Spirituality and Health Research: Methods, Measurement, Statistics, and Resources

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In Spirituality and Health Research: Methods, Measurement, Statistics, and Resources, Dr. Harold G. Koenig leads a comprehensive overview of this complex subject. Dr. Koenig is one of the world’s leading authorities on the relationship between spirituality and health, and a leading researcher on the topic. As such, he is distinctively qualified to author such a book.
This unique source of information on how to conduct research on religion, spirituality, and health includes practical information that goes well beyond what is typically taught in most undergraduate, graduate, or even post-doctoral level courses. This volume reviews what research has been done, discusses the strengths and limitations of that research, provides a research agenda for the future that describes the most important studies that need to be done to advance the field, and describes how to actually conduct that research (design, statistical analysis, and publication of results). It also covers practical matters such as how to write fundable grants to support the research, where to find sources of funding support for research in this area, and what can be done even if the researcher has little or no funding support.
The information gathered together here, which has been reviewed for accuracy and comprehensiveness by research design and statistical experts, has been acquired during a span of over twenty-five years that Dr. Koenig spent conducting research, reviewing others’ research, reviewing research grants, and interacting with mainstream biomedical researchers both within and outside the field of spirituality and health. The material is presented in an easy to read and readily accessible form that will benefit researchers at almost any level of training and experience.

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Product Details

  • ISBN-13: 9781599473499
  • Publisher: Templeton Press
  • Publication date: 11/15/2011
  • Edition description: First Edition, First edition
  • Pages: 408
  • Sales rank: 1,311,574
  • Product dimensions: 6.90 (w) x 9.20 (h) x 1.20 (d)

Meet the Author

Harold G. Koenig, MD completed his undergraduate education at Stanford University, his medical school training at the University of California at San Francisco, and his geriatric medicine, psychiatry, and biostatistics training at Duke University Medical Center. He is on the faculty at Duke as professor of psychiatry and behavioral sciences and associate professor of medicine. Dr. Koenig is also director of the Center for Spirituality, Theology, and Health at Duke University Medical Center, and is Distinguished Adjunct Professor at King Abdulaziz University in Jeddah, Saudi Arabia. Dr. Koenig has published extensively in the fields of mental health, geriatrics, and religion, with over 350 scientific peer-reviewed articles and book chapters and nearly 40 books in print or in preparation. He has given invited testimony to both the U.S. Senate and the U.S. House of Representatives on the role of religion in public health.

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Read an Excerpt

Spirituality & Health Research

Methods, Measurement, Statistics, and Resources

By Harold G. Koenig

Templeton Press

Copyright © 2011 Harold G. Koenig
All rights reserved.
ISBN: 978-1-59947-349-9


Overview of the Research


I. Mental Health
1. Positive Emotions
a. Well-Being
b. Hope and Optimism
c. Meaning and Purpose
d. Self-Esteem
e. Sense of Personal Control
2. Negative Emotions
a. Depression
b. Suicide
c. Anxiety
d. Alcohol Use/Abuse
e. Drug Abuse

II. Social Health
1. Human Virtues
2. Social Support
3. Social Capital

III. Physical Health
1. Health Behaviors
a. Exercise
b. Diet
c. Weight
d. Risky Sexual Activity
e. Smoking
2. Physical Disorders
a. Heart Disease
b. Hypertension
c. Cerebrovascular Disease
d. Dementia
e. Immune Dysfunction
f. Endocrine Dysfunction
g. Cancer
h. Overall Mortality

IV. Relationships with Health

V Summary and Conclusions

FOR THOUSANDS OF years, as far back as historical records go, people around the world have held religious beliefs and engaged in religious practices. Why would humans spend their time and energy on such activities? Why would such beliefs and practices persist and even flourish in some of the most developed countries of the world and among well-educated and informed people? For example, recent national polls of the United States by the Gallup and Pew organizations have found that 55 to 65 percent of Americans indicate that religion is an important or very important part of their daily life.1 What function does religion serve that keeps people believing and practicing? One possibility is that it helps to preserve health.

