Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research.

Empirical studies have identified significant links between religion and spirituality and health. The reasons for these associations, however, are unclear. Typically, religion and spirituality have been measured by global indices (e.g., frequency of church attendance, self-rated religiousness and spirituality) that do not specify how or why religion and spirituality affect health. The authors highlight recent advances in the delineation of religion and spirituality concepts and measures theoretically and functionally connected to health. They also point to areas for growth in religion and spirituality conceptualization and measurement. Through measures of religion and spirituality more conceptually related to physical and mental health (e.g., closeness to God, religious orientation and motivation, religious support, religious struggle), psychologists are discovering more about the distinctive contributions of religiousness and spirituality to health and well-being. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spiritual struggle related to plasma interleukin-6 prior to cardiac surgery.

Spiritual struggle appeared consistently to predict poor health outcomes, including mortality. Despite surging interest in the health benefits of religion and spirituality, the health hassle of existential conflicts and proinflammatory cytokines as a potential physiological mechanism has been overlooked. Based on psychological and theological assumptions, we argue for the universal nature of spiritual struggle, a crisis-related existential conflict, and for investigating its physiological influence as essential to understanding human nature. Increased levels of inflammatory cytokines such as interleukin-6 (IL-6) have been linked with adverse health outcomes and negative emotions. This study thus examined spiritual struggle related to plasma IL-6 in 235 adult patients undergoing cardiac surgery, along with positive religious coping, general coping, and optimism, controlling for standardized clinical medical indicators. Multiple regression analysis, following a preplanned sequence, showed that spiritual struggle (p = .011), behavioral coping (p = .013) were positively associated with excess plasma IL-6, controlling for medical correlates (e.g., left ventricular ejection fraction). We conclude that spiritual struggle, indicating the crisis in an existential relation, and behavioral coping strategies are associated with elevated pre-operative plasma IL-6. The interdisciplinary implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A qualitative study of childhood sexual abuse survivors in Taiwan: Toward a transactional and ecological model of coping.

In this study, we aimed to explore the experiences of 10 female Taiwanese childhood sexual abuse (CSA) survivors (age range = 20–39 years) to broaden our understanding of the post-abuse coping process in a Chinese sociocultural context. This investigation was grounded on a feminist paradigm, and the consensual qualitative research method (Hill et al., 2005; Hill, Thompson, & Williams, 1997) was utilized as the strategy of inquiry. The transactional and ecological model of coping that emerged from the data describes the dynamic interplay among (a) intrapersonal, interpersonal, and sociocultural factors and (b) the coping process and outcomes of CSA survivors. Implications for research on CSA recovery and culturally appropriate interventions in a collectivistic sociocultural context are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Appraisals of controllability and coping in caregivers and HIV+ men: Testing the goodness-of-fit hypothesis.

The authors examined goodness of fit between controllability appraisals and coping in 82 HIV+ and 162 HIV– gay men experiencing the chronic stress of caregiving and 61 HIV+ gay men who were not caregiving. Multiple assessments of each individual over a 2-year period allowed replication of prior cross-sectional research examining goodness of fit, as well as the creation of intraindividual goodness-of-fit scores that were then used to examine within-person fluctuations in goodness of fit over time and goodness of fit as an individual difference variable related to adjustment. Results indicate that the importance of goodness of fit varies for different kinds of coping: The concept was supported for problem-focused coping and, to a lesser extent, for emotion-focused coping but not for meaning-focused coping. Within-subject variation in goodness of fit was related to within-subject variation in depressed mood, but between-subjects variation (individual differences) in fit was not associated with depressed mood, suggesting that goodness of fit is better understood as a transactional variable than as a personality or "coping style" variable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Time to abandon small-sample cohort research in health psychology?

