title: Spirituality, religion, and clinical outcomes in patients recovering from an acute myocardial infarction.
abstract: OBJECTIVE
  To assess the prospective relationship between spiritual experiences and health in a sample of patients surviving an acute myocardial infarction (AMI) with depression or low social support.
  
  
  METHODS
  A subset of 503 patients participating in the enhancing recovery in coronary heart disease (ENRICHD) trial completed a Daily Spiritual Experiences (DSE) questionnaire within 28 days from the time of their AMI. The questionnaire assessed three spirituality variables-worship service/church attendance, prayer/meditation, and total DSE score. Patients also completed the Beck Depression Inventory to assess depressive symptoms and the ENRICHD Social Support Inventory to determine perceived social support. The sample was subsequently followed prospectively every 6 months for an average of 18 months to assess all-cause mortality and recurrent AMI.
  
  
  RESULTS
  Of the 503 participants who completed the DSE questionnaire at the time of index AMI, 61 (12%) participants either died or sustained a recurrent MI during the follow-up period. After adjustment for gender, education level, ethnicity, and a composite medical prognosis risk score derived specifically for the ENRICHD trial, we observed no relationship between death or nonfatal AMI and total spirituality as measured by the DSE (p = .446), worship service attendance (p = .120), or frequency of prayer/meditation (p = .679).
  
  
  CONCLUSIONS
  We found little evidence that self-reported spirituality, frequency of church attendance, or frequency of prayer is associated with cardiac morbidity or all-cause mortality post AMI in patients with depression and/or low perceived support.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. Blume003@mc.duke.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Gail
authors.initials: G
authors.lastname: Ironson
authors.forename: Carl
authors.initials: C
authors.lastname: Thoresen
authors.forename: Lynda
authors.initials: L
authors.lastname: Powell
authors.forename: Susan
authors.initials: S
authors.lastname: Czajkowski
authors.forename: Matthew
authors.initials: M
authors.lastname: Burg
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Patrick
authors.initials: P
authors.lastname: Steffen
authors.forename: Diane
authors.initials: D
authors.lastname: Catellier
mesh_terms: D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012067:Religion; D012306:Risk; D012944:Social Support; D029181:Spirituality; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology