Influência da religiosidade na saúde

csc Ciência & Saúde Coletiva Ciênc. saúde coletiva 1413-8123 1678-4561 ABRASCO - Associação Brasileira de Saúde Coletiva Rio de Janeiro, RJ, Brazil Historicamente, as relações entre religião e saúde foram assuntos de interesse no passado e,atualmente, tornaram-se crescentemente visíveis nas reuniões sociais, de comportamento e ciências da saúde. Dentre as várias questões a serem consideradas, o presente trabalho apresenta uma breve discussão sobre as relações entre a saúde e a religiosidade no processo de cura e tratamento de doenças. Várias investigações mostram que a participação religiosa está relacionada a efeitos benéficos para pessoas que estão em recuperação de doenças físicas e mentais, inclusive a psicologia aborda questões especiais sobre as correlações positivas entre convicção e prática religiosa, saúde mental, física e longevidade. Por outro lado, a religião também pode ser associada a resultados negativos e usos impróprios de serviços de saúde, como fanatismo, asceticismo, mortificações e tradicionalismo opressivo. O potencial para efeitos positivos e negativos de espiritualismo em saúde, combinado com os altos níveis de compromisso com a espiritualidade, evidencia a necessidade de pesquisas futuras. Independente dos possíveis mecanismos, se os indivíduos lucram em termos de saúde por conta da religião, esses deveriam ser motivados, respeitando as convicções individuais de cada um. TEMAS LIVRES FREE THEMES The influence of religiosity on health Influência da religiosidade na saúde Rômulo Romeu da Nóbrega AlvesI; Humberto da Nóbrega AlvesII; Raynner Rilke Duarte BarbozaIII; Wedson de Medeiros Silva SoutoIII IDepartamento de Biologia, Universidade Estadual da Paraíba. Av. das Baraúnas 351, Campus Universitário. 58109-753 Campina Grande PB. [e-mail] IIProjovem/JP, Prefeitura Municipal de João Pessoa IIIPrograma de Pós Graduação em Ciências Biológicas (Zoologia), Universidade Federal da Paraíba ABSTRACT The relationship between religion and health has been a subject of interest in the past and in the latest years becoming increasingly visible in the social, behavioral, and health sciences. Among several approaches to be considered, the present work provides a briefly discuss concerning the bond between health and religiosity in the cure process and diseases treatment. Several investigations show that religious participation is related with better outcomes for persons who are recovering from physical and mental illness, also the psychology science have committed special issues to positive correlations between religious belief and practice, mental and physical health and longevity. On the other hand, religion may also be associated with negative outcomes and the inappropriate use of health services as fanaticism, asceticism, mortifications and oppressive traditionalism. The potential for both positive and negative effects of spirituality on health, combined with the high levels of engagement with spirituality suggests that this area is ripe for future sustained research. Independent of the possible mechanisms, if individuals receive health profits by the religion; those should be motivated, respecting the individual faith of each one. Key words: Relationship, Religious belief, Health, Spirituality RESUMO Historicamente, as relações entre religião e saúde foram assuntos de interesse no passado e,atualmente, tornaram-se crescentemente visíveis nas reuniões sociais, de comportamento e ciências da saúde. Dentre as várias questões a serem consideradas, o presente trabalho apresenta uma breve discussão sobre as relações entre a saúde e a religiosidade no processo de cura e tratamento de doenças. Várias investigações mostram que a participação religiosa está relacionada a efeitos benéficos para pessoas que estão em recuperação de doenças físicas e mentais, inclusive a psicologia aborda questões especiais sobre as correlações positivas entre convicção e prática religiosa, saúde mental, física e longevidade. Por outro lado, a religião também pode ser associada a resultados negativos e usos impróprios de serviços de saúde, como fanatismo, asceticismo, mortificações e tradicionalismo opressivo. O potencial para efeitos positivos e negativos de espiritualismo em saúde, combinado com os altos níveis de compromisso com a espiritualidade, evidencia a necessidade de pesquisas futuras. Independente dos possíveis mecanismos, se os indivíduos lucram em termos de saúde por conta da religião, esses deveriam ser motivados, respeitando as convicções individuais de cada um. Palavras-chave: Relações, Crenças religiosas, Saúde, Espiritualidade Introduction The relationship between religion and health has been of longstanding interest in the health, social, and behavioral sciences, spanning a period of >100 years1-4. Research examining the relationships between religion and the health of individuals and populations has become increasingly visible in the social, behavioral, and health sciences5. Systematic