Conditions," was published in the Journal of Spirituality in Mental Health.

More information: "Relationships Between Negative Spiritual Beliefs and Health Outcomes for Individuals With Heterogeneous Medical Conditions." DOI: 10.1080/19349637.2015.1023679


Provided by University of Missouri-Columbia

Religion, spirituality influence health in different but complementary ways

Religion and spirituality have distinct but complementary influences on health, new research from Oregon State University indicates.

12 may 2014--"Religion helps regulate behavior and health habits, while spirituality regulates your emotions, how you feel," said Carolyn Aldwin, a gerontology professor in the College of Public Health and Human Sciences at OSU.

Aldwin and colleagues have been working to understand and distinguish the beneficial connections between health, religion and spirituality. The result is a new theoretical model that defines two distinct pathways.

Religiousness, including formal religious affiliation and service attendance, is associated with better health habits, such as lower smoking rates and reduced alcohol consumption. Spirituality, including meditation and private prayer, helps regulate emotions, which aids physiological effects such as blood pressure.

The findings were published recently in the journal Psychology of Religion and Spirituality. Co-authors were Crystal L. Park of the University of Connecticut, and Yu-Jin Jeong and Ritwik Nath of OSU. The research was supported by a grant from the John Templeton Foundation.

"No one has ever reviewed all of the different models of how religion affects health," said Aldwin, the Jo Anne Leonard endowed director of OSU's Center for Healthy Aging Research. "We're trying to impose a structure on a very messy field."

There can be some overlap of the influences of religion and spirituality on health, Aldwin said. More research is needed to test the theory and examine contrasts between the two pathways. The goal is to help researchers develop better measures for analyzing the connections between religion, spirituality and health and then explore possible clinical interventions, she said.

Provided by Oregon State University

Faith in God associated with improved survival after liver transplantation

Study reveals religiosity prolongs life span

01 oct 2010--Italian researchers report that liver transplant candidates who have a strong religious connection have better post-transplant survival. This study also finds that religiosity—regardless of cause of death—prolongs the life span of individuals who underwent liver transplantation. Full findings are now available online and in the October issue of Liver Transplantation. a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases (AASLD).

Much of the medical profession today is focused on the delivery of services, rather than whole patient care which not only takes into account physical well-being, but psychological, social, and spiritual aspects as well. Although there is a lack of interest in religion by the medical community, the authors point out that 90% of the world's population today is involved in some form of religion or spiritual pursuit. Prior studies have demonstrated that religiosity allows individuals to better cope with illness, and may even influence disease progression. Furthermore, a report by McCullough et al. that included a meta-analysis of 42 studies (surveying roughly 126,000 people) found active religious involvement increased the odds of being alive at follow-up by 26%.

"Our study tested the hypothesis that religiosity—seeking God's help, having faith in God, trusting in God, trying to discern God's will even in the disease—improves survival of patients with end-stage liver disease who underwent liver transplantation," explains Franco Bonaguidi, D.Psych., and lead author of the study. The study team selected 179 patients who received a liver transplant between January 2004 and December 2007, and who also completed the religiosity questionnaire. Participants (129 males and 50 females) had a media age of 52 years and were followed for 4 years (median = 21 months) post-transplantation. Indications for liver transplant included: viral hepatitis (68%), alcoholic liver disease (17%), and autoimmune hepatitis (7%).

Results indicate that the Search for God factor (hazard ratio = 2.95) and length of stay in the intensive care unit (1.05) were independently associated with survival. Furthermore, it was the personal relationship between the patient and God, regardless of religious creed (Christian, Muslim, or other) rather than formal church attendance that positively affected survival. As one participant described, "I recovered my life by the will of Someone up there…I had great faith in Him. This closeness made me feel strong and calm."

Dr. Bonaguidi concluded, "We found that an active search for God—the patient's faith in a higher power rather than a generic destiny—had a positive impact on patient survival." The authors caution that this study focuses on a severely ill patient population, therefore the conclusions may not be applicable to individuals with different illnesses or degrees of disease severity.

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This study is published in the October issue of the Liver Transplantation. Media wishing to receive a PDF of this article may contact healthnews@wiley.com.

