religious experience research paper

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What Counts as a ‘Religious Experience?’: Phenomenology, Spirituality, and the Question of Religion

This paper: a) offers a phenomenology of the religious that challenges the assumption that “religious experience” is primarily to be understood as a type of experience, called ‘religious’ experience, which is distinct from other (i.e., ‘non-religious’) experiences; and b) traces out some implications of this for phenomenological and other scholarly approaches to religion. To achieve these aims, the paper begins by explaining the phenomenological claim-found most explicitly in Husserl and Merleau- Ponty-that all experiences are expressive of a certain kind of spirit. This account of spirit, when applied to the phenomenological understanding of the ‘religious,’ allows us to distinguish between religiosity (as a transcendental structure), religions (as dynamic forces that express that structure), and religious phenomena (as concrete phenomena that express religions). In turn, this tri-partite distinction allows us to explain how religiosity leads to the development of religion in a way that suggests that ‘the religious’ is best conceived as a particular dimension of all experience. In that light, two major implications for the study of religion emerge from the phenomenology of the religious provided in this paper: 1) the realm of possible subjects of study is greatly expanded; while 2) the proper object of study is narrowed and clarified

Barber, Michael. Religion and Humor as Emancipating Provinces of Meaning. Dordrecht: Springer, 2017. 10.1007/978-3-319-62190-6 Search in Google Scholar

Barber, Michael. “The Finite Province of Religious Meaning and the Appresentative Mindset,” delivered at “The Symbolic Construction of Reality,” 3rd Meeting of the International Schutz Circle for Phenomenology and Interpretive Social Science, Waseda University, Tokyo, Japan, May 6-8, 2016. Page numbers refer to author’s unpublished manuscript. Search in Google Scholar

Bergson, Henri. Mind-Energy: Lectures and Essays. Translated by H. Wildon Carr. New York: Henry Holt and Company, 1920. Search in Google Scholar

Caputo, John D. The Insistence of God: A Theology of Perhaps. Bloomington: Indiana University Press, 2013. Search in Google Scholar

Caputo, John D. The Prayers and Tears of Jacques Derrida: Religion with/out Religion. Bloomington: Indiana University Press, 1997. 10.2307/j.ctt2005rjr Search in Google Scholar

Caputo, John D. The Weakness of God: A Theology of the Event. Bloomington: Indiana University Press, 2006. Search in Google Scholar

Dahl, Espen. Phenomenology and the Holy: Religious Experience after Husserl. London: SCM Press, 2010. Search in Google Scholar

DeRoo, Neal. Futurity in Phenomenology: Promise and Method in Husserl, Levinas and Derrida. Fordham University Press, 2013. 10.5422/fordham/9780823244645.001.0001 Search in Google Scholar

DeRoo, Neal. “Spiritual Expression and the Promise of Phenomenology,” in The Subject(s) of Phenomenology: New Approaches to Husserl edited by Iulian Apostelescu, Verdran Grahovac, and Patrick Flack. New York: Springer, forthcoming. Search in Google Scholar

Derrida, Jacques. “Faith and Knowledge: The Two Sources of ‘Religion’ at the Limits of Reason Alone” in Acts of Religion, edited by Gil Anidjar, 40-101. New York and London: Routledge, 2002. Search in Google Scholar

Derrida, Jacques. Edmund Husserl’s Origin of Geometry: An Introduction. Translated by John P. Leavey. Lincoln and London: University of Nebraska Press, 1989. Search in Google Scholar

Derrida, Jacques. The Problem of Genesis in Husserl’s Philosophy. Translated by Marian Hobson. Chicago: University of Chicago Press, 2003. 10.7208/chicago/9780226143774.001.0001 Search in Google Scholar

Derrida, Jacques. Voice and Phenomena: An Introduction to the Problem of the Sign in Husserl’s Phenomenology. Translated by Leonard Lawlor. Evanston: Northwestern University Press, 2010. Search in Google Scholar

de Vries, Hent. “Introduction: Why Still ›Religion‹?” in Religion: Beyond a Concept, edited by Hent de Vries, 1-98. New York: Fordham University Press, 2008. Search in Google Scholar

Dooyeweed, Herman. A New Critique of Theoretical Thought. Three Volumes. Translated by David H. Freeman, William S. Young and Henry de Jongste. Philadelphia, PA: The Reformed and Presbyterian Publishing Company, 1953-1957. Search in Google Scholar

Henry, Michel. “Material Phenomenology and language (or, pathos and language)” Translated by Leonard Lawlor. Continental Philosophy Review 32 [1999]: 343-365. 10.1023/A:1006910211299 Search in Google Scholar

Husserl, Edmund. Analyses concerning Active and Passive Synthesis: Lectures on Transcendental Logic. Husserliana Band XI. Translated by A. J. Steinbock. Dordrecht/ Boston/London: Kluwer Academic, 2001. 10.1007/978-94-010-0846-4 Search in Google Scholar

Husserl, Edmund. Cartesian Meditations: An Introduction to Phenomenology. Husserliana Band I. Translated by D. Cairns. Dordrecht/Boston/London: Springer, 1999. Search in Google Scholar

Husserl, Edmund. Die Lebenswelt. Auslegungen der vorgegebenen Welt und ihrer Konstitution. Texte aus dem Nachlass (1916-1937). Husserliana Band XXXIX. Dordrecht: Springer, 2008. Search in Google Scholar

Husserl, Edmund. Erste Philosophie. Zweiter Teil: Theorie der phänomenologischen Reduktion. Husserliana Band VIII. The Hague: Martinus Nijhoff, 1959. Search in Google Scholar

Husserl, Edmund. Experience and Judgment: Investigations in a genealogy of logic. Edited by Ludwig Landgrebe. Translated by J.S. Churchill and K. Ameriks. Evanston: Northwestern University Press, 1973. Search in Google Scholar

Husserl, Edmund. Formal and Transcendental Logic. Translated by Dorion Cairns. The Hague: Martinus Nijhoff, 1969. 10.1007/978-94-017-4900-8 Search in Google Scholar

Husserl, Edmund. Ideen zu einer reinen Phänomenologie und Phänomenologischen Philosophie. Zweites Buch: Phänomenologische Untersuchungen zur Konstitution. Husserliana Band IV. The Hague: Martinus Nijhoff, 1952. Search in Google Scholar

Husserl, Edmund. Logical Investigations. Translated by J.N. Findlay. London and New York: Routledge, 2001. Search in Google Scholar

Husserl, Edmund. The Crisis of European Sciences and Transcendental Phenomenology. Translated by David Carr. Evanston: Northwestern University Press, 1970. Search in Google Scholar

Kwant, Remy C. The Phenomenology of Expression. Pittsburgh: Duquesne University Press, 1969. Search in Google Scholar

Landes, Donald A. Merleau-Ponty and the Paradoxes of Expression. London: Bloomsbury, 2013. Search in Google Scholar

Lawlor, Leonard. Thinking through French Philosophy: The Being of the Question. Bloomington: Indiana University Press, 2003. 10.2307/j.ctt200603v Search in Google Scholar

Maclaren, Kym. “Life is Inherently Expressive,” Chiasmi International VII [2005], 241-260. 10.5840/chiasmi2005740 Search in Google Scholar

McCutcheon, Russell T. Manufacturing Religion: The Discourse on Sui Generis Religion and the Politics of Nostalgia. Oxford and New York: Oxford University Press, 1997. Search in Google Scholar

Merleau-Ponty, Maurice. “Eye and Mind.” Translated by Michael B. Smith in The Merleau- Ponty Aesthetics Reader: Philosophy and Painting edited by Galen A. Johnson, 121-149. Evanston: Northwestern University Press, 1993. Search in Google Scholar

Merleau-Ponty, “Indirect Language and the Voices of Silence.” Translated by Michael B. Smith in The Merleau-Ponty Aesthetics Reader: Philosophy and Painting edited by Galen A. Johnson, 76-120. Evanston: Northwestern University Press, 1993. Search in Google Scholar

Merleau-Ponty, Maurice. Nature: Course Notes from the College de France. Edited by Dominique Seglard and translated by Robert Vallier. Evanston: Northwestern University Press, 2003. Search in Google Scholar

Merleau-Ponty, Maurice. Phenomenology of Perception. Translated by Donald A. Landes. New York and London: Routledge, 2013. 10.4324/9780203720714 Search in Google Scholar

Merleau-Ponty, Maurice. The Visible and the Invisible. Translated by Alphonso Lingis. Evanston: Northwestern University Press, 1968. Search in Google Scholar

Pulkinnen, Simo. “Lifeworld as an Embodiment of Spiritual Meaning: The Constitutive Dynamics of Activity and Passivity in Husserl,” in The Phenomenology of Embodied Subjectivity Contributions to Phenomenology 71, edited by R.T. Jensen and Dermot Moran. Cham: Springer 2013. 10.1007/978-3-319-01616-0_7 Search in Google Scholar

Schaefer, Donovon O. Religious Affects: Animality, Evolution and Power. Durham: Duke University Press, 2015. Search in Google Scholar

Schilbrack, Kevin. Philosophy and the Study of Religions: A Manifesto. Malden and Oxford: Wiley Blackwell, 2014. Search in Google Scholar

Schilbrack, Kevin. “What isn’t Religion?” The Journal of Religion. 93:3 (July 2013), 291-318. 10.1086/670276 Search in Google Scholar

Schutz, Alfred. “On Multiple Realities.” In The Problem of Social Reality, vol. 1 of Collected Papers, edited by Maurice Natanson, 207-259. The Hague: Martinus Nijhoff, 1962. 10.1007/978-94-010-2851-6_9 Search in Google Scholar

Simmons, J. Aaron, and Stephen Minister (eds.). Reexamining Deconstruction and Determinate Religion: Toward a Religion with Religion. Duquesne University Press, 2012. Search in Google Scholar

Simmons, J. Aaron. “Vagueness and Its Virtues: A Proposal for Renewing Philosophy of Religion.” In Philosophy of Religion After Religion, edited by Richard Amesbury and Michael Rodgers, 45-70. Tübingen: Mohr Siebeck, 2018. Search in Google Scholar

Steinbock, Anthony J. Home and Beyond: Generative Phenomenology after Husserl. Evanston: Northwestern University Press, 1995. Search in Google Scholar

Smith, James K.A. Desiring the Kingdom: Worship, Worldview and Cultural Formation. Cultural Liturgies Volume 1. Grand Rapids, MI: Baker, 2009. Search in Google Scholar

Smith, James K.A. Imagining the Kingdom: How Worship Works. Cultural Liturgies Volume 2. Grand Rapids, MI: Baker, 2013. Search in Google Scholar

Smith, James K.A. “Re-Kanting Postmodernism? Derrida’s Religion within the Limits of Reason Alone” Faith and Philosophy 17.4 (2000): 558-71. 10.5840/faithphil200017438 Search in Google Scholar

Smith, James K.A. You are what you Love: The Spiritual Power of Habit. Grand Rapids: Brazos Press, 2016. Search in Google Scholar

Smith, Jonathan Z. Imagining Religion: From Babylon to Jonestown. Chicago: University of Chicago Press, 1982. Search in Google Scholar

Supp-Montgomerie, Jenna. “Affect and the Study of Religion,” Religion Compass 9:10 [October 2015], 335-345. 10.1111/rec3.12166 Search in Google Scholar

Taylor, Charles. A Secular Age. Cambridge, MA and London: Harvard University Press, 2007. Search in Google Scholar

Tylor, Edward Burnett. Religion in Primitive Culture. Gloucester, MA: Peter Smith, 1970. Search in Google Scholar

Yancy, George. Black Bodies, White Gazes: The Continuing Significance of Race. New York: Rowman and Littlefield, 2008. Search in Google Scholar

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Religion, Spirituality, and Health: The Research and Clinical Implications

Harold g. koenig.

1 Departments of Medicine and Psychiatry, Duke University Medical Center, P.O. Box 3400, Durham, NC 27705, USA

2 Department of Medicine, King Abdulaziz University, Jeddah 21413, Saudi Arabia

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

1. Historical Background and Introduction

Religion, medicine, and healthcare have been related in one way or another in all population groups since the beginning of recorded history [ 1 ]. Only in recent times have these systems of healing been separated, and this separation has occurred largely in highly developed nations; in many developing countries, there is little or no such separation. The history of religion, medicine, and healthcare in developed countries of the West, though, is a fascinating one. The first hospitals in the West for the care of the sick in the general population were built by religious organizations and staffed by religious orders. Throughout the Middle Ages and up through the French Revolution, physicians were often clergy. For hundreds of years, in fact, religious institutions were responsible for licensing physicians to practice medicine. In the American colonies, in particular, many of the clergy were also physicians—often as a second job that helped to supplement their meager income from church work.

Care for those with mental health problems in the West also had its roots within monasteries and religious communities [ 2 ]. In 1247, the Priory of St. Mary of Bethlehem was built in London on the Thames River [ 3 ]. Originally designed to house “distracted people,” this was Europe's (and perhaps the world's) first mental hospital. In 1547, however, St. Mary's was torn down and replaced by Bethlehem or Bethlem Hospital [ 4 ]. Over the years, as secular authorities took control over the institution, the hospital became famous for its inhumane treatment of the mentally ill, who were often chained [ 5 ], dunked in water, or beaten as necessary to control them. In later years, an admission fee (2 pence) was charged to the general public to observe the patients abusing themselves or other patients [ 4 ]. The hospital eventually became known as “bedlam” (from which comes the word used today to indicate a state of confusion and disarray).

In response to the abuses in mental hospitals, and precipitated by the death of a Quaker patient in New York asylum in England, an English merchant and devout Quaker named William Tuke began to promote a new form of treatment of the mentally ill called “moral treatment.” In 1796, he and the Quaker community in England established their own asylum known as the York Retreat [ 6 ]. Not long after this, the Quakers brought moral treatment to America, where it became the dominant form of psychiatric care in that country [ 6 ]. Established in Philadelphia by the Quakers in 1813, “Friends Hospital” (or Friends Asylum) became the first private institution in the United States dedicated solely to the care of those with mental illness [ 7 ]. Psychiatric hospitals that followed in the footsteps of Friends Asylum were the McLean Hospital (established in 1818 in Boston, and now associated with Harvard), the Bloomingdale Asylum (established in 1821 in New York), and the Hartford Retreat (established in 1824 in Connecticut)—all modeled after the York Retreat and implementing moral treatment as the dominant therapy.

It was not until modern times that religion and psychiatry began to part paths. This separation was encouraged by the psychiatrist Sigmund Freud. After being “introduced” to the neurotic and hysterical aspects of religion by the famous French neurologist Jean Charcot in the mid-1880s, Freud began to emphasize this in a widely read series of publications from 1907 through his death in 1939. Included among these were Religious Acts and Obsessive Practices [ 8 ], Psychoanalysis and Religion [ 9 ], Future of an Illusion [ 10 ], and Moses and Monotheism [ 11 ]. These writings left a legacy that would influence the practice of psychiatry—especially psychotherapy—for the rest of the century and lead to a true schism between religion and mental health care. That schism was illustrated in 1993 by a systematic review of the religious content of DSM-III-R, which found nearly one-quarter of all cases of mental illness being described using religious illustrations [ 12 ]. The conflict has continued to the present day. Consider recent e-letters in response to two articles published in The Psychiatrist  about this topic [ 13 , 14 ] and an even more recent debate about the role of prayer in psychiatric practice [ 15 ]. This conflict has manifested in the clinical work of many mental health professionals, who have generally ignored the religious resources of patients or viewed them as pathological. Consider that a recent national survey of US psychiatrists found that 56% said they never, rarely, or only sometimes inquire about religious/spiritual issues in patients with depression or anxiety [ 16 ]. Even more concerning, however, is that the conflict has caused psychiatrists to avoid conducting research on religion and mental health. This explains why so little is known about the relationship between religious involvement and severe mental disorders (see Handbook of Religion and Health ) [ 17 ].

Despite the negative views and opinions held by many mental health professionals, research examining religion, spirituality, and health has been rapidly expanding—and most of it is occurring outside the field of psychiatry. This research is being published in journals from a wide range of disciplines, including those in medicine, nursing, physical and occupational therapy, social work, public health, sociology, psychology, religion, spirituality, pastoral care, chaplain, population studies, and even in economics and law journals. Most of these disciplines do not readily communicate with each another, and their journal audiences seldom overlap. The result is a massive research literature that is scattered throughout the medical, social, and behavioral sciences.

To get a sense of how rapidly the research base is growing see Figure 1 . The graphs plot the number of studies published in peer-reviewed journals during every noncumulative 3-year period from 1971 to 2012. Note that about 50% of these articles are reports of original research with quantitative data, whereas the other 50% are qualitative reports, opinion pieces, reviews, or commentaries. Google Scholar presents a more comprehensive picture since it includes studies published in both Medline and non-Medline journals. These graphs suggest that the volume of research on R/S and health has literally exploded since the mid-1990s.

Religion spirituality and health articles published per 3-year period (noncumulative) Search terms: religion, religious, religiosity, religiousness, and spirituality (conducted on 8/11/12; projected to end of 2012).

2. Definitions

Before summarizing the research findings, it is first necessary to provide definitions of the words religion and spirituality that I am using. There is much controversy and disagreement concerning definitions in this field, particularly over the term “spirituality,” and space here does not allow a full discussion of these complex issues. For an in depth discussion, including an exploration of contamination and confounding in the measurement of spirituality, I refer the reader to other sources [ 18 – 20 ]. Here are the definitions we provided in the Handbook .

“[Religion] Involves beliefs, practices, and rituals related to the transcendent , where the transcendent is God, Allah, HaShem, or a Higher Power in Western religious traditions, or to Brahman, manifestations of Brahman, Buddha, Dao, or ultimate truth/reality in Eastern traditions. This often involves the mystical or supernatural. Religions usually have specific beliefs about life after death and rules about conduct within a social group. Religion is a multidimensional construct that includes beliefs, behaviors, rituals, and ceremonies that may be held or practiced in private or public settings, but are in some way derived from established traditions that developed over time within a community. Religion is also an organized system of beliefs, practices, and symbols designed (a) to facilitate closeness to the transcendent, and (b) to foster an understanding of one's relationship and responsibility to others in living together in a community.” [ 21 ].

“Spirituality is distinguished from all other things—humanism, values, morals, and mental health—by its connection to that which is sacred, the transcendent . The transcendent is that which is outside of the self, and yet also within the self—and in Western traditions is called God, Allah, HaShem, or a Higher Power, and in Eastern traditions may be called Brahman, manifestations of Brahman, Buddha, Dao, or ultimate truth/reality. Spirituality is intimately connected to the supernatural, the mystical, and to organized religion, although also extends beyond organized religion (and begins before it). Spirituality includes both a search for the transcendent and the discovery of the transcendent and so involves traveling along the path that leads from nonconsideration to questioning to either staunch nonbelief or belief, and if belief, then ultimately to devotion and finally, surrender. Thus, our definition of spirituality is very similar to religion and there is clearly overlap.” [ 22 ].

For the research review presented here, given the similarity in my definition of these terms and the fact that spirituality in the research has either been measured using questions assessing religion or by items assessing mental health (thereby contaminating the construct and causing tautological results), I will be using religion and spirituality interchangeably (i.e., R/S).

3. Method of the Review

I summarize the research findings between R/S and health first in the area of mental health outcomes, then for health behaviors, and finally for physical health outcomes. The information presented here is based on a systematic review of peer-reviewed original data-based reports published though mid-2010 and summarized in two editions of the Handbook of Religion and Health [ 23 , 24 ]. How these systematic reviews were conducted, however, needs brief explanation. This is particularly true for ratings of study methodology that are used to summarize the findings below.

The systematic review to identify the studies presented in the Handbooks and summarized in this paper was conducted as follows. We utilized a combination of strategies to identify the studies (excluding most reviews or qualitative research). First, we systematically searched online databases (PsycINFO, MEDLINE, etc.) using the search words “religion,” “religiosity,” “religiousness,” and “spirituality” to identify studies on the R/S-health relationship. Second, we asked prominent researchers in the field to alert us to published research they knew about and to send us research that they themselves had conducted. Third, if there were studies cited in the reference lists of the studies located, we tracked down those as well. Using this method, we identified over 1,200 quantitative original data-based publications during the period 1872 to 2000 and 2,100 studies examining the R/S-health relationship from 2000 to 2010. All of these studies are described in the appendices of the two editions of the Handbook. Based on other reviews of the research conducted around this same time period (but more limited), we estimate that our review captured about 75% of the published research. Bear in mind that many, many more qualitative studies have been published on the topic that were not included in this review.

In order to assess the methodological quality of the studies, quality ratings were assigned as follows. Ratings of each of the more than 3,300 studies were made on a scale from 0 (low) to 10 (high) and were performed by a single examiner (HGK) to ensure rating consistency. Scores were determined according to the following eight criteria: study design (clinical trial, prospective cohort, cross-sectional, etc.), sampling method (random, systematic, or convenience), number of R/S measures, quality of measures, quality of mental health outcome measure, contamination between R/S measures and mental health outcomes, inclusion of control variables, and statistical method, based on a scheme adapted from Cooper [ 25 ]. Cooper emphasized the definition of variables, validity and reliability of measures, representativeness of the sample (sample size, sampling method, and response rates), research methods (quality of experimental manipulation and adequacy of control group for clinical trials), how well the execution of the study conformed to the design, appropriateness of statistical tests (power, control variables), and the interpretation of results.

To assess the reliability of the ratings, we compared HGK's ratings on 75 studies with the ratings made by an independent outside reviewer (Andrew Futterman, Ph.D., professor of psychology, College of the Holy Cross, a scientist familiar with the scoring criteria and active in the field of R/S-health research). When we examined correlations between HGK and Futterman's ratings, we found them moderately correlated (Pearson r = 0.57). Since scores of 7 or higher indicated higher quality studies, we also compared the scores between the two raters in terms of lower (0–6) versus higher (7–10) quality. This was done by dichotomizing scores into two categories (0–6 versus 7–10) and comparing the categories between the two examiners. The kappa of agreement ( κ ) between the two raters was 0.49 (where kappas of 0.40 to 0.75 indicate good agreement [ 26 ]). Overall, the raters agreed on whether quality was low or high in 56 of the 75 studies or 75%. I now summarize the results of the systematic review described above.

4. Religion, Spirituality, and Mental Health

Approximately 80% of research on R/S and health involves studies on mental health. One would expect stronger relationships between R/S and mental health since R/S involvement consists of psychological, social, and behavioral aspects that are more “proximally” related to mental health than to physical health. In fact, we would not expect any direct or immediate effects of R/S on physical health, other than indirectly through intermediary psychosocial and behavioral pathways. With regard to mental health, we would expect R/S to boost positive emotions and help neutralize negative emotions, hypothesizing that it serves as both a life-enhancing factor and as a coping resource. With regard to the latter, there is both qualitative and quantitative research suggesting that R/S helps people to deal better with adversity, either external adversity (difficult environmental circumstances) or internal adversity (genetic predisposition or vulnerability to mental disorders).

In the present paper, I have chosen to cite original reports as examples of the most rigorous studies in each area based on ratings in the Handbooks (i.e., 7 or higher on 0–10 scale). Cited here are both positive and negative studies reporting significant relationships. For some topics, such as well-being and depression, there are too many high-quality studies to cite, so only a few examples of the best studies are provided.

4.1. Coping with Adversity

In the first edition of the Handbook [ 27 ], we identified 110 studies published prior to the year 2000 and 344 studies published between 2000 and 2010 for a total of 454 studies. Among these reports are descriptions of how R/S helped people to cope with a wide range of illnesses or in a variety of stressful situations. These include people dealing with general medical illness [ 28 , 29 ], chronic pain [ 30 ], kidney disease [ 31 ], diabetes [ 32 , 33 ], pulmonary disease [ 34 ], cancer [ 35 , 36 ], blood disorders [ 37 ], heart/cardiovascular diseases [ 38 , 39 ], dental [ 40 ] or vision [ 41 ] problems, neurological disorders [ 42 ], HIV/AIDS [ 43 ], systemic lupus erythematosus [ 44 ], irritable bowel syndrome [ 45 ], musculoskeletal disease [ 46 ], caregiver burden [ 47 – 49 ],  psychiatric illness [ 50 , 51 ], bereavement [ 52 , 53 ], end-of-life issues [ 54 , 55 ], overall stress [ 56 – 58 ], natural disasters [ 59 , 60 ], war [ 61 , 62 ] or acts of terrorism [ 63 ], and miscellaneous adverse life situations [ 64 – 66 ]. In the overwhelming majority of studies, people reported that R/S was helpful.

4.2. Positive Emotions

Positive emotions include well-being, happiness, hope, optimism, meaning and purpose, high self-esteem, and a sense of control over life. Related to positive emotions are positive psychological traits such as altruism, being kind or compassionate, forgiving, and grateful.

4.2.1. Well-Being/Happiness

By mid-2010, at least 326 quantitative, peer-reviewed studies had examined relationships with R/S. Of those, 256 (79%) found only significant positive associations between R/S and well-being (including eight studies at a statistical trend level, that is, 0.05 < P < 0.10). Only three studies (<1%) reported a significant inverse relationship between R/S and well-being. Of the 120 studies with the highest methodological rigor (7 or higher in quality on the 0–10 scale), 98 (82%) reported positive relationships (including two at a trend level) [ 67 – 77 ] and one study reported a negative relationship (but only at a trend level) [ 78 ].

4.2.2. Hope

At least 40 studies have examined relationships with R/S, and of those, 29 (73%) reported only significant positive relationships with degree of hope; no studies found an inverse relationship. Of the six highest quality studies, half found a positive relationship [ 79 – 81 ].

4.2.3. Optimism

We located 32 studies examining relationships with R/S, and of those, 26 (81%) reported significant positive relationships. Of the 11 best studies, eight (73%) reported significant positive relationships [ 82 – 85 ]. Again, as with hope, no studies reported inverse relationships.

4.2.4. Meaning and Purpose

At least 45 studies have examined relationships with R/S, and 42 (93%) reported significant positive relationships. These studies were often in populations where there was a challenge to having meaning and purpose, such as in people with chronic disabling illness. Of the 10 studies with quality ratings of 7 or higher, all 10 reported significant positive associations [ 86 – 89 ].