programs of research investigate religious phenomena within the context of coherent theoretical and conceptual frameworks that describe the causes and consequences of religious involvement for health outcomes5. Despite sustained attention to these concerns, health research (i.e. epidemiological and medical research) is generally unfamiliar with extant developments in the conceptualization and measurement of religion involvement6. There are many reasons why studies Religion and Health Relationships and their implications should be carried out and recorded. Among several approaches to be considered, this paper briefly discusses those concerning the bond between the health and the religiosity in the cure process and diseases treatment. Religions and health in history Historically, traditional cultures recognized the importance of belief and expectancy within the healing encounter and created complex rituals and ceremonies designed to elicit or foster the expectancy and participation of healer and patient, as well as the community as a whole. Spiritual healing techniques have been a fundamental component of the healing rituals of virtually all societies since the advent of man7. Early Egyptian and Greek civilizations depicted the ancient healing practice of the laying on of hands in their hieroglyphics, pictographs and cuneiform writings8. Biblical reference to healing performed by Jesus, Peter, John and others helped make spiritual healing a commonly accepted practice of early Christianity9. Whether used for curing illness or preventing disease, the primary purpose of most forms of spiritual healing was to maintain the physical, psychological and spiritual well-being of the individual and the community. Traditionally, spiritual healing practitioners believed that illness manifested on the physical level due to an imbalance in the psychological or spiritual aspects of the individual. The role of the healer was to correct this imbalance by utilizing culturally accepted and proven methods of healing10,11. Within this framework, the diagnosis of illness and the development of a treatment regimen were undertaken from a holistic perspective which cultivated the patient's belief and expectancy of healing12-14. With the advent of modern medicine, however, the significance of cultivating belief and expectancy within the healing encounter was abandoned in reliance upon a reductionist, mechanistic and non-ritualistic approach to healing15. This approach ignored the psychological and spiritual aspects of health and focused on biological abnormalities and specific microorganisms as the primary cause of disease7. Recently, however, research within the field of mind/body medicine has re-examined the relationship between the individual's psychological and spiritual perspective and their physical health16,17. Religion and health researches Despite recognized methodological and analytical issues5, overall the findings indicate a consistent and salutary influence of religious factors on individual and population health3,18. In the past several years, systematic research on religious involvement and physical and mental health has begun to explore the functional mechanisms linking these constructs19-24. In recent years, several books have been published21,25-31 and major journals in public health and medicine have featured empirical research, literature reviews, and special issues on these and related topics3,19-21,27,28,32-36.There are a number of excellent reviews of studies of religious and spiritual healing and the nature, functional properties, and efficacy of various healing modalities37. Studies involving Christian denominations and sects currently dominate research into the effects of religion on health38-40. Evidence from epidemiological and clinical studies and medical research supports the impact of religious affiliation and involvement on a diverse array of mental and physical health indicators and disease states. This literature encompasses studies of cancer, hypertension, stroke, other cardiovascular conditions, gastrointestinal diseases, overall and cause-specific mortality, indicators of physical disability, self ratings of health status, and reports of symptomatology41-52, encompassing numerous disease entities or types of rates23. Several investigations indicate that religious involvement is associated with better outcomes for persons who are recovering from physical and mental illness53-55. One recent study of immune system function in a sample of older adults56 found a weak association between religious-service attendance and immune system status, independent of effects of depression and negative life events. Overall, better physical health status, as measured by a variety of indicators, is moderately associated with higher levels of religious involvement, even when defined by numerous indicators and examined within diverse groups (i.e. as defined by clinical disorder, gender, age cohort, denomination, race/ethnicity, and social