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The ironson-woods spirituality/religiousness index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS

Ironson, Gail, Solomon, George F., Balbin, Elizabeth G., O’Cleirigh, Conall, George, Annie, Kumar, Mahendra, Larson, David, Woods, Teresa E.·2002·Annals of Behavioral Medicine

DOI 10.1207/s15324796abm2401_05

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Abstract

The purpose of this study was to determine the reliability and validity of an instrument that measures both spirituality and religiousness, to examine the relation between spirituality and religiousness and important health outcomes for people living with HIV and to examine the potential mediators of these relations. One aim was to determine whether subscales of spirituality, religiousness, or both would be independently related to long survival in people living with AIDS. The Ironson-Woods Spirituality/Religiousness (SR) Index is presented with evidence for its reliability and validity. Four factors were identified on the Ironson-Woods SR Index (Sense of Peace, Faith in God, Religious Behavior, and Compassionate View of Others). Each subscale was significantly related to long survival with AIDS. That is, the long-term survivor (LTS) group (n = 79) scored significantly higher on these factors than did the HIV-positive comparison (COMP) group (n = 200). Long survival was also significantly related to both frequency of prayer (positively) and judgmental attitude (negatively). In addition, the Ironson-Woods SR Index yielded strong and significant correlations with less distress, more hope, social support, health behaviors, helping others, and lower cortisol levels. The relation between religious behavior and health outcomes was not due to social support. Further analyses were conducted, which identified urinary cortisol concentrations and altruistic behavior as mediators of the relation between SR and long survival.

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Carrico, A. W., Gifford, E. V., & Moos, R. H. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.12.004 · Cited by 92
Longitudinal Spiritual Coping with Trauma in People with HIV: Implications for Health Care
Kremer, H., & Ironson, G. H. (2014) · AIDS Patient Care and STDs · doi:10.1089/apc.2013.0280 · Cited by 88
Self-citation
Religious beliefs, social support, self‐efficacy and adjustment to cancer
Howsepian, B. A., & Merluzzi, T. V. (2009) · Psycho-Oncology · doi:10.1002/pon.1442 · Cited by 89
SPIRITUALITY, MENTAL HEALTH, PHYSICAL HEALTH, AND HEALTH-RELATED QUALITY OF LIFE AMONG WOMEN WITH HIV/AIDS: INTEGRATING SPIRITUALITY INTO MENTAL HEALTH CARE
Dalmida, S. G. (2006) · Issues in Mental Health Nursing · doi:10.1080/01612840500436958 · Cited by 86
“…relationships among spirituality, psychological variables (Coleman & Holzemer, 1999; Nelson et al., 2002; Simoni, Martone, & Kerwin, 2002; Somlai et al., 1996; Tuck, McCain, & Elswick, 2001) and the immune system (Ironson et al., 2002; Koenig et al., 1997; Sephton et al., 2001; Woods et al., 1999).”
BackgroundInfluential
Measuring Spirituality and Religiosity in Clinical Settings: A Scoping Review of Available Instruments
Austin, P., Macdonald, J., & MacLeod, R. (2018) · Religions · doi:10.3390/rel9030070 · Cited by 95
Spirituality and Religiousness are Associated With Fewer Depressive Symptoms in Individuals With Medical Conditions
Lucette, A., Ironson, G. H., Pargäment, K. I., & KRAUSE, N. M. (2016) · Psychosomatics · doi:10.1016/j.psym.2016.03.005 · Cited by 89
“94) subscale have previously demonstrated good reliability.(38) Internal consistency for the 4 items presented in this study was good (α 1⁄4 0.”
MethodSelf-citation
Psychosocial and Neurohormonal Predictors of HIV Disease Progression (CD4 Cells and Viral Load): A 4 Year Prospective Study
Ironson, G. H., O’Cleirigh, C. M., Kumar, M., Kaplan, L. M., Balbin, E., Kelsch, C. B., Fletcher, M. A., & Schneiderman, N. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0877-x · Cited by 87
“However, our previous work has shown relationships between psychosocial variables and neurohormones, such as spirituality and low cortisol [66] and perceived stress and NE [7] and changes in symptoms of PTSD and both cortisol and NE [67].”
