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

“38), both evaluated using the Ironson-woods SR index [18].”

“In a sample of 279 adults with HIV, Ironson and colleagues found religiosity and spirituality corresponded to lower cortisol levels, increased positive health behaviors, larger social supports, hope, and improved long-term survival among older adults with HIV.(51) Similarly, in a sample of 450 HIV/AIDS outpatients, Sz…”

“In correlational studies, giving to others is associated with positive health outcomes including fewer health conditions among older adults and longer-term survival among people with AIDs (W. M. Brown, Consedine, & Magai, 2005; Ironson et al., 2002; Schwartz, et al., 2009; Schwartz, et al., 2003).”

“, 2001), HIV/ AIDS (Ironson et al., 2002), heart disease (Contrada et al.”

“In addition to enhancing coping skills, stress management interventions also may reduce stress levels and enhance psychosocial functioning by modifying stressor appraisals (perceptions; Astin, 1997), supporting the creation of meaning (Folkman, 1997), enhancing spirituality (Ironson et al., 2002), and fostering inner…”

“Spirituality and religiousness were assessed with the short form of the Ironson-Wood Spirituality/Religiousness Index (IWSRI; Ironson et al., 2002) which consists of 25 items grouped into two spirituality scales and two religiousness scales.”

“Empirical evidence exists around the link between spirituality, a number of objective physiological and psychological markers of health and well-being (Ironson et al. 2002; Kashdan and Nezlek 2012; Migdal and MacDonald 2013).”

“We measured spirituality and religiosity using the short version of the IronsonWoods Spirituality and Religiosity Index (SRI) (Ironson et al., 2002) and included it as a continuous variable, with higher scores indicating higher levels of spirituality and religiousness.”

“Ironson et al. (2002) found a decreased percentage of risky sexual behaviors in religious people.”

“Religiosity and spirituality have been linked to a reduction in symptoms of anxiety and depression in medically ill populations (Ironson et al., 2002; Phillips, Paukert, Stanley, & Kunik, 2009) as well as a reduced risk of cardiovascular events (Koenig, McCullough, & Larson, 2001; McCullough, Hoyt, Larson, Koenig, & T…”

“For example, a number of studies suggest that greater involvement in religion is associated with lower blood pressure (Maselko, Kubzansky, Kawachi, Seman, & Berkman, 2007), C-reactive protein (King, Mainous, & Pearson, 2002), interleukin-6 (Lutgendorf, Russell, Ullrich, Harris, & Wallace, 2004), white blood cell count…”

“- Ref - Days since first HIV diagnosis N Mean (Std Dev) Median (25th, 75th) 198 1269.1 (1495.8) 623.5 (83.0, 2322.0) 26 1199.0 (1617.7) 259.0 (41.0, 2530.0) 172 1279.7 (1481.3) 695.5 (92.5, 2317.0) 1.00 (1.00, 1.00) CD4 cell count N Mean (Std Dev) Median (25th, 75th) 198 591.3 (224.0) 566.0 (420.0, 720.0) 26 556.1 (15…”

“Moreover, other studies (Cotton et al, 2006 ) including the parent study (Ironson et al, 2005a ; Ironson et al, 2005b ; Ironson et al, 2006 ; Ironson et al, 2002 ), have found that increases in spirituality following HIV diagnosis were associated with positive health outcomes.”

“Urinary cortisol concentration was reported to be the basic mediator for this association.(30) Notably, a study of immune system function among a sample of older adults reported a relatively weak association between church attendance and healthier immune system indicators,(31) a result not verified in our group.”

“Second, because the dimensions of religiousness appear to be correlated (Ironson et al. 2002; Koenig, Parkerson, et al. 1997; Krause 1993; Peterman et al. 2002), multicollinearity can be an issue, particularly when a researcher examines multiple interaction effects in addition to the direct effects…”

“In particular, holding religious beliefs may reduce depression and increase optimism.(6,7) An HIV diagnosis may in fact strengthen religious convictions, as people look for solace and meaning to deal with a difficult life transition.”

“In the face of chronic illness, quality of life and even mortality are related to religious beliefs and practices and spiritual beliefs and practices (Ironson et al., 2002; Laubmeier, Zakowski, & Bair, 2004).”

“[101] G.”

“Hope predicted so much of the variance in quality of life that it was interesting to find only one study in a literature search that corroborated this finding (Ironson et al., 2002).”

