title: A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer.
abstract: Religion and spirituality (R/S) are patient-centered factors and often are resources for managing the emotional sequelae of the cancer experience. Studies investigating the correlation between R/S (eg, beliefs, experiences, coping) and mental health (eg, depression, anxiety, well being) in cancer have used very heterogeneous measures and have produced correspondingly inconsistent results. A meaningful synthesis of these findings has been lacking; thus, the objective of this review was to conduct a meta-analysis of the research on R/S and mental health. Four electronic databases were systematically reviewed, and 2073 abstracts met initial selection criteria. Reviewer pairs applied standardized coding schemes to extract indices of the correlation between R/S and mental health. In total, 617 effect sizes from 148 eligible studies were synthesized using meta-analytic generalized estimating equations, and subgroup analyses were performed to examine moderators of effects. The estimated mean correlation (Fisher z) was 0.19 (95% confidence interval [CI], 0.16-0.23), which varied as a function of R/S dimensions: affective R/S (z = 0.38; 95% CI, 0.33-0.43), behavioral R/S (z = 0.03; 95% CI, -0.02-0.08), cognitive R/S (z = 0.10; 95% CI, 0.06-0.14), and 'other' R/S (z = 0.08; 95% CI, 0.03-0.13). Aggregate, study-level demographic and clinical factors were not predictive of the relation between R/S and mental health. There was little indication of publication or reporting biases. The correlation between R/S and mental health generally was positive. The strength of that correlation was modest and varied as a function of the R/S dimensions and mental health domains assessed. The identification of optimal R/S measures and more sophisticated methodological approaches are needed to advance research.
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.|The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
authors.forename: John M
authors.initials: JM
authors.lastname: Salsman
authors.affiliation: Department of Educational Psychology, University of Texas at Austin, Austin, Texas.
authors.forename: James E
authors.initials: JE
authors.lastname: Pustejovsky
authors.affiliation: Health Outcomes and Behavior Department, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Heather S L
authors.initials: HS
authors.lastname: Jim
authors.affiliation: School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Munoz
authors.affiliation: Department of Psychology, University of Notre Dame, Notre Dame, Indiana.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Merluzzi
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, Connecticut.
authors.forename: Login
authors.initials: L
authors.lastname: George
authors.affiliation: Department of Psychology, University of Connecticut, Storrs, Connecticut.
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Park
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Danhauer
authors.affiliation: Behavioral Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Allen C
authors.initials: AC
authors.lastname: Sherman
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mallory A
authors.initials: MA
authors.lastname: Snyder
authors.affiliation: Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois.
authors.forename: George
authors.initials: G
authors.lastname: Fitchett
mesh_terms: D000223:Adaptation, Psychological; D003071:Cognition; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D012068:Religion and Medicine; D029181:Spirituality; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology
keywords: anxiety; cancer; depression; distress; meta-analysis; quality of life; religion; spirituality