Self-citation
What Can We Learn About the Spiritual Needs of Palliative Care Patients From the Research Literature?
Cobb, M., Dowrick, C. F., & Lloyd‐Williams, M. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.06.017 · Cited by 86
Development and implementation of a spiritual coping group intervention for adults living with HIV/AIDS: A pilot study
Tarakeshwar, N., Pearce, M., & Sikkema, K. J. (2005) · Mental Health Religion & Culture · doi:10.1080/13694670500138908 · Cited by 81
“Ironson et al. (2002) found that, among men and women with HIV, specific dimensions of spirituality (sense of peace, faith in God) were associated with better immune status (i.e., lower cortisol) and mental health (i.e., lower anxiety, perceived stress).”
Background
Burden of Cardiovascular Risk Factors, Subclinical Atherosclerosis, and Incident Cardiovascular Events Across Dimensions of Religiosity: The Multi-Ethnic Study of Atherosclerosis
Feinstein, M., Liu, K., Ning, H., Fitchett, G., & Lloyd-Jones, D. M. (2010) · Circulation · doi:10.1161/circulationaha.109.879973 · Cited by 79
The Effect of HIV/AIDS Disease Progression on Spirituality and Self-Transcendence in a Multicultural Population
Ramer, L., Johnson, D. L., Chan, L. S., & Barrett, M. T. (2006) · Journal of Transcultural Nursing · doi:10.1177/1043659606288373 · Cited by 79
“Ironson et al. (2002) determined the reliability and validity of an instrument for examining the relation between spirituality and religiousness and health outcomes for people living with HIV.”
Background
Coping with HIV Stigma: Do Proactive Coping and Spiritual Peace Buffer the Effect of Stigma on Depression?
Chaudoir, S. R., Norton, W. E., Earnshaw, V. A., Moneyham, L. L., Mugavero, M. J., & Hiers, K. M. (2011) · AIDS and Behavior · doi:10.1007/s10461-011-0039-3 · Cited by 77
Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature
Kendrick, H. M. (2016) · AIDS Care · doi:10.1080/09540121.2016.1201196 · Cited by 80
“…meaning, values, religious support, and R/S history (Dalmida et al., 2009; Fitzpatrick et al., 2007; Holstad et al., 2006; Ironson & Kremer, 2009; Ironson et al., 2002, 2006; Mellins et al., 2009; Pecoraro et al., 2013; Powell-Cope et al., 2003; Simoni et al., 2006; Vyas et al., 2014;…”
BackgroundMethodInfluential
Prayer at Midlife is Associated with Reduced Risk of Cognitive Decline in Arabic Women
Inzelberg, R., Afgin, A. E., Massarwa, M., Schechtman, E., Israeli‐Korn, S., Strugatsky, R., Abuful, A., Kravitz, E., Farrer, L. A., & Friedland, R. P. (2013) · Current Alzheimer Research · doi:10.2174/1567205011310030014 · Cited by 77
“Possible mechanisms by which spirituality/religiosity may affect health outcomes include a more favorable immune profile [6, 7], lower rates of depression [8, 9], higher compliance with treatment [10], quicker response to acute health crises [11-13], healthier lifestyles (e.”
Background
Religious Participation and Biological Functioning in Mexico
Hill, T. D., Rote, S. M., & Ellison, C. G. (2017) · Journal of Aging and Health · doi:10.1177/0898264317716244 · Cited by 75
“, 2007), cortisol (Ironson et al., 2002; Tobin & Slatcher, 2016), and overall allostatic load (Hill et al.”
BackgroundResult
Religiosity May Help Preserve the Cortisol Rhythm in Women with Stress-Related Illness
Dedert, E. A., Studts, J. L., Weissbecker, I., Salmon, P. G., Banis, P., & Sephton, S. E. (2004) · The International Journal of Psychiatry in Medicine · doi:10.2190/2y72-6h80-bw93-u0t6 · Cited by 74
“Among these studies, relationships between religiosity and positive health outcomes may actually be driven by social support [3].”