4.2.5. Self-Esteem

Critics have claimed that R/S adversely affects self-esteem because it emphasizes humility rather than pride in the self [ 90 ]. Furthermore, R/S could exacerbate guilt in some for not living up to the high standards of conduct prescribed by religious traditions, resulting in low self-esteem. We found 69 studies that examined associations with R/S, and of those, 42 (61%) found greater self-esteem among those who were more R/S and two (3%) reported lower self-esteem. Of the 25 studies with the highest methodological rigor, 17 (68%) reported greater self-esteem [ 91 – 98 ] and two (8%) found worse self-esteem [ 99 , 100 ]. Not surprisingly, these findings are parallel to those of depression below (in the opposite direction, of course).

4.2.6. Sense of Control

Although one might expect R/S to correlate positively with an external locus of control (i.e., the Transcendent controlling events), and some studies confirm this, the majority of research finds a positive correlation with an internal not an external sense of control. Of 21 studies that have examined these relationships, 13 (61%) found that R/S was related to a greater sense of personal control in challenging life circumstances. Of the nine best studies, four reported significant positive relationships (44%) [ 101 – 104 ] and three report significant negative relationships (33%) [ 105 – 107 ], whereas the two remaining studies reported complex or mixed results (significant positive and negative associations, depending on R/S characteristic). R/S beliefs may provide an indirect sense of control over stressful situations; by believing that God is in control and that prayer to God can change things, the person feels a greater sense of internal control (rather than having to depend on external agents of control, such as powerful other people).

4.2.7. Positive Character Traits

With regard to character traits, the findings are similar to those with positive emotions. With regard to altruism or frequency of volunteering, 47 studies have examined relationships with R/S. Of those, 33 (70%) reported significant associations, whereas five (11%) found less altruism among the more R/S; of the 20 best studies, 15 (75%) reported positive relationships [ 108 – 113 ] and two (10%) found negative associations [ 114 , 115 ] (both concerning organ donations, which some religions prohibit). With regard to forgiveness, 40 studies have examined correlations with R/S, and 34 (85%) reported significant positive relationships and no studies found negative associations. Among the 10 highest quality studies, seven (70%) reported greater forgiveness among the more R/S [ 116 – 119 ], a finding that recent research has supported [ 120 ]. Regarding gratefulness, five of five studies found positive associations with R/S [ 121 , 122 ], and with regard to kindness/compassion, three of three studies reported significant positive relationship with R/S [ 123 ]. Admittedly, all of the studies measuring character traits above depend on self-report.

4.3. Depression

As with self-esteem, mental health professionals have argued that R/S might increase guilt by focusing on sin and could thus lead to depression. Again, however, this has not been found in the majority of studies. Given the importance of depression, its wide prevalence in the population, and the dysfunction that it causes (both mental and physical), I describe the research findings in a bit more detail. Overall, at least 444 studies have now examined relationships between R/S and depression, dating back to the early 1960s. Of those, 272 (61%) reported significant inverse relationships with depression (including nine studies at a trend level), and 28 (6%) found relationships between R/S and greater depression (including two studies at a trend level). Of the 178 studies with the highest methodological rigor, 119 (67%) reported inverse relationships [ 124 – 135 ] and 13 (7%) found positive relationships with depression [ 136 – 148 ].

Of 70 prospective cohort studies, 39 (56%) reported that greater R/S predicted lower levels of depression or faster remission of depression, whereas seven (10%) predicted worse future depression and seven (10%) reported mixed results (both significant positive and negative associations depending on R/S characteristic). Of 30 clinical trials, 19 (63%) found that R/S interventions produced better outcomes than either standard treatment or control groups. Two studies (7%) found standard treatments were superior to R/S interventions [ 149 , 150 ] and one study reported mixed results.

Note that an independent review of this literature published in 2003 found that of 147 studies involving 98,975 subjects, the average correlation between R/S and depression was −0.10. Although this is a small correlation, it translates into the same effect size that gender has on depressive symptoms (with the rate of depression being nearly twice as common in women compared to men). Also, the average correlation reported in the 2003 review was 50% stronger in stressed versus nonstressed populations [ 151 ].

A widely renowned psychiatric epidemiology group at Columbia University, led by Lisa Miller and Myrna Weissman, has come out with a series of recent reports on R/S and depression studying a cohort of low- and high-risk children born to parents with and without depressive disorder. The findings from this cohort support an inverse link between R/S and depression, particularly in high-risk individuals [ 152 – 154 ].

4.4. Suicide

Correlations between R/S and suicide attempt, completed suicide, and attitudes toward suicide are consistent with those found for depression, self-esteem, and hope. Those who are depressed, without hope, and with low self-esteem are at greater risk for committing suicide. At least 141 studies have now examined relationships between R/S and the suicide variables above. Of those, 106 (75%) reported inverse relationships and four (3%) found positive relationships. With regard to the 49 studies with the highest methodological rigor, 39 (80%) reported less suicide, fewer suicide attempts, or more negative attitudes toward suicide among the more R/S [ 155 – 170 ] and two (4%) found positive relationships (one study in Delhi, India [ 171 ], and one in college students distressed over R/S concerns [ 172 ]).

4.5. Anxiety

Anxiety and fear often drive people toward religion as a way to cope with the anxiety. Alternatively, R/S may increase anxiety/fear by its threats of punishment for evil deeds and damnation in the next life. There is an old saying that emphasizes this dual role: religion comforts the afflicted and afflicts the comforted. Sorting out cause and effect here is particularly difficult given the few prospective cohort studies that have examined this relationship over time. However, a number of clinical trials have also examined the effects of R/S interventions on anxiety levels. Overall, at least 299 studies have examined this relationship, and of those, 147 (49%) reported inverse association with R/S (three at a trend level), whereas 33 (11%) reported greater anxiety in those who were more R/S. Of the latter, however, only one was a prospective study, one was a randomized clinical trial, and 31 (94%) were cross-sectional studies (where it was not clear whether R/S caused anxiety or whether anxiety increased R/S as a coping response to the anxiety). Of the 67 studies with quality ratings of seven or higher, 38 (55%) reported inverse relationships [ 173 – 182 ] and seven (10%) found positive relationships (greater anxiety among the more R/S) [ 183 – 189 ].

Among these 299 studies were 239 cross-sectional studies, 19 prospective cohort studies, 9 single-group experimental studies, and 32 randomized clinical trials. Of the 19 longitudinal studies, 9 (47%) reported that R/S predicted a lower level of anxiety over time; one study (5%) found an increase in anxiety (among women undergoing abortion for fetal anomaly) [ 189 ], seven reported no association, and two reported mixed or complex results. Of the nine experimental studies, seven (78%) found a reduction in anxiety following an R/S intervention (before versus after comparison). Of the 32 randomized clinical trials, 22 (69%) reported that an R/S intervention reduced anxiety more than a standard intervention or control condition, whereas one study (3%) found an increase in anxiety following an R/S intervention in persons with severe alcohol dependence [ 190 ].

4.6. Psychotic Disorder/Schizophrenia

We identified 43 studies that have examined relationships between R/S and chronic psychotic disorders such as schizophrenia. Of the 43 studies examining psychosis, 14 (33%) reported inverse relationships between R/S and psychotic symptoms (one at a trend level), 10 (23%) found a positive relationship between R/S and psychotic symptoms (one at a trend level), eight reported mixed results (significant negative and positive associations, depending on the R/S characteristic measured), and one study reported complex results. Of these studies, seven had quality ratings of seven or higher; of those, two found inverse relationships, two found positive relationship, two reported mixed results (negative and positive), and one found no association. Note that the two studies finding inverse relationships between R/S and psychosis were both prospective studies [ 191 – 193 ], finding that R/S predicted better outcomes in subjects with psychotic disorders or symptoms. Of the two studies reporting positive relationships (both cross-sectional), one study found that importance of religion was significantly and positively associated with religious delusions [ 194 ] (not surprising), and the other study found that importance of religion was associated with “psychotic-like” symptoms in a national sample of Mexican Americans [ 195 ]; since the latter study involved participants who were not mentally ill, religion-related cultural factors may have influenced this finding. For a recent and more comprehensive discussion of R/S, schizophrenia, other chronic psychotic disorders, and the challenges distinguishing psychotic symptoms from religious beliefs, the reader is referred elsewhere [ 196 ].

4.7. Bipolar Disorder

Despite it's importance and wide prevalence, we could locate only four studies examining the relationship between R/S and bipolar (BP) disorder. Two found a positive association between R/S and bipolar disorder, and the remaining two reported mixed findings (both positive and negative correlations, depending on R/S characteristic). Of the two studies with high-quality ratings, one found a positive association and the other reported mixed findings. The first study of 334 US veterans with BP disorder found that a higher frequency of prayer or meditation was associated with mixed states and a lower likelihood of euthymia, although no association was found between any religious variable and depression or mania [ 197 ]. A second study examined a random national sample of 37,000 Canadians and found that those who attributed greater importance to higher spiritual values were more likely to have BP disorder, whereas higher frequency of religious attendance was associated with a lower risk of disorder [ 198 ]. In a qualitative study of 35 adults with bipolar disorder (not included in the review above), one of the six themes that participants emphasized when discussing their quality of life was the spiritual dimension. Over one-third of participants in that study talked about the relationship between BP disorder and R/S, emphasizing struggles to disentangle genuine spiritual experiences from the hyperreligiosity of the disorder. In another report, a case of mania precipitated by Eastern meditation was discussed; also included in this article was a review of nine other published cases of psychosis occurring in the setting of meditation [ 199 ].

4.8. Personality Traits

Personality traits most commonly measured today in psychology are the Big Five: extraversion, neuroticism, conscientiousness, agreeableness, and openness to experience. These are assessed by the NEO Personality Inventory [ 200 ]. Another personality inventory commonly used in the United Kingdom is the Eysenck Personality Questionnaire, which assesses extraversion, neuroticism, and psychoticism [ 201 ]. Relationships between personality traits and R/S using these measures have been examined in many studies [ 202 ]. With regard to psychoticism (a trait that assesses risk taking or lack of responsibility, rather than psychotic symptoms), 19 studies have examined its relationship to R/S, with 84% of those reporting significant inverse relationships (and no studies reporting a positive relationship). There have been at least 54 quantitative studies examined relationships between R/S and neuroticism, of which 24% found an inverse relationship and 9% reported a positive relationship (most of the remaining found no association). Concerning extraversion, there have been 50 studies, with 38% reporting a positive relationship with R/S and 6% reporting an inverse or negative relationship. With regard to conscientiousness, there have been 30 studies, of which the majority (63%) reported significant positive relationships with R/S and only 3% found significant inverse relationships. For agreeableness, 30 studies have examined relationships with R/S, and 87% of these studies reported positive relationships (no studies report inverse relationships). Finally, there have been 26 studies examining openness to experience, and of those, 42% found positive relationships with R/S and 12% reported negative relationships. Thus, R/S persons tend to score lower on psychoticism and neuroticism, and higher on extraversion, conscientiousness, agreeableness, and openness to experience. They score especially low on psychoticism and especially high on agreeableness and conscientiousness. These personality traits have physical health consequences that we are only beginning to recognize [ 203 – 205 ].

4.9. Substance Abuse

If R/S influences one domain of mental health, it is in the area of substance abuse. With regard to alcohol use, abuse, and dependence, at least 278 studies have now examined relationships with R/S. Of those, 240 (86%) reported inverse relationships and only 4 studies (1%) indicated a positive relationship. Of the 145 studies with the best methodology, 131 (90%) reported inverse relationships [ 206 – 221 ] and only one study found a positive relationship [ 222 ]. Findings are similar with regard to drug use or abuse. We located 185 studies, of which 84% reported inverse relationship with R/S and only two studies (1%) found positive relationships. Of the 112 best studies, 96 (86%) reported inverse relationships [ 223 – 238 ] and only one study found a positive relationship [ 239 ]. The vast majority of these studies are in young persons attending high school or college, a time when they are just starting to establish substance use habits (which for some will interfere with their education, future jobs, family life, and health). Thus, the protective effects of R/S on substance abuse may have influences on health across the lifespan.

4.10. Social Problems

Here I examine research in two areas of social instability (delinquency/crime and marital instability) and two areas of social stability (social support and social capital). Given the emphasis that most major world religions place on human relationships, love, and compassion, one might expect that some of the strongest relationships with R/S would be found here, and they are indeed.

4.10.1. Delinquency/Crime

At least 104 studies have examined relationships with R/S. Of those, 82 (79%) reported significant inverse relationships (five at a trend level), whereas three (3%) found positive relationships with more delinquency/crime. Of the 60 studies with quality ratings of 7 or higher, 49 (82%) reported inverse relationships [ 240 – 252 ] and only one study found a positive relationship [ 253 ]. Of particular interest are the 10 studies examining relationships between R/S and school grades/performance in adolescents and college students between 2000 and 2009, of which all 10 (100%) found that more R/S youth did better than less religious youth [ 254 ].

4.10.2. Marital Instability

We identified 79 studies that examined relationships with marital instability. Of those, 68 (86%) found R/S related to greater marital stability and no studies reported an association with greater marital instability. Of the 38 methodologically most rigorous studies, 35 (92%) reported significant relationships between R/S and greater marital stability [ 255 – 265 ]. An independent meta-analysis reviewing research conducted before the year 2000 likewise concluded that greater religiousness decreased the risk of divorce and facilitated marital functioning and parenting [ 266 ].

4.10.3. Social Support

There is substantial evidence indicating a relationship between R/S and social support. Of 74 quantitative peer-reviewed studies of R/S and social support, 61 (82%) found significant positive relationships, and none found inverse relationships. Of the 29 best studies, 27 (93%) reported significant positive relationships [ 82 , 267 – 274 ]. For older adults in particular, the most common source of social support outside of family members comes from members of religious organizations [ 275 , 276 ].

4.10.4. Social Capital

Social capital, an indirect measure of community health, is usually assessed by level of community participation, volunteerism, trust, reciprocity between people in the community, and membership in community-based, civic, political, or social justice organizations. Research has examined relationships between R/S and social capital. We located a total of 14 studies, with 11 (79%) finding significant positive relationships between R/S and level of social capital, and none reporting only inverse relationships. Almost all of these studies were of high quality, and of the 13 studies with ratings of seven or higher, 10 (77%) found that R/S was related to greater social capital [ 277 – 280 ].

5. Explaining the Relationship: R/S and Mental Health

R/S influences mental health through many different mechanisms, although the following are probably the predominant ones (see Figure 2 ). First, religion provides resources for coping with stress that may increase the frequency of positive emotions and reduce the likelihood that stress will result in emotional disorders such as depression, anxiety disorder, suicide, and substance abuse. Religious coping resources include powerful cognitions (strongly held beliefs) that give meaning to difficult life circumstances and provide a sense of purpose. Religions provide an optimistic worldview that may involve the existence of a personal transcendental force (God, Allah, Jehovah, etc.) that loves and cares about humans and is responsive to their needs. These cognitions also give a subjective sense of control over events (i.e., if God is in control, can influence circumstances, and be influenced by prayer, then prayer by the individual may positively influence the situation). Religious beliefs provide satisfying answers to existential questions, such as “where did we come from,” “why are we here,” and “where are we going,” and the answers apply to both this life and the next life, thus reducing existential angst. These beliefs also help to normalize loss and change and provide role models of persons suffering with the same or similar problems (often illustrated in religious scriptures). Thus, religious beliefs have the potential to influence the cognitive appraisal of negative life events in a way that makes them less distressing. For people with medical illness, these beliefs are particularly useful because they are not lost or impaired with physical disability—unlike many other coping resources that are dependent on health (hobbies, relationships, and jobs/finances).

Theoretical model of causal pathways for mental health (MH), based on Western monotheistic religions (Christianity, Judaism, and Islam). (Permission to reprint obtained. Original source: Koenig et al. [ 17 ]). For models based on Eastern religious traditions and the Secular Humanist tradition, see elsewhere. (Koenig et al. [ 24 ]).

Second, most religions have rules and regulations (doctrines) about how to live life and how to treat others within a social group. When individuals abide by those rules and regulations, this reduces the likelihood of stressful life events that reduce positive emotions and increased negative ones. Examples of stressful life events that religion may help people avoid are divorce or separation, difficulties with children, financial stress resulting from unfair practices in the marketplace, incarceration for lawbreaking (cheating or crime), and venereal diseases from risky sexual practices. Religions also usually discourage the use of drugs and excessive amounts of alcohol that increases the risk of engaging in the behaviors above (crime, risky sex) that are associated with negative mental health consequences.

Third, most religions emphasize love of others, compassion, and altruistic acts as well as encourage meeting together during religious social events. These prosocial behaviors have many consequences that buffer stress and lead to human support when support is needed during difficult times. Because religion encourages the helping of others and emphasizes a focus outside of the self, engagement in other-helping activities may increase positive emotions and serve to distract from one's own problems. Religion also promotes human virtues such as honesty, forgiveness, gratefulness, patience, and dependability, which help to maintain and enhance social relationships. The practice of these human virtues may also directly increase positive emotions and neutralize negative ones.

Thus, there are many possible mechanisms by which R/S may enhance mental and social health. This is not to say that R/S always does so. Religion may also be used to justify hatred, aggression, prejudice, and the exclusion of others; gain power and control over vulnerable individuals (as seen in cults); foster rigid thinking and obsessive practices; lead to anxiety, fear, and excessive guilt over minor infractions (and even self-mutilation in some cases); produce psychosocial strains due to failure to live up to high religious standards; lead to escape from dealing with family problems (through excessive involvement in religious or spiritual activities); and delay diagnosis and effective mental health care (due to antagonistic relationships with mental health professionals). While R/S is not a panacea, on the balance, it is generally associated with greater well-being, improved coping with stress, and better mental health. This relationship with mental health has physical health consequences (see Section 7 below).

6. Religion, Spirituality, and Health Behaviors

Religious doctrines influence decisions about health and health behaviors. In the Judeo-Christian scriptures, for example, there is an emphasis on caring for the physical body as a “Temple of the Holy Spirit” (see 1 Corinthian 6:19-20) [ 281 ]. Religious scriptures in other faith traditions also emphasize the person's responsibility to care for and nourish their physical body [ 282 – 284 ]. Behaviors that have the potential to harm the body are usually discouraged. This is reflected in teachings from the pulpit and influences what is considered appropriate within religious social groups. In summarizing the research on R/S and health behaviors, I cite only a few of the studies with high-quality ratings since there are so many.

6.1. Cigarette Smoking

The influence of R/S is most evident in it's “effects” on cigarette smoking. At least 137 studies have examined relationship between R/S and smoking, and of those, 123 (90%) reported statistically significant inverse relationships (including three at a trend level) and no studies found either a significant or even a trend association in the other direction. Of the 83 methodologically most rigorous studies, 75 (90%) reported inverse relationships with R/S involvement [ 213 , 285 – 294 ]. Not surprisingly, the physical health consequences of not smoking are enormous. Decreased cigarette smoking will mean a reduction in chronic lung disease, lung cancer, all cancers (30% being related to smoking), coronary artery disease, hypertension, stroke, and other cardiovascular diseases.

6.2. Exercise

Level of exercise and physical activity also appears linked to R/S. We located 37 studies that examined this relationship. Of those, 25 (68%) reported significant positive relationships (two at a trend level) between R/S involvement and greater exercise or physical activity, whereas six (16%) found significant inverse relationships. Of 21 studies with the highest quality ratings, 16 (76%) reported positive associations [ 82 , 295 – 300 ] and two (10%) found negative associations [ 296 , 301 ].

Writers in the popular press have encouraged the combining of R/S activity and exercise through “prayer walking” [ 302 , 303 ] and “walking meditation.” [ 304 ].

At least 21 studies have examined relationships between R/S and a healthy diet. A healthy diet here involves increased intake of fiber, green vegetables, fruit, and fish; low intake of snacks, processed foods, and fat; regular vitamin intake; frequent eating of breakfast; overall better nutrition (following recommended nutritional guidelines). Of those studies, 13 (62%) found a significant positive association between R/S and a healthier diet (one at a trend level) and one found a worse diet [ 305 ]. Among the 10 studies with the highest quality ratings, seven (70%) reported a better diet among those who were more R/S [ 213 , 306 – 310 ]. In addition, we identified 23 studies that examined relationships between R/S and blood cholesterol levels. Of those, more than half (12 studies) found significantly lower cholesterol among those who were more R/S, whereas three studies (13%) reported significantly higher cholesterol levels. Of the nine best studies, five (56%) reported lower cholesterol [ 311 – 313 ] or a lowering of cholesterol in response to a R/S intervention [ 314 , 315 ], whereas one found higher cholesterol (but only in Mexican American men) [ 316 ].

6.4. Weight

Although R/S people tend to eat a healthier diet, they also eat more of it. This, then, is the one health behavior that places R/S individuals at greater risk for medical illness. At least 36 studies have examined the associations between weight (or body mass index) and R/S involvement. Of those, 14 (39%) found a positive relationship (R/S associated with greater weight), whereas only seven (19%) reported an inverse relationship. The situation does not improve when results from the most rigorously designed studies are examined. Among the 25 studies with the highest quality ratings, 11 (44%) reported greater weight among the more R/S [ 82 , 317 – 322 ] and five (20%) found lower weight (or less underweight [ 323 ]). Lower weight among the more R/S appears only in a few religious groups (Amish [ 324 ], Jews [ 325 ], and Buddhists [ 326 ]), in those with certain demographic characteristics (white, older, and high education) [ 327 ], and in response to a specific R/S intervention [ 328 ] or practice [ 314 , 329 ]. Faith-based weight-reduction programs in religious communities have been shown to be effective [ 328 , 330 , 331 ].

6.5. Sexual Behavior

We identified 95 studies that examined relationships between R/S and risky sexual activity (sex outside of marriage, multiple partners, etc.). Of those, 82 studies (86%) found significant inverse relationships with R/S (one at a trend level) and only one study (1%) found a significant relationship with more risky sexual activity [ 332 ]. Of the 50 highest quality studies, 42 (84%) reported inverse relationships [ 333 – 343 ] and none found a positive one. If those who are more R/S engage in less risky sexual behavior, this means they should have fewer venereal diseases, that is, less syphilis, gonorrhea, herpes, chancroid, chlamydia, viral hepatitis, and human papillomavirus and human immunodeficiency virus, many of which have serious physical health consequences.

7. Religion, Spirituality, and Physical Health

There is rapidly growing evidence that stress and negative emotions (depression, anxiety) have (1) adverse effects on physiological systems vital for maintenance of physical health and healing [ 344 – 346 ], (2) increase susceptibility to or worse outcomes from a wide range of physical illnesses [ 347 – 351 ], and (3) may shorten the lifespan prematurely [ 352 , 353 ]. Social support, in turn, has long been known to protect against disease and increase longevity [ 354 – 356 ]. By reducing stress and negative emotions, increasing social support, and positively affecting health behaviors, R/S involvement should have a favorable impact on a host of physical diseases and the response of those diseases to treatment. As in the earlier sections, I cite high-quality studies as examples. Since there are fewer high-quality studies for physical health than for mental health or for health behaviors, I cite all of the studies with ratings of seven or higher.

7.1. Coronary Heart Disease (CHD)

Given the strong connections between psychosocial stressors, health behaviors, and CHD, it is not surprising that there is a link with R/S. Our review uncovered 19 studies that examined associations between R/S and CHD. Of those, 12 (63%) reported a significant inverse relationship, and one study reported a positive relationship. Of the 13 studies with the most rigorous methodology, nine (69%) found inverse relationships with CHD [ 357 – 365 ] and one found a positive one [ 366 ]. In addition, there have been at least 16 studies examining relationships between R/S and cardiovascular reactivity, heart rate variability, outcomes following cardiac surgery, and other cardiovascular functions. Of those, 11 studies (69%) reported that R/S was significantly related to positive cardiovascular functions or outcomes [ 367 – 374 ] or to lower levels of inflammatory markers such as C-reactive protein [ 375 – 377 ] and fibrinogen [ 378 ] that place individuals at high risk for cardiovascular disease.

7.2. Hypertension

The word “hypertension” itself suggests a relationship with stress or tension, and high blood pressure has been linked to greater psychosocial stress [ 379 – 381 ]. At least 63 studies have examined the relationship between R/S and blood pressure (BP), of which 36 (57%) reported significantly lower BP in those who are more R/S (five at a trend level) and seven (11%) reported significantly higher BP (one at a trend level). Of the 39 highest quality studies, 24 (62%) report lower BP (including one at a trend level) among those who are more R/S [ 382 – 394 ] or in response to an R/S intervention [ 328 , 395 – 404 ] (including a study whose results were reported twice, once for the overall sample and once for the sample stratified by race).

Two lower quality studies [ 405 , 406 ] and five well-done studies [ 407 – 411 ] (13%, including one at a trend level), however, reported higher BP in the more R/S or with religious fasting. The reason for an association between R/S and higher BP is not entirely clear. Perhaps, in certain population subgroups, intrapsychic religious conflict between psychosexual drives and religious standards creates unconscious stress that elevates BP. However, there is another possibility. This may be related to confounding by ethnicity. Three of the five studies reporting increased BP with increased R/S included in their samples a large proportion of ethnic minorities (samples from large urban settings such as Detroit and Chicago, made up of 36% to 100% African Americans). Since African Americans are more likely to have high BP (40% with hypertension) [ 412 ] and because African Americans are also the most religious ethnic group in society [ 413 ], it may be that controlling for race in these analyses is simply not sufficient to overcome this powerful confound.

7.3. Cerebrovascular Disease

Relationships between R/S, hypertension and other cardiovascular diseases or disease risk factors ought to translate into a lower risk of stroke. We located nine studies that examined this relationship, of which four reported a lower risk of stroke, all having quality ratings of seven or higher [ 414 – 417 ].

One study, however, reported significantly more carotid artery thickening, placing R/S individuals at higher risk for stroke [ 418 ]. Again, however, 30% of that sample was African American an ethnic group, known to be both highly religious and at high risk for stroke.

