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High Spiritual Coping after 9/11 and When Illness Strikes: Findings in The New England Journal of Medicine and Mayo Clinic Proceedings

A national survey recently published in The New England Journal of Medicine examining stress following the Sept. 11, 2001, terrorist attacks1 found that 90% turned to prayer, religion, or spirituality to help them cope with the crises. Meanwhile, researchers at the Mayo Clinic have recently underscored the health benefits of spiritual coping.

Regarding nationwide reactions after the Sept. 11 attacks, "Our survey indicates that… most turned to religion, and also to one another for social support," noted the team of 10 researchers who investigated the stress and coping mechanisms of 560 adults 3 to 5 days following the attacks. The stress survey found that among the nationally representative sample contacted in half-hour phone interviews that 90% reported symptoms of stress and 44% had one or more substantial symptoms. Among children, 35% had one or more stress symptoms and 47% were worried about their own safety and loved ones.

The adults "coped by talking with others (98%), turning to religion (90%), participating in group activities (60%) and making donations (36%)" the researchers reported. More specifically regarding to what degree respondents turned to prayer, religion or spiritual feelings, only 10% said "not at all," 15% "a little bit," 31% "a medium amount," and 57% "a lot."

These findings on how people coped with the terrorist attacks paralleled the findings from coping studies on other national disasters, underscoring the high relevance of spirituality and religion. For example, a study of persons affected by the Oklahoma City bombing found that those who turned to God for strength had less depression and improved quality of life2. A study on victims of a massive Midwest flood discovered that those who ranked religious beliefs as highly important to them felt less drained and overwhelmed by the crises3. Also flood victims who identified positive actions to take had less psychological distress and less despondency.

(Note: For further review of these studies, please see the ICIHS Fall 2001 newsletter vol. 5, issue 3, Health & Spirituality Connection, "Coping with Crises." Request the newsletter by calling Pam Colella at (301) 984-7162, ext. 309.

Building on this past disaster research, in the recent New England Journal of Medicine survey, the researchers used five questions regarding symptoms of stress reported by 50% or more of the survivors of the Oklahoma City Bombing from a 17-question Posttraumatic Stress Disorder Check List to assess stress following the Sept. 11 attacks. These included 1) feeling very upset when something reminded you of what happened, 2) having repeated, disturbing memories, thoughts, or dreams about what happened, 3) having difficulty concentrating, 4) having trouble falling or staying asleep, and 5) feeling irritable and having angry outbursts.

The researchers concluded, "After the September 11 terrorist attacks, Americans across the country, including children, had substantial symptoms of stress. Even clinicians, who practice in regions that are far from the recent attacks, should be prepared to assist people with trauma-related symptoms of stress."

Commenting on these findings, Dr. David Larson, MD, MSPH, president of the International Center for the Integration of Health and Spirituality, noted, "The substantial number - 90%- of those who turned to prayer, religion or spirituality at some level illustrates the frequency of spiritual or religious coping when handling stress." "This survey does not clarify the degree the respondents felt helped or harmed by religious coping, but does show a large majority turned to spiritual resources. Given such relevance, it is not surprising that an increasing number of medical fields are giving more research attention to spiritual/religious factors," he noted.

For instance, the December 2001 issue of the peer-reviewed journal produced by the Mayo Clinic, the Mayo Clinic Proceedings, presented a research review of spirituality/religion and health. Mayo researcher Dr. Paul S. Mueller and his colleagues concluded4:
"Most studies have shown that religious involvement and spirituality are associated with better health outcomes, including greater longevity, coping skills, and health related quality of life (even during terminal illness) and less anxiety, depression and suicide."

"Several studies have shown that addressing the spiritual needs of the patient may enhance recovery from illness," the Mayo research team added. Yet "despite these findings, the spiritual needs of patients are often ignored or not satisfied," they noted, citing unpublished data from the Mayo Patient Expectations Survey in 1994.

"Physician interest in patient spirituality has increased because of a growing number of studies that have shown an association between increased religious involvement and spirituality and better health outcomes," the Mayo researchers stated.

"The physician's duty is not to judge a patient's private attitudes and behaviors but to understand their importance. Hence, physicians should inquire about and support a patient's spiritual beliefs and needs, especially during severe and terminal illness…Indeed, lack of appropriate spiritual care may constitute a form of negligence," the Mayo researchers noted.

The Mayo researchers concluded, "Because the goals of medicine are to cure disease when possible and to relieve suffering always, including spirituality in clinical practice should be within the purview of the physician…and should be viewed in the same light as other psychosocial factors.

Dr. Larson noted, "This research review published in the Mayo Clinic Proceedings underscores medicine's continuing and positive response to handling spiritual and religious issues in clinical research, education, and care. As with the findings in The New England Journal of Medicine survey, many turn to spirituality to cope with life crises and serious or chronic illness."

________________________________________________ 1Schuster MA, Stein BD, Jaycox LH, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. The New England Journal of Medicine 2001; 345(20):1507-1512. 2 Pargament KI, Smith BW, Koenig HG, Perez. Patterns of positive and negative religious coping with major life stressors. Journal for the Scientific Study of Religion 1998; 37(4): 710-724. 3Smith BW. Coping as a predictor of outcomes following the 1993 Midwest flood. Journal of Social Behavior and Personality 1996; 11(2): 225-239. 4Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: Implications for clinical practice. Mayo Clinic Proceedings 2001; 76(12): 1225-1235.

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