1. Context
Spirituality places far greater emphasis on human principles than religious practices, and indicates a person’s feelings about the meaning and goals of life beyond material values (1). Spirituality encompasses a series of meanings that underline aspiration, compatibility, vision, beliefs, and the meaningfulness of conditions (2). It is an inextricable element of human life and an important factor that enables humans to overcome numerous challenges. When considering spirituality, a different definition of health is given with respect to independent human identity. Traditionally, health represents humans’ biologic identity based on modern medical science and the principle definitions of health (3); however, another identity is humans’ psychological or sympathetic perceptions, which constitute community health.
During the 19th and first half of the 20th century, diseases were described as disorders in the body’s physiologic processes, a definition that remains dominant in medicine. In the second half of the 20th century, the indirect impact of physical and mental interaction on health status was officially recognized. Attention then turned to the question of why some individuals become ill frequently and have delayed recoveries. Presently, people are again considering that there is a relationship between spirituality and health. Religious beliefs and spirituality are deemed beneficial to the maintenance of physical and psychological health, a reality which, once more, revives the idea of the integration of the body and the psyche (4). Notwithstanding, the trend in medical science is inclined toward the dominant perspectives of religious outlook, which are free of extravagance and prejudice (5). All divine religions, particularly Islam, place special emphasis on the non-material aspects of life and draw attention to the spiritual life of mankind. Due to this capacity, Islam, as well as other monotheistic religions, play a key role in helping people cope with disease (6).
As Imam Ali (May God’s greetings be upon him) stated 14 centuries ago, “Be aware that poverty is the greatest of all evils, and physical ill health is more severe than destitution, and worse still is illness of the heart, and remember that the greatest blessing is piety of the heart, followed by, in order of importance, bodily health and financial security.” Herein, sin and transgression are mentioned with respect to the ailing soul and heart (5). In addition, Imam Ali urged people to avoid scourges, hardships, and difficulties through prayer, a means that emphasizes the impact of prayer and praise to God on physical and psychological health (5).
Imam Sadegh (May God’s greetings be upon him) said, “If any one of you gets caught up in one of the worldly sorrows, it isn’t difficult if he/she, after having prayer’s ablution (vozou) goes to the mosque, prays, and asks God to remove his/her sadness. Have you not heard that God has said, ‘Seek help from patience and praying’” (7).
Nowadays, many studies regarding the connection between spirituality and health are in progress. Naturally, the topics discussed in this context comprise a series of criteria such as mortality, the eventual benchmark of health, living efficiency, and treatment. Additionally, it is thought that the different aspects of religion, as with most prominent aspects of spirituality, could have a positive impact on health (8, 9). Thus, religious practices and acts of worship, especially at special times and in particular places, could lead to the regulation of the body’s important physiological reactions (10). Experimental results have largely been compatible with the perspective that, through different mechanisms, religion is an important factor in preventing many diseases and the promotion of health (11, 12). Gallup’s opinion poll conducted in 1998 indicated that 60% of Americans reported religion to be of the utmost importance in their lives, and over 82% believed that they needed spiritual improvement, the survey thus confirming people’s considerable concern with spirituality (13). Such observations and results have redoubled the need to pay attention to the effect of religious beliefs on the psychological and physical health of people and their impact on trends of compliance, recovery, and the treatment of disease. The present study explores the latest findings on the impact of spirituality on physical and psychological health.
2. Evidence Acquisition
This study comprised a review that included an integration and descriptive summary of some of the key existing research on the effects of spirituality on health. The documentation method, which is a standard procedure in scientific research, was used to provide a perspective on the effect of spirituality on health.
All articles on spirituality published from 1972 to 2014 were reviewed using electronic databases such as Scopus, PubMed, and Google Scholar. The key search terms included “spirituality” in connection with “mortality,” “coping,” “recovery,” and “treatment” to address the three key areas of health, namely mortality, coping and compliance, and recovery. One of the inclusion criteria for article selection was the subject, which needed to be related to spirituality and health. Considering the goal of the research, 51 articles were selected after an initial examination of the papers and an analysis of the information. The criterion for the selection of the articles was their emphasis on the impact of religion and spirituality on disease outcomes. Following the finalization of the selection, the impact on the health of patients and the patients’ disease status was classified into three groups: mortality, compliance and coping, and recovery.
