Featured CME Topic: Spirituality
Religion, Spirituality, and Medicine: Research
Findings and Implications for Clinical Practice
Harold G. Koenig, MD
allows the patient to interpret the meaning for himself or herself.
Abstract: A growing body of scientific research suggests connec- However, when discussing the research, it is necessary to be
tions between religion, spirituality, and both mental and physical more precise. Most of the work done thus far has focused on
health. The findings are particularly strong in patients with severe or religion because there is more agreement about its meaning, and
chronic illnesses who are having stressful psychologic and social it is associated with behaviors that can be quantified.
changes, as well as existential struggles related to meaning and Why are many patients religious? One reason is because
purpose. Recent studies indicate that religious beliefs influence med- religion is so widespread in the United States, particularly in
ical decisions, such as the use of chemotherapy and other life-saving the South.2 Religious belief, membership, importance, and
treatments, and at times may conflict with medical care. This article attendance are prevalent and steadily increase with age. Since
addresses the ways physicians can use such information. Spirituality most patients with serious or chronic health problems are
is an area that makes many physicians uncomfortable, since training older, it is not surprising that many are religious. There is also
in medical schools and continuing medical education programs are a considerable gap between patients’ and physicians’ levels
limited. Not only do most physicians lack the necessary training, of religiosity.3,4
they worry about spending additional time with patients and over- A second reason why religion is so common among med-
stepping ethical boundaries. While these concerns are valid, each ical patients is that as people become ill, they experience
can be addressed in a sensible way. Taking a spiritual history, sup- stress over the changes in life that illness causes. Many who
porting the patient’s beliefs, and orchestrating the fulfillment of were not religious previously may turn to religion for com-
spiritual needs are among the topics this article will address. The fort. Whether it is as a new method of coping or a lifelong
goal is to help physicians provide medical care that is sensitive to the belief, religion becomes increasingly important as patients face
way many patients understand and cope with medical illness. the Goliath of illness. Those who seek comfort in religion ap-
Key Words: mental and physical health, religion, spiritual needs proach it in many ways. In the United States, this often involves
belief in a loving and caring God, private religious activities
(such as prayer and meditation), reading religious scriptures for
R eligious beliefs and practices are common among pa-
tients seeking medical care, and even those who indicate
that they are not religious often identify themselves as being
direction and encouragement, or looking for support from a pas-
tor or members of a faith community.
Systematic studies of religious coping in medical settings
spiritual in some way.1 Spirituality is more individualistic and document the high proportion of patients who depend on
self-determined, whereas religion typically involves connec- religious beliefs and practices to cope with health problems.
tions to a community with shared beliefs and rituals. Because In a study of 337 patients who were consecutively admitted to
of the heavy overlap between religiosity and spirituality the general medicine, cardiology, and neurology services of
(nearly 90% of medical patients consider themselves both Duke University Medical Center in North Carolina, nearly
religious and spiritual), these two terms will be used inter-
changeably in this article. When it comes to discussing such
matters with patients, it is probably best to use the term
spirituality because of its broad and inclusive nature, which Key Points
• Research is increasingly demonstrating a relation be-
tween religion/spirituality and health.
• Physicians should be aware of this research and un-
From the Departments of Psychiatry and Medicine, Duke University Medical
Center, GRECC, VA Medical Center, Durham, NC. derstand its clinical implications.
Reprint requests to Dr. Harold Koenig, Box 3400, Duke University Medical • It is recommended that a brief spiritual history be
Center, Durham, NC 27710. E-mail: taken from all patients with serious or chronic illness.
Accepted September 10, 2004. • If spiritual issues are present, referral to chaplains or
Copyright © 2004 by The Southern Medical Association other spiritual care experts is recommended.