7.4. Alzheimer's Disease and Dementia

Physiological changes that occur with stress and depression (elevated blood cortisol, in particular) are known to adversely affect the parts of the brain responsible for memory [ 419 – 421 ]. The experience of negative emotions may be like pouring hydrochloric acid on the brain's memory cells [ 422 ]. By reducing stress and depression through more effective coping, R/S may produce a physiological environment that has favorable effects on cognitive functioning. Furthermore, R/S involvement may also engage higher cortical functions involved in abstract thinking (concerning moral values or ideas about the transcendent) that serve to “exercise” brain areas necessary for retention of memories. Regardless of the mechanism, at least 21 studies have examined relationships between R/S involvement and cognitive function in both healthy persons and individuals with dementia. Of those, 10 (48%) reported significant positive relationships between R/S and better cognitive functioning and three (14%) found significant negative relationships. Of the 14 studies with the highest quality ratings, eight (57%) reported positive relationships [ 423 – 430 ] and three (21%) reported negative relationships with cognitive function [ 431 – 433 ]. Studies finding negative relationships between R/S and cognitive function may be due to the fact that R/S persons have longer lifespans (see below), increasing the likelihood that they will live to older ages when cognition tends to decline. More recent research supports a positive link between R/S and better cognitive function in both dementia and in old age [ 434 , 435 ].

7.5. Immune Function

Intact immune function is critical for health maintenance and disease prevention and is assessed by indicators of cellular immunity, humoral immunity, and levels of pro- and anti-inflammatory cytokines. We identified 27 studies on relationships between R/S and immune functions, of which 15 (56%) found positive relationships or positive effects in response to a R/S intervention, and one (4%) found a negative effect [ 436 ]. Of the 14 studies with the highest quality ratings, 10 (71%) reported significant positive associations [ 437 – 443 ] or increased immune functions in response to a R/S intervention [ 444 – 447 ]. No high-quality study found only an inverse association or negative effect, although one study reported mixed findings [ 448 ]. In that study, religious attendance was related to significantly poorer cutaneous response to antigens; however, it was also related (at a trend level) to higher total lymphocyte count, total T-cell count, and helper T-cell count. In addition, importance of religious or spiritual expression was related to significantly higher white blood cell count, total lymphocyte count, total T cells, and cytotoxic T cell activity.

There have also been a number of studies examining R/S and susceptibility to infection (or viral load in those with HIV), which could be considered an indirect measure of immune function. We identified 12 such studies, of which eight (67%) reported significantly lower infection rates or lower viral loads in those who were more R/S (including one at a trend level); none found greater susceptibility to infection or greater viral load. Ten of the 12 studies had quality ratings of 7 or higher; of those, seven (70%) reported significant inverse associations with infection/viral load [ 440 , 441 , 449 – 454 ].

7.6. Endocrine Function

Because stress hormones (cortisol, epinephrine, and norepinephrine) have a known influence on immune (and cardiovascular) functions, they are important factors on the pathway between R/S involvement and health [ 455 , 456 ]. We identified 31 studies that examined R/S and associations with or effects on endocrine functions. Of those, 23 (74%) reported positive relationships or positive effects and no studies reported negative associations or negative effects. Of the 13 methodologically most rigorous studies, nine (69%) reported positive associations with R/S [ 457 – 461 ] or positive effects of an R/S intervention (all involving Eastern meditation) [ 462 – 465 ]. We (at Duke) are currently examining the effects of religious cognitive-behavioral therapy on a host of pro- and anti-inflammatory cytokines, cortisol, and catecholamines in patients with major depressive disorder, although results will not be available until 2014 [ 466 ].

7.7. Cancer

At least 29 studies have examined relationships between R/S and either the onset or the outcome of cancer (including cancer mortality). Of those, 16 (55%) found that those who are more R/S had a lower risk of developing cancer or a better prognosis, although two (7%) reported a significantly worse prognosis [ 467 , 468 ]. Of the 20 methodologically most rigorous studies, 12 (60%) found an association between R/S and lower risk or better outcomes [ 469 – 480 ], and none reported worse risk or outcomes. The results from some of these studies can be partially explained by better health behaviors (less cigarette smoking, alcohol abuse, etc.), but not all. Effects not explained by better health behaviors could be explained by lower stress levels and higher social support in those who are more R/S. Although cancer is not thought to be as sensitive as cardiovascular disorders to psychosocial stressors, psychosocial influences on cancer incidence and outcome are present (discussions over this are ongoing [ 481 , 482 ]).

7.8. Physical Functioning

Ability to function physically, that is, performing basic and instrumental activities of daily living such as toileting, bathing, shopping, and using a telephone, is a necessary factor for independent living. Persons who are depressed, unmotivated, or without hope are less likely to make attempts to maintain their physical functioning, particularly after experiencing a stroke or a fall that forces them into a rehabilitation program to regain or compensate for their losses. Several studies have examined the role that R/S plays in helping people to maintain physical functioning as they grow older or regain functioning after an illness. We identified 61 quantitative studies that examined relationships between R/S and disability level or level of functioning. Of those, 22 (36%) reported better physical functioning among those who were more R/S, 14 (23%) found worse physical functioning, and six studies reported mixed findings. Considering the 33 highest quality studies, 13 (39%) reported significantly better physical functioning among those who were more R/S (including one study at a trend level) [ 483 – 495 ], six (18%) found worse functioning [ 496 – 501 ], and five studies (15%) reported mixed results [ 82 , 124 , 502 – 504 ] (significant positive and negative associations, depending on R/S characteristic). Almost all of these studies involve self-reported disability and many were cross-sectional, making it impossible to determine order of causation—that is, (1) does R/S prevent the development of disability, (2) does disability prevent R/S activity, (3) does R/S promote disability, or (4) does disability cause people to turn to religion to cope with disability.

7.9. Self-Rated Health

There is more agreement across studies regarding the relationship between R/S and self-rated health (SRH) than between R/S and physical functioning. While based on participants' subjective impression, self-rated health is strongly related to objective health, that is, future health, health services use, and mortality [ 505 – 507 ]. Might R/S, perhaps because it is related to greater optimism and hope, influence one's self-perceptions of health in a positive way? At least 50 studies have now examined the relationship between R/S and self-rated health. Of those, 29 (58%) reported that R/S was related to better SRH, while five (10%) found that it was related to worse SRH. Of the 37 methodologically most rigorous studies, 21 (57%) reported significant positive relationships between R/S and SRH [ 503 , 508 – 527 ], whereas three (8%) found the opposite [ 528 – 530 ].

7.10. Pain and Somatic Symptoms

On the one hand, pain and other distressing somatic symptoms can motivate people to seek solace in religion through activities such as prayer or Scripture study. Thus, R/S is often turned to in order to cope with such symptoms. For example, in an early study of 382 adults with musculoskeletal complains, R/S coping was the most common strategy for dealing with pain and was considered the second most helpful in a long list of coping behaviors [ 531 ]. More recent research supports this earlier report [ 532 ]. On the other hand, R/S may somehow cause an increase in pain and somatic symptoms, perhaps by increasing concentration on negative symptoms or through the physical manifestations of hysteria, as claimed by Charcot in his copious writings around the turn of the 20th century [ 533 ].

We identified 56 studies that examined relationships between R/S and pain. Of those, 22 (39%) reported inverse relationships between R/S and pain or found benefits from an R/S intervention, whereas 14 (25%) indicated a positive relationship between R/S and greater pain levels (13 of 14 being cross-sectional). Of the 18 best studies, nine (50%) reported inverse relationships (less pain among the more R/S [ 534 ] or reduced pain in response to a R/S intervention [ 535 – 542 ]), while three (20%) reported positive relationships (worse pain in the more R/S) [ 543 – 545 ]. Research suggests that meditation is particularly effective in reducing pain, although the effects are magnified when a religious word is used to focus attention [ 546 , 547 ]. No clinical trials, to my knowledge, have shown that meditation or other R/S interventions increase pain or somatic symptoms.

7.11. Mortality

The most impressive research on the relationship between R/S and physical health is in the area of mortality. The cumulative effect of R/S, if it has any benefits to physical health, ought to reveal itself in an effect on mortality. The research suggests it does. At least 121 studies have examined relationships between R/S and mortality. Most of these are prospective cohort studies, where baseline R/S is assessed as a predictor of mortality during the observation period, controlling for confounders. Of those studies, 82 (68%) found that greater R/S predicted significantly greater longevity (three at a trend level), whereas six studies (5%) reported shorter longevity. Considering the 63 methodologically most rigorous studies (quality ratings of 8 or higher), 47 (75%) found R/S predicting greater longevity (two at trend level) [ 548 – 566 ], whereas three (5%) reported shorter longevity [ 567 – 569 ]. Another systematic review [ 570 ] and two meta-analyses [ 571 , 572 ] have confirmed this relationship between R/S and longer survival. The effects have been particularly strong for frequency of attendance at religious services in these three reviews. Survival among frequent attendees was increased on average by 37%, 43%, and 30% (mean effect being 37% across these reviews). An increased survival of 37% is highly significant and equivalent to the effects of cholesterol lowering drugs or exercise-based cardiac rehabilitation after myocardial infarction on survival [ 573 ].

8. Explaining the Relationship: R/S and Physical Health

How might R/S involvement influence physical health and longevity? There are at least three basic pathways: psychological, social, and behavioral (see Figure 3 ).

Theoretical model of causal pathways to physical health for Western monotheistic religions (Christianity, Islam, and Judaism). (Permission to reprint obtained. Original source: Koenig et al. [ 17 ]). For models based on Eastern religious traditions and the Secular Humanist tradition, see elsewhere (Koenig et al. [ 24 ]).

8.1. Psychological

As noted above, there is ample evidence that R/S—because it facilitates coping and imbues negative events with meaning and purpose—is related to better mental health (less depression, lower stress, less anxiety, greater well-being, and more positive emotions). Furthermore, several randomized clinical trials have shown that R/S interventions improve mental health (at least in those who are R/S). There is also much evidence that poor mental health has adverse physiological consequences that worsen physical health and shorten the lifespan (see earlier references). Thus, it stands to reason that R/S might influence physical health through psychological pathways.

8.2. Social

R/S involvement is associated with greater social support, greater marital stability, less crime/delinquency, and greater social capital. R/S beliefs and doctrines encourage the development of human virtues such as honesty, courage, dependability, altruism, generosity, forgiveness, self-discipline, patience, humility, and other characteristics that promote social relationships. Participation in a R/S community not only provides supportive social connections and opportunities for altruism (through volunteering or other faith-based altruistic activities), but also increases the flow of health information that may increase disease screening and promote health maintenance. Social factors, in turn, are known to influence both mental health and physical health and predict greater longevity [ 574 – 576 ]. Again, if R/S boosts supportive social interactions and increases community trust and involvement, then it should ultimately influence physical health as well.

8.3. Health Behaviors

Finally, R/S promotes better health behaviors, and is associated with less alcohol and drug use, less cigarette smoking, more physical activity and exercise, better diet, and safer sexual practices in the overwhelming majority of studies that have examined these relationships. Living a healthier lifestyle will result in better physical health and greater longevity. Consider the following report that appeared on CNN (Cable Network News). On January 3, 2009, after the death of the Guinness Book of World Records' oldest person, Maria de Jesus age 115, next in line was Gertrude Baines from Los Angeles. Born to slaves near Atlanta in 1894, she was described at 114 years old as “spry,” “cheerful,” and “talkative.” When she was 112 years old, Ms. Baines was asked by a CNN correspondent to explain why she thought she had lived so long. Her reply: “God. Ask Him. I took good care of myself, the way he wanted me to.” Brief and to the point.

8.4. Other Pathways

There are many ways by which R/S could have a positive influence on physical health, although the pathways above are probably the major ones. Genetic and developmental factors could also play a role in explaining these associations. There is some evidence that personality or temperament (which has genetic roots) influences whether or not a person becomes R/S. To what extent R/S persons are simply born healthier, however, is quite controversial. Note that more R/S persons are typically those with the least resources (minority groups, the poor, and the uneducated), both in terms of finances and access to healthcare resources. Karl Marx said that religion is the “opiate of the masses.” Rather than being born healthier, then, the opposite is more likely to be true for R/S persons. R/S could actually be viewed as acting counter to an evolutionary force that is trying to weed genetically vulnerable people from the population. R/S involvement is providing the weak with a powerful belief system and a supportive community that enables them to survive. For a more complete discussion of the role of genetic factors in the R/S-physical health relationship, see the Handbook [ 577 ].

Another important point needs to be made. Nowhere do I claim that supernatural mechanisms are responsible for the relationship between R/S and health. The pathways by which R/S influences physical health that researchers can study using the natural methods of science must be those that exist within nature—that is, psychological, social, behavioral, and genetic influences. Thus, this research says nothing about the existence of supernatural or transcendent forces (which is a matter of faith), but rather asks whether belief in such forces (and the behaviors that result from such beliefs) has an effect on health. There is every reason to think it does.

9. Clinical Implications

There are clinical implications from the research reviewed above that could influence the way health professionals treat patients in the hospital and clinic.

9.1. Rationale for Integrating Spirituality

There are many practical reasons why addressing spiritual issues in clinical practice is important. Here are eight reasons [ 578 ] (and these are not exhaustive).

First, many patients are R/S and have spiritual needs related to medical or psychiatric illness. Studies of medical and psychiatric patients and those with terminal illnesses report that the vast majority have such needs, and most of those needs currently go unmet [ 579 , 580 ]. Unmet spiritual needs, especially if they involve R/S struggles, can adversely affect health and may increase mortality independent of mental, physical, or social health [ 581 ].

Second, R/S influences the patient's ability to cope with illness. In some areas of the country, 90% of hospitalized patients use religion to enable them to cope with their illnesses and over 40% indicate it is their primary coping behavior [ 582 ]. Poor coping has adverse effects on medical outcomes, both in terms of lengthening hospital stay and increasing mortality [ 583 ].

Third, R/S beliefs affect patients' medical decisions, may conflict with medical treatments, and can influence compliance with those treatments. Studies have shown that R/S beliefs influence medical decisions among those with serious medical illness [ 584 , 585 ] and especially among those with advanced cancer [ 586 ] or HIV/AIDs [ 587 ].

Fourth, physicians' own R/S beliefs often influence medical decisions they make and affect the type of care they offer to patients, including decisions about use of pain medications [ 588 ], abortion [ 589 ], vaccinations [ 590 ], and contraception [ 591 ]. Physician views about such matters and how they influence the physician's decisions, however, are usually not discussed with a patient.

Fifth, as noted earlier, R/S is associated with both mental and physical health and likely affects medical outcomes. If so, then health professionals need to know about such influences, just as they need to know if a person smokes cigarettes or uses alcohol or drugs. Those who provide health care to the patient need to be aware of all factors that influence health and health care.

Sixth, R/S influences the kind of support and care that patients receive once they return home. A supportive faith community may ensure that patients receive medical followup (by providing rides to doctors' offices) and comply with their medications. It is important to know whether this is the case or whether the patient will return to an apartment to live alone with little social interaction or support.

Seventh, research shows that failure to address patients' spiritual needs increases health care costs, especially toward the end of life [ 592 ]. This is a time when patients and families may demand medical care (often very expensive medical care) even when continued treatment is futile. For example, patients or families may be praying for a miracle. “Giving up” by withdrawing life support or agreeing to hospice care may be viewed as a lack of faith or lack of belief in the healing power of God. If health professionals do not take a spiritual history so that patients/families feel comfortable discussing such issues openly, then situations may go on indefinitely and consume huge amounts of medical resources.

Finally, standards set by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) and by Medicare (in the US) require that providers of health care show respect for patients' cultural and personal values, beliefs, and preferences (including religious or spiritual beliefs) [ 593 ]. This point was reinforced by a personal communication with Doreen Finn ( [email protected] ), Senior Associate Director, who works under Mark Pelletier ( [email protected] ), Executive Director, JCAHO, Hospital Accreditation (January 6–12, 2012). If health professionals are unaware of those beliefs, they cannot show respect for them and adjust care accordingly.

9.2. How to Integrate Spirituality into Patient Care

What would I recommend in terms of addressing spiritual issues in clinical care?

First and foremost, health professionals should take a brief spiritual history. This should be done for all new patients on their first evaluation, especially if they have serious or chronic illnesses, and when a patient is admitted to a hospital, nursing home, home health agency, or other health care setting. The purpose is to learn about (1) the patient's religious background, (2) the role that R/S beliefs or practices play in coping with illness (or causing distress), (3) beliefs that may influence or conflict with decisions about medical care, (4) the patient's level of participation in a spiritual community and whether the community is supportive, and (5) any spiritual needs that might be present [ 594 ]. It is the health professional , not the chaplain, who is responsible for doing this two-minute “screening” evaluation. If spiritual needs are discovered, then the health professional would make a referral to pastoral care services so that the needs can be addressed. The spiritual history (and any spiritual needs addressed by pastoral services) should be documented in the medical record so that other health professionals will know that this has been done. Although notes need not be detailed, enough information should be recorded to communicate essential issues to other hospital staff.

Ideally, the physician, as head of the medical care team, should take the spiritual history. However, since only about 10% of physicians in the US “often or always” do so [ 595 ], the task often falls to the nurse or to the social worker. Although systematic research is lacking in this area, most nurses and social workers do not take a spiritual history either. Simply recording the patient's religious denomination and whether they want to see a chaplain, the procedure in most hospitals today, is NOT taking a spiritual history.

Second, R/S beliefs of patients uncovered during the spiritual history should always be respected. Even if beliefs conflict with the medical treatment plan or seem bizarre or pathological, the health professional should not challenge those beliefs (at least not initially), but rather take a neutral posture and ask the patient questions to obtain a better understanding of the beliefs. Challenging patients' R/S beliefs is almost always followed by resistance from the patient, or quiet noncompliance with the medical plan. Instead, the health professional should consult a chaplain and either follow their advice or refer the patient to the chaplain to address the situation. If the health professional is knowledgeable about the patient's R/S beliefs and the beliefs appear generally healthy, however, it would be appropriate to actively support those beliefs and conform the healthcare being provided to accommodate the beliefs.

Third, most health professionals without clinical pastoral education do not have the skills or training to competently address patients' spiritual needs or provide advice about spiritual matters. Chaplains have extensive training on how to do this, which often involves years of education and experience addressing spiritual issues. They are the true experts in this area. For any but the most simple spiritual needs, then, patients should be referred to chaplains to address the problem.

Fourth, conducting a spiritual history or contemplating a spiritual intervention (supporting R/S beliefs, praying with patients) should always be patient centered and patient desired. The health professional should never do anything related to R/S that involves coercion. The patient must feel in control and free to reveal or not reveal information about their spiritual lives or to engage or not engage in spiritual practices (i.e., prayer, etc.). In most cases, health professionals should not ask patients if they would like to pray with them, but rather leave the initiative to the patient to request prayer. The health professional, however, may inform R/S patients (based on the spiritual history) that they are open to praying with patients if that is what the patient wants. The patient is then free to initiate a request for prayer at a later time or future visit, should they desire prayer with the health professional. If the patient requests, then a short supportive prayer may be said aloud, but quietly, with the patient in a private setting. Before praying, however, the health professional should ask the patient what he or she wishes prayer for, recognizing that every patient will be different in this regard. Alternatively, the clinician may simply ask the patient to say the prayer and then quietly confirm it with an “amen” at the end.

Fifth, R/S beliefs of health professionals (or lack of belief) should not influence the decision to take a spiritual history, respect and support the R/S beliefs of patients, or make a referral to pastoral services. These activities should always be patient centered, not centered on the health professional. One of the most common barriers to addressing spiritual issues is health professionals' discomfort over discussing such issues. This often results from lack of personal R/S involvement and therefore lack of appreciation for the importance and value of doing so. Lack of comfort and understanding should be overcome by training and practice. Today, nearly 90% of medical schools (and many nursing schools) in the US include something about R/S in their curricula [ 596 ] and this is also true to a lesser extent in the United Kingdom [ 597 ] and Brazil [ 598 ]. Thus, spirituality and health is increasingly being addressed in medical and nursing training programs.

Sixth, health professionals should learn about the R/S beliefs and practices of different religious traditions that relate to healthcare, especially the faith traditions of patients they are likely to encounter in their particular country or region of the country. There are many such beliefs and practices that will have a direct impact on the type of care being provided, especially when patients are hospitalized, seriously ill or near death. A brief description of beliefs and practices for health professionals related to birth, contraception, diet, death, and organ donation is provided elsewhere [ 599 ].

Finally, if spiritual needs are identified and a chaplain referral is initiated, then the health professional making the referral is responsible for following up to ensure that the spiritual needs were adequately addressed by the chaplain. This is especially true given the impact that unmet spiritual needs are likely to have on both medical outcomes and healthcare costs. Given the short lengths of stay in today's modern hospital (often only 2–4 days), spiritual needs identified on admission are unlikely to be resolved by discharge. Therefore, a spiritual care discharge plan will need to be developed by the hospital social worker in consultation with the chaplain, which may involve (with the patient's written consent) contact with the patient's faith community to ensure that spiritual needs are addressed when the patient returns home. In this way, continuity of pastoral care will be ensured between hospital and community.

10. Conclusions

Religious/spiritual beliefs and practices are commonly used by both medical and psychiatric patients to cope with illness and other stressful life changes. A large volume of research shows that people who are more R/S have better mental health and adapt more quickly to health problems compared to those who are less R/S. These possible benefits to mental health and well-being have physiological consequences that impact physical health, affect the risk of disease, and influence response to treatment. In this paper I have reviewed and summarized hundreds of quantitative original data-based research reports examining relationships between R/S and health. These reports have been published in peer-reviewed journals in medicine, nursing, social work, rehabilitation, social sciences, counseling, psychology, psychiatry, public health, demography, economics, and religion. The majority of studies report significant relationships between R/S and better health. For details on these and many other studies in this area, and for suggestions on future research that is needed, I again refer the reader to the Handbook of Religion and Health [ 600 ].

The research findings, a desire to provide high-quality care, and simply common sense, all underscore the need to integrate spirituality into patient care. I have briefly reviewed reasons for inquiring about and addressing spiritual needs in clinical practice, described how to do so, and indicated boundaries across which health professionals should not cross. For more information on how to integrate spirituality into patient care, the reader is referred to the book, Spirituality in Patient Care [ 601 ]. The field of religion, spirituality, and health is growing rapidly, and I dare to say, is moving from the periphery into the mainstream of healthcare. All health professionals should be familiar with the research base described in this paper, know the reasons for integrating spirituality into patient care, and be able to do so in a sensible and sensitive way. At stake is the health and well-being of our patients and satisfaction that we as health care providers experience in delivering care that addresses the whole person—body, mind, and spirit.

Conflict of Interests

The author declares that he has no conflict of interests.

Acknowledgment

The support to write this paper was provided in part by the John Templeton Foundation.

ORIGINAL RESEARCH article

The role of spirituality and religiosity in subjective well-being of individuals with different religious status.

• Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy

Spirituality and religiosity have been found to be positive predictors of subjective well-being, even if results are not altogether consistent across studies. This mixed evidence is probably due to the inadequate operationalization of the constructs as well as the neglect of the moderation effect that the individuals’ religious status can have on the relation between spirituality/religiosity and subjective well-being. The current study aimed to investigate the relationship of spirituality and religiosity with subjective well-being (operationalized as both life satisfaction and balance between positive and negative affect) and to test whether differences exist according to individuals’ religious status (religious, non-religious, and uncertain). Data were collected from 267 Italian adults aged 18–77 ( M = 36.68; SD = 15.13), mainly women (59.9%). In order to test the role of spirituality (operationalized as Purpose, Innerness, Interconnection, and Transcendence) and religiosity (operationalized as three dimensions of the religious identity: Commitment, In-depth Exploration, and Reconsideration of Commitment) in subjective well-being, two path analysis models were run, one for each predictor. To test the invariance of the two models across the individuals’ religious status, two multi-group models were run. The models concerning spirituality were tested on the entire sample, finding that spirituality had a positive impact on subjective well-being (except for the dimension of Interconnection) and that this relation is unaffected by the individual’s religious status. The models concerning religiosity were instead tested only on religious and uncertain, finding that the relationship between religiosity and subjective well-being changes across religious status. In particular, the main difference we found was that religious identity commitment positively predicted satisfaction with life among religious, but not among uncertain individuals. An interpretation of the results and their implications are discussed.

Introduction

Subjective well-being (SWB) concerns people’s evaluations of the quality of their own lives ( Diener, 1984 ; Stratham and Chase, 2010 ). This appraisal comprises a cognitive and an affective component ( Diener, 1984 ; Luhmann, 2017 ; Diener et al., 2018 ), which refer, respectively, to cognitive judgments about achieving important values and goals in the life span of the individual and to the balance between positive and negative affect ( Luhmann et al., 2012a , b ). Thus, SWB corresponds to an overall satisfaction with one’s life (e.g., Diener, 1984 ) and long-term levels of happiness that result from a global self-evaluation of whether individuals are living a good existence or not ( Diener and Seligman, 2004 ; Diener et al., 2009a ; Diener, 2012 ).

In the literature, the affective dimension of SWB has been alternatively operationalized and measured as the presence of positive well-being (e.g., happiness; Sagiv and Schwartz, 2000 ; Pollard and Lee, 2003 ), the prevalence of positive affect [e.g., the Positive and Negative Affect Schedule (PANAS), Watson et al., 1988 ; the Scale of Positive and Negative Experience (SPANE), Diener et al., 2009b ], or the absence of negative affect ( Cummins, 2013 ). The cognitive dimension of SWB – that is life satisfaction – has been measured through both the Satisfaction With Life Scale (SWLS; Diener et al., 1985 ), which refers to a global evaluation of life satisfaction (e.g., Mak et al., 2011 ), and the Personal Well-being Index (PWI; Cummins and Lau, 2004 ), which requires a domain evaluation of life satisfaction ( Lai et al., 2013 ).