Full citation: "Religiosity Associated with Prolonged Survival in Liver Transplant Recipients." Franco Bonaguidi, Claudio Michelassi, Franco Filipponi, Daniele Rovai. Liver Transplantation; Published Online: June 18, 2010 (DOI: 10.1002/lt.22122); Print Issue Date: October 2010. http://onlinelibrary.wiley.com/doi/10.1002/lt.22122/abstract

Religious Feelings Associated with Women's Lengthier Survival

By John Gever
NEW YORK, 23 nov 2008--Expressions of religious feeling by participants in the Women's Health Initiative translated into a greater likelihood of survival during the study, researchers here said.

Post-menopausal women who, at study baseline, reported certain types of religious feeling had hazard ratios for all-cause mortality of 0.80 to 0.89 (P<0.05) with a mean 7.7 years of follow-up, reported Eliezer Schnall, Ph.D., of Yeshiva University, and colleagues online in Psychology and Health.
But these expressions of religious feeling did not affect mortality or morbidity associated with coronary heart disease, the researchers said.
In fact, some models showed positive associations between religiosity and cardiac illness and death, they said.
It was not the first study to connect religious attachments to reduced mortality, but with more than 92,000 participants in the Women's Health Initiative, it may be the largest.
And like those earlier studies, this one shed little light on exactly how religious feelings may forestall death.
"In an effort to assess which pathways may be relevant to the decreased mortality found for those with religious affiliation and more frequent religious service attendance, causes of death were compared across groups," Dr. Schnall and colleagues wrote. "However, no significant differences were found."
They concluded that the protective effect of religious attachment seems real, but the reasons for it are still not understood.
At baseline in the study, women were asked whether they had a religious affiliation; how frequently they attended worship services; and whether religion provided a great deal of strength and comfort, a little, or none.
The hazard ratios for all-cause death during follow-up associated with these variables, relative to participants expressing the lowest level of religious attachment, were:
Having a religious affiliation: HR 0.84 (95% CI 0.75 to 0.93)
Attending services less than weekly: HR 0.85 (95% CI 0.79 to 0.92)
Attending services weekly: HR 0.80 (95% CI 0.75 to 0.86)
Attending services more often than weekly: HR 0.80 (95% CI 0.73 to 0.87)
Religion provides a little comfort: HR 0.95 (95% CI 0.86 to 1.05)
Religion provides a great deal of comfort: HR 0.89 (95% CI 0.82 to 0.98)
These hazard ratios reflected adjustments for age, ethnicity, income, education, body mass index, and current morbidities.
The apparent benefits of deriving substantial strength and comfort from religion disappeared when the researchers also controlled for smoking and alcohol consumption.
And having a religious affiliation was no longer a protective factor when these health behaviors and psychosocial variables, such as self-reported social support and life satisfaction, were included in the analysis.
But the protective effect of attendance at religious services at least weekly remained significant in these enhanced models, with hazard ratios of 0.87 to 0.90 (P<0.05).
About 5,900 of the study participants died during follow-up, excluding the first year. Of these, 425 deaths were among those who did not identify themselves as having a particular religion.
A seemingly disproportionate number of those deaths were from cancer -- 47.1% compared with 42.4% of deaths in the religiously affiliated, although the difference did not reach statistical significance.
But coronary heart disease accounted for only 9.9% of deaths among the religiously unaffiliated versus 13.2% of those who said they had a religion.
Religious affiliation correlated with overall cardiac morbidity and mortality with a hazard ratio of 1.46 (95% CI 1.22 to 1.75).
The raw numbers also suggested that cardiac disease and death was increased with religious service attendance and the degree of strength and comfort provided by religion, with hazard ratios of up to 1.49.
The statistical significance of these associations largely vanished when other variables were factored in -- but in many cases just barely, with the lower limit of 95% confidence intervals at 0.97 to 0.99 for the resulting hazard ratios.
Again, Dr. Schnall and colleagues were at a loss to explain why religious attachment might increase cardiac disease risks.
They noted that their results could have differed if they had longer follow-up or used other measures of religious feeling.
They also said their study's focus on post-menopausal women limited its interpretation for men and younger women.
The Women's Health Initiative was funded by the National Heart, Lung, and Blood Institute. External funding for this analysis was not reported.
No potential conflicts of interest were reported.

Primary source: Psychology and HealthSource reference:Schnall E, et al. "The relationship between religion and cardiovascular outcomes and all-cause mortality in the Women's Health Initiative Observational Study" Psychol Health 2008; DOI: 10.1080/08870440802311322.