Comments on the original article, "Avoidant coping as a predictor of mortality in veterans with end-stage renal disease" by E. J. Wolf and D. L. Mori (see record 2009-06704-009), in which the authors report that among 61 patients with endstage renal disease (ESRD), avoidant coping more than doubled the odds of mortality in multivariable analysis. The authors concluded that evaluating coping style in patients with ESRD would be clinically useful and that interventions targeting avoidant coping should be investigated. In this commentary, the current authors note that Wolf and Mori’s (2009) finding was based on a sample where only 23 patients died over 9 years, and results were evaluated using a Cox regression model with six covariates, a ratio of only 3.8 outcome events per variable—well below recommended thresholds (e.g., Babyak, 2004; Peduzzi et al., 1995). Beyond this, the model did not assess key variables typically included in studies of ESRD outcomes (e.g., transplant status, cardiovascular problems). Wolf and Mori chose to focus on the relationship between avoidant coping and mortality. However, bivariable correlations and confidence intervals reported or generated from data in the article showed that the association between avoidant coping and mortality (r=.28, 95% CI [.03 to .50]) was not significantly stronger than two other correlations that were in the opposite direction of what would have been expected: hypertension with mortality (r=?.39, 95% CI [?.15 to ?.59]) and medication compliance with mortality (r=.16, 95% CI [?.10 to .40]). Oddities of this sort are often encountered in very small datasets and, as a result, stronger evidence must be accrued from larger, more robust samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What American Psychological Association leaders have to say about Psychology of Religion and Spirituality.

What do American Psychological Association (APA) leaders have to say about the new journal Psychology of Religion and Spirituality? A survey was sent to 204 current APA council representatives and divisional residents, yielding 63 completed questionnaires (31% response rate). Respondents generally affirmed the importance of religion and spirituality as topics of inquiry in psychology. Although not highly religious themselves, respondents recognize religion and spirituality as important aspects of human diversity. In considering the new journal, current APA leaders who responded to the survey are particularly interested in articles relating religion and spirituality to health and coping and articles considering cross-cultural and interfaith issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-Related Differences Among Adults Coping With Pain: Evaluation of a Developmental Life-Context Model.

The pain and coping literature is limited because of its almost exclusive focus on young adults. Our goal was to develop and evaluate a theoretically sound model of age-related differences in coping. Age-related increases in emotion-focused and avoidance-oriented coping and decreases in problem-focused coping were expected to arise from age-related differences in life-context (e.g., health status, stress levels) and in the pain experience. Questionnaire data were collected from 280 older and younger adults with pain. Increasing age was associated with lower pain severity/interference and greater perceived control over pain. Life-context partially mediated this relationship. As hypothesized, there were age-related declines in problem-focused coping. Contrary to expectations, however, older adults also used fewer emotion-focused coping strategies. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies.

Objectives: To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI). Study Design: Qualitative. Participants: Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior. Method: In-person interviews were conducted and data were analyzed using a hermeneutic approach. Results: Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals’ knowledge regarding TBI, providing more structured treatment). Conclusions: Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of hardiness and religiousness to depression and anger.

Both hardiness and religiousness share spirituality, in the sense of searching for meaning in one's life, and have been shown to have a buffering effect on stresses that maintains and enhances performance, morale, and health. This study investigates how hardiness and religiousness compare in their relationship to depression, anger, and the coping and social support mechanisms whereby they may have these relationships. Participants were military and governmental personnel who completed accepted measures of hardiness, religiousness, and other variables on a volunteer basis. Correlational and multiple regression analyses showed that, by comparison with religiousness, hardiness has the larger and more comprehensive negative relationship with depression and anger, and positive relationship with coping and social support. The conceptual and empirical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with work-family conflict: A leader-member exchange perspective.

Leader-member exchange (LMX) theory is applied as a framework for understanding coping with work-family conflict. The effectiveness of four work-family coping strategies (i.e., preventive and episodic forms of both problem-focused and emotion-focused coping) is considered with emphasis on how the LMX relationship contributes to each form of coping with work interference with family. The LMX-based model of work-family coping accounts for the development of family-friendly work roles, use of organizational family-friendly policies, and the negotiation of flextime and flexplace accommodations. Constraints on the relationship between LMX and work-family coping associated with supervisor authority and resources and aspects of the organizational context are also discussed. Research and applied implications of the model are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does repressive coping promote resilience? Affective-autonomic response discrepancy during bereavement.