In this first chapter I briefly review research on the relationships between religious involvement and mental, social, and physical health. That research has been rapidly increasing in volume, especially over the past twenty years. Figure 1.1 shows the number of peer-reviewed articles on religion/spirituality (R/S) and health appearing in Medline and PsychINFO from 1965 to 2009. Note that the figures are noncumulative, referring to the number of articles published during each five-year period. Although only about 5 to 10 percent of these articles are research related, the number of research studies is rapidly accumulating. Overall, there now exist about three thousand quantitative original databased studies on R/S and health. The review in this chapter sets the stage for the remainder of this book, which focuses on a critique of the research and, in particular, on a discussion of how to conduct, analyze, interpret, publish, and fund research on religion, spirituality and health.

Mental Health

The majority (70 to 75 percent) of research on R/S and health has focused on mental health (Figure 1.2). I summarize this research by dividing it into studies on positive emotions and studies on negative emotions. The summaries presented here (see Table 1.1 on page 19) are from systematic reviews of the literature contained in the appendices of two editions of the Handbook of Religion and Health; all studies referred to below are reviewed there in detail.

Positive Emotions

R/S has been linked to a number of positive psychological emotions that represent the opposite of the negative emotions and mental disorders that I discuss in the next section.


As of early 2010 at least 326 quantitative studies had examined relationships between R/S and well-being, with 256 (79 percent) finding greater happiness, satisfaction with life, or overall sense that life is good in those who were more R/S. All of these studies reported statistically significant findings, except for eight studies in which results were at a trend level (0.05 < p < 0.10). Of the 120 studies judged as the methodologically most rigorous, 98 (82 percent) found greater well-being among those who were more R/S (two at a trend level). Less than 1 percent reported lower well-being in the more R/S.

Hope and Optimism

At least 40 studies have examined relationships between R/S and hope, with 29 (73 percent) finding greater hope among the more R/S (two at a trend level). Likewise, at least 32 studies have examined relationships between R/S and optimism, and of those, 26 (81 percent) reported a significant positive relationship.

Meaning and Purpose

Having meaning and purpose in life is a positive aspect of mental health that is not only strongly correlated with well-being but also associated with resilience in the face of difficult circumstances. Of the 45 studies that have now examined relationships with R/S, 42 (93 percent) reported greater meaning or purpose among the more R/S. Of the 10 best studies in terms of methodological rigor, all 10 (100 percent) reported significant positive relationships.


Low self-esteem is often associated with an emotional disorder such as depression. In contrast, high self-esteem is strongly correlated with positive emotions and good mental health. Of 69 quantitative studies examining the relationship between R/S and self-esteem, 42 (61 percent) found significantly higher levels of self-esteem in those scoring higher on R/S; only 2 studies (3 percent) reported that R/S persons had lower self-esteem. Of the 25 methodologically most rigorous studies, 17 (68 percent) reported greater self-esteem in the more R/S.

Sense of Personal Control

Persons with a high internal locus of control (LOC) believe that events in life are a result of their own actions; in contrast, those with an external LOC believe that powerful others or external events control their lives. Of the 21 studies we identified in our systematic review that examined relationships between R/S and LOC, 13 (62 percent) reported that those who were more R/S scored significantly higher on having a sense of personal control.

Negative Emotions

In contrast to these positive indicators of mental health are negative emotional states, which when they interfere with an individual's functioning are called "mental disorders." These include depression, suicide, anxiety, alcohol abuse, and drug abuse.


Depression was the leading cause of disability in the world (measured by years of life lived with disability) in 1990 and is expected to be the world's second-leading cause of disability in 2020, surpassed only by cardiovascular disease. The lifetime prevalence of depression in the United States is 20 percent in women and 10 percent in men. At least 444 studies have now quantitatively examined relationships between R/S and depression, and 272 (61 percent) of those found less depression, faster remission from depression, or a reduction in depression severity in response to an R/S intervention (ten studies at a trend level). In contrast, only 6 percent reported greater depression in those who were more R/S. Of the 178 methodologically most rigorous studies, 119 (67 percent) found inverse relationships between R/S and depression.


Strongly linked to depression is suicide. Nearly 10 percent of those with severe depression end their lives by committing suicide, and depression is the most common cause of suicide. We identified 141 studies that had examined relationships between R/S and some aspect of suicide (completed suicide, attempted suicide, or attitudes toward suicide), and 106 (75 percent) reported significant inverse relationships; 80 percent of the best designed studies reported this finding.


