• Burden and Mental Health of Family Caregivers of Cancer Patients: The Impact of Spirituality

      La, In Seo; Johantgen, Mary E. (2020)
      Background: As the primary source of care for individuals with cancer, family caregivers are relied on for treatment support and emotional care during the cancer trajectory. Studies on caregiver burden and psychological sequelae among cancer caregivers have been conducted cross-sectionally. Spirituality has been suggested as a potential buffer between burden and sequelae. Yet, there have been very few longitudinal studies addressing burden, depression, and spirituality, and there is limited information on psychometric properties of the spirituality measures in cancer caregivers. Purpose: The aims of this study were to: 1) evaluate validity of the Spiritual Perspective Scale (SPS) and explore differences in spirituality across caregiver and patient characteristics, 2) describe caregiver burden during active cancer treatment and explore caregiver and patient factors influencing caregiver burden, and 3) examine changes in caregiver burden, spirituality, and depression and explore the moderating effect of spirituality on burden-depression relationship over time. Methods: A secondary analysis of data from a longitudinal study of cancer caregivers from the NIH Clinical Center was conducted. Caregivers completed measures, including the Spiritual Perspective Scale (SPS), Caregiver Reaction Assessment (CRA), and NIH Toolbox and PROMIS® measures. Structural equation modeling and linear mixed modeling were used for testing study aims. Results: The SPS was found to have satisfactory psychometric properties in cancer caregivers. Adjusting for a direct effect of race did not alter the pattern of results, and caregivers who were older, female, racial/ethnic minorities, less educated, affiliated with a religion, and who provided care to anyone other than the patient reported higher levels of spirituality. Baseline mutuality between the caregiver and patient was negatively associated with initial burden. Changes in caregiver burden were related to being spouse caregivers, sole caregivers, and income. Scores on total burden, spirituality, and depression remained stable over time. Caregivers’ spirituality moderated the link between burden and depression (-1.26, p = .025). Conclusions: Higher levels of spirituality may act as a protective factor in the relationship between burden and depression during active cancer treatment. Identified factors related to burden and strategies to strengthen spirituality should be considered to improve caregiver mental health.
    • Religion and spirituality in adults with mental illness

      Goertz, Sherry; Johantgen, Mary E. (2009)
      Background: Religion, which includes components of religiousness and spirituality, is an important dimension of coping for many Americans. However, the breadth and depth of how people use religion as a coping mechanism is not well understood. Little evidence exists as to which religious and spiritual factors are most conducive to health. During the past two decades research has been conducted to examine religious coping (RC) using mostly healthy subjects. While aspects of RC seem to be used by persons with mental illness, few studies have been conducted among this group. Purpose: This study described the prevalence and correlates of RC in US adults, comparing those who have experienced psychiatric disorders with those who have not. Methods: A secondary analysis of the National Co-Morbidity Survey Replication (NCS-R; Kessler & Merikangas, 2003) was conducted. The NCS-R was an extensive investigation of the prevalence and correlates of psychiatric disorders in the United States, the third in a series of population based studies. The study sample consisted of 4818 adults. Principal components of 5 items were analyzed to construct weighted factor based scores as a Measure of Religious Coping (MeRC). Regression analyses through complex samples general linear model provided descriptive correlational findings comparing respondents who have had specific psychiatric disorders (mood disorders, anxiety disorders, substance disorders & impulse control disorders) with those who have not. Results: The MeRC represented one factor with strong internal consistency, content and construct validity. The influential demographic correlates of religious coping were gender, race, age, education, and region of the country which showed moderate effects and explained over 11% of the variance. Significant differences in religious coping were confirmed from this nationally representative data in a few of the diagnostic categories of mental illness (i.e. intermittent explosive disorder, oppositional defiance disorder, conduct disorder, nicotine dependence, alcohol abuse and social phobia) after controlling for influential demographics, yet the effect sizes were small. Conclusion: Overall, there was a high prevalence of RC. Having had a mental illness did not have much influence on RC. The study provided evidence that many persons who have had mental illness use RC in ways similar to people who have not had a mental illness.
    • Spiritual growth of recovering alcoholic Adult Children of Alcoholics