class) within the population6,20,23. Evidence concerning the impact of religion on indicators of mental health22 indicates strong positive associations between religious involvement and mental health outcomes. Studies (primarily epidemiologic) indicate that religious factors have a salutary influence on a diverse set of outcomes, including depression, drug and alcohol use, delinquent behavior, suicide, psychological distress, and certain functional psychiatric diagnoses57-60. Religious strategies may be particularly important for coping with mental and physical illness and disability. Persons who use religious coping appear to handle their conditions more effectively than those who do not53,61,62. Several studies indicate that religious coping is significant for mental and physical health outcomes for a variety of life circumstances, especially health problems53,63 and bereavement64,65. Religious coping also appears to reduce levels of depression and anxiety60,66 in connection with bereavement and other loss events67. The significance and relationship of a given religious factor to health outcomes will potentially vary across distinct social categories (e.g. race/ethnicity, denomination, age, social class, and region)5. That religion is instrumental in shaping behaviors (e.g. risk taking and protective behaviors) that are consequential for physical and mental health. This includes directly and formally proscribing specific behaviors that are health risks (e.g. dietary restrictions and prohibitions against the use of alcohol and tobacco), as well as encouraging behaviors that are conducive to health (e.g. regular exercise). These distinctive patterns of lifestyle and health behaviors could result in lower rates of chronic and acute illnesses within identified religious groups5. Additionally, religious adherents may have reduced risk for stressful life circumstances because religious teachings embody general guidelines for behavior (e.g. moderation and conformity) that discourage individual deviance and encourage interpersonal harmony68. Participation in religious groups confers a number of benefits in terms of enhanced social resources. These advantages include the size of one's social networks, frequency of interactions with network members, both actual and anticipated (subjective-support) exchanges of various types of informal and formal assistance (i.e. instrumental, socioemotional, and appraisal assistance), and positive perceptions of support relationships (e.g. satisfaction and anticipated help)68,69. The use of religion to promote individual and community healing (i.e. restorative activities) has been associated with the experience of strong, positive emotions regarding the self, such as feelings of self-worth, competence, and connection with others70. While the literature contains over two hundred experimental studies examining various forms of spiritual healing such as Therapeutic Touch, Intercessory Prayer, Reiki, LeShan, etc. only a small percentage of these studies have attempted to systematically assess the outcome of spiritual healing therapies and correlate the results with psychological aspects of health and illness including patient and healer belief or expectancy71-75. Research in religion and health has suggested positive relationships, and most recently has concentrated on the experience of religion, or spirituality76. Levin77,78 investigated the effects of religiosity on numerous conditions, including chronic disease, functional disability, psychological wellbeing, and subjective perceptions of health, while controlling for age, race, ethnicity, gender, social class, denomination, as well as other social and psychological factors. Kaplan79 found religious protections, such as increased hope, social personal regulation, and regulation of depression, fear and anxiety, to have positive effects on a patient's cardiovascular system. Benson80 showed how prayer provided emotional comfort, and thus, improved health. Idler81 concluded that religious beliefs may indeed alter a person's perception of illness and disabilities and provide greater comfort. Koenig66 detailed the numerous ways that the "healing power of faith" can improve one's health, including relaxation effects, coping and social support. An increasing replication of studies finds a correlation between religious belief and practice and mental and physical health and longevity82. Several major journals in the field of psychology have recently devoted special issues to positive correlations between religious belief and practice and mental and physical health and longevity82. In addition, this research suggests that religious belief and practice involve both ordinary psychological processes and unique psychological-spiritual contents. On one hand, religion exerts its influence through common psychological channels like social support, healthy behavior, a sense of coherence, and medical compliance. On the other hand, by orienting motivation towards matters