May 4, 1998 DURHAM, N.C. -- A new study on the health effects of religion among sick, older patients has shown that the stronger a person's religious faith, the faster he or she recovered from depression, especially if the patient was disabled or chronically ill, a Duke University researcher reports.
In a study of 87 depressed patients hospitalized for medical conditions like heart disease and stroke, those who scored high on a measure of "intrinsic religiosity" recovered faster from depression than those who scored low on the scale. Intrinsic religiosity was defined as a deep, internally-motivated type of religious commitment, related to but distinct from organized religious activities and private meditation or prayer.
Results of the study, funded by the National Institute of Mental Health, are published in the April issue of the American Journal of Psychiatry.
"This is the first study to show that religious faith by itself, independent of medical intervention and quality of life issues, can help older people recover from a serious mental disorder," said Dr. Harold Koenig, a Duke psychiatrist and lead author of the study.
Specifically, the study found that for every 10-point increase in a person's intrinsic religiosity as measured by a scientifically validated questionnaire, there was a 70 percent increase in the speed of recovery from depression. Recovery time was even faster for older patients whose medical conditions worsened or failed to improve after discharge. For each 10-point rise in religious faith, there was a 100 percent increase in the speed of remission from depression, compared to their nonreligious counterparts.
While Koenig's previous studies have shown a link between religious activities and good mental and physical health, none until now has shown a cause-and-effect relationship, whereby religious faith actually accelerated recovery time.
He said the findings are significant because the rate of major depression among medically-ill, hospitalized elders is between 10 percent and 25 percent, compared to just 1 percent in the general population of older adults. Further, he said, research has shown that depressed people are at significantly greater risk of dying from heart disease and a host of other physical ailments, and that depression slows recovery from disease.
"A lot of older people have exhausted their medical treatment options, and we can't do a lot to enhance their physical functioning. But we can facilitate coping mechanisms that ameliorate their psychological and mental distress," Koenig said. "That's no small accomplishment, given the fact that senior citizens are the biggest consumers of health services, and depression can dramatically increase the use of costly health services."
Koenig theorized the mechanism at work may be that religious beliefs provide a world view in which medical illness, suffering and death can be better understood and accepted; or, that religious beliefs provide a basis for self-esteem that is more resilient than other sources of self-esteem -- such as material goods or physical abilities -- which decline with increasing age and worsening health.
The study included patients admitted to Duke University Hospital's general medicine, cardiology or neurology units from November 1993 to March 1996. All patients received a one- to two-hour baseline evaluation to assess their physical, mental and psychosocial functioning. To be considered depressed, patients had to experience at least 3 out of 13 criterion symptoms for two weeks or longer during the past month and had to score at a certain level on two nationally recognized depression scales.
Depressed patients were followed up at 12-week intervals for nearly a year after discharge to assess the severity and persistence of their depressive symptoms. A full remission from depression was defined as two weeks or longer of experiencing fewer than three of nine traditional criteria.
Because of concern that religious patients might be more likely to deny or conceal depressive symptoms, the researchers examined the relationship between baseline intrinsic religiousity and baseline depression by comparing the 87 depressed cases with 77 non-depressed "control" patients. The average, baseline intrinsic religiousity scores for cases and controls were similar, indicating that religious faith did not affect reporting of symptoms in the depressed group.
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