Anxiety is a negative emotion that may present as an isolated problem by itself or in combination with depression. Of the 299 studies we located that examined relationships with R/S, 147 (49 percent) reported inverse relationships. Of the 67 best-designed studies, 38 (55 percent) reported inverse relationships. Of 33 studies reporting greater anxiety among the more R/S, all but 2 studies were cross-sectional in design, leaving open the possibility that anxiety led to greater R/S as individuals turned to religion to cope with whatever was making them anxious (as the saying goes, "There are no atheists in foxholes"). Interestingly, of the 40 experimental studies or clinical trials, 29 (73 percent) reported that an R/S intervention was effective in reducing anxiety.

Alcohol Use/Abuse

We identified 278 studies that examined relationships between R/S and alcohol use or abuse, and 240 (86 percent) of those found less alcohol use or abuse among the more R/S (eleven at a trend level). Of the 145 best-designed studies, 131 (90 percent) reported significant inverse relationships with R/S. Less than 1 percent reported a positive relationship.

Drug Abuse

At least 185 studies have examined relationships between R/S and drug abuse, and 155 (84 percent) of those found less drug abuse among those who were more R/S. Of the 38 prospective cohort studies, clinical trials, or experimental studies, 36 (95 percent) found that R/S predicted less drug use or reported that R/S interventions reduced drug use.

Thus, there is a lot of evidence indicating that R/S beliefs and behaviors are associated with more positive emotions and fewer negative emotions, emotional disorders, or substance use problems.

Social Health

Social health is known to influence physical health and disease susceptibility on the individual level and to affect resiliency in response to trauma or disaster on the individual and community levels. Under social health I include human virtues (prosocial positive psychological traits), social support, marital stability, social capital, and delinquency/crime.

Human Virtues

Among the human virtues (or prosocial positive psychological traits), I include forgiveness, altruism, and gratefulness. These virtues enhance and maintain social relationships. With regard to forgiveness, at least 40 studies have now examined relationships with R/S. Of those, 34 (85 percent) found that R/S was significantly correlated with being more forgiving (one at a trend level). Similarly, at least 47 studies have examined relationships between R/S and altruism (volunteering, donating money to the needy, etc.), of which 33 (70 percent) reported more altruistic activities among the more religious. Finally, we located 5 studies that examined relationships between R/S and gratefulness, and all five found significantly higher levels of gratefulness among the more religious.

Social Support

We identified 74 studies that examined relationships between R/S and social support, and 61 (82 percent) found significant positive associations, especially the more methodologically rigorous studies, where 93 percent (27 of 29 studies) reported this finding. An important aspect of social support is having a marital partner available to provide support in time of need. Of 79 additional studies that examined relationships with marital satisfaction, marital commitment, relationship cohesion, marital sexual fidelity, divorce/separation, spousal abuse, couples' problem solving, or forgiveness in marriage, 68 (86 percent) found significant positive relationships with R/S (one at a trend level). Of the higher-quality studies, 92 percent (35 of 38) reported positive relationships.

Social Capital

Social capital is defined as community participation, volunteerism, trust, reciprocity between people in the community, and membership in community-based, civic, political, or social justice organizations. Social capital reflects the overall social health of a community. In contrast, crime and delinquency rates reflect the opposite. A number of studies have now examined relationships between R/S, social capital, and its converse, delinquency and crime. At least 14 studies have examined relationships between R/S and social capital, and 11 (79 percent) found significant positive associations. At least 104 studies have now examined relationships between R/S and antisocial behaviors, crime, or delinquency, and 82 (79 percent) found lower rates among those who were more R/S (two at a trend level). Another aspect of social capital is performance by youth in school. Of the 11 studies that examined relationships between R/S and school performance (assessed by grades, GPA, or likelihood of graduation), all 11 (100 percent) found significant positive relationships.

Thus, R/S involvement is strongly associated with prosocial traits, greater social support, and higher social capital, all of which could influence relationships with physical health.