of ultimate concern and attributing sacredness to ordinary activities, religion also plays a distinctive role in human life82. Along with the presumed benefits of religious involvement for health, religion may also be associated with negative outcomes, such as poorer mental and physical health status, negative coping behaviors, and inappropriate use of health services20,21. Ness83 verified negative and positive aspects of the religious convictions in the physical and mental health; among the negatives could be mentioned the fanaticism, asceticism, mortifications and oppressive traditionalism; the positive aspects are personal health, community health, complementarity of the religious conceptions with the medical conceptions of human well being. In summary, the religion seems to be a psychosocial factor and the biological benefit in the recovery of the physical and mental diseases. Independent of the possible mechanisms, if individuals receive health profits by the religion; those should be motivated, respecting the faith individuality of each one. Investigations of religion and health have ethical and practical implications that should be addressed by the public, health professionals, the research community, and the clergy. Future research directions point to promising new areas of investigation that could bridge the constructs of religion and health. The potential for both positive and negative effects of spirituality on health, combined with the high levels of engagement with spirituality, suggests that this area is ripe for future sustained research. Additional prospective studies are also needed to enhance our understanding of the temporal ordering of the relationship between exposure to spirituality and the timing of health consequences, and to strengthen our confidence in causal inferences. Conclusion In summary, the religion seems to be a psychosocial factor and the biological benefit in the recovery of the physical and mental diseases. Independent of the possible mechanisms, if individuals receive health profits by the religion; those should be motivated, respecting the faith individuality of each one. Investigations of religion and health have ethical and practical implications that should be addressed by the lay public, health professionals, the research community, and the clergy. Future research directions point to promising new areas of investigation that could bridge the constructs of religion and health. The potential for both positive and negative effects of spirituality on health, combined with the high levels of engagement with spirituality suggests that this area is ripe for future sustained research. Additional prospective studies are also needed to enhance our understanding of the temporal ordering of the relationship between exposure to spirituality and the timing of health consequences, and to strengthen our confidence in causal inferences. Collaborators RRN Alves and HN Alves worked in the bibliographical classification, conception and the article final composition; RRD Barboza worked in the conception, final composition and final language translation of the article; WMS Souto worked in the conception, composition and final formatting. Artigo apresentado em 05/01/2008 Aprovado em 04/04/2008 1. Levin JS, Schiller PL. Is there a religious factor in health?. J. Relig. Health 1987; 26:9-36. Is there a religious factor in health? J. Relig. Health 1987 9 36 26 Levin JS Schiller PL 2. Levin JS, Tobin SH. Religion and psychological well-being. In: Kimble MA, McFadden SH, Ellor JW, Seeber JJ, editors. Aging, Spirituality, and Religion: A Handbook. Minneapolis: Fortress; 1996. p. 3046. Aging, Spirituality, and Religion: A Handbook 1996 30 46 Levin JS Tobin SH Kimble MA McFadden SH Ellor JW Seeber JJ 3. Levin JS, Vanderpool HY. Is frequent religious attendance really conducive to better health: toward an epidemiology of religion. Soc. Sci. Med. 1987; 24:589600 Is frequent religious attendance really conducive to better health: toward an epidemiology of religion Soc. Sci. Med. 1987 589 600 24 Levin JS Vanderpool HY 4. Levin JS, Vanderpool HY. Is religion therapeutically significant for hypertension?. Soc. Sci. Med. 1989; 29:6978. Is religion therapeutically significant for hypertension? Soc. Sci. Med. 1989 69 78 29 Levin JS Vanderpool HY 5. Chatters LM. Religion and health: public health research and practice. Annu. Rev. Public Health 2000; 21:335367. Religion and health: public health research and practice Annu. Rev. Public Health 2000 335 367 21 Chatters LM 6. Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status. Arch. Fam. Med.1998; 7:118124. Religious commitment and health status Arch. Fam. Med. 1998 118 124 7 Matthews DA McCullough ME Larson DB Koenig HG Swyers JP Milano MG 7. Wirth DP. Implementing spiritual healing in modern medical practice. Adv. J. Mind-Body Health1993; 9:69-81. Implementing spiritual healing in modern medical practice Adv. J. Mind-Body Health 1993 69 81 9 Wirth DP 8. Krieger D. The imprimatur of nursing. Am. J. Nursing1975; 5: 784-787. The imprimatur of nursing Am. J. Nursing 1975 784 787 5 Krieger D 9. Bresler DE. Free Yourself From Pain.1st ed. New York: Simon & Schuster; 1979. Free Yourself From Pain 1979 Bresler DE 10. Krippner S, Villoldo A. The Realms of Healing. 