“Religiosity is a relative concept comprising the cognitive, emotive, behavioral, interpersonal, and physiological processes that bind religion and spirituality ( Hill and Pargament 2003; Larson et al. 1998).”

“There is evidence that adults may use S/R to assist them in managing stressors, which has contributed to improved immune and physiological functioning (Dedert et al., 2004; Ironson et al., 2002; King, Mainous, & Pearson, 2002; Lynn et al., 2010; Mihaljević et al., 2011; Tartaro et al., 2005).”

“” A loss of spirituality or faith, which has been shown to escalate psychological distress (Chibnall, Videen, Duckro, & Miller, 2002; Ironson et al., 2002), was identified in a few cases.”

“One study found that religious involvement was associated with less psychological distress and more long-term survival among HIV-positive individuals [8].”

“And spiritual well-being influences such diverse outcomes as recovery from addiction [10], teen sexual activity [11], depression [12], eating disorders [13], breast cancer [14], long survival with acquired immune deficiency syndrome [ 15 ] and a number of health behaviors [16].”

“Previous studies with HIV-positive adults have demonstrated the importance of religion/spirituality for this population (Ironson et al., 2002) and have found that HIV diagnosis influences family relationships (Pequegnat and Bray, 1997), health care (Collins et al.”

“…(Tarakeshwar et al., 2006; Vallurupalli et al., 2012), gynaecological disorders (Boscaglia, Clarke, Jobling, & Quinn, 2005) and HIV infection (Ironson et al., 2002; Ironson, Stuetzle, & Fletcher, 2006), and that religiosity is associated with improvements in aspects of individuals’ overall…”

“The Ironson-Woods Sense of Peace subscale (Ironson et al., 2002) is a 9-item questionnaire that assesses how participants’ spirituality functions to help them make meaning of their lives and feel connected to the sacred.”

“…adherence are consistent with previous studies conducted among HIV-infected individuals that identified a link between spiritual issues and a number of outcomes, including psychological wellbeing, quality of life and survival (Flannelly & Inouye, 2001; Ironson et al., 2002; Tuck et al., 2001).”

“Around the same time, in the late 1990s, a small number of people became identified as ‘long-term non-progressors’; they either progressed very slowly or not at all to full-blown AIDS (Barroso, 1997; Cruess et al., 2003; Folkman et al., 1996; Ironson et al., 2002; O’Cleirigh et al., 2003; Thornton et al., 2000; Troop…”

“This is in contrast to the findings other studies, which reported that religiosity and spirituality have positive associations with better mental health [33–35] and better physical health [33,36,37].”

“Third, while the questions on religiousness are typical of those used in similar studies [7, 35], they are not part of a validated index of religiousness such as the DUREL [36] or Ironson-Woods Index [37], scales that were created after the start of the current cohort study.”

“…success, medication adherence, and overall well-being (Bormann et al. 2006; Braxton et al. 2007; Cotton et al. 2006; Dalmida 2006; Ironson and Kremer 2009; Ironson et al. 2002; Ironson, Stuetzle et al. 2006; Pargament et al. 2004; Szaflarski et al. 2006; Tsevat et al. 2009; Woods et al. 1999).”

“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Pargament et al., 2001; Tuck et al., 2001; Cotton et al., 2006; Ironson et al., 2006; Yi et al, 2006; Koenig, 2008; Koenig et al., 1998; Ironson et al., 2002; Lyon et al., 2014).”

“Also, elevated cortisol is sometimes associated with poor HIV outcomes (Antoni et al. 2000, 2005; Cruess et al. 2000; Ironson et al. 2002; Leserman 2003) but findings are inconsistent and mechanisms of cortisol dysregulation remain complex (Cole 2008; Sapolsky et al. 2007).”

“Possible mechanisms by which religiosity/spirituality impact health outcome include low rates of depression [16], better treatment compliance [17], improved immune function [18], and healthier diets [19].”

“…Likert scale at baseline using the 25-item Ironson-Woods Spirituality/Religiousness (SR) Index (Cronbach’s α = 0.96), developed and validated by Ironson et al. (2002) to describe the beliefs and affective, behavioral, and somatic realms of patients facing life-threatening illnesses,…”

“The Ironson-Woods Sense of Peace subscale (Ironson et al., 2002) is a nine-item questionnaire that assesses participants’ spirituality.”

“For those infected with HIV, such enclaves may force alienation from the religious and spiritual supports that could actually help them.”