Background
Gender, ethnicity and spiritual coping among bereaved HIV-positive individuals
Tarakeshwar, N., Hansen, N. B., Kochman, A., & Sikkema, K. J. (2004) · Mental Health Religion & Culture · doi:10.1080/1367467042000240383 · Cited by 73
“Religiosity as a coping response has been associated with lower depression (Woods, Antoni, Ironson, & Kling, 1999), greater optimism (Biggar et al., 1999), better quality of life (Flanelly, & Inouye, 2001), greater life satisfaction (Carson, 1993), and better physical health (Ironson et al., 2002).”
BackgroundInfluential
Religious participation predicts diurnal cortisol profiles 10 years later via lower levels of religious struggle.
Tobin, E. T., & Slatcher, R. B. (2016) · Health Psychology · doi:10.1037/hea0000372 · Cited by 72
Predictors of Psychological Well-Being in a Diverse Sample of HIV-Positive Patients Receiving Highly Active Antiretroviral Therapy
Safren, S. A., Radomsky, A. S., Otto, M. W., & Salomon, E. (2002) · Psychosomatics · doi:10.1176/appi.psy.43.6.478 · Cited by 71
Worldview Under Stress: Preliminary Findings on Cardiovascular and Cortisol Stress Responses Predicted by Secularity, Religiosity, Spirituality, and Existential Search.
Schnell, T., Fuchs, D., & Hefti, R. (2020) · Journal of Religion and Health · doi:10.1007/s10943-020-01008-5 · Cited by 69
Religious Attendance and Biological Risk: A National Longitudinal Study of Older Adults
Suh, H., Hill, T. D., & Koenig, H. G. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0721-0 · Cited by 69
Multiple Dimensions of HIV Stigma and Psychological Distress Among Asians and Pacific Islanders Living With HIV Illness
Kang, E., Rapkin, B. D., Remien, R. H., Mellins, C. A., & Oh, A. (2005) · AIDS and Behavior · doi:10.1007/s10461-005-3896-9 · Cited by 69
“…with HIV/AIDS have supported the associations between psychological distress and perceived social support (Hudson et al., 2001; Fleishman et al., 2000), HIV illness progression (Golub et al., 2003), physical functioning (Vogl et al., 1999) and spirituality (Tuck et al., 2001; Ironson et al., 2002).”
Background
Spiritual coping predicts 5-year health outcomes in adolescents with cystic fibrosis
Reynolds, N. C., Mrug, S., Britton, L. J., Guion, K., Wolfe, K. R., & Gutierrez, H. H. (2014) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2014.01.013 · Cited by 68
“These estimates are comparable to the effects of spiritual coping on mortality in older adults [14,17] and are consistent with the role of spiritual coping in health outcomes of multiple adult patient groups [11–13,15,16].”
BackgroundResult
Spirituality and Religiosity in Patients with HIV: A Test and Expansion of a Model
Kudel, I., Cotton, S., Szaflarski, M., Holmes, W. C., & Tsevat, J. (2010) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9229-x · Cited by 68
“In patients with HIV, spirituality/religiosity has also been found to be associated with improved cortisol levels [13, 14] and CD4+ counts [15].”
Background
Religion, Spirituality, and HIV Clinical Outcomes: A Systematic Review of the Literature
Doolittle, B. R., Justice, A. C., & Fiellin, D. A. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1651-z · Cited by 70
“However, neither spirituality nor self-transcendence was associated with disease progression or severity [18].”
Background
The Revised Intrinsic/Extrinsic Religious Orientation Scale in a Sample of Attica’s Inhabitants
Darvyri, P. P., Galanakis, M., Avgoustidis, A. G., Pateraki, N. S., Vasdekis, S. N., & Darviri, C. (2014) · Psychology · doi:10.4236/psych.2014.513166 · Cited by 68
Positive emotions: exploring the other hemisphere in behavioral medicine
Chesney, M. A., Darbes, L. A., Hoerster, K., Taylor, J. M., Chambers, D. B., & Anderson, D. E. (2005) · International Journal of Behavioral Medicine · doi:10.1207/s15327558ijbm1202_2 · Cited by 65
SPIRITUAL WELL-BEING, SLEEP DISTURBANCE, AND MENTAL AND PHYSICAL HEALTH STATUS IN HIV-INFECTED INDIVIDUALS
Phillips, K. D., Mock, K. S., Bopp, C. M., Dudgeon, W. D., & Hand, G. A. (2006) · Issues in Mental Health Nursing · doi:10.1080/01612840500436917 · Cited by 62
“A growing body of evidence suggests that spiritual well-being, or spirituality, enhances health and contributes to quality of life for HIV-infected individuals (Chibnall, Videen, Duckro, & Miller, 2002; Coleman & Holzemer, 1999; Gray & Cason, 2002; Ironson et al., 2002).”