3rd ed. Millbrae: Celestial Arts; 1976. The Realms of Healing 1976 Krippner S Villoldo A 11. Achterberg J. Imagery in Healing: Shamanism and Modern Medicine.1st ed. Boston: New Science Library; 1985. Imagery in Healing: Shamanism and Modern Medicine 1985 Achterberg J 12. Pelletier K. Mind as Healer, Mind as Slayer.8th ed. New York: Dell; 1977. Mind as Healer, Mind as Slayer 1977 Pelletier K 13. Kleinman A. Patients and Healers in the Context of Culture: an Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry.Berkeley: University of California Press; 1980. Patients and Healers in the Context of Culture: an Exploration of the Borderland Between Anthropology, Medicine, and Psychiatry 1980 Kleinman A 14. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann. Int. Med. 1978; 88:251-258. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research Ann. Int. Med. 1978 251 258 88 Kleinman A Eisenberg L Good B 15. Myers SS, Benson H. Psychological factors in healing: a new perspective on an old debate. Behav. Med.1991; 18:5-11. Psychological factors in healing: a new perspective on an old debate Behav. Med. 1991 5 11 18 Myers SS Benson H 16. Ader R, Felten DL, Cohen N. Psychoneuroimmunology. 2nd ed. New York: Academic Press; 1991. Psychoneuroimmunology 1991 Ader R Felten DL Cohen N 17. Houldin AD, Lev E, Prystowsky MB, Redei E, Lowery BJ. Psychoneuroimmunology: a review of literature. Holist. Nursing Pract.1991; 5:10-21. Psychoneuroimmunology: a review of literature Holist. Nursing Pract. 1991 10 21 5 Houldin AD Lev E Prystowsky MB Redei E Lowery BJ 18. Levin JS, Chatters LM, Ellison CG, Taylor RJ. Religious involvement, health outcomes, and public health practice. Curr. Issues Public Health 1996; 2:220225. Religious involvement, health outcomes, and public health practice Curr. Issues Public Health 1996 220 225 2 Levin JS Chatters LM Ellison CG Taylor RJ 19. Chatters LM, Levin JS, Ellison CG. Public health and health education in faith communities. Health Behav. Educ.1998; 25:689699. Public health and health education in faith communities Health Behav. Educ. 1998 689 699 25 Chatters LM Levin JS Ellison CG 20. Ellison CG, Levin JS. The religion health connection: evidence, theory and future directions. Health Educ. Behav.1998; 25:700720. The religion health connection: evidence, theory and future directions Health Educ. Behav. 1998 700 720 25 Ellison CG Levin JS 21. Levin JS. Religion and health: is there an association, is it valid and is it causal?. Soc. Sci. Med.1994; 38:14751482. Religion and health: is there an association, is it valid and is it causal? Soc. Sci. Med. 1994 1475 1482 38 Levin JS 22. Levin JS, Chatters LM. Research on religion and mental health: an overview of empirical findings and theoretical issues. In: Koenig HG. Handbook of Religion and Mental Health. San Diego: Academic; 1998. p. 3450. Handbook of Religion and Mental Health 1998 34 50 Levin JS Chatters LM Koenig HG 23. Levin JS, Chatters LM, Ellison CG, Taylor RJ. Religious involvement, health outcomes, and public health practice. Curr. Issues Public Health1996; 2:220225. Religious involvement, health outcomes, and public health practice Curr. Issues Public Health 1996 220 225 2 Levin JS Chatters LM Ellison CG Taylor RJ 24. Newberg AB, d'Aquili EG. The neuropsychology of spiritual experience. In: Koenig HG. Handbook of Religion and Mental Health. San Diego: Academic; 1998. p. 7594. Handbook of Religion and Mental Health 1998 75 94 Newberg AB d'Aquili EG Koenig HG 25. Koenig HG. Research on Religion and Aging.Westport: Greenwood; 1995. Research on Religion and Aging 1995 Koenig HG 26. Koenig HG. Religious attitudes and practices of hospitalized medically ill older adults. Int. J. Geriatr. Psychiatry 1998; 13:213224. Religious attitudes and practices of hospitalized medically ill older adults Int. J. Geriatr. Psychiatry 1998 213 224 13 Koenig HG 27. Levin JS, Tobin SH. Religion and psychological well-being. In: Kimble MA, McFadden SH, Ellor JW, Seeber JJ, editors. Aging, Spirituality, and Religion: A Handbook. Minneapolis: Fortress; 1996. p. 3046. Aging, Spirituality, and Religion: A Handbook 1996 30 46 Levin JS Tobin SH Kimble MA McFadden SH Ellor JW Seeber JJ 28. Levin JS, Vanderpool HY. Religious factors in physical health and the prevention of illness. In: Pargament KI, Maton KI, Hess RE, editors. Religion and Prevention in Mental Health: Research, Vision, and Action. New York: Haworth; 1992. p. 83103. Religion and Prevention in Mental Health: Research, Vision, and Action 1992 83 103 Levin JS Vanderpool HY Pargament KI Maton KI Hess RE 29. Pargament KI. The Psychology of Religion and Coping: Theory, Research, Practice. New York: Guilford; 1997. 