Insights: Two Paths: Religion and Psychiatry

By NICHOLAS BAKALAR
Of all medical specialties, psychiatrists are the least religious, a survey has found, and the most religious doctors are the least likely to refer their patients to psychiatrists.
In addition to questions about their own beliefs, the 100 psychiatrists and 1,044 other specialists who responded to the survey were asked about their attitudes toward religion in clinical practice. For example, the survey asked doctors whether they thought it proper to ask about patients’ religious beliefs and whether they had ever prayed with a patient.
Although psychiatrists were just as likely as other physicians to report that religious beliefs influenced their practice — about half said it did — just 29 percent of psychiatrists, compared with 47 percent of other doctors, said they attended religious services more than once a month. When asked whether they described themselves as religious or spiritual, 42 percent of psychiatrists and 53 percent of other doctors said they did. About a third of psychiatrists, but almost half of other physicians, said they “look to God for strength, support, and guidance.” Psychiatrists were significantly less likely to be Protestant or Catholic and more likely to be Jewish or have no religious affiliation.
Most doctors would refer a patient to a psychiatrist for emotional problems. Protestants were about half as likely as those with no religious affiliation to do so, preferring clergy or other religious counselors.
“Religion and psychiatry are two different ways of responding, and two different ways of bringing healing,” said Dr. Farr A. Curlin, the lead author of the paper, published in the September issue of Psychiatric Services and an assistant professor of medicine at the University of Chicago. “In some clinical situations, they will always be rivals.”

Psychiatrists are the least religious of all physicians

And religious physicians appear to be less willing to refer patients to them
A nationwide survey of the religious beliefs and practices of American physicians has found that the least religious of all medical specialties is psychiatry. Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall.
The study, published in the September 2007 issue of Psychiatric Services, also found that religious physicians, especially Protestants, are less likely to refer patients to psychiatrists, and more likely to send them to members of the clergy or to a religious counselor.
"Something about psychiatry, perhaps its historical ties to psychoanalysis and the anti-religious views of the early analysts such as Sigmund Freud, seems to dissuade religious medical students from choosing to specialize in this field," said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "It also seems to discourage religious physicians from referring their patients to psychiatrists."
"Previous surveys have documented the unusual religious profile of psychiatry," he said, "but this is the first study to suggest that that profile leads many physicians to look away from psychiatrists for help in responding to patients’ psychological and spiritual suffering."
"Because psychiatrists take care of patients struggling with emotional, personal and relational problems," Curlin said, "the gap between the religiousness of the average psychiatrist and her average patient may make it difficult for them to connect on a human level."
In 2003, to learn about the contribution of religious factors on physicians' clinical practices, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties, including an augmented number of psychiatrists; 1,144 (63%) physicians responded, including 100 psychiatrists.
The survey contained questions about medical specialties, religion, and measures of what the researchers called intrinsic religiosity—the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life."
Although 61 percent of all American physicians were either Protestant (39%) or Catholic (22%), only 37 percent of psychiatrists were Protestant (27%) or Catholic (10%). Twenty-nine percent were Jewish, compared to 13 percent of all physicians. Seventeen percent of psychiatrists listed their religion as "none," compared to only 10 percent of all doctors.
Curlin's survey also included this brief vignette, designed to present "ambiguous symptoms of psychological distress" as way measure the willingness of physicians to refer patients to psychiatrists.
"A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first" (a psychiatrist or psychologist, a clergy member or religious counselor, a health care chaplain, or other)."
Overall, 56 percent of physicians indicated they would refer such a patient to a psychiatrist or psychologist, 25 percent to a clergy member or other religious counselor, 7 percent to a health care chaplain and 12 percent to someone else.
Although Protestant physicians were only half as likely to send the patient to a psychiatrist, Jewish physicians were more likely to do so. Least likely were highly religious Protestants who attended church at least twice a month and looked to God for guidance "a great deal or quite a lot."
"Patients probably seek out, to some extent, physicians who share their views on life’s big questions," Curlin said. That may be especially true in psychiatry, where communication is so essential. The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems.