Background
Spiritual Wellness, Holistic Health, and the Practice of Health Education
Hawks, S. R. (2004) · American Journal of Health Education · doi:10.1080/19325037.2004.10603599 · Cited by 63
“The Ironson-woods Spirituality/Religiousness Index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS.”
Background
Perceived Stress Mediates the Effects of Coping on the Quality of Life of HIV-Positive Women on Highly Active Antiretroviral Therapy
Weaver, K. E., Antoni, M. H., Lechner, S. C., Durán, R. E., Penedo, F. J., Fernandez, M. I., Ironson, G. H., & Schneiderman, N. (2004) · AIDS and Behavior · doi:10.1023/b:aibe.0000030248.52063.11 · Cited by 61
“…why religious coping was unrelated to perceived stress and quality of life in this population, as other researchers have found significant relationships between greater religiousness/spirituality and less perceived stress and distress in HIV+ individuals (Ironson et al., 2002; Woods et al., 1999).”
Self-citation
A Comparison of Two Spirituality Instruments and Their Relationship With Depression and Quality of Life in Chronic Heart Failure
Bekelman, D. B., Parry, C., Curlin, F. A., Yamashita, T. E., Fairclough, D. L., & Wamboldt, F. S. (2010) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2009.08.005 · Cited by 65
“used and have demonstrated validity and reliability in previous psychometric testing.(21,22) In addition, they are uniquely suited to this”
BackgroundMethod
The Relationship Between Religious and Psychospiritual Measures and an Inflammation Marker (CRP) in Older Adults Experiencing Life Event Stress
Ironson, G. H., Lucette, A., Hylton, E., Pargäment, K. I., & KRAUSE, N. M. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0600-8 · Cited by 60
Self-citation
To Take or Not to Take: Decision-Making About Antiretroviral Treatment in People Living with HIV/AIDS
Kremer, H., Ironson, G. H., Schneiderman, N., & Hautzinger, M. (2006) · AIDS Patient Care and STDs · doi:10.1089/apc.2006.20.335 · Cited by 60
Self-citation
Spiritual Well-Being and Health-Related Quality of Life Among African–American Women with HIV/AIDS
Dalmida, S. G., Holstad, M. M., DiIorio, C. K., & Laderman, G. (2010) · Applied Research in Quality of Life · doi:10.1007/s11482-010-9122-6 · Cited by 59
“…Pargament 2003; Miller and Thoresen 2003), HIV persons, in general (Ironson et al. 2002; Woods et al. 1999), and for HIV-positive women, including an improvement in quality of life (QOL; Grimsley 2006; Sowell et al. 2001) and longer HIV-related survival (Ironson et al. 2002; Ironson et al. 2006).”
BackgroundInfluential
The Invisible Wound: Moral Injury and Its Impact on the Health of Operation Enduring Freedom/Operation Iraqi Freedom Veterans
Yan, G. W. (2016) · Military Medicine · doi:10.7205/milmed-d-15-00103 · Cited by 58
Effects of Religious vs. Conventional Cognitive-Behavioral Therapy on Inflammatory Markers and Stress Hormones in Major Depression and Chronic Medical Illness: A Randomized Clinical Trial
Berk, L., Bellinger, D. L., Koenig, H. G., Daher, N. S., Pearce, M., Robins, C. J., Nelson, B., Shaw, S. F., Cohen, H. J., & King, M. (2015) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2015.53028 · Cited by 63
Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS
O’Cleirigh, C. M., Ironson, G. H., Antoni, M. H., Fletcher, M. A., McGuffey, L., Balbin, E., Schneiderman, N., & Solomon, G. F. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00524-x · Cited by 57
“The ECOMPLTS group was systematically chosen from a larger comparison group described elsewhere [24] so that the ECOMPLTS group would be equivalent to the LTS group on demographics and background variables.”
