Spirituality and Meaning

Our ability to create satisfactory meaning out of the events in our lives has been well-estabilshed as a factor in mental health. Spirituality is often defined in terms of meaning and purpose in life, illness, death and other existential concerns. When defined in this way, spirituality has been shown to be strongly protective against depression.

Conversely, measures of how religious someone is based on attending services or strength of beliefs (whether or not they are associated with an institutionalizd religion) generally are not. In fact, many studies have found a slight increase in the likelihood of someone being depressed if they invest a lot of meaning in religious practices.

People receiving treatment for depression often rate their spirituality as one of the most important parts of their recovery. Much of the research on spirituality and depression has been focused on elderly or terminally ill people, although similar results have been found for college students and the middle-aged.

Developing Positive Meaning and Spirituality

Most of the research on involving meaning and spirituality is focused on how important it is for mental health. There is little controlled research on effective ways to improve these qualities. One thing we do know is that thinking about the meaning of events in life or of life itself does no harm. I recommend reflecting on your life, your experiences and other aspects of life that trouble you and try to find some positive meaning in them. You might want to read books or talk with people who have a strong sense of meaning and purpose in their lives.

Also, try to develop a ritual or habit around self-care. Depression is very responsive to anything that you believe will be of help, so your wholehearted belief is important to make your treatment work.

Research

Nelson, C. et al. Spirituality, Religion, and Depression in the Terminally Ill . Psychosomatics 43:213-220, June 2002.

This study examined the impact of spirituality and religiosity on depressive symptom severity in a sample of terminally ill patients with cancer and AIDS. A strong negative association was observed between the FACIT Spiritual Well-Being scale and the HDRS, but no such relationship was found for religiosity, because more religious individuals had somewhat higher scores on the HDRS. Similar patterns were observed for the FACIT subscales, finding a strong negative association between the meaning and peace subscale (which corresponds to the more existential aspects of spirituality) and HDRS scores, whereas a positive, albeit nonsignificant, association was observed for the faith subscale (which corresponds more closely to religiosity). These results suggest that the beneficial aspects of religion may be primarily those that relate to spiritual well-being rather than to religious practices per se. Implications for clinical interventions and palliative-care practice are discussed.

Breitbart, W. Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer. Volume 10, Number 4 / May, 2002.

As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. This paper reviews the topics of spirituality and end-of-life care, defines spirituality, and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. These two constructs of spirituality are reviewed in terms of their role in supportive care.

Cooper, L. et al. How Important Is Intrinsic Spirituality in Depression Care? A Comparison of White and African-American Primary Care Patients. J Gen Intern Med. 2001 September; 16(9): 634–638.

We used a cross-sectional survey to compare the views of African-American and white adult primary care patients (N = 76) regarding the importance of various aspects of depression care. Patients were asked to rate the importance of 126 aspects of depression care (derived from attitudinal domains identified in focus groups) on a 5-point Likert scale. Intrinsic spirituality was rated 6 by both African Americans and whites.

MCCOUBRIE R. DAVIES A. Is there a correlation between spirituality and anxiety and depression in patients with advanced cancer? Supportive care in cancer. 2006, vol. 14, no4, pp. 379-385.

Religion and spirituality are generally recognised as having different meanings-religion entailing a relationship with a higher being, while spirituality can be thought of in terms of meaning and purpose in life. Results: Eighty-five complete data sets were obtained. A significant negative correlation was found between both anxiety and depression scores and overall spiritual well-being scores (p<0.0001). When the SWBS subscale scores were analysed individually, a significant negative correlation was found between the existential well-being scores and the anxiety and depression scores (p<0.001). However, no correlation was found between the religious well-being scores and anxiety or depression.

Wink, P. et al. Religion as Moderator of the Depression-Health Connection. Research on Aging, Vol. 27, No. 2, 197-220 (2005).

When spirituality is measured as adherence to noninstitutionalized religious beliefs and practices, it does not protect against depression. Religiousness did protect against depression associated with poor health in an elderly population.

Ellermann, C. Reed, P. Self-Transcendence and Depression in Middle-Age Adults. Western Journal of Nursing Research, Vol. 23, No. 7, 698-713 (2001).

Self-transcendence has been found to be an important correlate of mental health in older adults and adults facing the end of life. This relationship was also found in middle-aged adults.

Reker, G. Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. The Gerontologist, Vol 37, Issue 6 709-716, 1997.

Showed that choice/responsibleness, social resources, and physical health predicted depression in community elderly; personal meaning, optimism, social resources, and physical health predicted depression in institutionalized elderly. In both samples, the existential variables accounted for unique variance in depression over and above that accounted for by traditional measures. The important role of existential constructs in transcending personal and social losses and feelings of depression are discussed.

Fehring RJ, Brennan PF, Keller ML. Psychological and spiritual well-being in college students. Res Nurs Health. 1987 Dec;10(6):391-8.

In two separate studies of 95 and 75 college students, several tests were administered. Found that spiritual well-being, existential well-being, and spiritual outlook showed strong inverse relationships with negative moods suggesting that spiritual variables may influence psychological well-being.

Blinderman, C. Existential issues do not necessarily result in existential suffering: lessons from cancer patients in Israel. Palliative Medicine, Vol. 19, No. 5, 371-380 (2005).

A qualitative assessment of 40 patients with advanced cancer was undertaken through an interview process addressing the following themes: autonomy, dignity/body image, social isolation, coping mechanisms, guilt/past disappointments, spiritual health, meaning, hope and death/dying. The findings of this study indicate that existential concerns are endemic in this patient population, but that significant distress is relatively uncommon.

Neimeyer, R. (ed.) Meaning Reconstruction and the Experience of Loss. APA: Washington DC (2001).

Focuses on the importance of creating meaning out of losses in order to process them healthily. Reviews a large body of research supporting this claim.

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