Different aspects may contribute to and influence how people appraise the many facets of their lives, ranging from individual characteristics that distinguish between happy and unhappy personalities, to values people consider important and worth pursuing in life or the fulfillment of social needs ( Balzarotti et al., 2016 ; Diener et al., 2018 ; Schwartz and Sortheix, 2018 ). Among others, a growing body of research investigates the role that spirituality and religiosity play in individuals’ self-perceived well-being, identifying a positive effect of religion and spirituality on many psychosocial and health-related outcomes across the lifespan (e.g., Fabricatore et al., 2000 ; Fry, 2000 ; Mueller et al., 2001 ; George et al., 2002 ; Levin and Chatters, 2008 ; Krause, 2011 ; VanderWeele, 2017 ).

Given the complexity of religiosity and spirituality constructs, it turns out to be critical to specify how these concepts have been conceptualized in literature. In line with Pargament (1997) , religiosity and spirituality are intended in terms of the individual’s values, beliefs, behaviors, and identity, which may focus on either the sacred or the functional aspects of religion.

Specifically, on the one hand, religiosity is often seen as “the formal, institutional, and outward expression” ( Cotton et al., 2006 , p. 472) of one’s relationship with the sacred, and it is typically operationalized as beliefs and practices associated with a particular religious worldview and community ( Iannello et al., 2019 ). On the other hand, spirituality is conceptualized as the search for meaning in life, for a personal connection with transcendent realities, and for interconnectedness with humanity ( Zinnbauer et al., 1999 ; Benson and Roehlkepartain, 2008 ; Worthington et al., 2011 ), and it is thus operationalized as the human desire for transcendence, introspection, interconnectedness, and the quest for meaning in life ( King and Boyatzis, 2015 ), which can be experienced in and/or outside of a specific religious context ( Benson et al., 2003 ).

Association Between Religiosity, Spirituality, and Subjective Well-Being

Spirituality and religiosity have been found to be positive predictors of SWB, even if results are not altogether consistent across studies ( Kim-Prieto and Miller, 2018 ). Concerning the cognitive dimension of SWB, a number of studies found a positive relationship between spirituality as well as religiosity and life satisfaction ( Yoon and Lee, 2004 ). To explain these findings, it has been suggested that people who experience more connection with and direction from a higher power, that is, people who show high religious and spiritual involvement, tend to give a more positive appraisal of their lives ( Vishkin et al., 2016 , 2019 ; Ramsay et al., 2019 ). The sense of being in connection with a higher power, with others, and, in general, with life represents an effective way to maintain a positive evaluation of one’s life, despite all the possible negative circumstances that one may encounter. Additionally, religious and spiritual involvement may benefit individuals’ lives through empowering both internal (e.g., feeling of self-worth) and social (e.g., sense of belonging to a network) resources ( Lim and Putnam, 2010 ).

Further support to this view consists in the role of religious beliefs and practices that are usually positively related to life satisfaction ( Koenig and Larson, 2001 ; Abu-Raiya et al., 2015 ; Krause, 2015 ). Holding beliefs with strong conviction, whether referring to the existence or non-existence of God, may itself exert a salutary effect and enhance individual well-being by reducing the cognitive dissonance. In the absence of subjective certainty, people could experience a state of psychological tension that they are motivated to reduce ( Kahneman et al., 1982 ; Kitchens and Phillips, 2018 ). This could be the underlying reasons to the fact that once religious and non-religious individuals are fairly compared regarding the strength of their beliefs, they report a similar level of well-being, as showed by Galen and Kloet (2011) .

To better understand the role of religiosity on SWB, it is also important to consider how religiosity is conceived within the specific background culture. For example, Graham and Crown (2014) used a large-scale dataset including about 160 nations, and they found an overall positive relation between religiosity and SWB moderated by culture. Specifically, in cultures with high levels of religiosity, being religious had a greater impact on SWB, compared to cultures with low levels of religiosity. The same result has been found by Stavrova et al. (2013) : by using the European and World Values Studies datasets, the authors found that the predictive power of religiosity on life satisfaction was greater in highly religious cultures, whereas the relation was negative in cultures that valued atheism.

However, other research failed to find any connection between religiosity and life satisfaction ( Kirkpatrick and Shaver, 1992 ; Mak et al., 2011 ), thus questioning the existence of a direct relationship between individuals’ beliefs as well as attitudes toward religion and their own satisfaction with life.

As for the effect of religiosity and spirituality on the affective dimension of SWB, findings are mixed as well. Some studies, which reported a weak relationship between religiosity/spirituality and positive affect ( Diener et al., 2011 ; Lun and Bond, 2013 ), highlighted a possible effect of the social structure provided by religious affiliation on experiencing positive affect.

In particular, it seems that some practices – such as prayer – positively contribute in inducing positive states such as gratitude ( Lambert et al., 2009 ). Moreover, recent studies report the role played by self-transcendent emotions, such as awe, hope, love, and forgiveness in mediating the relationship between religion and well-being ( Van Cappellen et al., 2016 ). These studies emphasize the role of religiosity in the induction of positive emotions ( Fredrickson, 2002 ).

Furthermore, according to Ramsay et al. (2019) , another important mechanism that can explain the relationship between religiosity and well-being is that of emotional regulation, which consists in the modulation of emotional states functionally to the environment’s demands. To the extent that religion constantly trains people to reassess emotional events, religious individuals may become more used to cognitive reappraisal. These hypotheses have recently been confirmed by studies by Vishkin et al. (2016) , even among individuals of different religions ( Vishkin et al., 2019 ).

Other studies failed to report a correlation between religiosity/spirituality and positive/negative affect ( Fabricatore et al., 2000 ), thus suggesting that being more religiously involved and spiritually integrated does not relate significantly to one’s affective experience.

A possible explanation of the inconsistency of findings across studies might lie in the different operationalization of these constructs and in the diverse instruments used to measure them. Both religiosity and spirituality have been defined and measured differently across studies. Multiple and different indicators of religiosity and spirituality have been associated with SWB, thus accounting, at least partly, for the mixed evidence ( Lun and Bond, 2013 ).

The Present Study

The literature about the relationship between religiosity, spirituality, and SWB has not yet achieved consistent results ( Lun and Bond, 2013 ; Kim-Prieto and Miller, 2018 ), and we argue that there are three main general flaws in this research field.

First, the theoretical framework used to define and measure SWB as associated with religiosity and spirituality has often been too broad and focused only on the cognitive or the affective dimension of SWB, thus leading to an incomplete investigation ( Lim and Putnam, 2010 ). To overcome this weakness, in the present study, we clarified the theoretical reference model about SWB as including both a cognitive and an affective component ( Diener, 1984 ; Luhmann, 2017 ; Diener et al., 2018 ), and we used the typical measures to assess them, which are life satisfaction and balance between positive and negative affect ( Diener et al., 1985 ; Watson et al., 1988 ; Luhmann et al., 2012a , b ).

Second, religiosity and spirituality constructs appear in literature as distinct even if interconnected ( Zinnbauer et al., 1999 ; Hill and Pargament, 2008 ), and the studies have typically considered only one of the two and its association with SWB ( Fabricatore et al., 2000 ; Lun and Bond, 2013 ; Kim-Prieto and Miller, 2018 ). Such a basic distinction may not be helpful for understanding how religion and spirituality differ in their associations with dimensions of SWB. In the present study, we operationalized religiosity in terms of religious identity, which refers to the extent to which people see their religious beliefs, practices, and community belonging as central to the representation that they have of themselves and that they want to give outside of themselves ( Lopez et al., 2011 ). Spirituality instead was operationalized as the human desire for transcendence, introspection, interconnectedness and the quest for meaning in life ( King and Boyatzis, 2015 ). The distinct role of religiosity and spirituality on SWB has been tested through two separate path analysis models.

Third, we noticed that the grouping of religious experience reported on a subjective level was not univocal ( Galen and Kloet, 2011 ; Kitchens and Phillips, 2018 ). In several studies, those with weak belief (low or weakly religious) and those with complete non-belief (completely non-religious or atheists) have been conflated in one group, thus combining opposite poles on the certainty of belief dimension (i.e., weakly religious with confidently non-religious). This grouping made it difficult to compare the obtained results. Following the suggestion by Galen and Kloet (2011) , in the present study, we distinguished participants according to their religious status without collapsing the completely non-religious individuals and the uncertain ones.

Specifically, starting from these premises, the present study aims at (1) investigating the role of religiosity and spirituality on the cognitive and affective dimension of SWB and (2) studying whether the relationship between religiosity/spirituality and SWB varies according to the individuals’ religious status (religious, non-religious, uncertain).

Materials and Methods

An advertisement for research participation containing a hyperlink to a questionnaire on a secure server of the Psychology Department was sent by email to students’ and researchers’ personal contacts. Then, the sample was recruited through non-random snowball sampling.

The online survey took approximately 25 min to complete. Participating in the survey was entirely voluntary without any form of compensation. All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Ethical Committee of the Department of Psychology of Università Cattolica del Sacro Cuore of Milan.

Participants

Data were collected from December 2017 to May 2018. The convenient sample was composed of 267 Italian adults aged 18–77 ( M = 36.68; SD = 15.13), mainly women (59.9%). For what concerns their religious status, most of the participant reported to be religious (58.1%), whereas 14.2% stated they were non-religious. The remaining 27.7% of participants were declared to have unsure beliefs about their religious status as they stated they were neither religious nor non-religious. Only to religious and uncertain participants we asked to select which religious they belong to and 95.9% of them reported to be Christian (mainly Catholic).

In order to validate the religious statuses (religious, non-religious, and uncertain) that participants attributed to themselves, we assessed behavioral indicators of religiosity ( Fincham et al., 2010 ; Krause, 2010 ) by asking them to report the frequency of their attendance to religious services as well as the frequency of their praying on a 5-point scale (0 = never; 1 = only in special occasions; 2 = rarely; 3 = at least once a month; 4 = at least once a week; 5 = every day or almost every day).

Religious participants stated they attended church services at least once a month ( M = 2.97; SD = 1.33) and to prayed at least once a week ( M = 3.74; SD = 1.50). Non-religious participants reported that they do attend religious services ( M = 0; SD = 0) and do not pray ( M = 0.27; SD = 1.08). Finally, people that felt to be between religious and non-religious (i.e., uncertain) stated that they attended religious services ( M = 1.19; SD = 1.03) and prayed ( M = 1.10; SD = 1.31) only in special occasions.

Spirituality

Spirituality was assessed using the Italian version ( Iannello et al., 2019 ) of the 28-item Spirituality Assessment Scale ( Howden, 1992 ). Items were rated on a 6-point scale from 1 (strongly disagree) to 6 (strongly agree) and belonged to four different subscales. Specifically, the Purpose subscale is composed of four items (sample item: “My life has meaning and purpose”), and the Innerness (sample item: “I have an inner strength”) and the Interconnection (sample item: “I have a general sense of belonging”) subscales are both composed of nine items, while the Transcendence subscale (sample item: “Even when I feel discouraged, I trust that life is good”) is composed of six items. As this scale is not yet validated on the Italian population, we verified that the expected factorial structure fitted well our data, obtaining sufficient fit indices: χ 2 (307) = 590.13; p < 0.001; RMSEA = 0.06 (0.05, 0.07); p = 0.010; CFI = 0.900; SRMR = 0.06. This scale resulted to be also highly reliable. The Cronbach’s α for the four subscales was α = 0.835, α = 0.846, α = 0.801, and α = 0.713, respectively.

Religiosity

Religious identity formation was measured by the 13-item Utrecht-Management of Identity Commitments Scale (U-MICS; Crocetti et al., 2008 , 2010 ) that assesses three identity formation processes (commitment, in-depth exploration, and reconsideration of commitment) within the religious domain ( Iannello et al., 2019 ). Specifically, individuals must make identity commitments, such as to particular religious worldviews, but then they can either deepen those commitments through in-depth exploration – which involves the desire to reflect, learn, and share their commitments – or step back and reconsider those commitments, perhaps in preparation to disengage from them and redirect toward different religious beliefs ( Crocetti et al., 2008 ). The U-MICS scale has been already validated in Italy ( Crocetti et al., 2010 ), but in domains other than religious identity. Consequently, we verified that the expected three-factor structure was confirmed also on our sample. We obtained sufficient fit indices: χ 2 (62) = 162.03; p < 0.001; RMSEA = 0.08 (0.07, 0.10); p < 0.001; CFI = 0.938; SRMR = 0.04.

As expected, the scale is composed of three subscales, each corresponding to a different identity formation process: the 5-item Commitment subscale (sample item: “My religion gives me security in life”), the 5-item In-depth exploration subscale (sample item: “I try to find out a lot about my religion”), and the 3-item Reconsideration of commitment subscale (sample item: “I often think that a different religion would make my life more interesting”). Items were rated on a 5-point scale from 1 (completely untrue) to 5 (completely true). All the subscales were highly reliable, respectively α = 0.936, α = 0.906, and α = 0.864. This scale was administered only to participants who reported to be religious or uncertain, as we argued that non-religious had a religious status that could not allow them to answer items referring to “my religion.”

Life Satisfaction

The cognitive dimension of the SWB was measured by the Italian version of the Satisfaction with Life Scale (SWLS; Diener et al., 1985 ; Di Fabio and Busoni, 2009 ). The scale is composed of five items (sample item: “If I could live my life over, I would change almost nothing.”) eventuated of a 7-point scale (1 = strongly disagree; 7 = strongly agree). Internal consistency of the scale was high (α = 0.862).

Positive and Negative Affect

The emotional dimension of the SWB was measured by the Italian version of the Positive and Negative Affect Schedule (PANAS; Watson et al., 1988 ; Terraciano et al., 2003 ). It consists of a list of 20 adjectives used to describe different feelings and emotions: 10 positive moods/emotions and 10 negative moods/emotions. Participants must indicate if they feel these emotions in that moment with a 5-point scale (1 = not at all; 5 = completely). Both the 10-item Positive Affect subscale (sample item: “interested”) and the 10-item Negative Affect (sample item: “nervous”) were highly reliable, respectively, α = 0.884 and α = 0.897.

Data Analysis

First, descriptive statistics were run for all the variables involved in the current study, separately for the three groups here investigated (religious, non-religious, and uncertain). SPSS (Version 20; IBM Corp., 2011 ) software was adopted. Second, the relationships between predictors (spirituality and religiosity) and outcome (SWB) were tested performing path analysis models separately for each predictor.

All models were run in Mplus (version 7; Muthén and Muthén, 1998–2014 ). As suggested by Rhemtulla et al. (2012) , variables measured on a 5- or more-point Likert scale were treated as continuous, allowing the adoption of Maximum Likelihood as estimator. Missing on each item, ranging from 0 to 7.83%, resulted in Missing Completely at Random [Little test’s χ 2 (114) = 139.194; p = 0.054] and was managed using the Full Information Maximum Likelihood method.

Spirituality and Subjective Well-Being

The model testing the relationship between spirituality (measured by four subscales: Purpose, Innerness, Interconnection, and Transcendence) and SWB (measured by three dimensions: Life Satisfaction, Positive Affect, and Negative Affect) was run on the entire sample ( n = 267), assuming that spirituality can be experienced regardless of religious status. As correlations were required among the four predictors’ dimensions as well as among the three outcomes’ dimensions, the model was saturated and it automatically fits the data perfectly.

In order to verify if the relationships found in the model run on the entire sample were invariant across the different religious statuses (religious, non-religious, and uncertain), a multi-group model was run where all the correlational and regression paths were constrained to be the same across groups. Since this alternative model was not saturated, overall fit indexes were meaningful. Model fit was evaluated adopting the following indexes: χ 2 value, Root Mean Squared Error of Approximation (RMSEA), and Comparative Fit Index (CFI). The model χ 2 is a measure of poor fit, such that large, significant χ 2 values indicate that the model fits the data poorly, whereas non-significant χ 2 values indicate that the model is consistent with the data. Additionally, RMSEA is a measure of poor fit, and values close to zero indicate better fit (i.e., values less than 0.08 indicate reasonable fit and values below 0.05 indicate good fit; Marsh et al., 2004 ). By contrast, CFI is a measure of goodness of fit, with values close to 1 indicating a good model. However, CFI values less than 0.90 indicate that the model does not fit the data well ( Marsh et al., 2004 ).

A χ 2 difference test ( Bollen, 1989 ) was used to evaluate whether adding the equality constraint (i.e., imposing all the paths to be the same across different religious statuses) led to significant decrement in fit. As the baseline model (i.e., the model in which the paths were freely estimated separately for each group) was a saturated model, the constrained model’s χ 2 , when non-significant ( p > 0.05), indicated that the relation between spirituality and SWB was invariant across religious, non-religious, and uncertain. Vice versa, significant χ 2 ( p < 0.05) of the constrained model indicated that at least one path was significantly different across groups. In this case, the constrained model had to be modified by setting one path “free” (non-invariant) in one of the three groups. As suggested by Dimitrov (2010) , the path to start freeing was selected based on modification indices reported in Mplus output.

Religiosity and Subjective Well-Being

The model testing the relationship between religious identity formation (measured by three subscales: Commitment, In-depth Exploration, and Reconsideration of Commitment) and SWB (measured by three dimensions: Life Satisfaction, Positive Affect, and Negative Affect) was run on a sub-sample ( n = 229), composed only of religious and uncertain, as we did not administer items about religiosity to those who were non-religious. As correlations were required among the three predictors’ dimensions as well as among the three outcomes’ dimensions, this model was saturated.

In order to verify if the relationships found in this model were invariant between religious and uncertain, a multi-group model was run where all the correlational and regression paths were constrained to be the same across the two groups.

As for the spirituality models, model fit was evaluated by χ 2 value, RMSEA, and CFI ( Marsh et al., 2004 ). A χ 2 difference test ( Bollen, 1989 ) was used to compare the free and the constrained models. If full invariance was not reached (i.e., significant χ 2 ), one path at a time was freeing according to modification indices ( Dimitrov, 2010 ).

Descriptive Statistics

In Table 1 , we reported the mean and the standard deviation for each variable investigated in this study, separately for diverse participants’ religious statuses (non-religious, uncertain, and religious). Statistics about religiousness dimensions are not available for non-religious participants as the instrument measuring religious identity was not administered to them.

Table 1 . Descriptive statistics separately for the participants’ religious status.

Results of the saturated model testing the relationship between spirituality (measured by four subscales: Purpose, Innerness, Interconnection, and Transcendence) and SWB (measured by three dimensions: Life Satisfaction, Positive Affect, and Negative Affect) were reported in Figure 1 . This model was run on all the participants (religious, non-religious, and uncertain).

Figure 1 . Path analysis testing the influence of spirituality on SWB ( n = 267). Only significant correlational and regression paths are represented ( * p < 0.05; ** p < 0.01; *** p < 0.001). Standardized values are reported.

In order to verify if the model represented in Figure 1 works equally for religious, non-religious, and uncertain, a multi-group model was run where all the (significant and non-significant) correlational and regression paths were constrained to be the same across groups. This constrained model had very good fit indices [ χ 2 (42) = 44.62; p = 0.36; RMSEA = 0.026 (0.000, 0.078); p = 0.71; CFI = 0.989]. Furthermore, the non-significant χ 2 showed that the impact of the spirituality on the SWB is the same regardless of the individual’s religious status.

Results of the saturated model testing the relationship between religious identity formation (measured by three subscales: Commitment, In-depth Exploration, and Reconsideration of Commitment) and SWB (measured by three dimensions: Life Satisfaction, Positive Affect, and Negative Affect) were reported in Figure 2 . This model was run only on religious and uncertain.

Figure 2 . Path analysis testing the influence of religious identity formation on SWB ( n = 229). Only significant correlational and regression paths are represented ( * p < 0.05; ** p < 0.01; *** p < 0.001). Standardized values are reported.

In order to verify if the relationships reported in Figure 2 were invariant between religious and uncertain, a multi-group model was run where all the (significant and non-significant) correlational and regression paths were constrained to be the same across the two groups. The model fully constrained resulted to be non-invariant between religious and uncertain (significant χ 2 ; see Table 2 ). In order to reach a constrained model non-significantly different (i.e., non-significant χ 2 ) from the baseline model (i.e., model with parameters free to be different between religious and uncertain), four parameters were successively made free (see Table 2 ). Four parameters non-invariant between the two religious statuses were reported in Table 3 .

Table 2 . Fit indices of models testing the relationship between religiosity and subjective well-being.

Table 3 . Religiosity model’s non-invariant parameters between religious and uncertain.

In summary, the impact of spirituality on SWB can be considered invariant regardless of the individual’s religious status. In other words, what is reported in Figure 1 works for religious, uncertain, and non-religious. Instead, the impact of religiosity on SWB differs according to the individual’s religious status. Specifically, in Figure 3 , we show in the solid line what is valid regardless of the religious status and, in the dotted line, what works differently for religious (R) and uncertain (U).

Figure 3 . Partial invariant model between religious (R) and uncertain (U) testing the influence of religious identity formation on SWB. Only significant and/or non-invariant (i.e., dotted line) correlational and regression paths are represented ( * p < 0.05; ** p < 0.01; *** p < 0.001). Non-standardized values are reported as they made comparisons across groups more interpretable.

This study aimed to investigate the role of spirituality and religiosity on SWB and to test whether differences exist according to individuals’ religious status (i.e., religious, non-religious, and uncertain). By looking at the different aspects of religion and spirituality in terms of their connection to the dimensions of SWB, the present analysis yielded interesting patterns of results.

Concerning the relationship between spirituality and SWB, we found a strong impact of spirituality – intended as the human desire for transcendence, introspection, interconnectedness, and the quest for meaning in life ( King and Boyatzis, 2015 ) – on SWB, and this relationship appears the same regardless of the individual’s religious status. Specifically, the spirituality dimension that was strongly connected with SWB, both in its cognitive and affective aspects, was that of purpose and meaning in life. According to Speed et al. (2018) , the drive to construct meaning or purpose in life is a quintessential consequence of being human rather than something that is conceived under a specific religious or philosophical framework. Thus, our results appeared as coherent with other studies that already showed the association between meaning in life and SWB ( Fabricatore et al., 2000 ; Steger et al., 2009 ). Furthermore, purpose in life, which addresses the extent to which individuals perceive their lives as having goals and meaning, has already been associated with positive affect ( Chen et al., 2019 ).

Innerness – intended as the perception of inner peace and inner strength in time of difficulties – was being negatively related to negative affect. In other words, we found that perceiving to have inner strength reduce the experience of negative affect. To understand this result, we could hint at the construct of self-efficacy and defined as the individual’s confidence in producing designated levels of performance and achieving what he/she wants ( Bandura, 1997 ). Several studies have found that people high in self-efficacy experience higher SWB than people with low self-efficacy ( Caprara and Steca, 2005 ; Lent et al., 2005 ; Strobel et al., 2011 ). Furthermore, Lightsey et al. (2006) found that generalized self-efficacy may play a role in the development of self-esteem, conceived as the general assessment of one’s overall self-worth, which may help in shaping negative affect.

Surprisingly, we found that interconnection – intended as a sense of belonging and connectedness to others and to the environment – was positively related to negative affect. Whereas some studies have shown the possibility of negative interaction within religious groups and congregations and the deleterious impact of this interaction on well-being ( Krause et al., 2000 ), the negative effect from a spiritual point of view has been less investigated. It is, however, plausible to think that sharing experiences within other individuals, regardless of their belonging to faith or religious groups, may imply possible relational difficulties and negative emotional experiences. Future research is encouraged to deepen this relationship.

Contrary to our expectations, transcendence was not associated with SWB. We expected to find a positive association between the transcendence dimension and the affective dimension of the SWB, as already suggested by Van Cappellen and Rimé (2013) . Indeed, the authors proposed that positive emotions and Self-Transcendence are intertwined; positive emotional states create an opened and broadened mindset favorable to self-transcendence.

However, in a content review of several notable spirituality measures, including the Spirituality Assessment Scale ( Howden, 1992 ), de Jager Meezenbroek et al. (2012) stated that the formulation of several items of that Scale is inappropriate. Items of the transcendence scale, such as “I have the ability to rise above or go beyond a physical or psychological condition” and “The boundaries of my universe extend beyond usual ideas of what space and time are thought to be,” do not require people to reflect about firsthand experience and probably have an inconsistent meaning because of the figurative language and abstract concepts. This lack of clarity in items formulation probably did not allow us to clearly test the link between transcendence and SWB.

Concerning the relationship between religiosity and SWB, we found that having a commitment towards a particular religion worldview helps both religious and uncertain to feel positive emotions. This result appears in line with several studies showing the role of religiosity in the induction of positive emotions ( Fredrickson, 2002 ) and reporting that religious individuals learn more adaptive strategies to regulate their emotions ( Vishkin et al., 2016 ). Furthermore, positive emotions have been demonstrated to be a direct consequence of behaviors related to religious commitment, such as religious attendance ( Lavrič and Flere, 2008 ).

At the same time, having this commitment does not increase the life satisfaction in both groups. In particular, we found that religious identity commitment has a positive impact on satisfaction with life, but only in religious and not in uncertain individuals. As shown in the literature ( Galen and Kloet, 2011 ), religious belief may assist in increasing an ideological confidence in a coherent worldview, while doubting one’s worldview is frequently associated with higher distress ( Krause, 2015 ). This could explain why the religious commitment differently impacts well-being for religious and uncertain. Specifically, we can suppose that having a religious commitment for religious individuals increases the coherence of their life, increasing in turn the evaluation of the life satisfaction. The coherence they see in their life helps them to be satisfied with their life. Instead, this life satisfaction increase does not happen for uncertain individuals as, for them, having a religious commitment is not fully coherent with their view of life.

Results did not show an impact of in-depth exploration – intended as the process of deeply exploring one’s own religious beliefs and practices and what they mean to individuals – on SWB. Even if the same result is confirmed as not significant for religious and uncertain individuals, we noticed different coefficients across the two groups. In particular, whereas the process of in-depth exploration was positively – even not significantly – related to life satisfaction among uncertain individuals, the same process was negatively – even not significantly – associated with life satisfaction among religious individuals. Probably, in the process of inner-exploring their own religious beliefs and practices, uncertain individuals might become more open to and accepting of alternative worldviews ( Saroglou, 2013 ), and this is associated with life satisfaction. On the contrary, for religious individuals, this kind of exploration is perceived as a threat to their own religious beliefs and, hence, negatively affects the cognitive representation of their own well-being.