      Carroll, Maria M.; Janzen, Curtis (1993)
      Jungian theory was used as a way of understanding human behavior and personality development and of enlarging the knowledge base for social work practice. The primary purposes of this exploratory multi-case study were: (1) to identify resources and methods which clinicians may use for promoting personality-spiritual development; and (2) to clarify and expand the profession's knowledge and understanding of spirituality and the transpersonal dimension of the person. The research participants, recovering alcoholic adult children of alcoholics, were assigned to one of two groups based on level of self-actualization (ten self-actualized; seven not-self-actualized) as determined by the Personal Orientation Inventory. Data collection included intensive interviews using Fowler's Faith Development Interview Instrument and the Recovery Interview Guide and the administration of several questionnaires: Clinical Measurement Package Index of Peer Relationships, Symptom Check List-90-Revised, and Problem Check List. A quantitative approach was used to identify the number of resources and methods which recovering alcoholic ACOAs used in their recovery and to relate level of spiritual development with current life functioning which included length of sobriety, faith stage, symptomatology, and problems in daily living. Qualitative methods addressed the types of resources and methods used in the recovery process as well as the respondents' views of spirituality and creativity. Respondents identified specific resources and methods as being particularly helpful. Positive relationships were found between level of self-actualization and most indicators of current life functioning, however, a negative relationship was found between level of self-actualization and length of sobriety. Different definitions of spirituality were made explicit, and a sketch of a new model which offers a broader view of the person was presented as a way of extending the current thinking about spirituality and a person's spiritual development. Implications of the findings for clinicians, researchers, and theoreticians were discussed.
    • Struggling with paradoxes: The spiritual experience of women with cancer

      Halstead, Marilyn Tuls; Belcher, Anne E. (1998)
      Spirituality is an important aspect of holistic health for women with cancer. Though extensive research focuses on spirituality, three major areas lack delineation. First, the developmental nature of spirituality requires exploration. Second, minimal systematic research directed at understanding spirituality from the perspective of women with cancer is reported. Finally, research exploring spirituality within specific time frames of the cancer trajectory is nonexistent. The purpose of this grounded theory study was to examine the spiritual experience of women diagnosed with cancer within 5 years of initial treatment. Data from two interviews with 10 Caucasian women, ranging from 40-70 years of age, were analyzed using the constant comparison technique. As the women began to suspect a cancer diagnosis, they questioned how this would affect their lives. The diagnosis posed a threat to the meaning they ascribed to their lives. This problem was resolved through the basic social psychological process of Struggling with Paradoxes, a 3-phase process consisting of deciphering the meaning (Phase I), realizing human limitations (Phase II), and learning to live with uncertainty (Phase III). In Phase I, deciphering the meaning, five paradoxes were uncovered that focused on confronting the possibility of their own death, staggering distress, and vulnerability. The women struggled to maintain coherence in old and new ways by connecting in giving and receiving processes. In Phase II, realizing human limitations, the demands of treatment initiated the women's struggle with three paradoxes. Confronting death, connecting for support, and asking the difficult questions were important dimensions that helped the women move toward letting go of ultimate control over their lives. As they entered Phase III, learning to live with uncertainty, the women attained greater well-being but realized that permanent survival could not be assured. In this phase, as the women struggled with two paradoxes, the dimensions of redefining meaning, identifying spiritual growth, reintegration, and facing the possibility of recurrence emerged. Findings confirm the importance of spirituality for women with cancer. Development of curriculum to enhance nurses' knowledge of spirituality is needed. Based on women's perspectives, development and testing of interventions that support and enhance spiritual growth is crucial for research-based practice.