Religious Struggle as a Predictor of Mortality Among Medically Ill Elderly Patients: A 2-Year Longitudinal Study
Abstract
BACKGROUND: Although church attendance has been associated with a reduced risk of mortality, no study has examined the impact of religious struggle with an illness on mortality. OBJECTIVE: To investigate longitudinally the relationship between religious struggle with an illness and mortality. METHODS: A longitudinal cohort study from 1996 to 1997 was conducted to assess positive religious coping and religious struggle, and demographic, physical health, and mental health measures at baseline as control variables. Mortality during the 2-year period was the main outcome measure. Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC. RESULTS: After controlling for the demographic, physical health, and mental health variables, higher religious struggle scores at baseline were predictive of greater risk of mortality (risk ratio [RR] for death, 1.06; 95% confidence interval [CI], 1.01-1.11; chi(2) = 5.89; P =.02). Two spiritual discontent items and 1 demonic reappraisal item from the religious coping measure were predictive of increased risk for mortality: "Wondered whether God had abandoned me" (RR for death, 1.28; 95% CI, 1.07-1.50; chi(2) = 5.22; P =.02), "Questioned God's love for me" (RR for death, 1.22; 95% CI, 1.02-1.43; chi(2) = 3.69; P =.05), and "Decided the devil made this happen" (RR for death, 1.19; 95% CI, 1.05-1.33; chi(2) = 5.84; P =.02). CONCLUSIONS: Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.
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A systematic review and two meta-analyses have confirmed the relationship between R/S and longer survival.
“Another systematic review [570] and two meta-analyses [571, 572] have confirmed this relationship between R/S and longer survival.”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [572]
Across the three reviews, survival among frequent attendees was increased on average by 37%, 43%, and 30%, with a mean effect of 37%.
“Survival among frequent attendees was increased on average by 37%, 43%, and 30% (mean effect being 37% across these reviews).”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [572]
In these three reviews, the effects on survival have been particularly strong for frequency of attendance at religious services.
“The effects have been particularly strong for frequency of attendance at religious services in these three reviews.”
From Religion, Spirituality, and Health: The Research and Clinical Implications (2012) · cites this paper as [572]
Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
Patterns of Positive and Negative Religious Coping with Major Life Stressors
Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998) · Journal for the Scientific Study of Religion · doi:10.2307/1388152 · Cited by 2,425 · see citing works
Self-citationKatz, S. (1963) · JAMA · doi:10.1001/jama.1963.03060120024016 · Cited by 2,421 · see citing works
The psychology of religion and coping : theory, research, practice
Pargament, K. (1998) · Review of Religious Research · doi:10.2307/3512468 · Cited by 1,680 · see citing works
Self-citationNew classification of physical status
Dripps, R. B. (1963) · Anesthesiology · Cited by 1,678 · see citing works
Measuring the quality of life of cancer patients
Spitzer, W. O., Dobson, A. J., Hall, J. P., Chesterman, E., Levi, J. A., Shepherd, R., Battista, R. N., & Catchlove, B. R. (1981) · Journal of Chronic Diseases · doi:10.1016/0021-9681(81)90058-8 · Cited by 1,521 · see citing works
Stages of Faith: The Psychology of Human Development and the Quest for Meaning
Keating, J. P., & Fowler, J. W. (1982) · Journal for the Scientific Study of Religion · doi:10.2307/1385902 · Cited by 1,453 · see citing works
Religious involvement and mortality: A meta-analytic review.
McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. E. (2000) · Health Psychology · doi:10.1037/0278-6133.19.3.211 · Cited by 1,088 · see citing works
Self-citationStages of Faith: The Psychology of Human Development and the Quest for Meaning
Hoehn, R. A., & Fowler, J. W. (1983) · Review of Religious Research · doi:10.2307/3511314 · Cited by 917 · see citing works
Religious involvement and U.S. adult mortality
Hummer, R. A., Rogers, R. G., Nam, C. B., & Ellison, C. G. (1999) · Demography · doi:10.2307/2648114 · Cited by 825 · see citing works
Frequent attendance at religious services and mortality over 28 years.
Strawbridge, W. J., Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997) · American Journal of Public Health · doi:10.2105/ajph.87.6.957 · Cited by 686 · see citing works
Religious Coping and Health Status in Medically Ill Hospitalized Older Adults
Koenig, H. G., Pargäment, K. I., & NIELSEN, J. (1998) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199809000-00001 · Cited by 664 · see citing works
Self-citationReligious coping and depression among elderly, hospitalized medically ill men
(1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.12.1693 · Cited by 544 · see citing works
Oxman, T. E., Freeman, D. H., & Manheimer, E. D. (1995) · Psychosomatic Medicine · doi:10.1097/00006842-199501000-00002 · Cited by 525 · see citing works
Fillenbaum, G. G. (1985) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1985.tb01779.x · Cited by 511 · see citing works
Does Religious Attendance Prolong Survival? A Six-Year Follow-Up Study of 3,968 Older Adults
Koenig, H. G., Hays, J. C., Larson, D. B., George, L. K., Cohen, H. J., McCullough, M. E., Meador, K. G., & Blazer, D. G. (1999) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/54.7.m370 · Cited by 341 · see citing works
Self-citationDiscussing Palliative Care with Patients
Lo, B., Quill, T. E., Tulsky, J. A., & Panel, F. T. A.-A. E.-O.-L. C. C. (1999) · Annals of Internal Medicine · doi:10.7326/0003-4819-130-9-199905040-00015 · Cited by 324 · see citing works
International Classification of Diseases, Ninth Revision, Clinical Modification
National Cancer Institute (2020) · Definitions · doi:10.32388/ggn38l · Cited by 296 · see citing works
Religion, Spirituality, and Medicine: Application to Clinical Practice
Koenig, H. G. (2000) · JAMA · doi:10.1001/jama.284.13.1708-jms1004-5-1 · Cited by 246 · see citing works
Self-citationThe role of religion in medical rehabilitation outcomes: A longitudinal study.
Fitchett, G. A., Rybarczyk, B. D., DeMarco, G. A., & Nicholas, J. J. (1999) · Rehabilitation Psychology · doi:10.1037/0090-5550.44.4.333 · Cited by 238 · see citing works
Does religious observance promote health? mortality in secular vs religious kibbutzim in Israel.
Kark, J. D., Shemi, G., Friedlander, Y., Martin, O., Manor, O., & Blondheim, S. H. (1996) · American Journal of Public Health · doi:10.2105/ajph.86.3.341 · Cited by 226 · see citing works
Exline, J. J., Yali, A. M., & Lobel, M. (1999) · Journal of Health Psychology · doi:10.1177/135910539900400306 · Cited by 225 · see citing works
A Brief Depression Scale for Use in the Medically Ill
Koenig, H. G., Cohen, H. J., Blazer, D. G., Meador, K. G., & Westlund, R. E. (1992) · The International Journal of Psychiatry in Medicine · doi:10.2190/m1f5-f40p-c4kd-ypa3 · Cited by 99 · see citing works
Self-citationAN ABBREVIATED MINI‐MENTAL STATE EXAM FOR MEDICALLY ILL OLDER ADULTS
Koenig, H. G. (1996) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1996.tb02449.x · Cited by 43 · see citing works
Self-citationFlammability of Fluoromar in the Circle Absorption System
Gramling, Z. W., & Volpitto, P. P. (1963) · Anesthesiology · doi:10.1097/00000542-196303000-00006 · Cited by 21 · see citing works
Wills, W., Trieman, N., & Leff, J. (1998) · International Journal of Geriatric Psychiatry · doi:10.1002/(sici)1099-1166(199804)13:4
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Cited by
Sorted by citations
Folkman, S., & Moskowitz, J. T. (2004) · Annual Review of Psychology · doi:10.1146/annurev.psych.55.090902.141456 · Cited by 3,485 · see citing works
Religion, Spirituality, and Health: The Research and Clinical Implications
Koenig, H. G. (2012) · ISRN Psychiatry · doi:10.5402/2012/278730 · Cited by 2,423 · see citing works
“Unmet spiritual needs, especially if they involve R/S struggles, can adversely a ff ect health and may increase mortality independent of mental, physical, or social health [581].”
BackgroundSelf-citationHill, P. C., & Pargament, K. I. (2003) · American Psychologist · doi:10.1037/0003-066x.58.1.64 · Cited by 1,948 · see citing works
Self-citationReligion and spirituality: Linkages to physical health.
Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003) · American Psychologist · doi:10.1037/0003-066x.58.1.36 · Cited by 1,093 · see citing works
Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J. (2004) · Journal of Health Psychology · doi:10.1177/1359105304045366 · Cited by 912 · see citing works
Self-citationReligiousness and mental health: a review
Moreira-Almeida, A., Lotufo Neto, F., & Koenig, H. G. (2006) · Revista Brasileira de Psiquiatria · doi:10.1590/s1516-44462006005000006 · Cited by 835 · see citing works
Self-citationReligious Coping is Associated with the Quality of Life of Patients with Advanced Cancer
Tarakeshwar, N., Vanderwerker, L. C., Paulk, E., Pearce, M. J., Kasl, S. V., & Prigerson, H. G. (2006) · Journal of Palliative Medicine · doi:10.1089/jpm.2006.9.646 · Cited by 391 · see citing works
Self-citationIronson, G., Stuetzle, R., & Fletcher, M. A. (2006) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2006.00648.x · Cited by 344 · see citing works
Instruments Measuring Spirituality in Clinical Research: A Systematic Review
Monod, S., Brennan, M., Rochat, E., Martin, E., Rochat, S., & Büla, C. J. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1769-7 · Cited by 338 · see citing works
Rodin, G., Lo, C., Mikulincer, M., Donner, A., Gagliese, L., & Zimmermann, C. (2009) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.10.037 · Cited by 323 · see citing works
Gratitude Toward God, Stress, and Health in Late Life
Krause, N. (2006) · Research on Aging · doi:10.1177/0164027505284048 · Cited by 284 · see citing works
A LIFE‐COURSE PERSPECTIVE ON SPIRITUALITY AND DESISTANCE FROM CRIME*
GIORDANO, P. C., LONGMORE, M. A., SCHROEDER, R. D., & SEFFRIN, P. M. (2008) · Criminology · doi:10.1111/j.1745-9125.2008.00104.x · Cited by 223 · see citing works
Exploring the Relationship between Spirituality, Coping, and Pain
Wachholtz, A. B., Pearce, M. J., & Koenig, H. (2007) · Journal of Behavioral Medicine · doi:10.1007/s10865-007-9114-7 · Cited by 219 · see citing works
Self-citationCoping (enfrentamento) religioso/espiritual
Panzini, R. G., & Bandeira, D. R. (2007) · Archives of Clinical Psychiatry (São Paulo) · doi:10.1590/s0101-60832007000700016 · Cited by 220 · see citing works
Contrada, R. J., Goyal, T. M., Cather, C., Rafalson, L., Idler, E. L., & Krause, T. J. (2004) · Health Psychology · doi:10.1037/0278-6133.23.3.227 · Cited by 205 · see citing works
Religious Attendance and Mortality: An 8-Year Follow-Up of Older Mexican Americans
Hill, T. D., Angel, J. L., Ellison, C. G., & Angel, R. J. (2005) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/60.2.s102 · Cited by 202 · see citing works
Faith to move mountains: Religious coping, spirituality, and interpersonal trauma recovery.
Bryant-Davis, T., & Wong, E. C. (2013) · American Psychologist · doi:10.1037/a0034380 · Cited by 201 · see citing works
Sullivan, M. J., Wood, L., Terry, J., Brantley, J., Charles, A., McGee, V., Johnson, D., Krucoff, M. W., Rosenberg, B., Bosworth, H. B., et al. (2009) · American Heart Journal · doi:10.1016/j.ahj.2008.08.033 · Cited by 188 · see citing works
Religious Attendance and Cause of Death over 31 Years
Oman, D., Kurata, J. H., Strawbridge, W. J., & Cohen, R. D. (2002) · The International Journal of Psychiatry in Medicine · doi:10.2190/rjy7-crr1-hcw5-xveg · Cited by 189 · see citing works
An 83-Year-Old Woman With Chronic Illness and Strong Religious Beliefs
Koenig, H. G. (2002) · JAMA · doi:10.1001/jama.288.4.487 · Cited by 182 · see citing works
Self-citationReligious involvement and health outcomes among older persons in Taiwan
Yeager, D. M., Glei, D. A., Au, M., Lin, H.-S., Sloan, R. P., & Weinstein, M. (2006) · Social Science & Medicine · doi:10.1016/j.socscimed.2006.05.007 · Cited by 182 · see citing works
Differing pathways between religiousness, spirituality, and health: A self-regulation perspective.