Care for the Underserved Not Influenced by Doctors' Religious Attendance

CHICAGO, July 31 -- Although religious doctors are more likely to consider medicine a calling, that doesn't translate into caring for more underserved patients, a survey has revealed.
Whether judged by "intrinsic religiosity" or frequency of church attendance, religious doctors cared for underserved patients at about the same rate that their less religious counterparts did, according to a report in the July/August issue of Annals of Family Medicine.
In fact, doctors who reported no religious affiliation at all were the most likely to practice among underserved populations (35%). Practitioners who were self-described as highly spiritual, but not necessarily religious, also cared for more underserved patients, said Farr A. Curlin, M.D., of the University of Chicago, and colleagues.
"The present study suggests that although physicians who practice among the underserved may explain their work in religious terms, religious physicians do not appear to disproportionately care for the underserved," the authors concluded.
From the earliest days of Hippocratic medical practice, codes of medical ethics have urged physicians to care for the poor, Dr. Curlin and colleagues noted. Even so, many poor patients and communities remain medically underserved.
Physicians have a variety of motives, including religious beliefs, for practicing among underserved populations. However, the investigators said, the association between physicians' religious characteristics and work among the underserved had not been examined previously.
Dr. Curlin and colleagues conducted a mail survey of a random sample of 2,000 U.S. physicians representing a variety of clinical specialties. The researchers received 1,260 responses (63%). Overall, 26% of respondents reported that their patient populations are considered underserved.
The investigators assessed intrinsic religiosity by respondents' answers to two questions about the extent to which religious beliefs influence the physicians' lives and activities. Both questions were drawn from a validated scale for religious motivation.
Among physicians deemed to be highly religious, 29% practiced among underserved populations, compared with 22% of the moderately religious and 27% of those with low intrinsic religiosity. Of physicians who reported at least twice-monthly church-going, 26% practiced among the underserved, the same as physicians reporting less frequent church attendance and slightly less than physicians who reported no church attendance (28%).
The authors reported that 32% of highly spiritual physicians cared for the underserved versus 26% among moderate spiritual doctors and 21% of practitioners who ranked low in spirituality (P<0.05).
Physicians who strongly agreed that religious beliefs influence medical practice were significantly more likely to practice among the underserved (36%, P<0.05) compared with doctors who felt less strongly (23%) or disagreed (26%).
Doctors whose families emphasized service to the poor were significantly more likely to practice among underserved populations (P<0.05). Physicians who strongly agreed that medicine is calling were more likely to care for underserved patients (31%), but the difference was not significantly different from physicians who felt less strongly (25%) or disagreed (25%).
A separate analysis limited to primary-care physicians yielded results similar to those of the entire survey cohort.
In the highly unlikely event that admissions officials ever consider medical school applicants' religious inclinations, Dr. Curlin and colleagues offered the following advice:
"[O]ur findings suggest that admissions officials should ignore both the general religiousness of candidates and their sense of calling to medicine, and should give preference to applicants who consider themselves very spiritual, who either have no religion or strongly agree that the religion they have influences their practice of medicine, or who agree that their families of origin emphasized service to the poor."
The authors reported no conflicts of interest. The study was funded by the Greenwall Foundation and the Robert Wood Johnson Clinical Scholars Program.Additional source: Annals of Family MedicineSource reference: Curlin FA et al. "Do religious physicians disproportionately care for the underserved?" Ann Fam Med 2007;5:epub.

Most Doctors See Religion as Beneficial, Study Says

By NICHOLAS BAKALAR
Most physicians in the United States believe that religion and spirituality have a positive effect on patients’ health, according to a survey published last week, and that God at least occasionally intervenes on their behalf.
Researchers questioned 1,144 doctors about how religion influences health care, and found that their responses varied with their religious beliefs. Fewer than 10 percent of doctors interviewed had no religious affiliation. A little more than a third said their intrinsic religious faith was high, a similar number said they were not very religious, and the rest called themselves moderately devout. The paper appears in the April 9 issue of The Archives of Internal Medicine.
Over all, only 1 percent believed that religion has a negative effect on health, and 2 percent said it has no influence one way or the other. But 54 percent said God sometimes affects a patient’s health, and 33 percent said religion and spirituality help prevent specific medical events like heart attacks, infections and death.
Physicians with high levels of belief were more than seven times as likely as those with low levels to believe that religion is a large influence on health. While more than 90 percent of very religious doctors believed that religion and spirituality can often help patients cope with their problems, 38 percent of them nevertheless held that religious belief can sometimes lead to negative emotions.