0038-4348/04/9712-1194
1194 © 2004 Southern Medical Association
, Featured CME Topic: Spirituality
90% reported using religion to some degree to cope, and and higher social support (19 of 20). This was particularly
more than 40% indicated that it was the most important factor true for those who were more functionally disabled.11–13 Be-
5
that kept them going. More than 60 studies have now ex- tween the years 2000 and 2002, more than 1,100 additional
amined the role that religion plays in helping patients cope articles, studies, and reviews involving religion, spirituality,
with such diverse medical conditions as arthritis, diabetes, and mental health appeared in psychologic literature, com-
kidney disease, cancer, heart disease, lung disease, HIV/ pared with 101 articles between 1980 and 1982, suggesting a
AIDS, cystic fibrosis, sickle cell anemia, amyotrophic lateral remarkable 11-fold increase in attention paid to this area by
sclerosis, chronic pain, and severe or terminal illness as an the scientific community.14
6
adolescent.
Patients in these studies commonly report that religious Religion and Physical Health
beliefs and practices are powerful sources of comfort, hope, Because religious beliefs and practices help patients to
and meaning, particularly in coping with a medical illness. As cope better with their illnesses, enhance their social support,
noted above, this is particularly true for patients with certain and help them to avoid self-destructive behaviors such as
disorders that are characterized by their chronic nature, extent substance abuse, it is important to understand how religion
of disability, or poor prognosis. There are also special popula- influences physical health through psychologic, social, and
tions for whom religion appears particularly relevant, including behavioral pathways. The effects of psychosocial stress on
the elderly, women, and ethnic minorities (for example, blacks physiologic functioning and health-related quality of life
and Hispanics).7 The next ques- are increasingly well-document-
tion is whether religious beliefs ed.15,16 If increased religiosity
and practices are actually effec- Religious beliefs and practices are reduces stress levels and en-
tive in helping people to cope. hances social support, then it
associated with
During most of the 20th century, ought to also affect physical
the answer given by prominent • Lower suicide rates
health. Although much research
mental health professionals was • Less anxiety must be done to clarify this re-
“No.” At best, religion was • Less substance abuse lation, there is growing evidence
viewed as irrelevant to health; at • Less depression and faster recovery that religiosity may benefit pa-
worst, it was seen as emotionally from depression tients’ physical health through
unhealthy and a symptom or its positive effects on their men-
• Greater well-being, hope, and
cause of neurosis.8,9 tal health.
optimism
A summary of the research
Religion, Well-being, • More purpose and meaning in life on physical health outcomes be-
and Mental Health • Higher social support fore the year 2000 (no system-
However, when researchers • Greater marital satisfaction and atic review has been done of the
began to systematically study stability research after 2000) produces
the consequences of religious the following10: religious beliefs
beliefs and practices, they found and activities have been associ-
quite different results. Even be- ated with better immune func-
fore the year 2000, more than 700 studies examined the re- tion (5 of 5 studies); lower death rates from cancer (5 of 7);
lation between religion, well-being, and mental health. In- less heart disease or better cardiac outcomes (7 of 11); lower
stead of documenting neurosis, nearly 500 of those studies blood pressure (14 of 23); lower cholesterol (3 of 3): and
demonstrated a significant positive association with better better health behaviors (23 of 25, less cigarette smoking; 3 of
10 5, more exercise; 2 of 2, better sleep). In addition, in studies
mental health, greater well-being, or lower substance abuse.
of mortality, 39 of 52 (75%) found that religious persons live
This included a number of randomized, clinical trials involv-
significantly longer (including at least two prospective stud-
ing treatments for depression, anxiety, and bereavement, with
ies involving follow-ups of 23 and 31 years).17,18 The effect
the majority finding that religious therapies have faster results
for regular religious attendance on longevity approximates
than secular therapies in religious patients. that of not smoking cigarettes (especially in women),19 add-
Not only were religious beliefs and practices associated ing an additional 7 years to the lifespan (14 years for blacks).20
with significantly less depression and faster recovery from
depression (60 of 93 studies), lower suicide rates (57 of 68),
less anxiety (35 of 69), and less substance abuse (98 of 120), Impact of Religion on Health Care
they were also associated with greater well-being, hope, and Besides the overall positive association between religi-
optimism (91 of 114), more purpose and meaning in life (15 osity, mental health, and physical health, religion also influ-
of 16), greater marital satisfaction and stability (35 of 38), ences factors that directly affect the delivery of health care.