Finally, the third process of the religious identity model ( Crocetti et al., 2010 ; Iannello et al., 2019 ), reconsideration of commitment, referring to the efforts one makes to change no longer satisfactory present commitments, was not expected to have an impact on SWB ( Karaś et al., 2015 ), and results confirmed our prediction.

Conclusions and Implications

In summary, we found that both life satisfaction and affect, the two dimensions of the SWB, showed somewhat different relational patterns with measures used to assess religiosity and spirituality. As revealed by the analyses, life satisfaction, a measure of one’s cognitive well-being, was more consistently associated with both religiosity and spirituality dimensions, while affect, a measure of one’s affective well-being, appeared to be more predicted by the spirituality dimensions (if we consider the number of significant relations).

On the one hand, religiosity and spirituality are meaning-making systems and serve as ways to understand the self and the interaction with the world ( Park, 2005 ), and they may engender perceived control and positive expectations about the future ( Jackson and Bergeman, 2011 ; Speed et al., 2018 ; Chen et al., 2019 ). On the other hand, there is a growing literature on emotional benefits of spiritual practices. Research has shown that specific meditation practices increase positive emotions, which in turn yield positive consequences for life satisfaction ( Fredrickson et al., 2008 ; Kok et al., 2013 ).

To better investigate differences in the role of religiosity and spirituality on SWB, we have to consider that other moderating variables, such as personal values one attaches to religion and spirituality, which concerns the respect, concern, and acceptance of the customs and ideas that traditional culture or religion provide the self, and other socio-cultural, cognitive, and individual variables may be important moderators of the influences on SWB ( Sagiv and Schwartz, 2000 ; Hayward and Krause, 2014 ; Van Cappellen et al., 2016 ).

For example, Diener et al. (2011) found that the positive relationship between religiosity and SWB was mediated by social support, feelings of respect, and meaning in life. These, in turn, were moderated by difficult life circumstances. Thus, results showed that when life circumstances were difficult, greater religiosity predicted greater SWB via greater social support and meaning in life.

Although interesting, these findings should be considered in light of several limitations. First, due to the correlational nature of the data, caution is required in the interpretation of the relationships among the variables as observed in the current research. In our models, we assumed that religiosity and spirituality led to greater SWB. However, future longitudinal designs are necessary to better ascertain temporal ordering and causality. The relatively small sample size – in particular if considering the wide age range among participants – represents a limitation of the present study. Findings should be replicated with a larger sample, possibly focusing on specific age cohorts to explore the pattern of relationships between spirituality, religiosity, and subjective well-being in specific life stages. The third limitation is related to the need to generalize results to the national cultural context in which the relationship is examined ( Lun and Bond, 2013 ). Thus, as the sample was mostly composed of Italian Catholic individuals, we have to be cautious in generalizing these results to other cultural contexts. Different religious orientations involve ideologies or social practices that could associate differentially with people’s SWB. Up to now, convincing and legitimate cross-religious studies have not yet been conducted ( Rizvi and Hossain, 2017 ), and future works are encouraged to take a religion-specific perspective and to consider how religiosity is conceived within the specific background culture ( Stavrova et al., 2013 ; Graham and Crown, 2014 ) to examine the relationship of religion and spirituality with well-being.

To conclude, we could say that in light of the value and the influence that spirituality and religiosity have on individuals’ subjective well-being, mental health professionals need to recognize this issue and integrate them in their work. Results coming from this study emphasize the importance of orienting clients in identifying their purpose and goals in life and this is in line with what the Self-Determination approach suggests ( Ryan and Deci, 2000 ). Furthermore, even if we do not want to deny the importance that intrinsic orientation to religious faith has for well-being, the results of the present study lead us to not underestimate the positive impact that adherence to faith and religious practices also exerts on SWB. Thus, psychologists working in both clinical and non-clinical settings must have open conversations with their clients to be aware of the role that spirituality and religiosity may play as a stressor or a resource and develop a mutually satisfactory relationship ( Shafranske and Cummings, 2013 ).

Data Availability

The datasets generated for this study are available on request to the corresponding author.

Ethics Statement

All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Ethical Committee of the Department of Psychology of Università Cattolica del Sacro Cuore of Milan.

Author Contributions

DV developed the study concept and collected data. DV, AS, and PI performed the data analysis and interpretation and wrote the first draft of the manuscript. All authors were involved in the critical revision of the manuscript and approved the final version of the manuscript.

The authors received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abu-Raiya, H., Pargament, K. I., Krause, N., and Ironson, G. (2015). Robust links between religious/spiritual struggles, psychological distress, and well-being in a national sample of American adults. Am. J. Orthopsychiatry 85, 565–575. doi: 10.1037/ort0000084

PubMed Abstract | CrossRef Full Text | Google Scholar

Balzarotti, S., Biassoni, F., Villani, D., Prunas, A., and Velotti, P. (2016). Individual differences in cognitive emotion regulation: implications for subjective and psychological well-being. J. Happiness Stud. 17, 125–143. doi: 10.1007/s10902-014-9587-3

CrossRef Full Text | Google Scholar

Bandura, A. (1997). Self-efficacy: The exercise of control . (New York: Freeman).

Google Scholar

Benson, P. L., and Roehlkepartain, E. C. (2008). Spiritual development: a missing priority in youth development. New Dir. Youth Dev. 2008, 13–28. doi: 10.1002/yd.253

Benson, P. L., Roehlkepartain, E. C., and Rude, S. P. (2003). Spiritual development in childhood and adolescence: toward a field of inquiry. Appl. Dev. Sci. 7, 205–213. doi: 10.1207/S1532480XADS0703_12

Bollen, K. A. (1989). Structural equations with latent variables . (New York, NY: John Wiley & Sons).

Caprara, G. V., and Steca, P. (2005). Affective and social self-regulatory efficacy beliefs as determinants of positive thinking and happiness. Eur. Psychol. 10, 275–286. doi: 10.1027/1016-9040.10.4.275

Chen, Y., Kim, E. S., Koh, H. K., Frazier, A. L., and VanderWeele, T. J. (2019). Sense of mission and subsequent health and well-being among young adults: an outcome-wide analysis. Am. J. Epidemiol. 188, 664–673. doi: 10.1093/aje/kwz009

Cotton, S., Zebracki, K., Rosenthal, S. L., Tsevat, J., and Drotar, D. (2006). Religion/spirituality and adolescent health outcomes: a review. J. Adolesc. Health 38, 472–480. doi: 10.1016/j.jadohealth.2005.10.005

Crocetti, E., Rubini, M., and Meeus, W. (2008). Capturing the dynamics of identity formation in various ethnic groups: developmental and validation of a three-dimensional model. J. Adolesc. 31, 207–222. doi: 10.1016/j.adolescence.2007.09.002

Crocetti, E., Schwartz, S. J., Fermani, A., and Meeus, W. (2010). The utrecht-management of identity commitments scale (U-MICS). Eur. J. Psychol. Assess. 26, 172–186. doi: 10.1027/1015-5759/a000024

Cummins, R. A. (2013). “Measuring happiness and subjective well-being” in Oxford handbook of happiness . eds. S. A. David, I. Boniwell, and A. Conley Ayers (Oxford, UK: Oxford University Press), 185–200.

Cummins, R. A., and Lau, A. L. D. (2004). Personal wellbeing index–intellectual disability . 2nd Edn. (Melbourne, Australia: Australian Center on Quality of Life, Deakin University).

de Jager Meezenbroek, E., Garssen, B., van den Berg, M., Van Dierendonck, D., Visser, A., and Schaufeli, W. B. (2012). Measuring spirituality as a universal human experience: a review of spirituality questionnaires. J. Relig. Health 51, 336–354. doi: 10.1007/s10943-010-9376-1

Di Fabio, A., and Busoni, L. (2009). Proprietà psicometriche della versione italiana della satisfaction with life scale (SWLS) con studenti universitari. Couns. G. Ital. Ric. Appl. 1, 201–212.

Diener, E. (1984). Subjective well-being. Psychol. Bull. 95, 542–575. doi: 10.1037/0033-2909.95.3.542

Diener, E. (2012). New findings and future directions for subjective well-being research. Am. Psychol. 67, 590–597. doi: 10.1037/a0029541

Diener, E., Emmons, R. A., Larsen, R. J., and Griffin, S. (1985). The satisfaction with life scale. J. Pers. Assess. 49, 71–75.

Diener, E., Napa Scollon, C., and Lucas, R. E. (2009a). “The evolving concept of subjective well-being: the multifaceted nature of happiness” in Assessing well-being. Social indicators research series . ed. E. Diener (Dordrecht, AN: Springer), 67–100.

Diener, E., Oishi, S., and Tay, L. (2018). Advances in subjective well-being research. Nat. Hum. Behav. 2, 253–260. doi: 10.1038/s41562-018-0307-6

Diener, E., and Seligman, M. (2004). Beyond money: toward an economy of well-being. Psychol. Sci. Public Interest 5, 1–31. doi: 10.1111/j.0963-7214.2004.00501001.x

Diener, E., Tay, L., and Myers, D. (2011). The religion paradox: if religion makes people happy, why are so many dropping out? J. Pers. Soc. Psychol. 101, 1278–1290. doi: 10.1037/a0024402

Diener, E., Wirtz, D., Biswas-Diener, R., Tov, W., Kim-Prieto, C., Choi, D., et al. (2009b). “New measures of well-being” in Assessing well-being. Social indicators research series . ed. E. Diener (Dordrecht, AN: Springer), 247–266.

Dimitrov, D. M. (2010). Testing for factorial invariance in the context of construct validation. Meas. Eval. Couns. Dev. 43, 121–149. doi: 10.1177/0748175610373459

Fabricatore, A. N., Handal, P. J., and Fenzel, L. M. (2000). Personal spirituality as a moderator of the relationship between stressors and subjective well-being. J. Psychol. Theol. 28, 221–228. doi: 10.1177/009164710002800305

Fincham, F. D., Lambert, N. M., and Beach, S. R. H. (2010). Faith and unfaithfulness: can praying for your partner reduce infidelity? J. Pers. Soc. Psychol. 99, 649–659. doi: 10.1037/a0019628

Fredrickson, B. L. (2002). How does religion benefit health and well-being? Are positive emotions active ingredients? Psychol. Inq. 13, 209–213.

Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., and Finkel, S. M. (2008). Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J. Pers. Soc. Psychol. 95, 1045–1062. doi: 10.1037/a0013262

Fry, P. S. (2000). Religious involvement, spirituality and personal meaning for life: existential predictors of psychological wellbeing in community-residing and institutional care elders. Aging Ment. Health 4, 375–387. doi: 10.1080/713649965

Galen, L. W., and Kloet, J. D. (2011). Mental well-being in the religious and the non-religious: evidence for a curvilinear relationship. Ment. Health Relig. Cult. 14, 673–689. doi: 10.1080/13674676.2010.510829

George, L. K., Ellison, C. G., and Larson, D. B. (2002). Explaining the relationships between religious involvement and health. Psychol. Inq. 13, 190–200. doi: 10.1207/S15327965PLI1303_04

Graham, C., and Crown, S. (2014). Religion and wellbeing around the world: social purpose, social time, or social insurance? Int. J. Wellbeing 4, 1–27. doi: 10.5502/ijw.v4i1.1

Hayward, R. D., and Krause, N. (2014). “Religion, mental health, and well-being: social aspects” in Religion, personality, and social behavior . ed. V. Saroglou (New York, NY: Psychology Press), 255–280.

Hill, P. C., and Pargament, K. I. (2008). Advances in the conceptualization and measurement of religion and spirituality: implications for physical and mental health research. Psychol. Relig. Spiritual. S1, 3–17. doi: 10.1037/1941-1022.S.1.3

Howden, J. W. (1992). Development and psychometric characteristics of the spirituality assessment scale. disseration’s thesis. (Denton, TX: Texas Woman’s University).

Iannello, N. M., Hardy, S. A., Musso, P., Lo Coco, A., and Inguglia, C. (2019). Spirituality and ethnocultural empathy among Italian adolescents: the mediating role of religious identity formation processes. Psychol. Relig. Spiritual. 11, 32–41. doi: 10.1037/rel0000155

IBM Corp (2011). IBM SPSS Statistics for Windows, Version 20.0 . (Armonk, NY: IBM Corp).

Jackson, B. R., and Bergeman, C. S. (2011). How does religiosity enhance well-being? The role of perceived control. Psychol. Relig. Spiritual. 3, 149–161. doi: 10.1037/a0021597

Kahneman, D., Slovic, P., and Tversky, A. (1982). Judgment under uncertainty: Heuristics and biases . (New York, NY: Cambridge University Press).

Karaś, D., Cieciuch, J., Negru, O., and Crocetti, E. (2015). Relationships between identity and well-being in Italian, Polish, and Romanian emerging adults. Soc. Indic. Res. 121, 727–743. doi: 10.1007/s11205-014-0668-9

Kim-Prieto, C., and Miller, L. (2018). “Intersection of religion and subjective well-being” in Handbook of well-being . eds. E. Diener, S. Oishi, and L. Tay (Salt Lake City, UT: DEF Publishers), 1–9.

King, P. E., and Boyatzis, C. (2015). “Religious and spiritual development” in Handbook of child psychology and developmental science: Socioemotional processes . 7th Edn. Vol. 3, eds. M. E. Lamb and R. M. Lerner (Hoboken, NJ: John Wiley and Sons), 975–1021.

Kirkpatrick, L. A., and Shaver, P. R. (1992). An attachment-theoretical approach to romantic love and religious belief. Personal. Soc. Psychol. Bull. 18, 266–275.

Kitchens, M. B., and Phillips, R. E. III. (2018). A curvilinear relationship between clear beliefs about God and self-concept clarity. Psychol. Relig. Spiritual. Advance online publication. doi: 10.1037/rel0000181

Koenig, H. G., and Larson, D. B. (2001). Religion and mental health: evidence for an association. Int. Rev. Psychiatry 13, 67–78. doi: 10.1080/09540260124661

Kok, B. E., Coffey, K. A., Cohn, M. A., Catalino, L. I., Vacharkulksemsuk, T., Algoe, S. B., et al. (2013). How positive emotions build physical health: perceived positive social connections account for the upward spiral between positive emotions and vagal tone. Psychol. Sci. 24, 1123–1132. doi: 10.1177/0956797612470827

Krause, N. (2010). Religious involvement, humility, and self-rated health. Soc. Indic. Res. 98, 23–39. doi: 10.1007/s11205-009-9514-x

Krause, N. (2011). Religion and health: making sense of a disheveled literature. J. Relig. Health 50, 20–35. doi: 10.1007/s10943-010-9373-4

Krause, N. (2015). Religious doubt, helping others, and psychological well-being. J. Relig. Health 54, 745–758. doi: 10.1007/s10943-014-9977-1

Krause, N., Chatters, L. M., Meltzer, T., and Morgan, D. L. (2000). Negative interaction in the church: insights from focus groups with older adults. Rev. Relig. Res. 41, 510–533. doi: 10.2307/3512318

Lai, L. C. H., Cummins, R. A., and Lau, A. L. D. (2013). Cross-cultural difference in subjective well-being: cultural response bias as an explanation. Soc. Indic. Res. 114, 607–619. doi: 10.1007/s11205-012-0164-z

Lambert, N. M., Fincham, F. D., Braithwaite, S. R., Graham, S. M., and Beach, S. R. H. (2009). Can prayer increase gratitude? Psychol. Relig. Spiritual. 1, 139–149. doi: 10.1037/a0016731

Lavrič, M., and Flere, S. (2008). The role of culture in the relationship between religiosity and psychological well-being. J. Relig. Health 47, 164–175. doi: 10.1007/s10943-008-9168-z

Lent, R. W., Singley, D., Sheu, H.-B., Gainor, K. A., Brenner, B. R., Treistman, D., et al. (2005). Social cognitive predictors of domain and life satisfaction: exploring the theoretical precursors of subjective well-being. J. Couns.Psychol. 52, 429–442. doi: 10.1037/0022-0167.52.3.429

Levin, J. S., and Chatters, L. M. (2008). Religion, aging, and health: historical perspectives, current trends, and future directions. Public Health 20, 153–172. doi: 10.1080/15528030801922103

Lightsey, O. R. Jr., Burke, M., Ervin, A., Henderson, D., and Yee, C. (2006). Generalized self-efficacy, self-esteem, and negative affect. Can. J. Behav. Sci. 38, 72–80. doi: 10.1037/h0087272

Lim, C., and Putnam, R. D. (2010). Religion, social networks, and life satisfaction. Am. Sociol. Rev. 75, 914–933. doi: 10.1177/0003122410386686

Lopez, A. B., Huynh, V. W., and Fuligni, A. J. (2011). A longitudinal study of religious identity and participation during adolescence. Child Dev. 82, 1297–1309. doi: 10.1111/j.1467-8624.2011.01609.x

Luhmann, M. (2017). “The development of subjective well-being” in Personality development across the life span . ed. J. Specht (San Diego, CA: Elsevier Academic Press), 197–218.

Luhmann, M., Hawkley, L. C., Eid, M., and Cacioppo, J. T. (2012a). Time frames and the distinction between affective and cognitive well-being. J. Res. Pers. 46, 431–441. doi: 10.1016/j.jrp.2012.04.004

Luhmann, M., Hofmann, W., Eid, M., and Lucas, R. E. (2012b). Subjective well-being and adaptation to life events: a meta-analysis. J. Pers. Soc. Psychol. 102, 592–615. doi: 10.1037/a0025948

Lun, V. M., and Bond, M. H. (2013). Examining the relation of religion and spirituality to subjective well-being across national cultures. Psychol. Relig. Spiritual. 5, 304–315. doi: 10.1037/a0033641

Mak, M. C. K., Han, Y. M. Y., You, J., Jin, M., and Bond, M. H. (2011). Building life satisfaction through attachment to mother and beliefs about the world: social axioms as mediators in two culturla groups. Ment. Health Relig. Cult. 14, 223–239. doi: 10.1080/13674670903456455

Marsh, H. W., Hau, K. T., and Wen, Z. (2004). In search of golden rules: comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Struct. Equ. Model. 11, 320–341. doi: 10.1207/s15328007sem1103_2

Mueller, P., Plevak, D. J., and Rummans, T. A. (2001). Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clin. Proc. 76, 1225–1235. doi: 10.4065/76.12.1225

Muthén, L. K., and Muthén, B. O. (1998–2014). Mplus user’s guide . (Los Angeles, CA: Muthén & Muthén).

Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice . (New York, NY: Guilford Press).

Park, C. L. (2005). Religion as a meaning-making framework in coping with life stress. J. Soc. Issues 61, 707–729. doi: 10.1111/j.1540-4560.2005.00428.x

Pollard, E. L., and Lee, P. D. (2003). Child well-being: a systematic review of literature. Soc. Indic. Res. 61, 59–78. doi: 10.1023/A:1021284215801

Ramsay, J. E., Tong, E. M., Chowdhury, A., and Ho, M. H. R. (2019). Teleological explanation and positive emotion serially mediate the effect of religion on well-being. J. Pers. 87, 676–689. doi: 10.1111/jopy.12425

Rhemtulla, M., Brosseau-Liard, P. É., and Savalei, V. (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychol. Methods 17, 354–373. doi: 10.1037/a0029315

Rizvi, M. A. K., and Hossain, M. Z. (2017). Relationship between religious belief and happiness: a systematic literature review. J. Relig. Health 56, 1561–1582. doi: 10.1007/s10943-016-0332-6

Ryan, R. M., and Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 55, 68–78. doi: 10.1037/0003-066X.55.1.68

Sagiv, L., and Schwartz, S. H. (2000). Value priorities and subjective well-being: direct relations and congruity effects. Eur. J. Soc. Psychol. 30, 177–198. doi: 10.1002/(SICI)1099-0992(200003/04)30:2<177::AID-EJSP982>3.0.CO;2-Z

Saroglou, V. (2013). “Religion, spirituality, and altruism” in APA handbook of psychology, religion, and spirituality: Vol. 1. Context, theory, and research . eds. K. I. Pargament, J. Exiline, and J. Jones (Washington, DC: American Psychological Association), 439–457.

Schwartz, S. H., and Sortheix, F. (2018). “Values and subjective well-being” in Handbook of well-being . eds. E. Diener, S. Oishi, and L. Tay (Salt Lake City, UT: Noba Scholar), 1–25.

Shafranske, E. P., and Cummings, J. P. (2013). “Religious and spiritual beliefs, affiliations, and practices of psychologists” in APA handbook of psychology, religion, and spirituality (Vol. 2): An applied psychology of religion and spirituality . eds. K. I. Pargament, A. E. Mahoney, and E. P. Shafranske (Washington, DC: American Psychological Association), 23–41.

Speed, D., Coleman, T. J. III, and Langston, J. (2018). What do you mean, “What does it all mean?” Atheism, nonreligion, and life meaning. SAGE Open 8:2158244017754238. doi: 10.1177/2158244017754238

Stavrova, O., Fetchenhauer, D., and Schlosser, T. (2013). Why are religious people happy? The effect of the social norm of religiosity across countries. Soc. Sci. Res. 42, 90–105. doi: 10.1016/j.ssresearch.2012.07.002

Steger, M. F., Oishi, S., and Kashdan, T. B. (2009). Meaning in life across the life span: levels and correlates of meaning in life from emerging adulthood to adulthood. J. Posit. Psychol. 4, 43–52. doi: 10.1080/17439760802303127

Stratham, J., and Chase, E. (2010). Childhood wellbeing – A brief overview . (Loughborough: Childhood Wellbeing Research Centre).

Strobel, M., Tumasjan, A., and Spörrle, M. (2011). Be yourself, believe in yourself, and be happy: self-efficacy as a mediator between personality factors and subjective well-being. Scand. J. Psychol. 52, 43–48. doi: 10.1111/j.1467-9450.2010.00826.x

Terraciano, A., McCrae, R. R., and Costa, P. T. Jr. (2003). Factorial and construct validity of the Italian positive and negative affect schedule (PANAS). Eur. J. Psychol. Assess. 19, 131–141. doi: 10.1027//1015-5759.19.2.131

Van Cappellen, P., and Rimé, B. (2013). “Positive emotions and self-transcendence” in Religion, personality, and social behavior . ed. V. Saroglou (New York: Psychology Press), 133–156.

Van Cappellen, P., Toth-Gauthier, M., Saroglou, V., and Fredrickson, B. L. (2016). Religion and well-being: the mediating role of positive emotions. J. Happiness Stud. 17, 485–505. doi: 10.1007/s10902-014-9605-5

VanderWeele, T. J. (2017). Religious communities and human flourishing. Curr. Dir. Psychol. Sci. 26, 476–481. doi: 10.1177/0963721417721526

Vishkin, A., Bigman, Y., Porat, R., Solak, N., Halperin, E., and Tamir, M. (2016). God rest our hearts: religiosity and cognitive reappraisal. Emotion 16, 252–262. doi: 10.1037/emo0000108

Vishkin, A., Bloom, P. B. N., and Tamir, M. (2019). Always look on the bright side of life: religiosity, emotion regulation and well-being in a Jewish and Christian sample. J. Happiness Stud. 20, 427–447. doi: 10.1007/s10902-017-9956-9

Watson, D., Clark, L. A., and Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Pers. Soc. Psychol. 54, 1063–1070. doi: 10.1037/0022-3514.54.6.1063

Worthington, E. L. Jr., Hook, J. N., Davis, D. E., and McDaniel, M. A. (2011). Religion and spirituality. J. Clin. Psychol. 67, 204–214. doi: 10.1002/jclp.20760

Yoon, D. P., and Lee, E. O. (2004). Religiousness/spirituality and subjective well-being among rural elderly whites, African Americans, and native Americans. J. Hum. Behav. Soc. Environ. 10, 191–211. doi: 10.1300/J137v10n01_05

Zinnbauer, B. J., Pargament, K. I., and Scott, A. B. (1999). The emerging meanings of religiousness and spirituality: problems and prospects. J. Pers. 67, 889–920. doi: 10.1111/1467-6494.00077

Keywords: subjective well-being, spirituality, religiosity, religious status, life satisfaction, positive affect, negative affect, religious identity

Citation: Villani D, Sorgente A, Iannello P and Antonietti A (2019) The Role of Spirituality and Religiosity in Subjective Well-Being of Individuals With Different Religious Status. Front. Psychol . 10:1525. doi: 10.3389/fpsyg.2019.01525

Received: 27 March 2019; Accepted: 17 June 2019; Published: 09 July 2019.

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Copyright © 2019 Villani, Sorgente, Iannello and Antonietti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Daniela Villani, [email protected]

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Psychological Analysis of Religious Experience: The Construction of the Intensity of Religious Experience Scale (IRES)

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• Stanisław Głaz 1  

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The aim of this article is to present the issues of religious experience, and the associated experience of God’s presence and God’s absence, and then its operationalization, as well as to construct the Intensity of Religious Experience Scale, IRES (Skala Intensywności Doświadczenia Religijnego, SIDR). The value of psychometric tool, the reliability and validity, were assessed. The study was conducted in three steps. Study 1 concerned the generalization of statements related to conception of Catholic religious experience; i.e., the subjective feeling whether one experiences God’s presence and God’s absence, and how such beliefs affect certain aspects of a person’s life. Study 2 was carried out on the sample of 217 people and was designed to perform Exploratory Factor Analysis and to assess three-week test–retest reliability of the IRES. Study 3 was based on the sample of 368 people and was aimed to perform Confirmatory Factor Analysis and concurrent validation of the IRES. The analysis of the religious experience showed that this kind of human experience has its own structure. The explication of the subject has confirmed the existence of two positive factors of religious experience; i.e., a subjective sense of experience of God’s presence and God’s absence that can influence on life of people living in the Catholic religion environment.

