Which domains of spirituality are associated with anxiety and depression in patients with advanced illness?

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 religiousattendance and devotion. Results: In adjusted analyses, greater spiritual wellbeing, 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. © 2011 Society of General Internal Medicine.