Southern Medical Journal • Volume 97, Number 12, December 2004 1195
Religion, Spirituality, and Medicine: Research
Findings and Implications for Clinical Practice
Harold G. Koenig, MD
allows the patient to interpret the meaning for himself or herself.
Abstract: A growing body of scientific research suggests connec- However, when discussing the research, it is necessary to be
tions between religion, spirituality, and both mental and physical more precise. Most of the work done thus far has focused on
health. The findings are particularly strong in patients with severe or religion because there is more agreement about its meaning, and
chronic illnesses who are having stressful psychologic and social it is associated with behaviors that can be quantified.
changes, as well as existential struggles related to meaning and Why are many patients religious? One reason is because
purpose. Recent studies indicate that religious beliefs influence med- religion is so widespread in the United States, particularly in
ical decisions, such as the use of chemotherapy and other life-saving the South.2 Religious belief, membership, importance, and
treatments, and at times may conflict with medical care. This article attendance are prevalent and steadily increase with age. Since
addresses the ways physicians can use such information. Spirituality most patients with serious or chronic health problems are
is an area that makes many physicians uncomfortable, since training older, it is not surprising that many are religious. There is also
in medical schools and continuing medical education programs are a considerable gap between patients’ and physicians’ levels
limited. Not only do most physicians lack the necessary training, of religiosity.3,4
they worry about spending additional time with patients and over- A second reason why religion is so common among med-
stepping ethical boundaries. While these concerns are valid, each ical patients is that as people become ill, they experience
can be addressed in a sensible way. Taking a spiritual history, sup- stress over the changes in life that illness causes. Many who
porting the patient’s beliefs, and orchestrating the fulfillment of were not religious previously may turn to religion for com-
spiritual needs are among the topics this article will address. The fort. Whether it is as a new method of coping or a lifelong
goal is to help physicians provide medical care that is sensitive to the belief, religion becomes increasingly important as patients face
way many patients understand and cope with medical illness. the Goliath of illness. Those who seek comfort in religion ap-
Key Words: mental and physical health, religion, spiritual needs proach it in many ways. In the United States, this often involves
belief in a loving and caring God, private religious activities
(such as prayer and meditation), reading religious scriptures for
R eligious beliefs and practices are common among pa-
tients seeking medical care, and even those who indicate
that they are not religious often identify themselves as being
direction and encouragement, or looking for support from a pas-
tor or members of a faith community.
Systematic studies of religious coping in medical settings
spiritual in some way.1 Spirituality is more individualistic and document the high proportion of patients who depend on
self-determined, whereas religion typically involves connec- religious beliefs and practices to cope with health problems.
tions to a community with shared beliefs and rituals. Because In a study of 337 patients who were consecutively admitted to
of the heavy overlap between religiosity and spirituality the general medicine, cardiology, and neurology services of
(nearly 90% of medical patients consider themselves both Duke University Medical Center in North Carolina, nearly
religious and spiritual), these two terms will be used inter-
changeably in this article. When it comes to discussing such
matters with patients, it is probably best to use the term
spirituality because of its broad and inclusive nature, which Key Points
• Research is increasingly demonstrating a relation be-
tween religion/spirituality and health.
• Physicians should be aware of this research and un-
From the Departments of Psychiatry and Medicine, Duke University Medical
Center, GRECC, VA Medical Center, Durham, NC. derstand its clinical implications.
Reprint requests to Dr. Harold Koenig, Box 3400, Duke University Medical • It is recommended that a brief spiritual history be
Center, Durham, NC 27710. E-mail: taken from all patients with serious or chronic illness.
Accepted September 10, 2004. • If spiritual issues are present, referral to chaplains or
Copyright © 2004 by The Southern Medical Association other spiritual care experts is recommended.