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Introduction

With regard to religion, the term “experience” means the process of directly obtaining information about religious reality and the entirety of religious experiences of man (Głaz 2003 ). It is connected with various Christian religions and in particular in Catholicism (Głaz 1998 ). James ( 1902 ) and Starbuck ( 1899 ) analyzing religious experience, they noticed that it is characterized by inexpressibility, impermanence and at the same time emphasizing its emotional element but it depends on the person, and other circumstances. For them the religious experience is the unique experience of “something more”, “divinity”. According to Otto ( 1968 ), religious experience is associated with a sense of sanctity and dependence. Religious experience has a responsive and dialogical character, and not only cognitive. It is a personal encounter with God, Absolut (Argyle 2000 ). Religious experience—according to Jung ( 1982 , 2010 )—cannot be identified with what is psychological. Psychological factors could be only carriers of religious content.

The analysis of religious experience, shows that there are different kinds of it (Maslow 1970 ; Allport 1972 ). It may occur in two varieties that is as ordinary, and as mystical. The mystical experience is already knowing God, while the ordinary experience is also an encounter with God directly in prayer, even though one does not hear His answer (Głaz 1998 ). Płużek ( 1986 ) mentions several varieties of religious experience. A frequent type is searching for and finding paths to God. Another variation of religious experience is searching for God, feeling His presence, also related to the return of man to God. A specific religious experience is the experience of the presence of God and the absence of God (Głaz 1998 ).

Many researchers, when analyzing the effects of religious experience, point to its creative character (Keating 2001 ; Jung 2010 ), not including those who perceive the experience in reductionist term, as suggested by Freud ( 1961 ) and others (Master and Houston 1966 ). A man who participated in the religious experience perceives the world as friendlier to him (Oman and Thoresen 2005 ), feels more integrated, more uniform, more efficiently organized (Rogers 2012 ), more creative, and characterized by the uniqueness of the self (Rogers 1975 ). Religious experience helps in searching for the meaning of life. It releases man from the old paths of life (Azari et al. 2005 ), which favors a positive influence on the further development of personality and religiousness (Rydz et al. 2017 ). A man who has had the experience of the Absolut, is more diligent, has greater satisfaction with a job (Fromm 1966 ). Researchers show that the religious experience also have therapeutic implications. It is able to change the views of a person to themselves, their own lives, the world and to other people. It liberate more creative power in man (Płużek 1986 ). Religious people discover in themselves the feelings of gratitude to God. It is expressed in prayer, adoration, thanksgiving, sacrifice, love for others and even in commitments (Shear 2005 ).

In the 1960s, in order to better understand and describe the structure of the religious experience of man, researchers used the method called open-ended responses, which is qualitative measure. For example, Klingberg ( 1959 ) conducted a study among adolescents, who were asked to answer the question “Once when I thought about God…?” Others proposed to answer such questions like “Have you ever as an adult had the feeling that you were somehow in the presence of God?” (Glock and Stark 1965 ). When the qualitative method used in the description of religious experience demonstrated to be insufficient and incomplete, quantitative research tools have been developed. Among the claims about religious content, the researchers also included statements regarding religious experience. These instruments were based on a review of scientific literature, both from a psychological and theological perspective. For example, Underwood and Teresi ( 2002 ) constructed a tool for measuring ordinary and everyday spiritual experiences “Daily Spiritual Experiences Scale”. Some statements include content about the experience of God’s presence: „I feel God’s presence”, “I desire to be closer to God or in union with Him”. Hall and Edwards ( 2002 ) developed a multi-dimensional tool to assess the level of religious maturity of the individual “The Spiritual Assessment Inventory”. It also contains statements regarding religious experience like “I am aware of God’s presence in times of need”, “My experience of God’s presence impacts me greatly”.

The Basics of the Intensity of Religious Experience Scale (IRES)

The basis of the scale of religious experience are the Catholic anthropology and the concept of God (Głaz 1998 ). The Catholic anthropology assumes that man is a person who fulfills his talents, predispositions, abilities in relationships with himself, with others and with God. Man, as an individual has a complex structure. It consists of the biological-physiological, psychological and spiritual dimensions (Frankl 1987 ). They work together. Each of them has an appropriate function. Bio-Physiological dimension includes the structural and functional integrity of the body. It includes impulsive dynamics and conditioning. The mental dimension is created by mental states such as experience, emotions and feelings. That is why man is open to the world, makes choices, and is creative. The spiritual dimension, which is the exclusive property of man, is an autonomous, dynamic factor. Thanks to its people get to know, reflect, analyze, evaluate, and make decisions. This dimension also directs man to God (Głaz 2013b ). Man has the ontical ability to establish a personal relationship with God. The Catholic concept of God presents Him as a personal God who revealed Himself in Christ, sending out the Holy Spirit, and entering into relationships with men (Jarosz 2011 ).

Literature shows that many pious people have experienced the presence of God and the absence of God (James 1902 ; Saint Jean de la Croix 1915 ). The both religious experiences can be noted in the lives of our contemporaries (Głaz 2011 , 2014 ). They are connected with the process of development of religious life (Głaz 1998 ). During the experience of God’s presence, man is aware of His presence in his life or His omnipresence in the world. This kind of experience is connected a feeling of joy, an elation, a feeling of surprise, and a feeling of inner calmness. It helps to deepen the relation with God and with other people. It also deepens the faith and love to God. Man who is convinced of God’s presence, can however experience His temporary absence. Sometimes it is accompanied by the inner emptiness and loneliness. It evokes feelings of dissatisfaction, doubt and sometimes even rejection by God (Głaz 1998 , 2014 ). During the experience of God’s absence, man experiences such features as lack of self-confidence, lack of patience, lack of understanding for oneself and others. In fact, it can be the greatest trial of faith because in spite of these appearing negative features, there are also such features as a desire to deepen faith, greater trust in God, greater involvement in religious life, awareness of own imperfections, appreciation of God’s presence (Głaz 1998 , 2013b ). Such internal and direct experiences can be perceived only by the experiencing man, and from the outside one can be people who experience it, and it can be observed from the outside by human behaviors. Awareness of these religious experiences may accompany a person for a longer or shorter time, in various stages of their life’s development (Eigen 2001 ; Głaz 2014 ). Every kind of religious experience, that is the presence of God and the absence of God, brings something good in the life of a given person, and it given him or her a new content. It leaves a certain trace in the person’s life. Its effects are visible in life in the personal and social sphere, as well as in religious and psychological behaviors. The religious experience of the presence of God and the absence of God is integrated into the totality of human experience (Jung 2010 ). The cognitive, emotional and value dimension of a human being participates in it. It has a personal character, although it can be socially and culturally conditioned taking into account religious differences (Głaz 1998 ; Huber 2003 ). On the basis of such an understanding of religious experience, an attempt was made to construct a scale of the religious experience: God’s presence as well as God’s absence.

Construction of the IRES

Many factors indicate the need to construct the scale relating to the concept of Catholic religious experience: the experience of God’s presence and the experience of God’s absence.

We want to know to what extent the proposed concept of Catholic religious experience of subjective feeling of God’s presence and God’s absence influencing some life aspects is scientific, true and verifiable.

The motivation to construct a tool for measuring the experience God’s presence and God’s absence is the increase in religious awareness and the usefulness of religion in the life of Poles. The Institute of Statistics of the Catholic Church in Poland (2015) stated that over 90% of Polish citizens declare membership of the Roman Catholic Church. After political changes, there is a great interest among believers and doubters about religious movements and communities, as well as religious press. Every tenth Pole considers his faith as deep. Many people declare that they have experienced the presence and absence of God in their lives (Głaz 2011 , 2014 ). There is an increase in the participation of believers in the Sunday liturgy and the Eucharist in the last decade. There is also a visible departure from institutional religiosity in favor of intrinsic religiosity (Mariański 2011 , 2014 ; Głaz 2013b ; Szyszka 2018 ).

Researchers developed standardized tools for studying religiosity, taking into account the dimension of Christian religious experience (Hill and Hood 1999 ). Foreign language adaptations of this type of tools to Polish conditions were also made (Zarzycka 2007 ; Zarzycka and Bartczuk 2011 ). However, there is still a lack of a standardized and satisfactory tool for measuring Catholic religious experience. It seems that the present tool for studying Catholic religious experience: God’s presence and God’s absence will to some extent fill the gap in this area.

The Scale of Religious Experiences (SRE) contains 37 items (Głaz 2011 ). Only Exploratory Factor Analysis was performed, but no Confirmatory Factor Analysis was carried out (validity of the scale). It has three subscales: Religious experience, Experience of God’s presence, and Experience of God’s absence (Głaz 2011 ). During the examination, participants often pointed out that there is too many items, which sometimes caused troubles. It was decided to construct a scale with two factors experience of God’s presence as well as God’s absence. While constructing the scale, it was decided to abandon the Religious experience subscale.

The existing tools seem insufficient and require further expansion. This mainly concerns taking into account the specificity of Catholic religious experience: God’s presence and God’s absence, as well as indicating the positive role of these two aspects in the life of modern man.

In the development of tools for the study of religious experience, the merits of the researchers are undisputed. However existing tools have limited applications. The development of a tool to study Catholic religious experience: God’s presence and God’s absence has a comprehensive approach. It seems that thank to the tool a new aspects of the Catholic experience in relation to the various elements of human life can be investigated.

Thus, the main purpose of this article is, on the basis of the concept of religious experience, to show construct the tool containing two subscales measuring the experience of God’s presence and the experience of God’s absence of people living in the Catholic religion environment that have an influence on the cognitive, emotional, and behavioral spheres of human life in the religious and mental dimensions.

The aim of the research procedure is threefold: 1. Confirmation of the specificity of the Catholic religious experience of God’s presence and God’s absence in relation to human life; 2. The construction of the Intensity of Religious Experience Scale (IRES); 3. Determining the psychometric value of the scale.

Validation of IRES

The validation of the IRES was done in the three study steps. Study 1 was to collect statements related to the concept of Catholic religious experience of God’s presence and God’s absence, evaluating them, and generating items for further analysis. Study 2 was carried out to perform the Exploratory Factor Analysis and to assess the three-week test–retest reliability of the IRES. Study 3 was conducted out to perform the Confirmatory Factor Analysis.

Study 1: Pilot Study

In order to test the generated primary IRES statements, i.e., to clarify them to the adapted concept of Catholic religious experience of God’s presence and God’s absence, and to verify whether the individual statements actually measure what is intended to be measured, and whether they are understandable and correctly understood, pilot study were conducted.

The Scale of Religious Experience (SRE) (Głaz 2011 ) was used as the starting point for the development of the IRES scale. The SRE contains 37 items. As mentioned earlier, this scale is related to the Catholic religious experience. In its construction, these items whose loadings were higher than .400 were considered. The grouped homogeneous items and the list of loadings in the columns of factor matrices allowed for the constitution of three factors. They concern: 1. Religious experience, 2. Experiencing God’s presence, and 3. Experiencing God’s absence. The Cronbach’s alpha coefficient of reliability for individual factors is .89 ≤  α  ≤ .91. No confirmatory factor analysis was performed. It contains an unequal number of items in the factors. Therefore, it was decided to rephrase some items in the construction of the new version of the scale, and to give up some of the items and introduce others. It was also decided to exclude all the items constituting the first factor regarding religious experience, due to its inadequacy with the intended subscales.

The collected material related to the concept of Catholic religious experience of God’s presence and God’s absence obtained through surveys, in pastoral work, during interviews and taken from the scientific literature, as well as from the previous scale (SRE), served to develop an initial pool of items for the IRES. First of all, the statements were evaluated by a group of people in scientific seminars. Those statements, the content of which was similar and incomprehensible, were dropped out. Some of them were corrected. We generated a list of face-valid 31 statements that were accepted for analysis. Then the accuracy of each statement was evaluated by a group of theologians and psychologists and on its basis the final selection of the statements was made. According to the method proposed by Lawshe’s ( 1975 ), 31 prepared statements were evaluated on a three-point scale (3 =  this statement is essential for a given scale , 2 =  this statement is useful, but it is not essential for a given scale , 1 =  this statement should not be in a given scale ). The statements (10 statements) which, according to experts, demonstrated to be useless, ambiguous, were excluded. 21 statements were accepted for further analysis. Each of them has 7 possible answers. 7 =  definitely yes ( I definitely agree ), 6 =  yes ( I agree ), 5 =  rather yes ( I rather agree ), 4 =  I cannot decide , 3 =  rather not ( I rather don’t agree ), 2 =  no ( I do not agree ), 1 =  definitely not ( I definitely disagree ). The generated items for the future tool were subject to a further test procedure aimed at verifying its psychometric properties.

Study 2: Exploratory Factor Analysis and Three-Week Test–Retest Reliability of the IRES

After 21 statements related to the concept of Catholic religious experience of God’s presence and God’s absence was generated, the next step of work on the tool was to use exploratory factor analysis and three-week test–retest reliability of the IRES to determine an empirical verification of the scale validity. Based on the adapted conception of Catholic religious experience, a two-factorial research tool is expected, and subscales would have Cronbacha’s alpha coefficients sufficiently high.

Participants and Procedure

The group consisted of students at the Higher School of Insurance in Krakow, as well as Poles working in England in the town of Lincoln. People were asked about their place of birth, belonging to a religious group, as well as religious commitment. All respondents were born in Poland and grew up in a Catholic family. They consider themselves believers and practitioners. They take part in the Sunday Eucharist, they pray and take sacraments. They had in their lives the experiences of God’s presence and God’s absence. In order to obtain material for the further construction of the scale, people were asked to respond to each statement. The subject’s task was to express an opinion on a 7-point Likert-type scale, about the extent in which he or she agrees with or does not agree with the content of the statement. The analysis excluded those of people who did not respond to all test items. There were 10 of them. For further analysis, the results obtained on the basis of 217 correctly completed sets of questionnaires of people were used. The age of the respondents ranged from 23 to 47 ( M  = 39.2; SD  = 9.18). 22.3% of the surveyed population were men and 77.7% women.

Exploratory Factor Analysis of the IRES

In order to check whether the previously collected set of items related to the concept of Catholic religious experience of God’s presence and God’s absence has diagnostic power, it was evaluated by the method of competent judges, and then developed. The obtained data carried out in the sample were subjected to exploratory factor analysis. The separated factors were subjected to oblique rotation. According to the theory and adapted hypothesis, it was decided to use a two-factor solution. To determine the factual validity, the results were analyzed using the rotation method—Varimax. Matrix of factor loadings is included in Table  1 .

The variables (statements) whose loadings were higher than .450 were taken into account. 18 statements met these criteria (Table  1 ). Three statements were excluded because they had factor loadings lower than .450. One statement concerned the experience of God’s presence “During the experience of God’s presence, God reveals his intentions to man” (.411), and two statements concerned the experience of God’s absence. “I think the experience of God’s absence leaves in me the feeling of anxiety and uncertainty” (.401) and “Although in my life I experience the absence of God, I see God as the one who cares for me” (.364). The grouped statements of similar content, homogeneous and the combination of loadings in the columns of factor matrices, formed the basis for determining the name for particular factors, namely the first factor concerns the experience of God’s presence (PG), in which there were 10 statements, and the second factor concerns the experience of God’s absence (AG), which consists of 8 statements (see Table  1 ). Factor I, explains 33.1% of the variance of the experience of God’s presence, and the factor II accounts for 22.3% of the variance of the experience of God’s absence. The factors loadings of the items are strong. The obtained factors are correlated with each other. The obtained correlation coefficient between the separated factors is: r  = .39, p  < .01. This suggests that the accepted statements of the scale related to Catholic religious experience of God’s presence and God’s absence, and the isolated factors confirm the structure of religious experience and form the basis for further analyzes.

Reliability Analysis of the IRES

The reliability of the tool informs the researcher how far the statements included in the scale are similar to each other, whether they measure the same construct, in this case the experience of God’s presence and God’s absence. Verification of the reliability of the subscales were estimated using the internal coherence and absolute stability methods. In order to determine the internal coherence of the scale, Cronbach’s α coefficient and Guttman’s λ 6 for two subscales were calculated. Table  2 presents descriptive statistics and reliability indicators for both subscales.

The reliability indexes of the experience of God’s presence (PG) and the experience of God’s absence (AG) are high (Table  2 ). Cronbach’s values for both subscales are satisfactory, which shows a high reliability of the measure as well as Guttman’s do. The factor PG reveals a greater saturation of the contents related to the experience of God’s presence than the factor AG concerning the experience of God’s absence.

The stability of the subscales was estimated by a test–retest method with an interval of three weeks. The results are shown in Table  3 . The average results obtained from the test and retest are very similar. The obtained measures of correlation between the results from the first and second studies confirmed the stability of the scale. Both factors have a high stability indicator. For the subscale of the experience of the presence of God (PG), the correlation coefficient is r  = .83, p  < .001, and for the subscale of the experience of absence of God (AG), it is r  = .80, p  < .001.

Study 3: Confirmatory Factor Analysis and Concurrent Validation of the IRES

After exploratory factor analysis and reliability of the IRES, to check the adequacy of the hypothetical model, whether the factor structure of the scale from Study 2 would replicate in another sample, validity of the scale was done through the use of confirmatory factor analysis and criterion validity of the scale by applying the correlation method. It was assumed that a confirmatory factor analysis model with two-correlated factors would show adequate fit and that subscales would correlate moderately with factors of similar content.

The analysis was carried out on the results obtained among the group of students consisted of full-time and part-time of Jesuit University Ignatianum in Krakow. People were asked about their place of birth, religious commitment, as well as belonging to a religious group. All respondents were born in Poland and grew up in a Catholic family. They consider themselves practitioners and believers. They take part in the Sunday Eucharist, take sacraments and they pray. They declared that they had in their lives the experience of God’s presence and God’s absence. The analysis excluded those of people who did not respond to all test items. There were 27 of them. For further analysis, the results obtained on the basis of 368 correctly completed sets of questionnaires of people were used. The age of the participants ranged between 19 and 23 ( M  = 20.16; SD  = 3.19). 14.1% of the surveyed population were men and 85.9% women.

Participants completed the final IRES version, 18-item scale as developed and described in previous Study 2. The persons under study expressed their opinions on a 7-point Likert-type scale, how they agreed or disagreed with the content of the statements. The Cronbach’s alpha coefficients for the current study were .93 for God’s presence subscale and .87 for God’s absence subscale. The factor associated with the experience of God’s presence reveals greater satiation of the contents related to the experience of God’s presence ( M  = 5.3; SD  = 1.08) than the factor concerning the experience of God’s absence ( M  = 4.0; SD  = 1.12). In addition, participants completed the following measures:

The Personality Inventory (NEO-FFI) by McCrae and Costa ( 1997 ) used to determine the relatively constant personality traits. In McCrae and Costa’s view ( 1997 ) the distinguished traits really exist. They are significant for the individual’s adaptation to the environment. They are universal and stable, meaning independent of one’s race, cultural background, or gender, and biologically determined. The answer to the 60 items of the NEO-FFI questionnaire allows to obtain information on five basic personality dimensions such as: Neuroticism, Extroversion, Openness, Agreeableness, Conscientiousness. The subject’s task is to express an opinion according to a 5-point Likert scale. 5 =  definitely yes , 4 =  rather yes , 3 =  I cannot decide , 2 =  rather not , 1 =  definitely not . Adaptations to Polish conditions were made by Zawadzki et al. ( 1998 ). The scale has satisfactory reliability (.68 ≤  α  ≤ .82) and theoretical validity.

The Purpose in Life Test (PIL) by Crumbaugh and Maholick ( 1964 ) was used to assess the meaning of life. Crumbaugh and Maholick used Frankl’s existential ideas from logotherapy to assist in the development of their test. Frankl defined meaning in life as the ontological significance of life from the point of view of the experiencing individual (Frankl 1987 ). The test contains 20 statements. The subject’s task is to express an opinion according to a 7-point Likert-type scale, concerning the extent that one agrees with or does not agree with the content of the claim. 7 =  definitely yes , 6 =  yes , 5 =  rather yes , 4 = I cannot decide , 3 =  rather not , 2 =  no , 1 =  definitely not . Popielski ( 1987 ) made an adaptation of the scale to Polish conditions. The scale has satisfactory reliability (α = .90) and theoretical validity. The high overall score of the scale indicates a high level of sense of life, a low score—a low level of sense of life.

The Scale of Personal Religiosity (SPR) by Jaworski ( 1989 ) used to measure Catholic religiosity. It contains 30 statements. The subject’s task is to express an opinion according to a 5-point Likert-type scale, concerning the extent that one agrees with or does not agree with the content of the item. 5 =  definitely yes , 4 =  rather yes , 3 =  I cannot decide , 2 =  rather not , 1 =  definitely not . The scale has four factors: I—religious faith (WR), II—morality (MR), III—religious practices (PR), IV—religious self (SR). The correlation coefficient between the factors is positive and ranges from .51 to .62. Cronbach’s alpha coefficient is: .78 ≤  α  ≤ .89.

The Centrality of Religiosity Scale (CRS) by Huber was used to measure Christian religiosity (Huber and Huber 2012 ). The scale contains 15 questions. The subject’s task is to answer each question by choosing: 1 =  not at all , 2 =  slightly , 3 =  on average , 4 =  rather , 5 =  very . The scale defines five dimensions of Christian religiosity: interest in religious issues—the intellectual dimension (ZPR), religious beliefs—dimension of ideology (PR), prayer—dimension of private practice (M), religious experience—the dimension of religious experience (DR) and worship—dimension of public practice (K). Adaptation to Polish conditions was made by Zarzycka ( 2007 ). The reliability of the scale is estimated using Cronbach’s alpha and is: .82 ≤  α  ≤ .90. The obtained measures of correlation between the results obtained in the first and second studies confirmed the stability of the scale ( r  = .62– r  = .85).

The Scale of Personal Relationship to God (SPRdB) by Jarosz ( 2011 ) was used to measure the relationship to God. It contains 20 statements. The subject’s task is to express an opinion according to a 5-point Likert-type scale, concerning the extent that one agrees with or does not agree with the content of the item. 5 =  definitely yes , 4 =  rather yes , 3 =  I cannot decide , 2 =  rather not , 1 =  definitely not . This scale defines three types of relationships to God. Updated relationship (RZ), mutual relationship (RW), dialogue relationship (RD). The obtained measures of correlation between the results from the first and second tests confirmed the stability of the scale ( r  = .66– r  = .84). The reliability coefficient (Cronbach’s alpha) for individual factors is: .79 ≤  α  ≤ .92.

Validity of the IRES

The hypothesis was assumed that the confirmatory factor analysis model with two-correlated factors would show adequate fit. The values of the scale parameters were estimated and verified by the Maximum Likelihood (MLR) method by means of confirmatory factor analysis performed using the SPSS Amos package. The properties of the confirmatory factor analysis model are presented in Table  4 , and the size of the loadings of individual statements is shown in Fig.  1 .

The factor confirmation analysis model for the IRES. Above the arrows, the size of the factor loadings of the scale items has been placed ( N  = 368)

Absolute indices of goodness of fit were used to evaluate the model. Criteria indicated in Table  4 were assumed. Examining all the indices of goodness of fit considered in this study the values of the adapted model fit indicators for the tested model have proved satisfactory including RMSEA = .06 (Marsh and Hocevar 1985 ). Based on the obtained results, it can be assumed that the factor validity of the subscales has been confirmed. The obtained correlation coefficient between the separated factors is: r  = .31, p  < .01. This suggests that the structure of the scale is well-defined and plausible. It also indicates that the scale meets the required psychometric parameters.

Criterion Validity of the IRES

The criterion validity of the scale was checked and established by the method of correlation of values obtained in the scale by means of other research tools. It was expected according to the literature of the subject, as well as earlier studies (Głaz 2013a , 2014 ; Krok 2015 ), that the experience of God’s presence and the experience of God’s absence have a significant statistical and positive relationship with such personality traits as conscientiousness, openness, agreeableness, the meaning of life, and religiosity. Hence it was decided to show the strength and type of relationship between results obtained in the IRES and the Personality Inventory (NEO-FFI), the Purpose in Life Test (PIL), the Scale of Personal Religiosity (SPR), the Centrality of Religiosity Scale (CRS) and the Scale of Personal Relationship to God (SPRdB). In order to determine the strength of the relationship and its character between the variables taken in this work, Pearson’s correlation coefficient r was calculated. The results obtained in the scales shows Tables  5 and 6 .

The analysis of the results obtained in the IRES, in the NEO-FFI and in the PLT shows (Table  5 ) that a statistically significant relationship and positive occur between the experience of God’s presence (PG) and extraversion (E) ( r  = .12, p  < .05), openness (O) ( r  = .28, p  < .01), agreeableness (A) ( r  = .20, p  < .01), conscientiousness (C) ( r  = .12, p  < .05), and also between the experience of God’s absence (AG) and openness (O) ( r  = .13, p  < .05) and conscientiousness (C) ( r  = .13, p  < .05). Moreover, a significant statistical relationship is recorded between the experience of God’s presence (PG) ( r  = .32, p  < .01) and the experience of God’s absence (AG) ( r  = .18, p  < .01) and the sense of meaning in life (PIL).

Explanation of the results obtained in the scales: IRES, SPR, CRS, and SPRdB shows (Table  6 ) that the statistically significant relationship and positive is observed between the experience of God’s presence (PG) and religious faith (WR) ( r  = .73, p  < .001), morality (MR) ( r  = .72, p  < .001), religious practices (PR) ( r  = .74, p  < .001), religious self (SR) ( r  = .71, p  < .001), and self-forgiveness (PS) ( r  = .31, p  < .01). In addition, between the experience of God’s absence (AG) and religious faith (WR) ( r  = .22, p  < .01), morality (MR) ( r  = .23, p  < .01), religious practices (PR) ( r  = . 23, p  < .01), religious self (SR) ( r  = .22, p  < .01), and self-forgiveness (PS) ( r  = .13, p  < .05). Also, a statistically significant and positive relationship occurs between the experience of God’s presence (PG) and interest in religious issues (ZPR), ( r  = .57, p  < .01), religious beliefs (PR) ( r  = .61, p  < .01), prayer (M) ( r  = .55, p  < .01), religious experience (DR) ( r  = .64, p  < .01), worship (K) ( r  = .59, p  < .01), as well as an updated relationship (RZ) ( r  = .37, p  < .01), mutual relationship (RW) ( r  = .20, p  < .01) and dialogical relationship (RD)) (r = .16, p < .05). In addition, between the experience of God’s absence (AG) and interest in religious issues (ZPR) ( r  = .31, p  < .01), religious beliefs (PR) ( r  = .22, p  < .01), prayer (M) ( r  = .17, p  < .01), religious experience (DR) ( r  = .28, p  < .01), worship (K) ( r  = .21, p  < .01), as well as an updated relationship (RZ) ( r  = .15, p  < .05), mutual relationship (RW) ( r  = .12, p  < .05) and dialogical relationship (RD) ( r  = .11, p  < .05).

