Religion and Spirituality in Psychiatry

Integrating Spiritual Issues into Therapy 251disease or cancer, Rabins and colleagues (53)found that strength of religious belief at baselinewas associated with better emotional adjustmentamong caregivers at two-year follow-up, evenwhen personality variables, family functioning,and levels of anger and guilt were controlledfor. In another study of 127 caregivers of elderlypersons with disabilities, Chang and colleagues(54) found that caregivers who used religious orspiritual beliefs to cope with caregiving stress hada better relationship with care recipients, lowerlevels of depression, and better self-care; forexample, they experienced less “submersion” inthe caregiving role.Only a few published studies have quantitativelyassessed and examined the correlates of religiosityamong family caregivers of persons with seriousmental illness. (55) For example, sixty Hindufamily members of patients with schizophreniawere recruited through a public hospital in India.These individuals completed measures of caregivingburden, coping activities, religious beliefs andpractices, and adjustment. The results of the studyhighlight the prevalence of religious coping; 90percent of participants reported praying to God,and 50 percent viewed religion as a source of solace,strength, and guidance in coping with caregivingdemands. In multiple regression analyses,the authors found that strength of religious beliefwas linked to greater well-being among caregivers,with other types of coping and demographic characteristicscontrolled for. Although generalizationof these results is limited by cultural context, thesefindings highlight the prevalence and potentialbenefits of religiosity among caregivers of personswith serious mental illness.Johnson (56) interviewed a sample of 180family members about their understanding oftheir relative’s illness, sources of support, andways of coping and found that family membersoften turn to religion to cope with the stressof caring for an ill family member. Bland andDarlington (57) echoed these results in theirstudy of hope among family members of personswith serious mental illness. Five of the sixteenparticipants spontaneously identified religiousbeliefs and participation as a significant sourceof hope. Thus, research points to the importantrole of religiosity among family caregivers ofpersons with serious mental illness. Moreover,these preliminary studies, along with work inother caregiving populations, suggest that religiositymay have salutary effects on caregiveradjustment.A recent study aimed to characterize thenature of religiosity and sources of spiritualsupport in a sample of family caregivers of personswith serious mental illness in the NationalAlliance on Mental Illness (NAMI) Family toFamily Education program. (58) Forty-fourpercent reported having a relative with schizophrenia,50 percent had a relative with a majoraffective disorder, and the remaining 6 percenthad a relative with another diagnosis. The meanrating of importance of religion and spirituality,on a scale of 1 to 4, was 3.43 ± .83±, which ishalfway between “fairly important” and “veryimportant.” The mean rating of whether participantsconsidered God to be a source of comfortand strength was 3.26 ± 1.03, falling between“quite a bit” and “a great deal.” Overall, this was amoderately religious and spiritual sample, comparableto the general population.Thirty-one participants (37 percent) reportedthat they had received religious or spiritual supportin coping with their relative’s illness in thepast three months. The most frequent types ofspiritual support were praying or meditating,reading the Bible or other religious literature,and watching or listening to religious programson television or the radio. Notably, nineteen participants(23 percent) reported that they contactedclergy or a religious leader to talk aboutproblems or concerns related to their relative’sillness. Twenty-three participants (28 percent)reported relying on members of their congregationfor support in coping with their relatives’ illnessduring the previous three months. Personalreligiosity was positively associated with level ofmastery (r = .26, p = .017) and self-care (r = .33,p = .003) and negatively associated with level ofdepression (r = –.25; p = .025).Th e major findings of this study are twofold.First, a substantial proportion of family members