Harvard Study: How Are Spirituality and Health Related?

Spirituality improves medical care for those coping with 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 research that demonstrates the benefits of looking at 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 Health, Religion and Spirituality Initiative, among others, were published earlier this month in JAMA, the journal of the American Medical Association.

The connection 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 connection is particularly notable between community forms of spirituality and key outcomes such as reductions in overall mortality, suicide, depression and substance abuse, as well as better recovery from substance use disorders.

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

Spirituality in Serious Illness and Health is a detailed review of hundreds of studies with thousands of patients to see what research shows about the relationship between spirituality and health. The expert groups then analyzed the findings to create recommendations for ways to use this relationship to benefit both very sick people and public health.

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

Clinicians, public health experts, researchers, health system leaders, and medical ethicists comprised the panels. Key priorities generated by the panel in treating people with serious illness include:

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

In the field of public health, they offer:

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

Balboni said spirituality can manifest itself in many ways, not just as religion. “Early evidence at least suggests that a community where there is a shared purpose, value and connection to each other can have something like this.” It’s just that religious communities tend to do that – it’s the essence 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, our well-being and our flourishing as human beings.”

Determining the need

In a blog about the study in Psychology Today and in the Human Flourishing newsletter, Tyler J. VanderWeele, director of this program, noted “strong evidence that religious service attendance is 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 suicidal behavior.

He wrote that a deep dive into longitudinal studies suggests that those who attend religious services frequently enjoy a 27 percent lower risk of death at follow-up and a 33 percent lower chance of subsequent depression.

“Thus, spirituality or spiritual community has been shown to be important in both illness and health,” VanderWiel said.

Researchers considered high-quality studies published since 2000. “High quality” criteria include large sample sizes and validated measures. For health outcomes, studies also need a longitudinal design. They eliminated studies with a “serious or critical” risk of bias.

The panels discussed the health implications based on the evidence in the studies, ranking them from inconclusive to the strongest evidence to adhere to the recommendations.

By the time they went through the process of elimination, they had narrowed down nearly 9,000 articles to 371 on serious diseases. Of nearly 6,500 articles on health outcomes, they included 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 ask for spiritual care, but spiritual needs are rarely seen as part of medical care – although spirituality often influences the medical decisions patients make.

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

In life

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

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

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

During weekly and then daily visits as death neared, “I was a bridge between her isolated room and our bustling shrine of pilgrims, between her life defined by medication, medical visits and physical restrictions, and her life defined from her relationship with God,” Rev. Zietlow said. “I wore a church collar, my worship uniform, which signaled to her and the center’s 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, Mary still knew the liturgical elements that had fueled her spirit throughout her life, the Rev. Zetlow 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 wanted me to use as we celebrated this ritual meal together. We ate, drank and remembered that God’s presence is truly always with us”, recalls the pastor. “Her last words to me were ‘God bless you.’

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

Spirituality, she said, “can actually feed 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 a patient caregiver.”

From a public health perspective, she said: “As health systems at all levels recognize that people are spiritual beings and that this is an important aspect of flourishing, we can benefit from better care for human populations or communities by we draw on the resources of spirituality.’

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