Physical Health

In this section I begin by examining studies on R/S and health behaviors known to affect physical health (exercise, diet, weight, risky sexual activity, cigarette smoking), and then go on to explore more direct relationships between R/S and specific physical health conditions (heart disease, hypertension, cerebrovascular disease, dementia, immune dysfunction, endocrine dysfunction, cancer, and overall mortality).

Health Behaviors


At least 37 studies have examined relationships between R/S and exercise, and 25 (68 percent) of those found positive relationships, 6 (16 percent) reported negative relationships, and the remaining studies found no association. Of the 21 methodologically most rigorous studies, 16 (76 percent) reported that those who were more R/S were more likely to exercise.


We identified 21 studies that examined relationships between R/S and overall diet quality, and 23 studies examining relationships with cholesterol level. Of those examining overall diet, 13 (62 percent) found that those who were more R/S were more likely to consume a higher-quality diet (i.e., greater intake of fruits and vegetables, vitamins, fish, overall better nutritional status or lower risk). Of those examining cholesterol levels, 12 (52 percent) reported inverse relationships with R/S or a reduction in cholesterol in response to R/S interventions.


Relationships with weight, however, go in the opposite direction compared to other health behaviors. Of 36 studies that examined these associations, 14 (39 percent) found that R/S was associated with greater weight, whereas only 7 (19 percent) found lower weight among the more religious. Many of these studies controlled for race and gender, so it looks like greater weight is a problem among the more religious.

Risky Sexual Activity

Sexual activity that involves multiple partners, premarital sex, or extramarital sex increases the risk of sexually transmitted diseases such as HIV infection, gonorrhea, chlamydia, trichomoniasis, bacterial vaginosis, lymphogranuloma venereum, human papillomavirus, genital herpes, and syphilis. We identified 95 studies that examined relationships between R/S and risky sexual behaviors. Of those, 82 (86 percent) found such behaviors less common among the more R/S (84 percent of the methodologically most rigorous studies reported this). Of the 9 prospective cohort studies in this group, all 9 (100 percent) found that R/S predicted less risky sexual activity over time.


Cigarette smoking is known to cause chronic obstructive lung disease, heart disease, atherosclerosis, hypertension, stroke, and cataracts, as well as 87 percent of all lung cancers and 30 percent of all cancers in general, according to the American Cancer Society. At least 135 studies have now examined relationships between R/S and cigarette smoking, and 122 (90 percent) of those reported significant inverse relationships (three at a trend level). Of the 83 best-designed studies, 75 (90 percent) reported less smoking by the more R/S.

In general, then, those who are R/S live a healthier lifestyle that lowers their risk of physical illness. I now examine relationships between R/S and specific diseases and physiological states.

Physical Disorders

Heart Disease

At least 19 studies have examined relationships between R/S and coronary artery disease (CAD). Of those, 12 (63 percent) reported significant inverse associations (69 percent of studies with the best designs). In an additional 16 studies, R/S or spiritual interventions (primarily meditation) resulted in better cardiac surgery outcomes, lower cardiovascular reactivity, greater heart rate variability, or other positive cardiovascular functions in 11 (69 percent) of those studies.


Excerpted from Spirituality & Health Research by Harold G. Koenig. Copyright © 2011 Harold G. Koenig. Excerpted by permission of Templeton Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents


Part 1: Overview,
1. Overview of the Research,
2. Strengths, Weaknesses, and Challenges,
3. A Research Agenda for the Field,
Part 2: Methods and Design,
4. Identifying a Research Question,
5. Choosing a Research Design,
6. Selecting a Sample,
7. Qualitative Research,
8. Observational Research,
9. Clinical Trials,
10. Clinical Trials with Religious Interventions,
Part 3: Measurement,
11. Definitions,
12. Measurement I,
13. Measurement II,
Part 4: Statistical Analyses and Modeling,
14. Statistics I: General Considerations,
15. Statistics II: Statistical Tests and Approaches,
16. Confounders, Explanatory Variables, and Moderators,
17. Models and Mechanisms,
18. Statistical Modeling,
Part 5: Publishing and Funding Resources,
19. Publishing Results,
20. Funding for Research,
21. Writing a Grant,
Final Thoughts,

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