0038-4348/04/9712-1194
1194 © 2004 Southern Medical Association
, Featured CME Topic: Spirituality
90% reported using religion to some degree to cope, and and higher social support (19 of 20). This was particularly
more than 40% indicated that it was the most important factor true for those who were more functionally disabled.11–13 Be-
5
that kept them going. More than 60 studies have now ex- tween the years 2000 and 2002, more than 1,100 additional
amined the role that religion plays in helping patients cope articles, studies, and reviews involving religion, spirituality,
with such diverse medical conditions as arthritis, diabetes, and mental health appeared in psychologic literature, com-
kidney disease, cancer, heart disease, lung disease, HIV/ pared with 101 articles between 1980 and 1982, suggesting a
AIDS, cystic fibrosis, sickle cell anemia, amyotrophic lateral remarkable 11-fold increase in attention paid to this area by
sclerosis, chronic pain, and severe or terminal illness as an the scientific community.14
6
adolescent.
Patients in these studies commonly report that religious Religion and Physical Health
beliefs and practices are powerful sources of comfort, hope, Because religious beliefs and practices help patients to
and meaning, particularly in coping with a medical illness. As cope better with their illnesses, enhance their social support,
noted above, this is particularly true for patients with certain and help them to avoid self-destructive behaviors such as
disorders that are characterized by their chronic nature, extent substance abuse, it is important to understand how religion
of disability, or poor prognosis. There are also special popula- influences physical health through psychologic, social, and
tions for whom religion appears particularly relevant, including behavioral pathways. The effects of psychosocial stress on
the elderly, women, and ethnic minorities (for example, blacks physiologic functioning and health-related quality of life
and Hispanics).7 The next ques- are increasingly well-document-
tion is whether religious beliefs ed.15,16 If increased religiosity
and practices are actually effec- Religious beliefs and practices are reduces stress levels and en-
tive in helping people to cope. hances social support, then it
associated with
During most of the 20th century, ought to also affect physical
the answer given by prominent • Lower suicide rates
health. Although much research
mental health professionals was • Less anxiety must be done to clarify this re-
“No.” At best, religion was • Less substance abuse lation, there is growing evidence
viewed as irrelevant to health; at • Less depression and faster recovery that religiosity may benefit pa-
worst, it was seen as emotionally from depression tients’ physical health through
unhealthy and a symptom or its positive effects on their men-
• Greater well-being, hope, and
cause of neurosis.8,9 tal health.
optimism
A summary of the research
Religion, Well-being, • More purpose and meaning in life on physical health outcomes be-
and Mental Health • Higher social support fore the year 2000 (no system-
However, when researchers • Greater marital satisfaction and atic review has been done of the
began to systematically study stability research after 2000) produces
the consequences of religious the following10: religious beliefs
beliefs and practices, they found and activities have been associ-
quite different results. Even be- ated with better immune func-
fore the year 2000, more than 700 studies examined the re- tion (5 of 5 studies); lower death rates from cancer (5 of 7);
lation between religion, well-being, and mental health. In- less heart disease or better cardiac outcomes (7 of 11); lower
stead of documenting neurosis, nearly 500 of those studies blood pressure (14 of 23); lower cholesterol (3 of 3): and
demonstrated a significant positive association with better better health behaviors (23 of 25, less cigarette smoking; 3 of
10 5, more exercise; 2 of 2, better sleep). In addition, in studies
mental health, greater well-being, or lower substance abuse.
of mortality, 39 of 52 (75%) found that religious persons live
This included a number of randomized, clinical trials involv-
significantly longer (including at least two prospective stud-
ing treatments for depression, anxiety, and bereavement, with
ies involving follow-ups of 23 and 31 years).17,18 The effect
the majority finding that religious therapies have faster results
for regular religious attendance on longevity approximates
than secular therapies in religious patients. that of not smoking cigarettes (especially in women),19 add-
Not only were religious beliefs and practices associated ing an additional 7 years to the lifespan (14 years for blacks).20
with significantly less depression and faster recovery from
depression (60 of 93 studies), lower suicide rates (57 of 68),
less anxiety (35 of 69), and less substance abuse (98 of 120), Impact of Religion on Health Care
they were also associated with greater well-being, hope, and Besides the overall positive association between religi-
optimism (91 of 114), more purpose and meaning in life (15 osity, mental health, and physical health, religion also influ-
of 16), greater marital satisfaction and stability (35 of 38), ences factors that directly affect the delivery of health care.
Southern Medical Journal • Volume 97, Number 12, December 2004 1195