MethodSelf-citation
Religious Attendance and Biological Functioning
Hill, T. D., Rote, S. M., Ellison, C. G., & Burdette, A. M. (2014) · Journal of Aging and Health · doi:10.1177/0898264314529333 · Cited by 58
“…2002; King, Mainous, Steyer, & Pearson, 2001), interleukin-6 (Koenig et al., 1997; Lutgendorf, Russell, Ullrich, Harris, & Wallace, 2004), white blood cells (King et al., 2001), epinephrine (Maselko et al., 2007), cortisol (Ironson et al., 2002), and overall allostatic load (Maselko et al., 2007).”
BackgroundResult
Fatalism, medical mistrust, and pretreatment health‐related quality of life in ethnically diverse prostate cancer patients
Bustillo, N. E., McGinty, H. L., Dahn, J. R., Yanez, B. R., Antoni, M. H., Kava, B., & Penedo, F. J. (2015) · Psycho-Oncology · doi:10.1002/pon.4030 · Cited by 56
“The Religious Behavior subscale of the Ironson–Woods Spirituality/Religiousness Index short form was used to assess religiosity [25].”
Baseline Religion Involvement Predicts Subsequent Salivary Cortisol Levels Among Male But not Female Black Youth
Assari, S., Lankarani, M. M., Malekahmadi, M. R., Caldwell, C. H., & Zimmerman, M. A. (2015) · Intern J Endocrinol Metab · doi:10.5812/ijem.31790 · Cited by 55
“Religiosity and spirituality have been associated with reductions in mean urinary cortisol (22) and elevated levels of immune cell counts (23), however, in cross-sectional studies.”
Background

Authors: Ironson, G., Solomon, G. F., Balbin, E. G., O’Cleirigh, C., George, A., Kumar, M., Larson, D., & Woods, T. E.
Affiliations: University of Miami (US)
University of California, Los Angeles (US)
National Institutes of Health (US)
University of Wisconsin–Madison (US)
Corresponding author: Ironson, Gail
ORCID: Ironson, Gail
O’Cleirigh, Conall
Kumar, Mahendra
Larson, David
Venue: Annals of Behavioral Medicine
Publisher: Oxford University Press (OUP)
Published: 2002-02
Volume: 24
Issue: 1
Pages: 34-48
ISSN: 0742-5554 (ISSN-L)
0883-6612
1532-4796
DOI: 10.1207/s15324796abm2401_05
OpenAlex: W2084329367
Cited by: 337
References: 48
Citations by year: 2026: 7 · 2025: 2 · 2024: 5 · 2023: 9 · 2022: 10 · 2021: 10 · 2020: 12 · 2019: 4 · 2018: 10 · 2017: 15 · 2016: 20 · 2015: 16 · 2014: 26 · 2013: 19 · 2012: 22
FWCI: 15.11
Type: journal article
Language: en
Open access: closed
Locations: Annals of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (R01 MH53791, R01MH053791)
Topics: Social Sciences › Health › Religion, Spirituality, and Psychology
Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Workplace Spirituality and Leadership
Social Sciences › Arts and Humanities › Religious studies › Religion, Ecology, and Ethics
Keywords: spirituality, religiosity, HIV/AIDS, long-term survival, prayer frequency, religious behavior, belief in God, compassion, altruism, urinary cortisol, psychological distress, hope, social support, health behavior, instrument validity and reliability
MeSH terms: Adult, Female, Health Status, Humans, Hydrocortisone, Male, Middle Aged, Surveys and Questionnaires, Religion and Medicine, Social Support, Stress, Psychological, Reproducibility of Results, Health Behavior, HIV Infections, Survival Analysis, Outcome Assessment, Health Care

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The ironson-woods spirituality/religiousness index is associated with long survival, health behaviors, less distress, and low cortisol in people with HIV/AIDS

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