A large part of the research involving religion and health did not have religion as the focus of the study. Because of that, frequently, the measurement of religiosity involved only a single question, often simply religious denomination. However, the religious affiliation tells us little about what is religiosity and how important it is in someone's life. On account of that, studies using only a subject's religious affiliation have provided, with few exceptions, many inconsistent and contradictory findings.12,29 The strongest and most consistent results have not been found between different religious denominations, but by comparing different degrees of religious involvement (from a non-religious to a deeply religious person). Church attendance, i.e. how often someone attends religious meetings, is one of the most widely used questions to investigate the level of religious involvement. Other questions are non-organizational religiosity (time spent in private religious activities such as prayer, meditation, and reading religious texts) and subjective religiosity (the importance of the religion in someone's life). However, caution is necessary in interpreting the relationship between private religious practices and health in cross-sectional studies. People may pray more while they are sick or under stressful situations. Turning to religion when sick may result in a spurious positive association between religiousness and poor health. Conversely, a poor health status could decrease the capacity to attend a religious meeting, in that way creating another bias on the association between religiousness and health. Finally, a very important dimension of religiosity is religious commitment, which reflects the influence that religious beliefs have on a person's decisions and lifestyle. According to the Harvard psychologist Gordon Allport30 a persons' religious orientation may be intrinsic and/or extrinsic:
With some exceptions, most studies have also found a positive association between religiosity and other factors associated with well-being such as optimism and hope (12 out of 14 studies), self-esteem (16 out of 29 studies, but only one with a negative association), sense of meaning and purpose in life (15 out of 16 studies), internal locus of control, social support (19 out of 20) and being married or having higher marital satisfaction (35 out of 38). As will be discussed later, these may be some of the mediating factors between religiousness and well-being.50 In a high-quality research study involving a US national sample of 1126 non-institutionalized older people, the feeling of closeness with God was related to optimism after controlling for socio-demographic variables. This optimism, in turn, had a strong influence on their self-rated health status.51 In sum, following Levin & Chatters we can state that the existing research has shown that religious involvement, variously assessed, has protective effects with respect to a wide range of well-being-related outcomes (p. 507).52
The first European longitudinal study on this topic was published recently.57 A 6-year follow-up study was conducted in the Netherlands (where rates of church membership are substantially lower than those in the US: 51% vs. 77%) with a nationally representative random sample of 1,840 senior adults (aged 55 to 85). Frequent church attendance was associated with lower depressive symptoms during the follow-up, and the association persisted after adjusting for demographic variables, physical health, social support and alcohol use. Because the last two variables themselves could be influenced by religiousness, the results are even stronger. Supporting previous studies, the difference in depression scores between regular church attenders and non-frequent church attenders was larger for those with higher functional limitations.
Psychotherapies, mainly cognitive-behavioral therapy, accommodated to include patients religious beliefs and practices, have been successfully used in the treatment of depression and anxiety. These approaches have shown to be at least as effective as the secular psychotherapies in meta-analysis,58 and in some studies they were associated with faster improvement of the symptoms among religious patients.59-60 It is worth noting that one clinical trial found that cognitive behavioral therapy adapted to the religious values of the patient can be efficiently implemented by non-religious therapists.61
Similar to other areas in the religion-health research field, most early studies investigated the impact of denominational affiliation rather than religious involvement. The findings from these early studies were usually inconsistent; whereas, the most robust results have emerged from the examination of the effects of religious involvement in suicide. In a review, 84% of the 68 studies identified through 2000 found lower rates of suicide or more objections to suicide among the more religious subjects.12 These studies basically present two different approaches: aggregate (ecological) or individual data. The first type correlates data on religious involvement of entire populations (e.g.: production of religious literature or rates of church membership) and compares the suicide rates between different populations. Most of these studies found that the level of religious involvement in a given area is inversely proportional to that area's suicide rate. The second type of study correlates the individual religious involvement rates with suicide deaths, attempts or ideation. Below, we discuss some recent studies not included in Koenig et als.12 review.
In a US sample of 584 suicides and 4,279 natural deaths among subjects aged 50 and older, the suicide rate among people who did not attend religious activities was 4 times higher (OR 4.34) than those who had high participation, after adjusting for sex, race, marital status, age and frequency of social contact.67 Of the 27,738 deaths of young men aged 15-34 years from 1991 to 1995 in the state of Utah (USA), the relative risk of suicide among subjects with low religious commitment ranged from 3.28 to 7.64 being people with high religious commitment the parameter (risk = 1).68 Besides being associated with lower suicide rates, religious involvement has also been associated with more negative attitudes toward suicide and less suicide attempts, even in clinical samples. One recent study involving 371 depressed inpatients found that those with no religious affiliation, despite having the same level of depression, had more lifetime suicide attempts (66.2% vs. 48.3%), perceived less reasons for living and had fewer moral objections to suicide than religiously affiliated patients.69 In a nationally representative US sample of 16,306 adolescents, private - but not public - religiosity was associated with lower probability of having had suicidal thoughts or having attempted suicide.70 Similar results were found among 420 adolescents in Turkey. The group that received religious education reported less suicide ideation and lower acceptance of suicide, but were more accepting and sympathetic to a suicidal close friend than the secular ones.71 Finally, the use of religious or spiritual beliefs as a source of support and comfort was associated with less suicidal ideation among 835 African-American senior residents of public housings, after controlling for social and medical variables.72 The level of religiousness also has been found to be inversely associated with the acceptance of euthanasia and physician-assisted suicide in the general population in Britain,73 among the elderly in the US,74 physicians in Australia75 and cancer patients in a palliative care service in the US.76 Non-religious Belgian general practitioners were three times more frequently involved than the religious physicians in deaths resulting from administration of (lethal) drugs with the explicit intention of hastening the end of life of the patient without his/her explicit request.77
The most commonly studied religious practice is meditation.89 It has been reported that it can produce changes in personality, reduce tension and anxiety, diminish self-blame, stabilize emotional ups and downs, and improve self-knowledge. Improvement in panic attacks, generalized anxiety disorder, depression, insomnia, drug use, stress, chronic pain and other health problems have been reported. Follow-up studies have documented the effectiveness of these technique.90-91 Other religious practices (such as personal prayer, confession, forgiveness, exorcism, liturgy, blessings and altered states of consciousness); may also be effective, but more studies are necessary.
Religion is a multidimensional phenomenon and no single fact can explain its actions and consequences. The combination of beliefs, behaviors and environment promoted by the religious involvement probably act altogether to determine the religious effects on health.78,95 However, empirical studies have had limited success in accounting the psychosocial mechanisms described above for the health-promoting effects of the religious involvement. The explanation of the mechanisms by which religion affects health has been an intellectually and methodologically challenging enterprise.96
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Approximately half a million people are thought to develop multidrug-resistant tuberculosis annually. Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated. Poor access to treatment is probably driving the current epidemic, via ongoing transmission. Treatment scale-up is hampered by current treatment regimens, which are lengthy, expensive, poorly tolerated and difficult to administer in the settings where most patients reside. Although new drugs provide an opportunity to improve treatment regimens, current and planned clinical trials hold little promise for developing regimens that will facilitate prompt treatment scale-up. In this article we argue that clinical trials, while necessary, should be complemented by timely, large-scale, operational research that will provide programmatic data on the use of new drugs and regimens while simultaneously improving access to life-saving treatment. Perceived risks - such as the rapid development of resistance to new drugs - need to be balanced against the high levels of mortality and transmission that will otherwise persist. Doubling access to treatment and increasing treatment success could save approximately a million lives over the next decade. 59ce067264