Wellness Check: Spirituality

Spiritual health is associated with lower levels of burn-out in physicians

1. This systematic review found that low levels of spirituality correlated with high burn-out levels in medical doctors.

2. However, there was no significant association between religion and burn-out in the same population.

Evidence Rating Level: 1 (Excellent)

Physicians experience high levels of burn-out, which has become an increasing concern following the COVID-19 pandemic. Burn-out can have many adverse effects on physician well-being and can result in early retirement or resignation. Prior studies have shown that spiritual health and burn-out may be related. However, the impact that spirituality has on burn-out in medical doctors is not well defined. Thus, the present study aimed to assess the association between burn-out and spiritual health in physicians.

Of 1,049 identified records, 40 studies were included from database inception to March 2022. Studies were included if they had quantified data relating to both burn-out and spiritual health in physicians from any specialty or level of training. Broad definitions of spirituality and burn-out were used, and studies that measured aspects that were considered close to burn-out and spiritual health were included. Editorials and commentaries were excluded. The review was carried out according to PRISMA guidelines. The study quality was assessed using the AXIS tool. The primary outcome was the association between spirituality and burn-out in medical doctors.

The results demonstrated that many studies found an association between spiritual health and lower levels of burn-out in medical doctors. However, there was no significant association between religion and burn-out in physicians. Furthermore, studies that used a broader definition of spirituality rather than looking more specifically at religion were more likely to demonstrate a correlation between burn-out and spirituality. However, the review was limited by the heterogeneity of the included studies, which prevented the possibility of a meta-analysis. Nonetheless, the study demonstrated that spiritual health may be an important factor in preventing burn-out in medical doctors.

Religion and spirituality-based treatments are effective for mental health care

1. In this meta-analysis of randomized controlled trials, religion and spirituality-based (R/S) therapies were found to be moderately more efficacious at post-treatment and follow-up compared to non-R/S treatments.

2. R/S treatments were also associated with improvements in symptoms and functioning compared to non-R/S treatments.

Evidence Rating Level: 1 (Excellent)

Person-centered approaches are becoming increasingly important in mental health care. Many people worldwide identify as having a religious/spiritual affiliation; therefore, including religion and spirituality-based (R/S) therapies may help provide person-centered mental health care. However, the efficacy of these approaches in patients who identify as religious/spiritual is not well understood. As a result, the present study aimed to compare R/S treatments to non-R/S psychotherapies in treating patients with a diagnosed mental illness.

Of 9,688 identified records, 23 (n=1,499 participants) randomized controlled trials were included from inception to January 2022. Studies were included if patients were 18 years or older, had a diagnosed mental health disorder according to the DSM or ICD manuals, were treated in mental health care settings, compared psychotherapy treatments with a specific religious or spiritual component to an active control group, and included quantifiable data regarding the mental health disorder that was being examined, including symptoms and functioning. Studies were excluded if they used a religious or spiritual intervention focused on mindfulness, meditation, or yoga. The primary outcome was the difference in treatment outcomes between R/S and non-R/S treatment groups.

The results demonstrated that the overall effectiveness of R/S treatments was moderately greater than non-R/S treatments at post-treatment and follow-up. The study also showed that R/S treatments were associated with improved psychological symptoms and functioning compared to non-R/S therapies. However, the study was limited by the lack of inclusion of mediating variables, such as motivation and patient preference, which may have influenced the efficacy results of the various treatments. Nonetheless, the study demonstrated that for those with a religious/spiritual affiliation, R/S treatments may be helpful in managing mental illness.

Mindfulness-based elder care programs improve mental and spiritual health in residents of long-term care facilities

1. In this randomized controlled trial, seniors with disabilities in long-term care facilities who participated in an eight-week mindfulness-based elder care (MBEC) program experienced significant improvements in their mental health following the intervention.

2. Furthermore, those in the MBEC group also experienced significant improvements in spiritual well-being compared to the control group.

Evidence Rating Level: 1 (Excellent)

Seniors with disabilities often live in restrictive environments, negatively impacting their mental health and spiritual well-being. Holistic care, including mindfulness-based interventions (MBIs), is increasingly important in care settings to address these concerns. Due to the unique challenges that may be faced when incorporating MBIs for seniors in various settings, mindfulness-based elder care (MBEC) programs were developed. However, the direct impact of these programs on mental health and spiritual well-being has not been well-established. Thus, the present study aimed to assess the effect of MBEC programs on the mental health and spiritual well-being of older adults in long-term care.

This randomized controlled trial included 77 participants from northern and central Taiwan. Participants were included if they were 65 years or older, had been living in a residential long-term care institution for at least 3 months, and had an activities of daily living (ADL) score under 100. Participants were excluded if they had a history of major depression, severe sensory and/or cognitive impairments, or could not follow instructions. Participants were randomly assigned to either the MBEC program group (n=38) or the control group (n=39). Participants in the MBEC group attended eight weekly group sessions consisting of MBEC lectures and activities. The control group received usual care and a weekly visit from the research team. The Geriatric Depression Scale Short Form (GDS-SF) was used to assess depression, the State-Trait Anxiety Inventory (STAI) to evaluate anxiety, and the Spiritual Well-Being Scale (SWBS) to measure spiritual well-being in participants. Participants were assessed at baseline, mid-intervention, post-intervention, and at four weeks follow-up. The primary outcomes were depression and anxiety scores, and the secondary outcome was spiritual well-being.

The results demonstrated that the MEBC group had improvements in both depression and anxiety from baseline to the mid-intervention, post-intervention, and four-week follow-up assessments. The MEBC group also demonstrated improvements in spiritual well-being compared to the control group. However, the study was limited by the exclusion of participants with major mental illnesses, which may have limited the generalizability of the findings. Nonetheless, the present study demonstrated that MEBC programs may be useful in improving the mental and spiritual well-being of seniors with disabilities living in long-term care facilities.

Image: PD

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