Aldwin, C. M., Park, C. L., Jeong, Y.-J., & Nath, R. (2014) · Psychology of Religion and Spirituality · doi:10.1037/a0034416 · Cited by 171 · see citing works
Sherman, A. C., Simonton, S., Latif, U., Spohn, R., & Tricot, G. (2005) · Journal of Behavioral Medicine · doi:10.1007/s10865-005-9006-7 · Cited by 153 · see citing works
Prospective study of religious coping among patients undergoing autologous stem cell transplantation
Sherman, A. C., Plante, T. G., Simonton, S., Latif, U., & Anaissie, E. J. (2009) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9179-y · Cited by 141 · see citing works
Blumenthal, J. A., Babyak, M. A., Ironson, G., Thoresen, C., Powell, L., Czajkowski, S., Burg, M., Keefe, F. J., Steffen, P., & Catellier, D. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3180cab76c · Cited by 119 · see citing works
Religious Participation and Mortality Risk Among the Oldest Old in China
Zhang, W. (2008) · The Journals of Gerontology Series B: Psychological Sciences and Social Sciences · doi:10.1093/geronb/63.5.s293 · Cited by 107 · see citing works
Ai, A. L., Peterson, C., Bolling, S. F., & Rodgers, W. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.06.082 · Cited by 103 · see citing works
Spiritual coping and adjustment in adolescents with chronic illness: a 2-year prospective study
Reynolds, N., Mrug, S., Hensler, M., Guion, K., & Madan-Swain, A. (2014) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsu011 · Cited by 97 · see citing works
Does spirituality as a coping mechanism help or hinder coping with chronic pain?
Wachholtz, A. B., & Pearce, M. J. (2009) · Current Pain and Headache Reports · doi:10.1007/s11916-009-0022-0 · Cited by 95 · see citing works
Ai, A. L., Wink, P., Tice, T. N., Bolling, S. F., & Shearer, M. (2009) · Journal of Behavioral Medicine · doi:10.1007/s10865-009-9228-1 · Cited by 95 · see citing works
Religiosity and Health: A Holistic Biopsychosocial Perspective
Page, R. L., Peltzer, J. N., Burdette, A. M., & Hill, T. D. (2020) · Journal of Holistic Nursing · doi:10.1177/0898010118783502 · Cited by 91 · see citing works
Park, C. L., Edmondson, D., Hale-Smith, A., & Blank, T. O. (2009) · Journal of Behavioral Medicine · doi:10.1007/s10865-009-9223-6 · Cited by 84 · see citing works
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Cowchock, F. S., Lasker, J. N., Toedter, L. J., Skumanich, S. A., & Koenig, H. G. (2010) · Journal of Religion and Health · doi:10.1007/s10943-009-9277-3 · Cited by 74 · see citing works
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Banthia, R., Moskowitz, J. T., Acree, M., & Folkman, S. (2007) · Journal of Health Psychology · doi:10.1177/1359105307074251 · Cited by 41 · see citing works
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Lawrence, R. M., Head, J., Christodoulou, G., Andonovska, B., Karamat, S., Duggal, A., Hillam, J., & Eagger, S. (2007) · International Psychogeriatrics · doi:10.1017/s1041610206004339 · Cited by 26 · see citing works
- Authors
- Pargament, K. I., Koenig, H. G., Tarakeshwar, N., & Hahn, J.
- ORCID
- Koenig, Harold G.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2001-08-13
- Volume
- 161
- Issue
- 15
- Pages
- 1881
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2033090463
- Cited by
- 759
- References
- 27
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 13 · 2023: 25 · 2022: 20 · 2021: 33 · 2020: 28 · 2019: 25 · 2018: 25 · 2017: 36 · 2016: 32 · 2015: 39 · 2014: 27 · 2013: 40 · 2012: 43
- FWCI
- 47.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Retirement Research Foundation
- Bowling Green State University
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Sociology and Political Science › Religion and Society Interactions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- religious struggle, mortality, religious coping, elderly patients, religion and illness
- MeSH terms
- Adaptation, Psychological, Aged, Disease, Female, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Predictive Value of Tests, Religion, Stress, Psychological, Proportional Hazards Models
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