Wellness Check: Spirituality

Religion and spirituality dimensions may be beneficial in bipolar disorder symptoms

1. In this scoping review, intrinsic religiosity and positive religious coping are the dimensions of religion and spirituality (R/S) that have the most positive correlations with improvement of bipolar disorder symptoms.

2. Furthermore, bipolar patients struggle with their religious experiences and wish that R/S would be considered by mental health professionals.

Evidence Rating Level: 2 (Good)

Bipolar disorder requires a holistic approach involving not only pharmacotherapy, but also psychotherapy. More recently, the inclusion of religion/spirituality has also been considered. To date, the literature has favored quantitative literature as opposed to qualitative studies. As a result, the objective of the present scoping review was to provide an updated synthesis of qualitative and quantitative studies addressing R/S of patients with bipolar disorder.

Of 690 screened studies, 18 (n=4 qualitative, 14 quantitative) were included in the review from database inception to July 2021. Studies were included if they placed an emphasis on bipolar disorder and its relationship with R/S. Articles were excluded if they only mentioned R/S in a study without describing the interaction with bipolar disorder. Articles were independently screened by 2 authors. The authors assessed for the statistical rigor of the included studies.

Results demonstrated that “degree of personal religious commitment or motivation”, “religious activities performed in private”, and “petition to God for forgiveness” were most consistently associated with beneficial effects amongst bipolar patients. Furthermore, it was shown that R/S is not static and the fluid nature of belief and illness provide further information to both clinicians and patient to explore together when discussing therapeutic intervention. Despite these results, the study was limited by the absence of a formal bias assessment of the included studies, which may impact the strength of the conclusions drawn. Nonetheless, the findings provide grounds on which future therapeutic approaches including R/S in bipolar disorder may be developed.

Religiosity may be associated with abstinence in Latinx individuals with substance use disorders

1. In this randomized controlled trial, participants had high scores for past-year religiosity and lifetime religiosity.

2. Furthermore, in the cognitive behavioral therapy (CBT) treatment group, religiosity was associated with a longer duration of abstinence

Evidence Rating Level: 2 (Good)

Latinx adults with substance use disorders are at high risk for dropout and often report treatment dissatisfaction. Spirituality and religion have been identified as factors related to substance use treatment outcomes; however, they have rarely been studied among Latinx populations. As a result, the objective of the present study was to assess the relationship between past-year religiosity scores and treatment outcomes in the full sample, while also exploring differences in baseline characteristics and treatment outcomes across subgroups.

The parent randomized controlled trial (RCT) described elsewhere included 92 participants from 3 outpatient clinics offering substance use treatment for Spanish-speakers in the United States. Participants were included if their primary language was Spanish, met current substance use criteria, and used substances within 28 days of the screening date. Participants were excluded if they were not sufficiently stable for 8 weeks of outpatient follow-up. The standard treatment group received usual substance use treatment whereas the treatment group included access to a culturally adapted CBT program (CBT4CBT-Spanish). Religiosity was measured at baseline using The Religious Background and Behavior (RBB) questionnaire. Similarly, daily substance use was assessed using the calendar-based Timeline Follow Back. Data was analyzed using two-tailed tests.

Results demonstrated that religiosity in the past year was positively associated with one measure of abstinence for those randomized to CBT4CBT-Spanish; however, this did not persist during a six-month follow-up period. Furthermore, in Latinx adults receiving a culturally adapted cognitive behavioral therapy treatment, religiosity may be associated with longer duration of abstinence. Despite these findings, the study was limited by the fact that the parent RCT was not designed to test religiosity or spirituality on outcomes. Nonetheless, the study had excellent follow-up rates and data availability which strengthen its results.

Spirituality and religion may have various effects on mental health through neurobiological correlates

1. In this study, Spirituality/Religion (S/R) may be protective against depression and alcohol use from various mechanisms, including neurobiological correlates and prayer.

2. Furthermore, the association between S/R, anxiety, psychosis, and neurobiological correlates remains uncertain.

Evidence Rating Level: 2 (Good)

Prior research in S/R have highlighted its positive role in improving outcomes of various mental health conditions. However, relatively little research has focused on S/R, mental health, and their neurobiological correlates. As a result, the objective of the present systematic review was to synthesize the available evidence regarding the relationship between S/R, mental health, and neurobiological correlates, as well as limitations and future directions in this area.

Of 903 identified records, 18 were included in the review from database inception to February 2021. Studies were included if they measured spirituality, mental health, and utilized neuroimaging or electrophysiology. Studies were excluded if they assessed a neurological disorder not related to mental health, or secular mindfulness/mindfulness to the exclusion of other aspects of spiritual life. Quality assessment was done following recommendations described by Sanderson et al. Screening was performed in three phases.

Results demonstrated that S/R may be protective against the development of depression especially amongst those with familial risk. In addition, S/R was associated with several neurobiological correlates (e.g. greater cortical thickness and decreased default mode network connectivity). With respect to alcohol use, prayer may reduce cravings and increase attention and control processes in the brain. However, correlations between S/R, anxiety, psychosis, and the brain remain uncertain. Despite these results, the study was limited by the fact that all research reviewed regarding S/R, neurobiology, and familial risk for depression came from the same dataset. Nonetheless, these findings highlight a need for high quality neuroimaging research to examine the relationship between S/R and various mental health disorders.

Parent decision making in poor-prognosis childhood cancer may extend beyond values and preferences

1. In this scoping review, factors that may influence parent decision making in poor-prognosis childhood cancer vary between parents and may lead to potential conflict and tradeoffs.

2. Furthermore, preferences between parents may change depending on a parents’ cognitive state.

Evidence Rating Level: 2 (Good)

In the recent decade, there has been an increasing number of treatment options and clinical trial options available for children diagnosed with poor-prognosis cancers. Currently, research in the field of parental decision making in poor-prognosis childhood cancer is limited. As a result, the objective of the present scoping review was to explore parent values and preferences regarding treatment decision-making when their child was receiving cancer-directed therapy for poor-prognosis cancer.

Of 586 identified records, 12 were included in the final analysis from 1996 to May 2021. Studies were included if they included the values and preferences of parents of poor-prognosis childhood cancer patients. Studies were excluded if values and preferences were not related to treatment decision making, continued prognostic communication regarding cancer diagnosis among others. The review was conducted following Joanna Briggs Institute. Quality of data extraction was performed by reviewing a random sample of 25% of the articles by a third reviewer.

Results demonstrated that factors that informed decision-making processes included: opinions of others, child’s wishes, religion, and faith. Furthermore, it was found that parents valued having enough time, being a good parent, and being involved in decision making, although preferences within these values varied. Despite these findings, the present study was limited financially and only included studies written in English. However, these results present the need to invest additional time to explore what is important to parents when making treatment decisions for their children.

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