548 p. The Psychology of Religion and Coping: Theory, Research, Practice 1997 548 Pargament KI 30. Pargament KI, Maton KI, Hess RE, editors. Religion and Prevention in Mental Health.New York: Haworth; 1992. Religion and Prevention in Mental Health 1992 Pargament KI Maton KI Hess RE 31. Schumaker JF, editor. Religion and Mental Health. New York: Oxford University Press; 1992. Religion and Mental Health 1992 Schumaker JF 32. Larson DB, Sherrill KA, Lyons JS, Craigie FC Jr, Theilman SB. Associations between dimensions of religious commitment and mental health reported in the American Journal of Psychiatry and Archives of General Psychiatry: 1978 1989. Am. J. Psych. 1992; 149:557559. Associations between dimensions of religious commitment and mental health reported in the American Journal of Psychiatry and Archives of General Psychiatry: 1978- 1989 Am. J. Psych. 1992 557 559 149 Larson DB Sherrill KA Lyons JS Craigie FC Jr Theilman SB 33. Levin JS. Religious factors in aging, adjustment, and health: a theoretical overview. J. Rel. Aging1988; 4:133146. Religious factors in aging, adjustment, and health: a theoretical overview J. Rel. Aging 1988 133 146 4 Levin JS 34. McFadden SH. Religion, spirituality and aging. In: Birren JE, Schaie KW. Handbook of the Psychology of Aging. San Diego: Academic; 1996. p. 16277. Handbook of the Psychology of Aging 1996 162 77 McFadden SH Birren JE Schaie KW 35. Vanderpool HY, Levin JS. Religion and medicine: how are they related? J. Relig. Health 1990; 29:920. Religion and medicine: how are they related? J. Relig. Health 1990 9 20 29 Vanderpool HY Levin JS 36. Weaver AJ, Samford JA, Larson DB, Lucas LA, Koenig HG, Patrick V. A systematic review of research on religion in four major psychiatric journals, 19911995. J. Nerv. Ment. Dis. 1998; 186:187189. A systematic review of research on religion in four major psychiatric journals, 1991-1995 J. Nerv. Ment. Dis. 1998 187 189 186 Weaver AJ Samford JA Larson DB Lucas LA Koenig HG Patrick V 37. Jonas WB, Levin LK. Essentials of Complementary and Alternative Medicine. Baltimore: Lippincott, Williams & Wilkins; 1999. Essentials of Complementary and Alternative Medicine 1999 Jonas WB Levin LK 38. Gorsuch RL. Measurement in psychology of religion revisited. J. Psychol. Christianity 1990; 9:8292. Measurement in psychology of religion revisited J. Psychol. Christianity 1990 82 92 9 Gorsuch RL 39. Hill PC. An overview of measurement issues and scales in the scientific study of spirituality. In: Studying Spirituality and Alcohol. Bethesda: National Institute of Alcohol Abuse and Alcoholism/Fetzer Institute; 1999. Studying Spirituality and Alcohol 1999 Hill PC 40. Hood RW Jr, Spilka B, Hunsberger B, Gorsuch RL. The Psychology of Religion: An Empirical Approach.New York: Guilford; 1996. The Psychology of Religion: An Empirical Approach 1996 Hood RW Jr Spilka B Hunsberger B Gorsuch RL 41. Bryant S, Rakowski W. Predictors of mortality among elderly African Americans. Res. Aging1992; 14:5067. Predictors of mortality among elderly African Americans Res. Aging 1992 50 67 14 Bryant S Rakowski W 42. Colantonio A, Kasl SV, Ostfeld AM. Depression symptoms and other psychosocial factors as predictors of stroke in the elderly. Am. J. Epidemiol.1992; 136:884894. Depression symptoms and other psychosocial factors as predictors of stroke in the elderly Am. J. Epidemiol. 1992 884 894 136 Colantonio A Kasl SV Ostfeld AM 43. Craigie FC, Larson DB, Lieu IY. References to religion in the Journal of Family Practice: dimensions and valence of spirituality. J. Fam. Pract.1990; 30:477480. References to religion in the Journal of Family Practice: dimensions and valence of spirituality J. Fam. Pract. 1990 477 480 30 Craigie FC Larson DB Lieu IY 44. Dwyer JW, Clarke LL, Miller MK. The effect of religious concentration and affiliation on county cancer mortality rates. J. Health Soc. Behav.1990; 31:185202 The effect of religious concentration and affiliation on county cancer mortality rates J. Health Soc. Behav. 1990 185 202 31 Dwyer JW Clarke LL Miller MK 45. Ferraro KF, Albrecht-Jensen CM. Does religion influence adult health? J. Sci. Stud. Relig. 1991; 30:193202. Does religion influence adult health? J. Sci. Stud. Relig. 1991 193 202 30 Ferraro KF Albrecht-Jensen CM 46. Hummer RA, Nam CB, Ellison CG. Religious involvement and U.S. adult mortality. Demography1999; 36:273285. Religious involvement and U.S. adult mortality Demography 1999 273 285 36 Hummer RA Nam CB Ellison CG 47. Kennedy GJ, Kelman HR, Thomas C, Chen J. The relation of religious preference and practice to depressive symptoms among 1,855 older adults. J. Gerontol. B Psychol. Sci.1996; 51:301308. The relation of religious preference and practice to depressive symptoms among 1,855 older adults J. Gerontol. B Psychol. Sci. 1996 301 308 51 Kennedy GJ Kelman HR Thomas C Chen J 48. Koenig HG, Hays JC, George LK, Blazer DG, Larson DB, Landerman LR. Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms. Am. J. Geriatr. Psych.1997; 5:131145. Modeling the cross-sectional relationships between religion, physical health, social support, and depressive symptoms Am. J. Geriatr. Psych. 1997 131 145 5 Koenig HG Hays JC George LK Blazer DG Larson DB Landerman LR 49. Koenig HG, Hays JC, Larson DB, Cohen HJ, Blazer DG. The relationship between religious activities and blood pressure in older adults. Int. J. Psych. Med.1998; 28:189213. The relationship between religious activities and blood pressure in older adults Int. J. Psych. Med. 1998 189 213 28 Koenig HG Hays JC Larson DB Cohen HJ Blazer DG 50. Krause N. Neighborhood deterioration, religious coping, and changes in health during later life. Gerontology 1998a; 38:653664. Neighborhood deterioration, religious coping, and changes in health during later life Gerontology 1998 653 664 38 Krause N 51. Krause N. Stressors in highly valued roles, religious coping, and mortality. Psychol. Aging1998b; 13:242255. Stressors in highly valued roles, religious coping, and mortality Psychol. Aging 1998 242 255 13 Krause N 52. Larson DB, Koenig HG, Kaplan BH, Greenberg RF, Logue E, Tyroler HA. The impact of religion on blood pressure status in men. J. Relig. Health 1989; 28:265278. The impact of religion on blood pressure status in men J. Relig. Health 1989 265 278 28 Larson DB Koenig HG Kaplan BH Greenberg RF Logue E Tyroler HA 53. Oxman TE, Freedman DH, Manheimer ED. Lack of social participation or religious strength and comfort as risk factors after cardiac surgery in the elderly. Psychosom. Med.1995; 57:515. Lack of social participation or religious strength and comfort as risk factors after cardiac surgery in the elderly Psychosom. Med. 1995 5 15 57 Oxman TE Freedman DH Manheimer ED 54. Pressman P, Lyons JS, Larson DB, Strain JS. Religious beliefs, depression, and ambulation status in elderly women with broken hips. Am. J. Psych.1990; 147:758760. Religious beliefs, depression, and ambulation status in elderly women with broken hips Am. J. Psych. 1990 758 760 147 Pressman P Lyons JS Larson DB Strain JS 55. Propst LR, Ostrom R,Watkins P, Dean T, Mashburn D. Comparative efficacy of religious and nonreligious cognitive behavioral therapy for the treatment of clinical depression in religious individuals. J. Consult. Clin. Psychol.1992; 60:94103. Comparative efficacy of religious and nonreligious cognitive behavioral therapy for the treatment of clinical depression in religious individuals J. Consult. Clin. Psychol. 1992 94 103 60 Propst LR Ostrom R Watkins P Dean T Mashburn D 56. Koenig HG, Cohen HJ, George LK, Hays JC, Larson DB, Blazer DG. Attendance at religious services, interleukin- 6, and other biological parameters of immune function in older adults. Int. J. Psych. Med.1997; 27:233250. Attendance at religious services, interleukin- 6, and other biological parameters of immune function in older adults Int. J. Psych. Med. 1997 233 250 27 Koenig HG Cohen HJ George LK Hays JC Larson DB Blazer DG 57. Cochran JK, Beegley L, Bock EW. The influence of religious stability and homogamy on the relationship between religiosity and alcohol use among Protestants. J. Sci. Stud. Relig.1992; 32:441456. The influence of religious stability and homogamy on the relationship between religiosity and alcohol use among Protestants J. Sci. Stud. Relig. 1992 441 456 32 Cochran JK Beegley L Bock EW 58. Gartner JD, Larson DB, Allen GD. Religious commitment and mental health: a review of the empirical literature. J. Psychol. Theol.1991; 19:625 Religious commitment and mental health: a review of the empirical literature J. Psychol. Theol. 1991 6 25 19 Gartner JD Larson DB Allen GD 59. Idler EL, Kasl SV. Religion among disabled and nondisabled persons II: Attendance at religious services as predictors of the course of disability. J. Gerontol. 1997; 52b:S306S316. Religion among disabled and nondisabled persons II: Attendance at religious services as predictors of the course of disability J. Gerontol. 1997 S306 S316 52b Idler EL Kasl SV 60. Williams DR, Larson DB, Buckler RE, Heckman RC, Pyle CM. Religion and psychological distress in a community sample. Soc. Sci. Med.1991; 32:12571262. Religion and psychological distress in a community sample Soc. Sci. Med. 1991 1257 1262 32 Williams DR Larson DB Buckler RE Heckman RC Pyle CM 61. Pargament KI, Ensing DS, Falgout K, Olsen H, Reilly B, Van Haitsma K, Warren R. Religious coping efforts as predictors of the outcomes of significant negative life events. Am. J. Commun. Psych.1990; 18:793824. Religious coping efforts as predictors of the outcomes of significant negative life events Am. J. Commun. Psych. 1990 793 824 18 Pargament KI Ensing DS Falgout K Olsen H Reilly B Van Haitsma K Warren R 62. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative coping with major life stressors. J. Sci. Stud. Relig.1998; 37:710724. Patterns of positive and negative coping with major life stressors J. Sci. Stud. Relig. 