3. Results
3.1. Mortality
To date, numerous studies have focused on the relationship between mortality and participation in religious activities (14-17). Although the evaluation of spirituality in relation to health has been challenged by the health and survival of cancer patients as well as the difficulty in providing a meaningful definition of advanced quantitative methods, the results obtained are in favor of spirituality and survival (18). Participation in religious activities is strongly associated with a reduction in mortality (10, 19, 20). In addition, praying as a special worshipping ceremony has been found to reduce mortality (21). It has also been ascertained that people with sustained and regular spiritual training live longer lives (22) and have about 60% less mortality due to heart disease than those who rarely go church (23). The results associated with this mechanism are possibly due to the direct relationship between increasing levels of interleukin 6 and mortality. In this connection, a study conducted on 1,700 elderly people showed a 50% reduction in the level of interleukin 6 among churchgoers compared to others (24).
3.2. Compliance and Coping
Religious coping is the most common reaction to health problems and disorders (25). Patients who are spiritual may use their beliefs to cope with disease, pain, and stressful situations. Patients with spiritual vision have a more positive perspective on life and report a better quality of life (26, 27) and well-being (27-29). One of the best examples of compliance with disease is based on evidence obtained from patients with different types of cancer (29-31). In such cases, patients cope more easily with their disease, are happier and more satisfied with their lives, and feel less pain (32) due to their spiritual beliefs and religious outlooks. Other evidence has shown that spirituality plays an important role in quality of health, especially among the elderly and those afflicted with non-communicable diseases (33, 34).
Studies have confirmed a connection between a spiritual lifestyle and people’s capacity to enjoy life, even when associated with symptoms of pain (35). The results of the distribution of pain questionnaire obtained from hospitalized patients in the United States showed that personal prayers are the most common non-medication approach to controlling pain (36). Prayer is therefore worth considering as a way to cope with pain.
Having a spiritual vision can help patients comply with disease and confront death. In one study, 93% of 108 patients suffering from cancer cited their religious beliefs as a strategy for coping with cancer (37). In another study, 26.1% of the subjects with cancer, chronic pain, and heart disease stated that religious practice helped them deal with their illnesses (38). Notably, a relatively high proportion of these patients comprised those afflicted with cancer. In terms of Alzheimer’s disease, praying is the most important spiritual training used to tackle the disease (39). Additionally, among patients and their families prayer is a strategy for managing cancer pain (40, 41). Studies of parents who had lost children to cancer confirmed the positive impact of spirituality on stress reduction and compliance with their conditions after the death of their children (40, 42). Saying prayers also helps alleviate anxiety and concern in mothers of children suffering from cancer (43). This effect was confirmed by meditation groups as well as written statements from patients. The positive impact of yoga and spirituality on the relationship between the body and the psyche and the role played by psychology (mind) in the Indian community have been reported (44); however, there were some ambiguities concerning the efficiency of the study.
3.3. Recovery
Recovery and convalescence following surgical operations are accelerated by spiritual commitments. Spirituality has been referred to as a positive and complementary approach to physical activity and treatment by physicians (21). Saying prayers as a practical manifestation of spirituality is effective in the treatment of many acute and chronic diseases (45). For example, heart transplant patients who participated in religious activities stated that their beliefs played an important role in their improved compliance with treatment, and they also exhibited higher levels of self-confidence, less anxiety and apprehension, and an improvement in physical performance over a period of 12 months (46). Similarly, people with spiritual vision have shown lower levels of depression, despair, and cognitive disorders, with positive recovery trends (2). By and large, people with less apprehension are healthier, and it seems likely that spirituality enables people to enjoy better health and to live better lives with less depression (47).
3.4. Advantages of Familiarity With Patients’ Spiritual Vision
Familiarity with the spiritual aspects of patients is beneficial to both patients and physicians. From most patients’ perspectives, a discussion with their physician about their beliefs is very beneficial; however, in practice, few physicians have such conversations with their patients. According to a study conducted at a lung hospital in Pennsylvania, 66% of patients indicated that their confidence in their physician was boosted when their physician queried their spiritual beliefs. In addition, 94% of patients who adhered to spiritual principles demanded that physicians consider their religious beliefs and the framework of their values, and as many as 50% of secular individuals stated that physicians must at least talk to patients with serious conditions about their religious beliefs (48).
From physicians’ perspectives, knowledge about the spiritual vision of patients helps them understand the disease. Notably, religious beliefs may impact healthcare-related decision-making, which is important for the development of treatment strategies (49). In addition, evaluating the spiritual vision of patients alleviates their living problems. Therefore, a sound understanding of patients’ spiritual beliefs is inseparable from patient care (50, 51). Table 1 presents excerpts from some reviewed studies on the relationship between spirituality and health categorized according to mortality, coping and compliance, and recovery.
