Harvard Research: How Spirituality and Health Are Linked?

Harvard Research: How Spirituality and Health Are Linked?

Spirituality enhances medical care for those facing serious illness. And it boosts overall health outcomes, even at the population level.

These claims are based on a review of more than two decades of high-quality studies showing the benefits of seeing and nurturing a patient’s spirituality as part of medical care or public health.

The findings, led by researchers from Harvard University’s Human Flourishing Program and colleagues from the university’s Initiative on Health, Religion and Spirituality, among others, were published earlier this month in JAMA, the Journal of the American Medical Association.

The relationship between body and soul is not a new discovery, according to Dr. Tracy A. Balboni, co-director of the Harvard initiative and professor of radiation oncology and lead author of the study. He said the correlation is particularly well known between common forms of spirituality and key outcomes such as reduced all-cause mortality, suicide, depression and substance abuse, as well as greater recovery from substance use disorders.

“There’s actually quite a bit of research work both in the context of health — healthy populations — and in the context of serious illness showing clear ways in which spirituality is linked to well-being, showing many remarkable associations with very rigorous research,” said Balboni, the who also directs Harvard’s radiation oncology program.

Spirituality in Serious Illness and Health is a detailed look at hundreds of studies with thousands of patients to see what research has shown about the relationship between spirituality and health. Panels of experts then analyzed the findings to create recommendations for ways to use this relationship to benefit both very ill people and public health.

The goal, they said, is “person-centered care with values.”

Clinicians, public health experts, researchers, health system leaders, and medical ethicists comprised the panels. The top priorities established by the team when treating people with serious illness include:

  • Regular integration of spiritual care into medical care.
  • Including spiritual care training in the training of interdisciplinary medical team members.
  • Including specialist spiritual professionals such as chaplains in patient care.

In the field of public health they propose:

  • That clinicians perceive the beneficial associations between religious/spiritual community and health to provide better person-centered care.
  • Increase public health professionals’ knowledge of the evidence that religious/spiritual community involvement is associated with health protection.
  • Recognition of spirituality as a social factor linked to health.

Balboni said spirituality can manifest itself in many ways, not just as religion. “At least the early data would show that a community where there is a common purpose, value and connection between them can have something similar. It’s just that religious communities tend to do that — that’s the core of what they do in general. So I think those are the most common forms.”

He added, “Finding that community that helps cultivate and sustain a framework of meaning, purpose, and value is critical to our health, our well-being, and our flourishing as human beings.”

Determining the need

In a blog about the research in Psychology Today and the Human Flourishing newsletter, Tyler J. VanderWeele, director of this program, noted “strong evidence that attending religious services was associated with a lower risk of mortality. less smoking, alcohol and drug use; better mental health; better quality of life; fewer subsequent depressive symptoms and less frequent suicidal behaviours’.

He wrote that a deep dive into longitudinal studies shows that those who frequently attend religious services enjoy a 27% lower risk of death during attendance and a 33% lower chance of subsequent depression.

“Spirituality or spiritual community thus appeared to be important in both illness and health,” VanderWeele said.

The researchers looked at high-quality studies published since 2000. Criteria for “high quality” included large sample sizes and validated measures. For health outcomes, studies also needed a longitudinal design. They removed studies with a “serious or critical” risk of bias.

The panels discussed health care implications based on the evidence from the studies, rating them from unclear to stronger evidence to meet the recommendations.

By the time they went through the process of elimination, they had narrowed down nearly 9,000 articles to 371 about serious diseases. Of nearly 6,500 articles with health outcomes, they included 215.

They found clear evidence that spirituality is important to most patients and that spiritual needs are common, whereas spiritual care is not. They also found that patients often want spiritual care, but spiritual needs are rarely addressed as part of medical care—even though spirituality often influences the medical decisions patients make.

Finally, the research review showed that when spiritual needs are not addressed, patients’ quality of life is not as good, while providing spiritual care provides better end-of-life outcomes.

In real life

The Rev. Amy Ziettlow has often seen the interplay of faith and medicine in her role as pastor of Holy Cross Lutheran Church in Decatur, Illinois. He said the JAMA study “resonates with my daily experience of church ministry.”

Any church has homebound, seriously ill members, said the Rev. Ziettlow, who was not involved in the study. “They live with chronic or acute pain, experience losses in memory and physical mobility, and are vulnerable to infections, especially COVID-19, influenza and pneumonia. By definition, ‘homebound’ means they are separated from their religious communities, and my role as a pastor aims to remind them that they are still connected to their church home and still connected to the presence of God,” he told the Deseret News via email.

Her example is Mary, who at age 96 had trouble walking and was living in a memory care facility when she started the hospice last April. Amid COVID-19 restrictions, only family members and Reverend Ziettlow were allowed to visit.

During weekly and then daily visits as death neared, “I was a bridge between her secluded room and our crowded sanctuary of believers, between her life defined by medication, medical visits and physical boundaries and her defined by her relationship with God’. said Rev. Ziettlow. “I wore a clerical collar, my worship uniform, which signified to her and to the care center staff that there would be ritual actions and words that connected Mary to her ultimate meaning, the story of God’s love and grace.”

Despite her failing memory, Maria still knew the liturgical elements that fed her spirit over a lifetime, the Rev. Ziettlow said. “He recited the Lord’s Prayer, the Apostle’s Creed and sang along to favorite hymns such as ‘Jesus Loves Me’ and ‘Amazing Grace’.”

Each visit ended with the sacrament of communion. “Mary kept a special plate and napkin that she liked me to use as we marked this ritual meal together. We ate, drank and remembered that God’s presence is truly with us always,” the pastor recalls. “Her last words to me were, ‘God bless you.’

Baldoni hopes the medical community, public health workers and all those who serve will pay attention to the connection between spirituality and health.

Spirituality, he said, “can really nourish the soul of medicine itself. I believe that as we better embrace the spiritual aspects of our patients, we embrace the spiritual aspects of what it means to be a patient caregiver.”

On the public health side, he said, “As health systems at all levels recognize that human beings are spiritual beings and that is an important aspect of flourishing, we can leverage better care for human populations or for communities by leveraging the resources of spirituality”.

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