The aim objective of the article was to present the construction a simple and psychometrically sound scale to study the intensity of religious experience: experience of God’s presence and God’s absence people living in the Catholic religion environment, that is a subjective feeling which is not examined in itself, but as the impact of that feeling on life. The article also presents the basis of the tool and rationale of its construction. The Intensity of Religious Experience Scale (IRES) has 18 items. There are two subscales. The first one consists of ten items (1, 2, 3, 7, 9, 11, 12, 13, 16, 18) and describes the intensity of the experience of the impact of the subjective conviction of feeling God’s presence on certain aspects of life (PG). The second subscale consists of eight statements (4, 5, 6, 8, 10, 14, 15, 17) and describes the impact of the subjective conviction of feeling God’s absence on certain aspects of life (AG).

Verification of the validity of the IRES scale and the extent to which the scale measures the adapted Catholic concept: the experience of God’s presence and God’s absence, was evaluated in three ways. The first step consisted in developing and generating statements related to the Catholic concept of religious experience of God’s presence and absence taken on. The second step concerned the use of the exploratory factor analysis, which was done and presented earlier (see results Table  1 ). Third method concerns the estimation of the validity of the scale through the use of confirmatory factor analysis (see results Fig.  1 and Table  4 ) and criterion validity of the scale by applying the correlation method (see results Tables  5 and 6 ). The validation process confirmed the IRES 18-item instrument, as valuable sound psychometric tool.

The IRES confirms that many of contemporary persons experiences God’s presence and God’s absence. According to the theory of Catholic religion (Głaz 1998 ) and the analysis of the structure of Catholic religious experience, it should be stated that within this experience there are two factors of it: God’s presence and God’s absence as subjective feelings.

The exploratory factor analysis method shows that the experience of God’s presence has a greater saturation with content related to this kind of experience than the experience of God’s absence. In the subscale of the experience of God’s presence, items have stronger factor loadings than items in the subscale of the experience of God’s absence. The mean value for the subscale of experience of God’s presence is higher than the average experience of God’s absence, as well as reliability measures, Cronbach’s and Guttman’s values. This indicates that in the Catholic religious experience being analyzed the experience of the presence of God is more important than the experience of God’s absence, and it plays a greater positive role in the life of the individual, which was also confirmed by previous studies (Głaz 2013a , b ).

The validity of the scale was done through the use of confirmatory factor analysis and criterion validity of the scale by applying the correlation method.

The confirmatory factor analysis shows that the factors loadings of the items are strong. Examining all the indices of goodness of fit considered in this study, including RMSEA, it should be stated that the proposed two-factor model of religious experience is satisfactory. In addition, the magnitude of loadings of confirmatory factor analysis for particular statements (.44–.81; Fig.  1 ) is similar to loadings obtained by the exploratory factor analysis (.461–.868; Table  1 ), what shows that the scale has satisfactory structure.

Criterion validity of the IRES was determined by the correlations with other adequate tools as The Personality Inventory (NEO-FFI), the Purpose in Life Test (PIL), The Scale of Personal Religiosity (SPR), The Centrality of Religiosity Scale (SCR) and The Scale of Personal Relationship to God (SPRdB).

Analysis of correlation indicated that there is a positive correlation between the experience of God’s presence and the experience of God’s absence, and certain personality traits measured with the NEO-FFI and the PIL. As expected according to previous research (Głaz 2013b ), it was confirmed that the sense of the influence of God’s presence or absence on one’s life has a statistically significant and positive relationship with conscientiousness and openness, moreover, the experience of God’s presence is related to extraversion and agreeableness. The correlation coefficient is: r  = .12– r  = .28. There is no such relationship between the experience of God’s presence and His absence with neuroticism. Both dimensions of religious experience have a significant positive relationship with the meaning of life ( r  = .18– r  = .32). Directions of the obtained correlations are in line with expectations, positive, but the obtained values of correlation coefficients are low.

The IRES correlates statistically significantly and positively with all dimensions of the SPR. The correlation coefficients of these dimensions of religiosity for the experience of God’s presence range from .71 to .74, while for the experience of God’s absence from .22 to .23. Similar values as to the correlation coefficients are recorded between the IRES and the SCR. The magnitude of correlation coefficients for the experience of God’s presence ranges from .55 to .64, and for the experience of God’s absence from .17 to .31.

The smallest correlation coefficients are observed between the IRES and the SPRdB. Correlation coefficients for the experience of God’s presence range from .16 to .37, and slightly lower for the experience of God’s absence. The small values obtained for correlation coefficients between the dimensions of the IRES and some parameters of religiosity of the SPRdB may result from the content difference of the measured dimensions of religiosity. The IRES measures a sense of influence of God’s presence or absence on one’s life. The SPRdB includes religious dimensions such as worship, religious commitment, faith, religious self, etc., with the exception of religious experience included in the SCR, and defines religious content slightly different from those included in the IRES. Stronger positive relationships were expected between the results of the IRES and the results obtained in the SPRdB. Nevertheless, it should be admitted that there are statistically significant and positive correlations between the experience of God’s presence and the experience of God’s absence, which is an important component of religiosity, and the presented parameters of human religiousness, which confirms the value of the scale.

The undertaken analysis rises some comments.

In the validation process of the tool exploratory and confirmatory factor analysis techniques were used, that produced an 18-item instrument, which exhibits sound psychometric properties. Meanwhile, each of the factors may still be strengthened through revision, by adding new items that are not included in the present study.

The samples in the present investigation are representative for the Catholic population of student age. Thus, cautions should be taken when generalizing the findings despite the strong evidence of reliability and validity of the instrument.

Many tools have been developed to study religiousness, including religious experience, and their positive impact on human life has been analyzed (Hill and Hood 1999 ; Hall and Edwards 2002 ; Huber and Huber 2012 ). Empirical verification of the Catholic concept of religious experience: God’s presence and God’s absence confirmed that contemporary man manifests tendencies to realize himself on a spiritual and psychological level.

The tool in question does not examine experience, but a sense of the influence of the presence of God and absence of God on one’s own life taking into account their positive aspect. According to Catholic theology, also feeling of the experience of God’s absence can play a positive role in the life of a believer, which has been confirmed (Jaworski 1989 ; Głaz 1998 , 2013b ).

There are many measures that show that Christian religiosity has a great influence on psychological well-being in the life of the believers (Jarosz 2011 ; Huber and Huber 2012 ; Krok 2015 ), none of these indices investigated the possible relationship between Catholic subjective belief about the feeling of influence of God’s presence and God’s absence on certain aspects of one’s life and psychological outcomes for example, the meaning of life, and satisfaction in life.

The IRES can be used among young people in the student age and maybe to older people as well, living in the Catholic religion environment. It can be used to diagnose how persons perceive their religious sense of God’s presence and God’s absence as affecting their life. It seems that the scale may be the most useful in studying individuals and religious groups that lead an intense religious life. The statements contained in it relate to certain aspects of deepened and mature religious life of an individual with its consequences regarding his personal and social life.

The test may have various applications, e.g., it can be a form of self-esteem in groups of young people to help guide their religious development. In high school or student groups, such a religious orientation can be helpful to young people, and for pastoralists leading such groups. Pastoral psychology presupposes the interpenetration of spiritual and mental development. Due to its nature and purpose, it can serve as a direct aid in pastoral practice of youth.

The both IRES subscales have a positive meaning and can be interpreted as measures of the sense of God’s presence and God’s absence as encouraging some aspects of human life. Thus, the high scores in the subscales of the experience of God’s presence and God’s absence can be interpreted positively as follows.

The high score in the subscale of the experience of God’s presence (PG) suggests that such person has confidence in God, and seeks to have a relationship with Him. He or she knows himself or herself, and is open to the needs of others, sees his or her life as meaningful and valuable, accompanied by joy and peace. Whereas, the low score on the scale indicates that a person’s life lacks a deep relationship with God. A person treats himself and others objectively, and a lack of commitment to others is visible. The life of oneself and others is seen as worthless and meaningless.

The high score in the subscale of the experience of God’s absence (AG) suggests that the person is striving for greater trust in God, perceiving Him as the one who triggers creative anxiety, and is conducive to discovering the meaning of life. He seeks to get to know himself better and to be more open to others, as well as to gain more knowledge about others. Moreover, the low score in the scale of the experience of God’s absence indicates that man treats God as a preferential value. He does not care about getting to know himself and others better. He is accompanied by a lack of openness to new challenges and a lack of commitment to others.

In addition, the literature points to the multifaceted nature of the Christian religious experience. This scale concerning the experience of God’s presence and God’s absence can be useful to develop a tool for the study of Catholic religious experience taking into account other aspects of it not analyzed so far.

An important advantage of the method is that it concerns the experience of the presence of God and the experience of absence of God within the Catholic religion. The scale is a tool with satisfactory psychometric parameters, taking into account the discriminating power of its item, as well as its reliability and validity.

Allport, G. (1972). L’individuo e la sua religione . Brescia: La Scuola.

Google Scholar  

Argyle, M. (2000). Psychology and religion. An introduction . New York: Routledge.

Azari, N., Missimer, J., & Seitz, R. (2005). Religious experience and emotion: Evidence for distinctive cognitive neural patterns. International Journal for the Psychology of Religion, 15, 263–281.

Article   Google Scholar  

Crumbaugh, J., & Maholick, L. (1964). An experimental study in existentialism. The psychometric approach to Frankls concept noogenic neurosis. Journal of Clinical Psychology, 20, 198–229.

Eigen, M. (2001). Ecstasy . Middletown: Wesleyan University Press.

Frankl, V. (1987). La sofferenza di una vita senza senso . Torino: Boringhieri.

Freud, S. (1961). A religious experience. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (vol. 21, pp. 167–172). London: Hogarth Press.

Fromm, E. (1966). Psychoanalyse und Religion . Zurich: Wilhelm Goldmann Verl.

Głaz, S. (1998). Doświadczenie religijne (Religious experience) . Kraków: Wydawnictwo WAM.

Głaz, S. (2003). Osobowościowe uwarunkowania przeżyć religijnych (Personality determinants of religious experience) . Poznań: Fundacja Humaniora.

Głaz, S. (2011). Osobowościowe uwarunkowania przeżycia religijnego młodzieży studiującej (Psychological factors of religious experience in young university students) . Kraków: Akademia Ignatianum.

Głaz, S. (2013a). The role of the meaning of life and religious experience of god’s presence and god’s absence amongst students with different levels of conscience sensitivity. Religions, 4, 132–144. https://doi.org/10.3390/rel4010132 .

Głaz, S. (2013b). Udział Kościoła w integralnym rozwoju młodzieży studiującej (The Church’s participation in the integral development of studying youth) . Kraków: Akademia Ignatianum.

Głaz, S. (2014). The importance of terminal values and religious experience of god’s presence and god’s absence in the lives of university students with various levels of empathy. Journal of Religion and Health . https://doi.org/10.1007/s10943-014-9884-5 .

Article   PubMed Central   Google Scholar  

Glock, C. Y., & Stark, R. (1965). Religion and society in tension . Chicago: Rand McNally.

Hall, T. W., & Edwards, K. J. (2002). The spiritual assessment inventory: A theistic model and measure for assessing spiritual development. Journal for the Scientific Study of Religion, 41 (2), 341–357. https://doi.org/10.1111/1468-5906.00121 .

Hill, P. C., & Hood, R. W., Jr. (Eds.). (1999). Measures of religiosity . Birmingham: Religious Education Press.

Huber, S. (2003). Zentralität und Inhalt. Ein neues multidimensionales Messmodell der Religiosität . Opladen: Leske and Budvich.

Book   Google Scholar  

Huber, S., & Huber, O. W. (2012). The Centrality of Religiosity Scale (CRS). Religions, 3, 710–724. https://doi.org/10.3390/rel3030710 .

James, W. (1902). The varieties of religious experience: A study in human nature. Being the gifford lectures on natural religion delivered at edinburgh in 1901 – 1902. United States: Longmans, Green & Co.

Jarosz, M. (2011). Skala Personalnej Relacji do Boga (The Scale of Personal Relationship to God). In M. Jarosz (Ed.), Psychologiczny pomiar religijności (Psychological measurement of religiosity) (pp. 113–129). Lublin: TN KUL.

Jaworski, R. (1989). Psychologiczne korelaty religijności personalnej (Psychological correlates of personal religiosity) . Lublin: Wydawnictwo KUL.

Jung, C. G. (1982). Esperenza e mistero . Torino: Boringhieri.

Jung, C. G. (2010). The Undiscovered Self . Abington: MPG Books Groups.

Keating, Th. (2001). Intimacy with god . New York: Crossroad Book.

Klingberg, G. (1959). A study of religious experience in children from nine to thirteen years of age. Religious Education, 54, 211–216.

Krok, D. (2015). Value systems and centrality of religiosity as predictors of non-religious and religious coping with stress in early adulthood. Archives of Psychiatry and Psychotherapy, 3, 21–31. https://doi.org/10.12740/APP/59050 .

Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28, 563–575.

Mariański, J. (2011). Katolicyzm Polski (Catholicism of Poland) . Kraków: WAM.

Mariański, J. (2014). Praktyki religijne w Polsce w procesie przemian (Religious practices in Poland in the process of transformation) . Sandomierz: Wydawnictwo Diecezjalne i Drukarnia w Sandomierzu.

Marsh, H. W., & Hocevar, D. (1985). Application of higher-order factor models and their invariance across groups. Psychological Bulletin, 97, 562–582.

Maslow, A. (1970). Religions, values, and peak experiences . Columbus: Ohio State University Press.

Master, R., & Houston, J. (1966). The varietes of psychodelic experiences . New York: Delta.

McCrae, R. R., & Costa, P. T. (1997). Personality trait structure as a human universal. American Psychologist, 52, 509–516.

Article   CAS   Google Scholar  

Oman, D., & Thoresen, C. E. (2005). Do religion and spirituality influence health? In R. F. Paloutzian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 435–459). New York: Guilford.

Otto, R. (1968). Le sacre: L’élément non-rationnel dans l’idée du divin et sa relation avec le rationnel . Paris: Payot.

Płużek, Z. (1986). Bóg i człowiek w doświadczeniu religijnym – interpretacja psychologiczna (God and man in religious experience – psychological interpretation. In W. Słomka (Ed.), Bóg i człowiek w doświadczeniu religijnym (God and man in religious experience) (pp. 255–264). Lublin: TN KUL.

Popielski, K. (1987). Testy egzystencjalne: Metody badania frustracji egzystencjalnej i nerwicy noogennej (Tests existentiels: Méthodes d’étude de la frustration existentielle et névrose noogčne). In K. Popielski (Ed.), Człowiek – pytanie otwarte (Homme – question ouverte) (pp. 237–261). Lublin: KUL.

Rogers, C. (1975). La terapia centrala sul cliente . Firenze: G. Martinelli.

Rogers, C. (2012). Un Modo di Essere . Firenze: Martinelli.

Rydz, E., Walesa, C. Z., & Tatala, M. (2017). Structure and level of religiosity test. Polish Psychological Bulletin, 48 (1), 20–27. https://doi.org/10.1515/ppb-2017-0003 .

Saint Jean de la Croix. (1915). La Montée du Carmel . Lille: Soc. Saint-Augustin.

Shear, J. (2005). Experimental studies of meditation and consciousness. In D. Jonte-Pace & W. Parsons (Eds.), Religion and psychology: Mapping the terrain (pp. 228–294). London: Routledge.

Starbuck, E. (1899). The psychology of religion . London: Walter Scott.

Szyszka, M. (2018). Małżeństwo, rodzina, ojcostwo – tendencje przemian (Marriage, family, paternity – trends in change). Roczniki Nauk Społecznych (Social Science Yearbooks), 46, 7–27.

Underwood, L. G., & Teresi, J. (2002). The Daily Spiritual Experience Scale: Development, theoretical description, reliability, exploratory factor analysis, and preliminary construct validity using health related data. Annals of Behavioral Medicine, 24, 22–33.

Zarzycka, B. (2007). Skala Centralności Religijnej S. Huberta (Scale of Religious Centrality S. Hubert). Roczniki Psychologiczne (Annals Psychology), 16, 133–157.

Zarzycka, B., & Bartczuk, R. (2011). Polska adaptacja Skali Emocji do Boga (EtG) S. Hubera (Polish adaptation of the Inventory of Emotions towards God (EtG) by S. Huber). In M. Jarosz, (Ed.), Psychologiczny pomiar religijności ( Psychological measurement of religiosity ) (pp. 263–293). Lublin: Towarzystwo Naukowe KUL.

Zawadzki, B., Strelau, J., Szczepaniak, P., & Śliwińska, M. (1998). Inwentarz osobowości NEO - FFI Costy i McCrae . ( Personality Inventory – NEO - FFI ). Warszawa: Pracownia Testów Psychologicznych PTP.

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Głaz, S. Psychological Analysis of Religious Experience: The Construction of the Intensity of Religious Experience Scale (IRES). J Relig Health 60 , 576–595 (2021). https://doi.org/10.1007/s10943-020-01084-7

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DOI : https://doi.org/10.1007/s10943-020-01084-7

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Table of Contents

• Chapter 1: Importance of Religion and Religious Beliefs
• Chapter 3: Views of Religious Institutions
• Chapter 4: Social and Political Attitudes
• Appendix A: Methodology
• Appendix B: Putting Findings From the Religious Landscape Study Into Context

Participation in several traditional forms of religious observance has declined in recent years. For example, the share of Americans who say they attend religious services at least once a week has ticked down by 3 percentage points since 2007, as has the share who say they pray every day.

These declines are closely connected to the continued growth of the religiously unaffiliated population. Religious “nones” are far less religiously observant than people who identify with a religion. But among those who are affiliated with a religion, levels of worship attendance and personal prayer have both been very steady since 2007.

While religious service attendance and frequency of prayer have declined among the general public, some indicators of religious engagement have ticked upward, such as the percentage of religiously affiliated adults who share their faith regularly. Growing numbers of Americans also say they regularly feel a deep sense of spiritual peace and well-being or say they feel a deep sense of wonder about the universe.

This chapter explores the ways in which American adults engage in religious practices and experiences, highlighting both how religious participation is changing and how it varies across religious groups.

Worship Service Attendance

Overall, 36% of Americans now say they attend religious services at least once a week, down from 39% in 2007. This decline is accompanied by a rise in the share of U.S. adults who say they seldom or never attend religious services (from 27% in 2007 to 30% in 2014). 10

As they do on many traditional measures of religious observance, Jehovah’s Witnesses and Mormons report the highest levels of regular worship attendance; 85% of Jehovah’s Witnesses say they attend religious services at least once a week, as do 77% of Mormons. Most evangelical Protestants (58%) and roughly half of members of the historically black Protestant tradition (53%) also say they attend religious services at least once a week, though the share of people in the historically black Protestant tradition reporting weekly worship attendance has declined 6 percentage points since 2007. Among other Christian groups, smaller shares (including 39% of Catholics and 33% of mainline Protestants) say they attend church weekly.

Regular attendance among members of non-Christian faiths has remained relatively stable since 2007.

Fully 72% of religiously unaffiliated adults say they seldom or never attend religious services, including nearly nine-in-ten self-identified atheists (89%) and eight-in-ten agnostics (79%). Attending worship services is more common among religious “nones” who describe their religion as “nothing in particular.”

More women than men say they attend religious services at least once a week (40% vs. 31%). This gender gap is evident among a variety of Christian groups, though not among Mormons. And among Christians overall, more blacks than Hispanics and whites say they attend religious services weekly or more.

Older Americans are more likely than younger Americans to say they attend services at least once a week. Among Christian groups, the age gap is particularly large for Catholics; most Catholics ages 65 and older (56%) say they go to church every week, compared with half as many Catholic adults under age 30 (28%). There also are large differences by age among members of the historically black Protestant tradition and mainline Protestants. Age differences in worship attendance are smaller or nonexistent among evangelical Protestants, Mormons and Jews.

Among the adult population overall, there is virtually no difference in frequency of religious service attendance between college graduates and those with less education. Among many Christian groups, however, college graduates are at least somewhat more likely than those with less education to say they attend religious services regularly.

Congregational Membership

Half of U.S. adults say they belong to a local house of worship. Among Christian groups, about seven-in-ten people who identify with the historically black Protestant tradition (72%) and the evangelical Protestant tradition (69%) say they belong to a local congregation. Roughly six-in-ten Catholics (59%) and 57% of mainline Protestants say they are official members of a church. This question was not asked as part of the 2007 Religious Landscape Study.

Adherents of non-Christian religions tend to be less likely than Christians to report official membership in a house of worship. Only one-in-five Buddhists and Hindus are members of a house of worship, along with roughly a third of Muslims (34%). This survey finds that about half of U.S. Jews (53%) say they belong to a synagogue, though other surveys have found lower membership rates, perhaps in part due to different question wording.

Just 8% of U.S. adults who describe themselves, religiously, as atheist, agnostic or “nothing in particular” belong to a local house of worship.

Participation in Scripture Study or Prayer Groups

A quarter of American adults (24%) say they participate in prayer groups, scripture study groups or other types of religious education at least once a week. Although the share of Americans who identify with a religion has been shrinking, the percentage of religiously affiliated adults who report participation in prayer groups, scripture study groups or religious education programs is somewhat higher today than it was in 2007 (30% vs. 27%) .

Again, Jehovah’s Witnesses and Mormons are notable for their high levels of weekly involvement in these types of groups (85% and 71%, respectively). More than four-in-ten members of evangelical and historically black Protestant churches also participate in such programs at least once a week (44% each).

Some of the demographic groups that are especially religiously observant in other ways – including blacks, older adults, women and adults without a college degree – also are more likely than others to say they participate in prayer groups, scripture study groups or religious education programs at least monthly. In several cases, however, these demographic differences are smaller within religious traditions than among the public as a whole.

Private Devotions

While a majority of Americans continue to say they pray at least once a day (55%), the share of U.S. adults who seldom or never pray has increased from 18% to 23% since 2007. This change is mainly tied to the growing share of Americans who say they have no religious affiliation. Religiously unaffiliated adults pray far less frequently compared with those who identify with a religion, and an increasing share of religious “nones” say they seldom or never pray.

Among those who do identify with a religious group, there have been only modest changes in self-reported frequency of prayer. Jehovah’s Witnesses remain among the most prayerful religious groups, with fully 90% saying they pray daily. Large majorities of Mormons (85%), members of the historically black Protestant tradition (80%) and evangelical Protestants (79%) also say they pray every day. Smaller majorities of Catholics (59%), Orthodox Christians (57%) and mainline Protestants (54%) report praying daily.

As with other measures of religious involvement, women are considerably more likely than men to say they pray daily, a pattern seen among many religious traditions. Similarly, older adults engage in daily prayer at much higher rates than younger adults, both among Americans overall and across several religious groups. And across the religiously affiliated and unaffiliated, blacks are much more likely than Hispanics and whites to say they pray on a daily basis.

College graduates are less likely than others to say they pray daily, at least in part because college graduates are far more likely than those with less education to identify as atheists or agnostics (and very few atheists and agnostics pray regularly). Among Christians, there is little difference in frequency of prayer between college graduates and those with less education. And among Mormons and evangelical Protestants in particular, college graduates are noticeably more likely than others to say they pray daily.

As was the case in 2007, the 2014 Religious Landscape Study finds that 35% of U.S. adults say they read scripture at least once a week. Regular scripture reading is most common among Jehovah’s Witnesses (88% of whom say they read scripture at least once a week), Mormons (77%), evangelical Protestants (63%) and members of the historically black Protestant tradition (61%).

Older adults are much more likely than younger adults to say they read scripture weekly or more, and blacks are more likely than Hispanics or whites to say they participate in this activity. Additionally, more women than men say they read scripture at least weekly.

Those with less education are more likely than college graduates to say they read scripture outside of religious services at least weekly, but among some religious groups, such as evangelical Protestants and Mormons, college graduates are more likely to read scripture on a weekly basis.

Four-in-ten Americans say they meditate at least once a week. Regular meditation is common among some groups that exhibit high levels of religious observance on a variety of indicators (e.g., Jehovah’s Witnesses and Mormons). In addition, two-thirds of U.S. Buddhists in the survey (66%) report meditating at least weekly. 11

However, sizable minorities of religiously unaffiliated adults, including one-in-five atheists (19%), a quarter of agnostics (24%) and 28% of those who describe their religion as “nothing in particular,” also say they meditate at least once a week. Respondents who say they meditate regularly may or may not do so in a religious sense; many people meditate for reasons other than religion or spirituality.

Sharing One’s Faith

About a quarter of adults in the U.S. who are affiliated with a particular religion (26%) say they share their faith with others at least once a week, up 3 percentage points since 2007. Christians are much more likely than members of non-Christian faiths to share their faith with others.

Jehovah’s Witnesses are known for going door to door to discuss their religion, and 76% say they share their faith with nonbelievers or people from other religious backgrounds at least weekly. A plurality of members of the historically black Protestant tradition (44%) also say they share their faith with others at least once a week.

Religiously unaffiliated respondents were asked how often they share their views on God and religion with religious people. Two-thirds of the unaffiliated (67%) say they seldom or never do this.

As is the case with other forms of religious practice, blacks who are affiliated with a religion are more likely than affiliated Hispanics and whites to say they share their faith at least monthly, and affiliated adults without a college degree are more likely than college graduates to do this.

But when it comes to differences by age among the religiously affiliated, this measure stands out: While older Americans display more religious engagement in several other ways, younger adults are slightly more likely than those ages 65 and older to share their faith.