Traditional theories of coping emphasize the value of attending to and expressing negative emotion while recovering from traumatic life events. However, recent evidence suggests that the tendency to direct attention away from negative affective experience (i.e., repressive coping) may promote resilience following extremely aversive events (e.g., the death of a spouse). The current study extends this line of investigation by showing that both bereaved and nonbereaved individuals who exhibited repressive coping behavior--as measured by the discrepancy between affective experience and sympathetic nervous system response--had fewer symptoms of psychopathology, experienced fewer health problems and somatic complaints, and were rated as better adjusted by close friends than those who did not exhibit repressive coping. Results are discussed in terms of recent developments in cognitive and neuroimaging research suggesting that repressive coping may serve a protective function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

At the intersection of culture and religion: A cultural analysis of religion's implications for secondary control and social affiliation.

Religion helps people maintain a sense of control, particularly secondary control—acceptance of and adjustment to difficult situations—and contributes to strengthening social relationships in a religious community. However, little is known about how culture may influence these effects. The current research examined the interaction of culture and religion on secondary control and social affiliation, comparing people from individualistic cultures (e.g., European Americans), who tend to be more motivated toward personal agency, and people from collectivistic cultures (e.g., East Asians), who tend to be more motivated to maintain social relationships. In Study 1, an analysis of online church mission statements showed that U.S. websites contained more themes of secondary control than did Korean websites, whereas Korean websites contained more themes of social affiliation than did U.S. websites. Study 2 showed that experimental priming of religion led to acts of secondary control for European Americans but not Asian Americans. Using daily diary methodology, Study 3 showed that religious coping predicted more secondary control for European Americans but not Koreans, and religious coping predicted more social affiliation for Koreans and European Americans. These findings suggest the importance of understanding sociocultural moderators for the effects of religion. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Self-critical perfectionism and daily affect: Dispositional and situational influences on stress and coping.

This study of university students (64 men and 99 women) examined both dispositional and situational influences of self-critical (SC) perfectionism on stress and coping, which explain its association with high negative affect and low positive affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Structural equation modeling indicated that the relation between SC perfectionism and daily affect could be explained by several maladaptive tendencies associated with SC perfectionism (e.g., hassles, avoidant coping, low perceived social support). Multilevel modeling indicated that SC perfectionists were emotionally reactive to stressors that imply possible failure, loss of control, and criticism from others. As well, certain coping strategies (e.g., problem-focused coping) were ineffective for high-SC perfectionists relative to low-SC perfectionists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between personality and coping: A meta-analysis.

Personality may directly facilitate or constrain coping, but relations of personality to coping have been inconsistent across studies, suggesting a need for greater attention to methods and samples. This meta-analysis tested moderators of relations between Big Five personality traits and coping using 2,653 effect sizes drawn from 165 samples and 33,094 participants. Personality was weakly related to broad coping (e.g., Engagement or Disengagement), but all 5 traits predicted specific strategies. Extraversion and Conscientiousness predicted more problem-solving and cognitive restructuring, Neuroticism less. Neuroticism predicted problematic strategies like wishful thinking, withdrawal, and emotion-focused coping but, like Extraversion, also predicted support seeking. Personality more strongly predicted coping in young samples, stressed samples, and samples reporting dispositional rather than situation-specific coping. Daily versus retrospective coping reports and self-selected versus researcher-selected stressors also moderated relations between personality and coping. Cross-cultural differences were present, and ethnically diverse samples showed more protective effects of personality. Richer understanding of the role of personality in the coping process requires assessment of personality facets and specific coping strategies, use of laboratory and daily report studies, and multivariate analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The fit between stress appraisal and dyadic coping in understanding perceived coping effectiveness for adolescents with type 1 diabetes.