“…the scope and purpose of this paper, there is a growing research literature on the role of religiousness and spirituality in coping with HIV/AIDS [6 – 10] Most of these published studies indicate that greater religiousness and/or spirituality is associated with more successful coping and better…”

“…have been mixed, with some suggesting slower disease progression and others finding no relationship to immune status (Fitzpatrick et al., 2007; Ironson et al., 2002; Ironson, Stuetzle, & Fletcher, 2006; Kudel, Cotton, Szaflarski, Holmes, & Tsevat, 2011; Woods, Antoni, Ironson, & Kling, 1999).”

“This 25-item instrument assesses four dimensions of S/R (Ironson et al., 2002).”

“These include studies of religion in relation to clinical outcomes (see Koenig 1999b) and biomedical markers (e.g., Ironson et al. 2002), as well as research on facets of the healthcare encounter (see Puchalski 2001), including the doctor–patient relationship (e.g., Puchalski and Ferrell 2010),…”

“Spiritual struggle may increase distress (Pargament et al. 2001, 2004; Lee et al. 2010), disease progression (Ironson et al. 2002) and even mortality (Pargament et al. 2001, 2004), while positive spiritual beliefs may influence well-being, particularly at the end-of-life (Tarakeshwar et al. 2006).”

“…(Koenig et al. 1997 ; Lutgendorf et al. 2004 ), white blood cells (King et al. 2001 ), Epstein-Barr virus (Das and Nairn 2016 ; Hill et al. 2014 ), epinephrine (Maselko et al. 2007 ), cortisol (Ironson et al. 2002 ), and overall allostatic load (Hill et al. 2014 ; Maselko et al. 2007 ).”

“Relevant measures include the Brief Multidimensional Measure of Religiousness/Spirituality [75], the Daily Spiritual Experiences Scale [76], and the IronsonWoods Spirituality/Religiousness Index [77].”

“For instance, Ironson et al. (2002) found that among PLWH, those who reported altruistic behaviors, including caring for another person(s) rather than merely expressing concern for others, had more favorable HIV outcomes (i.e. lower viral load and maintained CD4-cell count) at a 2-year follow up.”

“progression such as CD4 count, natural killer cell activity and viral load [18, 19] as well as to disease progression itself [20-22].”

“In the health care arena, spirituality has been associated with hope, better management of chronic illness, higher levels of health-promoting activities, and better health-related quality of life (HRQOL) ( Harvey and Silverman 2007; Klonoff and Landrine 1996; Krause and Van Tran 1989; Waite et al. 1999).”

“Moreover, confusion in clarifying the terminology for religiosity and spirituality constructs was illustrated by the Ironson-Woods Spirituality/Religiousness Index, which is a combination of both religious and spiritual items that were assessed as having reliability and validity (Ironson et al. 2002).”

“(26) A R/S total score is also calculated that could range from 25 to 125 (Cronbach’s alpha = 0.”

“…Spirituality and religiosity, two important covariates, were assessed using two subscales from the Ironson-Woods Spirituality/Religiousness Index Short Form: Compassionate View of Others (representing spirituality) and Religious Behavior (representing religiosity; Ironson et al., 2002).”

“Spirituality/Religiousness Index (IWSRI) was applied to capture participants’ spirituality (Ironson et al., 2002).”

“The empirical literature has demonstrated beneficial health outcomes for HIV-positive individuals who endorse varying types of spiritual/religious experience, including increased CD4 counts (Woods, Antoni, Ironson, & Kling, 1999), decreased psychological distress (Ironson et al., 2002), and slower disease progression…”

“…1972; Ludwig, 1983; Lynn, 2005; Schumaker, 1991, 1995) and validate research indicating religious and spiritual behavior (Dedert et al., 2004; Ironson et al., 2002; Lynn et al., 2010; Mihaljević et al., 2011; Tartaro, Luecken, & Gunn, 2005) and meditative approaches (Carlson, Speca, Patel,…”

“Spirituality in adults with HIV has been shown to be associated with lower stress (Ironson et al., 2002), better medication adherence (Parsons, Cruise, Davenport, & Jones, 2006), less alcohol use, greater optimism, greater self-esteem, and greater life satisfaction (Cotton et al., 2006).”

“Fifteen percent of the sample were drawn from a cohort study of long-term survivors [72].”

“We used baseline scores from The Ironson-Woods Sense of Peace subscale (Ironson et al., 2002) to assess spirituality.”