1998 710 724 37 Pargament KI Smith BW Koenig HG Perez L 63. Koenig HG, Cohen HJ, Blazer DG, Kudler HS, Krishnan KPP, Sibert TE. Religious coping and cognitive symptoms of depression in elderly medical patients. Psychosomatics 1995; 36:369375. Religious coping and cognitive symptoms of depression in elderly medical patients Psychosomatics 1995 369 375 36 Koenig HG Cohen HJ Blazer DG Kudler HS Krishnan KPP Sibert TE 64. Krause N. Stress, religiosity, and psychological well-being among older blacks. J. Aging Health 1992; 4:412439. Stress, religiosity, and psychological well-being among older blacks J. Aging Health 1992 412 439 4 Krause N 65. McIntosh DN, Silver RC, Wortman CB. Religion's role in adjustment to a negative life event: coping with the loss of a child. J. Pers. Soc. Psych. 1993; 65:812821. Religion's role in adjustment to a negative life event: coping with the loss of a child J. Pers. Soc. Psych. 1993 812 821 65 McIntosh DN Silver RC Wortman CB 66. Koenig, HG. The Healing Power of Faith: Science Explores Medicine's Last Great Frontier. New York: Simon & Schuster; 1999. The Healing Power of Faith: Science Explores Medicine's Last Great Frontier 1999 Koenig HG 67. Mattlin JA, Wethington E, Kessler R. Situational determinants of coping and coping effectiveness. J. Health Soc. Behav.1990; 31:103122. Situational determinants of coping and coping effectiveness J. Health Soc. Behav. 1990 103 122 31 Mattlin JA Wethington E Kessler R 68. Ellison CG. Religion, the life-stress paradigm, and the study of depression. In: Levin JS, editor.Religion in Aging and Health: Theoretical Foundations and Methodological Frontiers. Thousand Oaks: Sage; 1994. p. 78121 Religion in Aging and Health: Theoretical Foundations and Methodological Frontiers 1994 78 121 Ellison CG Levin JS 69. Ellison CG, George LK. Religious involvement, social ties, and social support in a southeastern community. J. Sci. Stud. Relig.1994; 33:4661. Religious involvement, social ties, and social support in a southeastern community J. Sci. Stud. Relig. 1994 46 61 33 Ellison CG George LK 70. Maton KI, Wells E. Religion as a community resource for well-being: prevention, healing and empowerment pathways. J. Soc. Issues1995; 51:177193. Religion as a community resource for well-being: prevention, healing and empowerment pathways J. Soc. Issues 1995 177 193 51 Maton KI Wells E 71. Benor DJ. Survey of spiritual healing research. Complement. Med. Res.1990; 4:9-33. Survey of spiritual healing research Complement. Med. Res. 1990 9 33 4 Benor DJ 72. Wirth DP, Cram JR. Multi-site electromyographic analysis of noncontact therapeutic touch. Int. J. Psychosom.1993; 40:47-55. Multi-site electromyographic analysis of noncontact therapeutic touch Int. J. Psychosom. 1993 47 55 40 Wirth DP Cram JR 73. Wirth DP, Cram JR. Psychophysiology of nontraditional prayer. Int. J. Psychosom.1994; 41: 68-75. Psychophysiology of nontraditional prayer Int. J. Psychosom. 1994 68 75 41 Wirth DP Cram JR 74. Solfvin J. Mental healing. In: Krippner S, editor.Advances in Parapsychological Research.Jefferson: McFarland; 1984. Advances in Parapsychological Research 1984 Solfvin J Krippner S 75. Wirth DP, Barrett MJ. Complementary healing therapies. Int. J. Psychosom.1994; 41:61-67. Complementary healing therapies Int. J. Psychosom. 1994 61 67 41 Wirth DP Barrett MJ 76. Sutherland J, Poloma MM, Pendleton B. Religion, Spirituality, and Alternative Health Practices: The Baby Boomer and Cold War Cohorts. J Relig Health 2003; 42:315-338. Religion, Spirituality, and Alternative Health Practices: The Baby Boomer and Cold War Cohorts J Relig Health 2003 315 338 42 Sutherland J Poloma MM Pendleton B 77. Levin JS. Religion in Aging and Health: Theoretical Foundations and Methodological Frontiers. Thousand Oaks: Sage; 1994. Religion in Aging and Health: Theoretical Foundations and Methodological Frontiers 1994 Levin JS 78. Levin JS. Religion, Health, and Psychological Well-Being in Older Adults. J Aging Health1998; 10:504531. Religion, Health, and Psychological Well-Being in Older Adults J Aging Health 1998 504 531 10 Levin JS 79. Kaplan BH. A Note on Religious Beliefs and Coronary Heart Disease. J S C Med Assoc 1976; 72:6064. A Note on Religious Beliefs and Coronary Heart Disease J S C Med Assoc 1976 60 64 72 Kaplan BH 80. Benson H. The Relaxation Response. New York: William Morrow; 1975. The Relaxation Response 1975 Benson H 81. Idler EL. Religious Involvement and Health of the Elderly: Some Hypotheses and an Initial Test. Social Forces 1987; 66:226238. Religious Involvement and Health of the Elderly: Some Hypotheses and an Initial Test Social Forces 1987 226 238 66 Idler EL 82. Jones JW. Religion, Health, and the Psychology of Religion: How the Research on Religion and Health Helps Us Understand Religion. J Relig Health 2004; 43(4):317-328. Religion, Health, and the Psychology of Religion: How the Research on Religion and Health Helps Us Understand Religion J Relig Health 2004 317 328 4 43 Jones JW 83. Ness PHV. Religion and public health. J Relig Health 1999; 38(1):15-26. Religion and public health J Relig Health 1999 15 26 1 38 Ness PHV