This study examined whether perceived coping effectiveness (PCE) was associated with better diabetes management and was higher when adolescents’ dyadic coping was matched to shared stress appraisals. There were 252 adolescents with Type 1 diabetes who completed stress and coping interviews where they appraised mothers’ and fathers’ involvement in stress ownership (mine, indirectly shared, directly shared with parent), in coping (uninvolved, supportive, collaborative, or controlling), and rated their effectiveness in coping. Adolescents completed assessments of depressive symptoms (Children’s Depression Inventory), self-care behaviors (Self-Care Inventory), and efficacy of disease management (Diabetes Self-Efficacy). Glycosylated hemoglobin levels were obtained from medical records. Higher PCE was associated with fewer depressive symptoms, self-care behaviors, and efficacy across age and, more strongly for older adolescents’ metabolic control. Appraisals of support or collaboration from parents were more frequent when stressors were appraised as shared. PCE was enhanced when dyadic coping with mothers (but not fathers) was consistent with stress appraisals (e.g., shared stressors together with collaborative coping). Stress and coping is embedded within a relational context and this context is useful in understanding the coping effectiveness of adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Goal adjustment capacities, coping, and subjective well-being: The sample case of caregiving for a family member with mental illness.

This study examined the associations between goal adjustment capacities, coping, and indicators of subjective well-being in 2 waves of data from individuals who provide care for a family member with mental illness. We hypothesized that goal adjustment capacities would predict higher levels of subjective well-being by facilitating coping with caregiving stress. Results showed that goal disengagement was associated with effective care-specific coping (e.g., less self-blame and substance use). Goal reengagement was also associated with effective care-specific coping (e.g., positive reframing), but at the same time it predicted the use of less effective strategies (e.g., venting and self-distraction). Moreover, goal disengagement predicted lower levels of caregiver burden and depressive symptoms and buffered the longitudinal effect of caregiver burden on increases in depressive symptoms. Goal reengagement, by contrast, predicted higher levels of caregiver burden and purpose in life and buffered the cross-sectional association between caregiver burden and depressive symptoms. Finally, effective (and less useful) care-specific coping statistically explained the adaptive (and maladaptive) effects of goal adjustment capacities on participants' well-being. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Adverse health effects of high-effort/low-reward conditions

In addition to the person-environment fit model (J. R. French, R. D. Caplan, & R. V. Harrison, 1982) and the demand-control model (R. A. Karasek & T. Theorell, 1990), a third theoretical concept is proposed to assess adverse health effects of stressful experience at work: the effort-reward imbalance model. The focus of this model is on reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful. Variables measuring low reward in terms of low status control (e.g., lack of promotion prospects, job insecurity) in association with high extrinsic (e.g., work pressure) or intrinsic (personal coping pattern, e.g., high need for control) effort independently predict new cardiovascular events in a prospective study on blue-collar men. Furthermore, these variables partly explain prevalence of cardiovascular risk factors (hypertension, atherogenic lipids) in 2 independent studies. Studying adverse health effects of high-effort/low-reward conditions seems well justified, especially in view of recent developments of the labor market.     

Religion, Spirituality, and Health.

Comments on the article by W. R. Miller and C. E. Thoresen (see record 2003-02034-003) on spirituality, religion, and health. The authors failed to mention how very far back into history the connections between religiousness, spirituality, and health go. On gender differences in religiousness and spirituality, Miller and Thoresen reported that more people see spirituality and religiousness as overlapping but not the same. However, several other studies have found that this relationship is more complex. Rayburn also comments on the article by P. C. Hill and K. I. Pargament (see record 2003-02034-006) on advances in the conceptualization and measurement of religion and spirituality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daily stress, coping, and well-being in parents of children with autism: A multilevel modeling approach.

This study used a repeated daily measurement design to examine the direct and moderating effects of coping on daily psychological distress and well-being in parents of children with Autism Spectrum Disorders (ASD). Twice weekly over a 12-week period, 93 parents provided reports of their daily stress, coping responses, and end-of-day mood. Multilevel modeling analyses identified 5 coping responses (e.g., seeking support, positive reframing) that predicted increased daily positive mood and 4 (e.g., escape, withdrawal) that were associated with decreased positive mood. Similarly, 2 coping responses were associated with decreased daily negative mood and 5 predicted increased negative mood. The moderating effects of gender and the 11 coping responses were also examined. Gender did not moderate the daily coping?mood relationship, however 3 coping responses (emotional regulation, social support, and worrying) were found to moderate the daily stress?mood relationship. Additionally, ASD symptomatology, and time since an ASD diagnosis were not found to predict daily parental mood. This study is perhaps the first to identify coping responses that enhance daily well-being and mitigate daily distress in parents of children with ASD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)