Stroke Journal Report
02/16/2007

Religious faith eases post-stroke distress, may aid recovery

American Heart Association rapid access journal report

DALLAS, Feb. 16 – Stroke patients who have strong religious faith have less emotional distress that can often complicate recovery and worsen rehabilitation outcomes, researchers report in Stroke: Journal of the American Heart Association.

In a study conducted in Rome, higher scores on a survey of religious and spiritual beliefs correlated with significantly less anxiety and depression.  The findings suggest that religious faith influences a person’s ability to cope with stroke and may protect against emotional distress. The findings also may have implications for the design and development of stroke rehabilitation programs.

“Religious and spiritual needs of each patient should be considered,” said Salvatore Giaquinto, M.D., chairman of the department of rehabilitation at the San Raffaele Pisana Rehabilitation Center in Rome, Italy.  “These needs must be considered with both sensitivity and compassion by all members of the rehabilitation staff.  The rehabilitation facility must also develop a mechanism to identify pastoral care resources available within the hospital and local community, and to assure that the patient’s needs are addressed.”

Emotional distress, particularly depression, often complicates recovery and rehabilitation after stroke and negatively affects patient outcome.

The association between faith and post-stroke emotional distress has received little attention in stroke research, Giaquinto said.  The modest amount of evidence that has accumulated suggests that faith positively influences health.  Prayer, yoga mantra (chanting) and transcendental meditation have been associated with positive effects on the heart and blood vessels, he said.

To evaluate the impact of religious faith on post-stroke depression, researchers interviewed 132 stroke survivors (median age 72) about religious beliefs and spirituality.  Answers to that questionnaire, the Royal Free Interview, were compared with the patients’ scores on the Hospital Anxiety and Depression Scale (HADS), a self-assessment tool.

The analysis showed higher scores on the anxiety and depression scale correlated significantly with lower scores on the religious and spirituality questionnaire.  The association remained significant after adjusting for other factors that could influence a stroke patient’s degree of emotional distress (such as mental and physical functioning, living conditions and marital status).  Separate analyses of the anxiety and depression subscales revealed similar associations between the religiosity/spirituality scores and the emotional distress scores.

The explanation for the association between faith and post-stroke emotional distress isn't clear.  One possibility is that religiously active people might have more social support, which can positively influence outcomes in various types of illness.

“Religious people who are active in their communities are more likely to receive external aid that can be provided by volunteers,” Giaquinto said.  “Social support lets them experience feelings of care, love and esteem.  The new experience of support and the background of faith tell the patients that they are not alone.”

Researchers note that the majority of Rome residents are Catholic and Rome is also the home of the Pope, but they say their results might extend to other cultures and other forms of religion, as well.

The researchers are continuing their study to determine whether faith and spirituality affect important physical and mental outcomes in stroke patients.

An accompanying editorial by Lalit Kalra, M.D., a stroke professor at King’s College London School of Medicine in the United Kingdom, said the study is unique and well designed. However, the link made between religious belief and better coping does not imply causality.

“The study does not establish that religious beliefs will definitely reduce emotional distress but shows that people who are religious have better coping abilities,” he said. “Hence, both these variables may define personal attributes of the patient. In other words, religious beliefs do not make a person cope better but identify patients who have better abilities to cope with chronic illness.”

Co-authors of the study are Cristiana Spiridigliozzi, MSc. and Barbara Caracciolo, MSc., both of the San Raffaele Pisana Rehabilitation Center.

Editor’s note: For more information on stroke, visit the American Stroke Association Web site, strokeassociation.org.

Statements and conclusions of study authors that are published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position.  The American Heart Association makes no representation or warranty as to their accuracy or reliability.

NR07-1129 (Stroke/Giaquinto)

####