title: Impact of spiritual symptoms and their interactions on health services and life satisfaction.
abstract: OBJECTIVE
  Recent work suggests that the biopsychosocial model should be expanded to include the spiritual dimension as well. The purpose of this study was to assess the independent effects of spiritual symptoms and their interactions with biopsychosocial symptoms on health care utilization, extreme use of services, and life satisfaction among primary care patients.
  
  
  METHODS
  Three hundred fifty-three adult waiting room patients at 2 primary care clinics completed the Biopsychosociospiritual Inventory (BioPSSI) as well as measures of life satisfaction and health care use. Hierarchical logistic regression analysis was performed with each outcome to determine whether adding spiritual symptoms and their interaction terms better accounted for outcomes than demographics, functional status, and chronic medical problems alone.
  
  
  RESULTS
  Spiritual symptoms (alone or in interaction) were associated with 7 of the 10 outcomes and were particularly important to extreme use of health care services and life satisfaction. Among best-fit models, spiritual symptoms alone were significantly associated with any mental health use (beta =0.694, P < or = .05), fair-poor health status (beta =0.837, P < or = .05), and life lacking meaning (beta =1.214, P < or = .001).
  
  
  CONCLUSIONS
  This study has shown the relevance of spiritual symptoms and their interactions to understanding health outcomes. Extreme utilization outcomes were related to the number of chronic problems, as well as to the social-spiritual interaction. Satisfaction outcomes were associated with physical and spiritual symptoms. These findings may have important implications for providing comprehensive, outcome-based care, as well as for modeling of research findings.
authors.affiliation: Department of Family & Community Medicine, University of Texas Health Science Center at San Antonio, Texas 78229-3900, USA. Katerndahl@uthscsa.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Katerndahl
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011594:Psychometrics; D011603:Psychophysiology; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D012649:Self Concept; D012917:Social Adjustment; D012959:Socioeconomic Factors; D029181:Spirituality; D011795:Surveys and Questionnaires
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