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A 2-Year Longitudinal Study

Kenneth I. Pargament, PhD; Harold G. Koenig, MD; Nalini Tarakeshwar, MA; June Hahn, PhD

Arch Intern Med. 2001;161:1881-1885.

Background  Although church attendance has been associated with a reduced risk of mortality, no study has examined the impact of religious struggle with an illness on mortality.

Objective  To investigate longitudinally the relationship between religious struggle with an illness and mortality.

Methods  A longitudinal cohort study from 1996 to 1997 was conducted to assess positive religious coping and religious struggle, and demographic, physical health, and mental health measures at baseline as control variables. Mortality during the 2-year period was the main outcome measure. Participants were 596 patients aged 55 years or older on the medical inpatient services of Duke University Medical Center or the Durham Veterans Affairs Medical Center, Durham, NC.

Results  After controlling for the demographic, physical health, and mental health variables, higher religious struggle scores at baseline were predictive of greater risk of mortality (risk ratio [RR] for death, 1.06; 95% confidence interval [CI], 1.01-1.11; ² = 5.89; P = .02). Two spiritual discontent items and 1 demonic reappraisal item from the religious coping measure were predictive of increased risk for mortality: "Wondered whether God had abandoned me" (RR for death, 1.28; 95% CI, 1.07-1.50; ² = 5.22; P = .02), "Questioned God's love for me" (RR for death, 1.22; 95% CI, 1.02-1.43; ² = 3.69; P = .05), and "Decided the devil made this happen" (RR for death, 1.19; 95% CI, 1.05-1.33; ² = 5.84; P = .02).

Conclusions  Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.

From the Department of Psychology, Bowling Green State University, Bowling Green, Ohio (Dr Pargament and Ms Tarakeshwar); Departments of Psychiatry and Medicine, Duke University Medical Center, Durham, NC (Dr Koenig); and The Procter & Gamble Company, Cincinnati, Ohio (Dr Hahn).

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