Speaking in Tongues, Observance of Dietary Restrictions and Other Practices Characteristic of Specific Religions

Speaking in tongues, a practice often associated with Pentecostal and charismatic churches, is not particularly common among Christians overall. Eight-in-ten U.S. Christians say they seldom or never speak or pray in tongues.

Not surprisingly, speaking in tongues is more common within Pentecostal denominations in both the evangelical and historically black Protestant traditions, as well as nondenominational charismatic churches within the evangelical tradition. For example, 34% of nondenominational charismatic evangelicals report speaking in tongues at least weekly, as do 33% of members of Pentecostal churches in the historically black Protestant tradition.

About half of Buddhists surveyed (48%) say they have a shrine or temple for prayer in their home. However, the 2014 Religious Landscape Study, which was conducted in English and Spanish but not in any Asian languages, may underestimate the share of Buddhists who maintain a shrine or temple in their home. Pew Research Center’s 2012 survey of Asian Americans , which was conducted in English and seven Asian languages, found that 57% of Asian-American Buddhists say they have a shrine or temple in their home.

Certain religious groups, such as Hindus, Jews and Muslims, have traditional dietary restrictions. For example, many Hindus do not eat beef, while Islamic and Jewish laws forbid the eating of pork (among other things). Nine-in-ten U.S. Muslims say they never eat pork, and two-thirds of Hindus (67%) say they do not eat beef. By contrast, most U.S. Jews (57%) say they do eat pork.

Spiritual Experiences

Most Americans (59%) say they experience a sense of spiritual peace and well-being at least once a week, up by 7 percentage points since 2007. And 46% of Americans report feeling a deep sense of wonder about the universe on a weekly basis, also up 7 points.

Groups that exhibit the highest levels of religious observance on traditional measures of religious practice (such as worship service attendance, prayer, etc.) also are most likely to say they regularly experience a sense of spiritual peace. Fully eight-in-ten Jehovah’s Witnesses (82%) and Mormons (81%), for instance, say they regularly feel a deep sense of spiritual peace, as do three-quarters of evangelical Protestants (75%) and members of the historically black Protestant tradition (73%).

However, four-in-ten religiously unaffiliated adults also say they regularly feel a deep sense of spiritual peace and well-being. And the religiously unaffiliated are no less likely than those who identify with a religion to say they often experience a deep sense of wonder about the universe. In fact, self-described atheists and agnostics are somewhat more likely than members of most religious groups to say they often experience such a sense of wonder.

More than three-quarters of Americans (78%) say they feel a strong sense of gratitude or thankfulness at least once a week. Fully 82% of Christians say they regularly feel a deep sense of gratitude, as do 73% of adherents of non-Christian faiths and two-thirds of the religiously unaffiliated (67%).

A majority of U.S. adults (55%), including roughly six-in-ten Christians, think about the meaning and purpose of life at least once a week. Within Christianity, most members of historically black Protestant churches (72%) and Mormons (71%) often think about the meaning of life, as do majorities of evangelical Protestants (64%) and Orthodox Christians (63%). By comparison, 52% of Catholics and 51% of mainline Protestants say they regularly ponder the meaning of life. Among the religiously unaffiliated, 45% say they think about the meaning and purpose of life at least once a week.

• Surveys that ask respondents how often they attend religious services typically obtain higher estimates of rates of weekly attendance than other, more indirect methods of data collection (such as asking respondents to keep a diary of how they spend their days, without specific reference to attendance at worship services). When prompted by a survey question to report how often they attend religious services, respondents who say they attend every week may be indicating that they see themselves as the kind of people who regularly go to services, rather than that they never miss a week of church. For a discussion of differences between self-reported attendance and actual attendance rates, see Brenner, Philip S. 2011. “Exceptional Behavior or Exceptional Identity? Overreporting of Church Attendance in the U.S.” Public Opinion Quarterly. Though this body of research suggests that attendance measures from surveys may not necessarily be the best gauge of the share of people who attend services in any given week, knowing whether respondents think of themselves as regular churchgoers is nevertheless very important because this measure of religious commitment often is correlated with other religious beliefs and practices, as well as with social and political attitudes. In addition to the over-reporting of church attendance that arises from asking respondents directly how often they attend religious services, readers should bear in mind that telephone opinion surveys can produce overestimates of religious attendance due to high rates of nonresponse. See, for example, Pew Research Center’s 2012 report “ Assessing the Representativeness of Public Opinion Surveys ” and Pew Research Center’s July 21, 2015, Fact Tank post “ The Challenges of Polling When Fewer People Are Available to be Polled .” ↩
• The 2012 Pew Research Center survey of Asian Americans , which was conducted in English as well as seven Asian languages, found that 27% of Asian-American Buddhists meditate weekly or more. The 2014 Landscape Study was conducted only in English and Spanish. ↩

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4]  Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I.     Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a.     US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b.     Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF.  Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c.     Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d.     Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e.     Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45]  Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II.     Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III.     A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders.  This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV.     Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

[1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

[3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk ; Kimmelman, J., Hyun, I., Benvenisty, N.  et al.  Policy: Global standards for stem-cell research.  Nature   533 , 311–313 (2016). https://doi.org/10.1038/533311a

[4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk

[5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources:

Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research.  The New England journal of medicine ,  351 (3), 207–209. https://doi.org/10.1056/NEJMp048145 ; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos . The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos ; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy , 38 (2/3), 264–284. http://www.jstor.org/stable/24439776 ; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells.  The New England journal of medicine ,  351 (3), 209–211. https://doi.org/10.1056/NEJMp048147 ; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality.  Bosnian journal of basic medical sciences ,  4 (1), 5–14. https://doi.org/10.17305/bjbms.2004.3453

[6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review.  Restorative neurology and neuroscience ,  28 (4), 589–603. https://doi.org/10.3233/RNN-2010-0543

[7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics . Oxford University Press.

[8] Sherley v. Sebelius , 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf

[9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109 th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text ; Bush, G. W. (2006, July 19). Message to the House of Representatives . National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html

[10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells . National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells

[11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells.  Social Research ,  73 (3), 819–834. http://www.jstor.org/stable/40971854

[12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics . 22. 10.1186/s12910-021-00678-4.

[13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics , 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight , 49 (4).

[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics , 22 (2), 112–122. https://doi.org/10.1111/dewb.12324

[15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324

[16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa.  Stem Cell Res Ther   4 , 54 (2013). https://doi.org/10.1186/scrt204 ; Pew Research Center. (2014, May 1). Public health a major priority in African nations . Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/

[17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024 . National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf

[18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80 , see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia . UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html

[20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries.  Middle East Fertil Soc J   24 , 8 (2020). https://doi.org/10.1186/s43043-019-0011-0 ; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics , 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247

[23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction.  Frontiers in pharmacology ,  13 , 1013740. https://doi.org/10.3389/fphar.2022.1013740

[25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech.

[26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine , 12 (6), 647–656. https://doi.org/10.2217/rme-2017-0035

[29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[30] Chen, H., Wei, T., Wang, H.  et al.  Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017.  BMC Public Health   22 , 434 (2022). https://doi.org/10.1186/s12889-022-12839-0

[31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan.  Curr Stem Cell Rep   1 , 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6

[32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production . NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production

[33] Park, S. (2012). South Korea steps up stem-cell work.  Nature . https://doi.org/10.1038/nature.2012.10565

[34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned.  Accountability in research ,  13 (1), 101–109. https://doi.org/10.1080/08989620600634193 .

[35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

[36] Association for the Advancement of Blood and Biotherapies.  https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia

[37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia.  BMC medical ethics ,  21 (1), 35. https://doi.org/10.1186/s12910-020-00482-6

[38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics , 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

[39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France.  Biotechnology Law Report ,  32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ...  Revista do Colegio Brasileiro de Cirurgioes ,  41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe   

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights.  Cultura (Iasi, Romania) ,  14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent?  Research Ethics ,  13 (1), 23-41.  https://doi.org/10.1177/1747016116650235

[52] The Qur'an  (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52.  https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation.  Journal of Religion and Health ,  30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law).  Journal of assisted reproduction and genetics ,  25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License .

National Humanities Center selects two A&S professors as 2024-25 Fellows

5/16/2024 By | Kate Blackwood , A&S Communications

Two faculty members in the College of Arts and Sciences have been named as National Humanities Center (NHC) Fellows for the 2024-25 year. Kim Haines-Eitzen , the Paul and Berthe Hendrix Memorial Professor of Near Eastern studies, and Mostafa Minawi , associate professor of history and director of Critical Ottoman and Post-Ottoman Studies, will pursue research projects in residence at the NHC in Durham, North Carolina.

“NHC fellowships are highly selective. It is a real honor to have two scholars from Cornell Arts and Sciences recognized with fellowships in the same year,” said Deborah Starr , professor of Near Eastern studies and chair of the department. “Near Eastern Studies is particularly excited to see the research of our department and graduate field faculty supported by this prestigious fellowship.”

Minawi and Haines-Eitzen are among 31 Fellows appointed for the 2024-05 academic year, chosen from among nearly 500 applications.

As an NHC fellow, Haines-Eitzen will develop her book project “Crossing the River of Fire: Apocalypse, Transformation, and the Elements in Late Antiquity. With a possible alternative title, “A Field Guide to the Apocalypse,” the book extends her interest in environmental and sensory history, tracing themes of kinesis, convergence, and transformation in the writings of late antiquity.

“From creation to the apocalypse, early Christians assembled a set of texts that traversed between the natural elements–earth, air, water, fire–and the imagination, merged the sensational with the contemplative, crossed the sublime with the violent,” Haines-Eitzen wrote in a summary of the project. “The transformational potency of flowing waters and blazing fires, living stones and dissonant earthquakes, howling winds and thundering voices offered Christian writers evocative and compelling images to breach new identities formed in the meshwork of Jewish, Zoroastian, Greek and Roman cultures and worldviews.”

“Having the opportunity to spend a full academic year at the National Humanities Center provides uninterrupted time for research and writing in a way that is increasingly difficult to find,” Haines-Eitzen said. “It allows me to deeply immerse myself in the project.”

During the residency, Minawi will work on a book tentatively titled “Ottoman-Ethiopian Relations and the Geopolitics of Imperialism in the Red Sea Basin and the Horn of Africa at the End of the 19th Century.” The research relies on a set of recently released Ottoman archival documents on Ottoman involvement in the Horn of Africa at the turn of the 20th century.

The short-lived province of Abyssinia was established in 1517, when the Ottomans occupied the African Red Sea coast, including the important cities of Massawa (Eritrea), Suakin (Sudan), and Zeila (Somalia). Following the 1884-85 Berlin Conference, the Ottomans, along with a number of European empires, were back in the Horn of Africa to compete over territories in the Red Sea Basin and northern coast of Somalia. Minawi’s book, under contract with Stanford University Press, is the first to investigate this Ottoman-Ethiopian-European competition for Northeast Africa between 1885 and WWI.

“Thinking, discussing ideas and writing is a true privilege that we rarely get to enjoy anymore,” Minawi said. “After the year we have had, I am looking forward to returning to the life of the mind. The Center will provide the space to concentrate on writing my third book and to engage with faculty in the Research Triangle and other fellows.”

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The Faculty Senate on Thursday approved a resolution to adjust the start dates of certain academic years in which the first day of class conflicts with Jewish high holidays. (Image credit: Andrew Brodhead)

The Faculty Senate on Thursday approved a resolution to adjust the start dates of the fall quarter for certain academic years in which the first day of class conflicts with Jewish high holidays.

For academic years 2026-27, 2036-37, and 2050-51, the academic year will now begin on Tuesday instead of the traditional Monday start date to avoid classes beginning on Yom Kippur, which is observed from sundown to sundown, or the first day of Rosh Hashanah, which is observed over two days.

Before voting to approve the resolution, senators discussed various concerns regarding consideration of other possible options, the impact of losing one day of instruction, the significance of the issue for the university’s Jewish community, and more.

Kate Maher , chair of the Committee on Undergraduate Standards and Policies, co-chair of the Academic Calendar Subcommittee, and professor of Earth system science, noted that the resolution doesn’t fully resolve all conflicts with holidays. When the evening of Rosh Hashanah aligns with the first day of classes in academic years 2025-26 and 2052-53, there will be no change to the academic calendar.

“This last piece is really important because it reflects a compromise that was made between honoring the observance of the holidays and minimizing the impacts to the academic calendar,” Maher said.

There will also be years when the first day of the quarter will be on the second day of Rosh Hashanah, or on the first two days of Sukkot, another Jewish holiday. For those years, the university should be proactive in messaging and accommodations, Maher said.

In contemplating this change, the subcommittee considered potential impacts on summer programs, STEM courses, and more, said David K. Stevenson , chair of the Committee of Graduate Studies, co-chair of the Academic Calendar Subcommittee, and the Harold K. Faber Professor of Pediatrics. The subcommittee also explored shifting the academic calendar forward or backward by a week, as well as other possibilities.

“We considered really carefully these different options,” Stevenson said. “…When it came down to it, because of the infrequency of these conflicts which we mapped out, this was the most reasonable solution.”

One senator asked whether other religious holidays were considered when reviewing conflicts with the academic calendar. Maher and Stevenson said that question came up early in the subcommittee’s work, but since they focused on the start of the fall quarter, Yom Kippur and Rosh Hashanah were the holidays applicable for that time period. “The overarching senate policy that is in place would suggest that any religious observance would take precedence for the start of the quarter,” Maher said.

Brian Conrad, professor of mathematics, read part of a letter signed by 11 colleagues expressing concern about losing a day of instruction and asking the senate to hold off on the vote until another solution could be reached. STEM courses “have lectures, labs, problem sets, and discussion sections that are carefully designed to fit around many constraints,” Conrad said. “And because the material is cumulative, rushed or omitted coverage early on leads to weaker foundation and increased student anxiety.”

Ruth O’Hara , the Lowell W. and Josephine Q. Berry Professor in the Department of Psychiatry and Behavioral Sciences, said that while she supported the resolution and appreciated the subcommittee’s work, it’s important to not minimize the impact that some courses and instructors will face as a result. Other senators noted that while it’s impactful, the loss of an instruction day will occur infrequently over the next several decades.

Deborah Hensler , the Judge John W. Ford Professor of Dispute Resolution and a Jewish faculty member, said that she had reorganized her classes in the past so that she and other Jewish students could observe the holidays, but that doing so “made me actually feel unwelcome.”

“There is a symbolic effect of this, when you’re in a community and the community chooses to take [the first day of the academic calendar for instruction] … and it is the most important day of your religion,” Hensler said. “I think it’s valuable for this community to take note of that.”

In other matters

Against a national backdrop of protests to the Israel-Hamas war across college campuses, President Richard Saller in remarks to the senate said the university has worked to plan for the management of campus activities during Admit Weekend as well as in the future. “We’ve talked through many scenarios, and our primary aim is to maintain the safety of the campus and the continued operations of our academic work,” Saller said.

Philip Levis , professor of computer science and of electrical engineering, asked Saller to clarify the policy for free speech and tabling in White Plaza during Admit Weekend. The university’s general policy is that free speech and tabling are allowed in White Plaza, except during a Big Five event, which includes Admit Weekend, Saller explained. “In terms of the enforcement of the policy, we will make judgments about how best to maintain the safety of the community and the peace of the campus,” Saller continued.

During reports from the senate’s Steering Committee, Meagan Mauter , associate professor of photon science, said that the Board on Conduct Affairs has adopted a bylaw that provides guidance for setting the level of review for reported Honor Code concerns. The bylaw emerged from discussions of the Stanford Student Conduct Charter of 2023 and new Honor Code, which were adopted last spring .

Mauter also shared a resolution from the Associated Students of Stanford University, which extends Green Library’s hours effective autumn quarter 2024 and has already been administratively approved.

Senators also heard a memorial resolution for Edwin M. Bridges , a retired professor of education known for applying problem-based learning to the training of educational learning. Bridges died at age 85 on March 18, 2019.

Maher is a senior fellow at the Woods Institute for the Environment, and professor, by courtesy, of Earth and planetary sciences. Mauter is a senior fellow at the Woods Institute for the Environment and at the Precourt Institute for Energy, and an associate professor, by courtesy, of chemical engineering. O’Hara is director of the Stanford Center for Clinical and Translational Research and Education (SPECTRUM), and senior associate dean for research at the Stanford School of Medicine . Stevenson is a professor, by courtesy, of obstetrics and gynecology.

School of Electrical and Computer Engineering

College of engineering, undergraduate research excellence celebrated at ors symposium.

In celebration of student research and innovation, the Opportunity Research Scholar's (ORS) Symposium was held on May 3, 2024. ORS is the Georgia Tech School of Electrical and Computer Engineering’s (ECE) undergraduate research program designed to enhance and expand the traditional classroom experience through long-term projects.

The annual symposium is the culmination of two semesters of research through the ORS program. Starting each fall, students in groups of three to four, conduct the research with the help of a graduate advisor and a faculty member.

At the end of the Spring semester, each group submits their research as a conference paper to the Institute of Electrical and Electronics Engineers (IEEE) ORSS, which decides the first and second place Best Paper Winners for the ECE ORSS. 

“The ORS Symposium is testament to the dedication, passion, and hard work of our student researchers,” ORS Director Shanthi Rajaraman said. “To witness the progress and growth of these young minds is rewarding and inspiring."

Students also present their research via posters at the symposium, with a People’s Choice Award given out to the best overall poster as decided by student participants and mentors.

Additionally, students have the opportunity to peer review other teams’ projects. For the past three years, the ORS Symposium has been open to teams beyond ECE. This year, there were 25 teams that participated, with 22 coming from Georgia Tech and three from Kennesaw State University.

Since its establishment, over 1,000 students have participated in the ORS program, with nearly twice as many ORS Ph.D. graduates going on to a career in a academics than the general ECE Ph.D. population, according to Rajaraman.

All the pictures from the symposium can viewed here.

The 2024 winners were:

Best Paper Award

From left to right: Avanish Narumanchi, Seongjin Kim, William Montello, Md. Nahid Haque Shazon (Mentor)

Title:   Investigating the Impacts of Device Geometry and an Alternative Write Current Scheme on Write Time and Switching Energy of SOT-MRAMs  Student Researchers: Seongjin Kim, William Montello, Avanish Narumanchi, Md. Nahid Haque Shazon Faculty Advisor: Azad Naemi

From left to right: Karsten Richardson, Cullen Lonergan, Luke Hanks

Title: Analog High-Level Synthesis for Field Programmable Analog Arrays Student Researchers: Luke Hanks, Cullen Lonergan, Karsten Richardson, Afolabi Ige, Pranav Mathews  Faculty Advisor: Jennifer Hasler

People’s Choice Award

From left to right: Emma McClelion, Hannah Xiao, Viktor Raykov

Title: Rectenna Characterized Under Varying 2-D Transmitter Positions & Power Beaming Amplitude Levels at 5.8 GHz Student Researchers: Hanna Xiao, Emma McClelion, Victor Raykov, Hanna Xiao, Kaitlyn Graves Faculty Advisor: Greg Durgin

Star USC scientist faces scrutiny — retracted papers and a paused drug trial

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Late last year, a group of whistleblowers submitted a report to the National Institutes of Health that questioned the integrity of a celebrated USC neuroscientist’s research and the safety of an experimental stroke treatment his company was developing.

NIH has since paused clinical trials for 3K3A-APC, a stroke drug sponsored by ZZ Biotech, a Houston-based company co-founded by Berislav V. Zlokovic , professor and chair of the department of physiology and neuroscience at the Keck School of Medicine of USC.

Three of Zlokovic’s research papers have been retracted by the journal that published them because of problems with their data or images. Journals have issued corrections for seven more papers in which Zlokovic is the only common author, with one receiving a second correction after the new supplied data were found to have problems as well.

For an 11th paper co-authored by Zlokovic the journal Nature Medicine issued an expression of concern , a note journals append to articles when they have reason to believe there may be a problem with the paper but have not conclusively proven so. Since Zlokovic and his co-authors no longer had the original data for one of the questioned figures, the editors wrote, “[r]eaders are therefore alerted to interpret these results with caution.”

“It’s quite unusual to see this volume of retractions, corrections and expressions of concern, especially in high-tier influential papers,” said Dr. Matthew Schrag, an assistant professor of neurology at Vanderbilt who co-authored the whistleblower report independently of his work at the university.

Both Zlokovic and representatives for USC declined to comment, citing an ongoing review initiated in the wake of the allegations, which were first reported in the journal Science.

“USC takes any allegations of research integrity very seriously,” the university said in a statement. “Consistent with federal regulations and USC policies, this review must be kept confidential.”

Science & Medicine

USC neuroscientist faces scrutiny following allegations of data manipulation

Accusations against USC’s Berislav Zlokovic were made by a small group of independent researchers and reported in the journal Science.

Nov. 24, 2023

Zlokovic “remains committed to cooperating with and respecting that process, although it is unfortunately required due to allegations that are based on incorrect information and faulty premises,” his attorney Alfredo X. Jarrin wrote in an email.

Regarding the articles, “corrections and retractions are a normal and necessary part of the scientific post-publication process,” Jarrin wrote.

Authors of the whistleblower report and academic integrity experts challenged that assertion.

“If these are honest errors, then the authors should be able to show the actual original data,” said Elisabeth Bik , a microbiologist and scientific integrity consultant who co-wrote the whistleblower report. “It is totally human to make errors, but there are a lot of errors found in these papers. And some of the findings are suggestive of image manipulation.”

Given the staid pace of academic publishing, publishing this many corrections and retractions only a few months after the initial concerns were raised “is, bizarrely, pretty quick,” said Ivan Oransky, co-founder of Retraction Watch .

The whistleblower report submitted to NIH identified allegedly doctored images and data in 35 research papers in which Zlokovic was the sole common author.

“There had been rumblings about things not being reproducible [in Zlokovic’s research] for quite some time,” Schrag said. “The real motivation to speak publicly is that some of his work reached a stage where it was being used to justify clinical trials. And I think that when you have data that may be unreliable as the foundation for that kind of an experiment, the stakes are just so much higher. You’re talking about patients who are often at the most vulnerable medical moment of their life.”

World & Nation

Countries struggle to draft ‘pandemic treaty’ to avoid mistakes made during COVID

After the devastation of the COVID-19 pandemic, the World Health Organization and leaders worldwide vowed to do better next time but are still struggling to finalize a global plan.

May 11, 2024

Over the years, Zlokovic has created several biotech companies aimed at commercializing his scientific work. In 2007, he co-founded ZZ Biotech , which has been working to gain federal approval of 3K3A-APC.

The drug is intended to minimize the bleeding and subsequent brain damage that can occur after an ischemic stroke, in which a blood clot forms in an artery leading to the brain.

In 2022, USC’s Keck School of Medicine received from NIH the first $4 million of a planned $30-million grant to conduct Phase III trials of the experimental stroke treatment on 1,400 people.

In Phase II of the trial, which was published in 2018 and called Rhapsody, six of the 66 patients who received 3K3A-APC died in the first week after their stroke, compared to one person among the 44 patients who got a placebo. Patients who received the drug also tended to report more disability 90 days after their stroke than those who got the placebo. The differences between the two groups were not statistically significant and could have been due to chance, and the death rate for patients in both groups evened out one month after the initial stroke.

“The statements that there is a risk in this trial is false,” said Patrick Lyden, a USC neurologist and stroke expert who was employed by Cedars-Sinai at the time of the trial. Zlokovic worked with Lyden as a co-investigator on the study.

One correction has been issued to the paper describing the Phase II results, fixing an extra line in a data table that shifted some numbers to the wrong columns. “This mistake is mine. It’s not anybody else’s. I didn’t catch it in multiple readings,” Lyden said, adding that he noticed the error and was already working on the correction when the journal contacted him about it.

He disputed that the trial represented any undue risk to patients.

“I believe it’s safe, especially when you consider that the purpose of Rhapsody was to find a dose — the maximum dose — that was tolerated by the patients without risk, and the Rhapsody trial succeeded in doing that. We did not find any dose that was too high to limit proceeding to Phase III. It’s time to proceed with Phase III.”

Schrag stressed that the whistleblowers did not find evidence of manipulated data in the report from the Phase II trial. But given the errors and alleged data manipulation in Zlokovic’s earlier work, he said, it’s appropriate to scrutinize a clinical trial that would administer the product of his research to people in life-threatening situations.

In the Phase II data, “there’s a coherent pattern of [patient] outcomes trending in the wrong direction. There’s a signal in early mortality … there’s a trend toward worse disability numbers” for patients who received the drug instead of a placebo, he said.

None are “conclusive proof of harm,” he said. But “when you’re seeing a red flag or a trend in the clinical trial, I would tend to give that more weight in the setting of serious ethical concerns around the pre-clinical data.”

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The NIH paused the clinical trial in November, and it remains on hold, said Dr. Pooja Khatr, principal investigator of the NIH StrokeNet National Coordinating Center. Khatr declined to comment on the pause or the trial’s future, referring further questions to USC and NIH.

The NIH Office of Extramural Research declined to discuss Rhapsody or Zlokovic, citing confidentiality regarding grant deliberations.

ZZ Biotech Chief Executive Kent Pryor, who in 2022 called the drug “a potential game-changer,” said he had no comment or information on the halted trial.

Zlokovic is a leading researcher on the blood-brain barrier, with particular interest in its role in stroke and dementia. He received his medical degree and doctorate in physiology at the University of Belgrade and joined the faculty at USC’s Keck School of Medicine after several fellowships in London. A polyglot and amateur opera singer , Zlokovic left USC and spent 11 years at the University of Rochester before returning in 2011 . He was appointed director of USC’s Zilkha Neurogenetic Institute the following year.

A USC spokesperson confirmed that Zlokovic has retained his titles as department chair and director of the Zilkha institute.

About this article

Corinne Purtill is a science and medicine reporter for the Los Angeles Times. Her writing on science and human behavior has appeared in the New Yorker, the New York Times, Time Magazine, the BBC, Quartz and elsewhere. Before joining The Times, she worked as the senior London correspondent for GlobalPost (now PRI) and as a reporter and assignment editor at the Cambodia Daily in Phnom Penh. She is a native of Southern California and a graduate of Stanford University.

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