Table 1. Studies on the Impact of Spirituality on Health
| Area of Study | Authors | Country | Method of Study | Results |
|---|---|---|---|---|
| Mortality | Bagiella et al. | US | Cohort | A connection exists between spirituality and health, but this association may also depend on interfering factors and unknown variables. |
| Gillum et al. | US | Longitudinal | The threat of death is reduced by regular participation in religious ceremonies at least once a week | |
| Williams and Sternthal | Australia | Review | There is a positive relationship between religious participation and health criteria: the greater the participation, the lower the mortality. | |
| Sullivan | US | Longitudinal | Taking part in religious activities protects people against death. Additionally, a notable relationship exists between hygienic practices and other factors. | |
| Coping and compliance | Taylor | - | Review | Praying and spiritually mediated recuperation and meditation are the most commonly used religious treatments. |
| Beuscher | Arkansas, US | Qualitative | Personal faith, saying prayers, a connection with a church, and family support help people with primary Alzheimer’s disease maintain positive perceptions of life. | |
| Harvey and Silverman | Pennsylvania, US | In-depth interviews | Spirituality plays an important role in the management of chronic diseases; however, there are racial differences with regard to the benefits derived from spirituality. | |
| Dehghani et al. | Iran | Clinical examinations | Praying alleviates anxiety. | |
| Peselow et al. | US | Structured clinical interviews | Individuals with greater religious tendencies experience less depression. In people with stronger religious beliefs, exposure to spiritual training enhances feelings of hope and improves perceptions of life. | |
| Recovery | Raisi et al. | - | Review | Religious practices such as saying prayers positively influence the treatment of many acute and chronic diseases. Most studies emphasized the positive effects of prayer on physical pain. |
| Harvey and Silverman | US | In-depth interviews | Elderly African Americans have greater beliefs in divine intervention than white Americans. In general, spirituality is an inextricable part of the welfare of the elderly who are ailing. | |
| Thege et al. | Hungary | Interviews | Spirituality improves health, and alleviates depression and anxiety. |
4. Conclusions
This study comprised a review to summarize existing research on the effects of spirituality on health in terms of mortality, coping and compliance, and recovery. In general, the results of the current review indicated remarkable effects of spirituality on health, a finding mentioned frequently in different studies (34, 52, 53). Numerous studies indicated that spirituality had a favorable impact on recovery, improved well-being (22, 29, 38, 46, 49), and lowered levels of depression (2, 47). The positive effects of spirituality on health are thus more tangible (54, 55), although using a positive religious compliance strategy does not necessarily reflect a lack of internal spiritual conflict (56).
Some studies have shown that religious coping strategies, like turning to God for help and feeling God’s presence, alleviate anxiety and apprehension in patients with multiple myeloma and additional physical symptoms in patients with cancer; however, there are some ambiguities regarding the positive impact of spirituality (57, 58). A religious person believes in spiritual powers, thinks, understands, and feels in special ways, and assumes conduct that leads to prosperity. It is recommended that religious practices form part of people’s daily lives (51), but such activities do not mean relinquishing all their responsibilities and social commitments.
On the contrary, as healthcare providers, we should perform our various duties with full sincerity in tandem with our spiritual and religious values. Most studies conducted on mortality underscore the need for participation in religious rituals, which are considered the sole aspect of spirituality. There are a limited number of studies dealing with the basic principles of religion, including the belief in God, the afterlife, and personal prayer. Therefore, the beneficial effects of spirituality on individual and community health necessitate that we pay attention to religious beliefs as a topic of discussion with patients, and redouble our awareness of the importance of healthcare providers with respect to treatment and hygienic services (59).
Currently, the education system in Iran falls short of offering spiritual care courses as part of a comprehensive educational program (60). Considering the prominent role of religion in Islamic states, particularly Iran, most studies on the relationship between spiritualism and health have been conducted in non-Islamic countries, especially the United States, which is indicative of the attention paid to spirituality in developed countries. Despite factual observations and the availability of research on the positive impact of spirituality in promoting people’s health and facilitating recovery, similar studies have unfortunately not gained prominence in Iran, and this is an important issue deserving of consideration by researchers and analysts. The findings of such investigations may help healthcare workers and physicians, in particular, gain awareness of the beneficial effects of spirituality in the course of patients’ treatment.
Ultimately, although spirituality in health is a paradigm with a similar approach across the globe, the meaning of spirituality can vary from one ideology to another. In fact, these variations in meaning could explain the behavior of religious group adherents. Hence, the attitudes and behaviors of devotees of different religions regarding illness and health could be interpreted based on their ideologies. Despite the similar outcomes of devotees’ attitudes and behaviors presented in this study, there are different points of view to health and illness in Abrahamic religions compared to other communions. For a better understanding of the affinities and distinctions between diverse religious beliefs, further investigations are recommended.
