Harvard research: How are spirituality, health linked?

Spirituality improves medical care for people dealing with serious illness. And it boosts overall health outcomes, even at the population level.

Those claims are based on a review of more than two decades of high-quality research demonstrating 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 link 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. She said the association is best known between common forms of spirituality and important outcomes such as reductions in all-cause mortality, suicide, depression and substance abuse, as well as better recovery from substance use disorders.

“There’s actually quite a bit of research work, both in the setting of health — healthy populations — and in the setting of serious illness that shows clear ways that spirituality coexists with well-being, and shows many notable associations with very rigorously done research,” he said. Balboni, who also leads the Harvard Radiation Oncology Program.

“Spirituality in Serious Illness and Health” is a detailed look at hundreds of studies involving thousands of patients to see what research has shown about the link between spirituality and health. Expert panels then parsed the findings to make recommendations on ways to use that relationship to the benefit of both very ill individuals and public health.

The goal, they said, is “person-centered, value-sensitive care.”

Clinicians, public health experts, researchers, health system leaders and medical ethicists formed the panels. The top priorities generated by the panel in treating people with severe illness include:

  • Routinely integrating spiritual care into medical care.
  • Incorporating spiritual care education into the training of interdisciplinary medical team members.
  • Including specialized spiritual practitioners such as chaplains in patient care.

In the field of public health, they propose:

  • That clinicians consider favorable associations between religious/spiritual community and health to provide better person-centred care.
  • Increasing health professionals’ knowledge of evidence that religious/spiritual community participation is associated with protecting health.
  • Recognizing spirituality as a social factor related to health.

Balboni said that spirituality can manifest in many ways, not just as religion. “In any case, early data suggests that a community with a shared purpose, value and connection to each other could have something similar. It’s just that religious communities often do – that’s the crux of what they do in general. So I think those are the most common forms.”

She added, “Finding that community that helps nurture and sustain a framework of meaning, purpose and value is critical to our health, well-being and thriving as humans.”

Defining the need

In a blog post about the study in Psychology Today and in the Human Flourishing newsletter, Tyler J. VanderWeele, director of that program, noted “strong evidence that attendance at religious services was associated with a lower risk of death; less smoking, alcohol and drug use; better mental health; better quality of life; fewer subsequent depressive symptoms and less frequent suicidal behavior.”

He wrote that the deep dive into longitudinal studies suggests that those who attend religious services often have a 27% lower risk of dying during follow-up and 33% less likely to have subsequent depression.

“Spirituality or spiritual community thus turned out to be important in both illness and health,” says VanderWeele.

The researchers considered high-quality studies published since 2000. Criteria for “high quality” included having large sample sizes and validated measurements. For health outcomes, studies also required a longitudinal design. They eliminated studies with a “severe or critical” risk of bias.

The panels discussed the healthcare implications based on the evidence in the studies, rating them from inconclusive to the strongest evidence to follow the recommendations.

By the time they went through the elimination process, they had narrowed down nearly 9,000 articles on serious illness to 371. Of the nearly 6,500 articles on health outcomes, there were 215.

They found clear evidence that spirituality is important to most patients and that spiritual needs are common, while 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 met, the patient’s quality of life is not as good, while providing spiritual care provides better outcomes at the end of life.

In real life

Reverend Amy Ziettlow has often seen the interplay of faith and medicine in her role as pastor of the Holy Cross Lutheran Church in Decatur, Illinois. She said the JAMA study “resonates with my day-to-day experience of municipal work.”

Every congregation has house-bound, critically ill members, said Rev. Ziettlow, who was not involved in the study. “They live with chronic or acute pain, experience memory loss and physical mobility, and are vulnerable to infections, especially COVID-19, the flu and pneumonia. By definition, ‘housebound’ means they are separated from their faith communities, and my role as a pastor is to remind them that they are still connected to their church at home and still connected to God’s presence,” she said. Deseret News by email.

Her example is Mary, who had difficulty walking at age 96 and was living in a memory ward when she started hospice in April. Amid COVID-19 restrictions, only family members and Rev. Zichtlow were allowed to visit.

During weekly, then daily visits as death approached, “I was a bridge between her isolated room and our bustling sanctuary of worshippers, between her life defined by medicine, medical visits and physical limitations and her life defined by her relationship with God,” the Rev. Ziettlow said. “I was wearing an ecclesiastical collar, my worship uniform, which signaled to her and the care center staff that ritual acts and words would take place that would connect Mary to her ultimate meaning, the story of God’s love and grace.”

Despite her flawed memory, Mary still knew the liturgical elements that had nurtured her spirit throughout her life, Reverend Zietlow said. “She recited the Lord’s Prayer, the Apostles’ 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 gladly used by me as we celebrated this ritual meal together. We ate, drank and remembered that God’s presence is really always with us,” the pastor recalled. “Her last words to me were, ‘God bless you’.”

Baldoni hopes the medical community, health professionals and all those they serve will pay attention to the connection between spirituality and health.

Spirituality, she said, “can nourish the soul of medicine itself. I believe that as we better embrace the spiritual aspects of our patients, we also embrace the spiritual aspects of what it means to be caregivers for patients.”

On the public health side, she said: “Because health systems at all levels recognize that humans are spiritual beings and that this is an important aspect of thriving, we can take better care of human populations or communities by leveraging the resources of spirituality.”

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