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The importance of spirituality in the treatment of mental illness is increasingly acknowledged, but mental healthcare professionals often feel they lack specific competence. An instrument is missing to quantify the spiritual care competence of mental healthcare professionals in the Netherlands. The aim of this study was thus to translate the Spiritual Care Competence Questionnaire (SCCQ) into Dutch and validate it for use in mental healthcare. After translation, the SCCQ-NL was distributed in a cross-sectional design among 3497 healthcare professionals in two mental healthcare institutions (MHIs) in the Netherlands. In the sample of 730 completed questionnaires, exploratory factor analysis revealed seven factors: perception of spiritual needs competencies, team spirit, spiritual self-awareness, documentation competencies, empowerment and proactive opening competencies, knowledge about other religions, and conversation competencies. One item was deleted during the process. Internal consistency for the 25-item SCCQ-NL subscales is sufficient with Cronbach’s alpha ranging from 0.64 to 0.81. Conversation competencies and perception of spiritual needs scored highest in the sample, next to knowledge about other religions and empowerment competencies, while spiritual self-awareness, team spirit and documentation competencies scored the lowest. Small but significant differences in several subscale scores were found for profession, identifying oneself as a believer, practicing prayer and/or meditation, age and working years. The SCCQ-NL can be used for the assessment of spiritual care competencies and for the planning and evaluation of training and improvement strategies.

Edukacja dla pokoju to dziedzina nauki i praktyki, która wykorzystuje nauczanie i uczenie się nie tylko do eliminowania wszelkich form przemocy, ale także do tworzenia struktur, które budują i podtrzymują sprawiedliwy i równy pokój i świat. Artykuł bada możliwości, wyzwania i ograniczenia związane z wdrażaniem edukacji dla pokoju z wykorzystaniem przestrzeni mediów społecznościowych.

BackgroundMore than 25 years after the end of the Balkan war, many people belonging to the post-war population are still traumatized by the war events and have been treated for post-traumatic stress disorder or other psychiatric diagnoses. We were interested in their Inner Peace needs, how these relate to indicators of mental health, and their needs to clarify open processes in their lives and to forgive and be forgiven.Materials and methodsIn a cross-sectional survey with standardized questionnaires (i.e., SpNQ, PCL-M, HADS, and BMLSS), 638 male patients who were treated in seven psychiatric centers in Croatia were enrolled. 68% were diagnosed with PTSD and 32% had other psychiatric diagnoses. Most had actively participated in the Balkan war (79%), and 60% for the whole war period.ResultsStrong needs to “immerse into beauty of nature” were stated by 47%, to “dwell at a place of quietness and peace” by 66%, and to “find inner peace” by 57%. These Inner Peace needs were highest in men treated with PTSD diagnoses as compared to men with other psychiatric diagnoses and were slightly lower in men who were active during the whole war period as compared to shorter phases of war participation. Regression analyses with Inner Peace needs as a dependent variable revealed that Clarification/Forgiveness needs were the best predictor, with further influences of PTSD symptoms and life satisfaction, explaining altogether 49% of the variance. The best predictors of their PTSD symptoms were life satisfaction, perceived burden, depressive symptoms, Inner Peace needs, religious trust, and duration of war participation, explaining 60% of the variance.ConclusionIn Croatian male war participants in clinical treatment decades after the war, Inner Peace needs indicate their ongoing intention to let go of their disturbing experiences and to find states of inner peace, particularly at specific places of quietness and peace. These needs can be considered metaphors for longing for wholeness, integrity, and safety, in contrast to the ongoing impact of unresolved issues. Thus, apart from psychotherapeutic treatment, sheltered places of nature, inspiration, and reconciliation might be elements to improve the difficult situation of post-war victims still suffering from their experiences.

BackgroundDue to public restrictions during the early stages of the COVID-19 pandemic, many people were unable to visit and bid a proper farewell to their dying loved ones. This study aimed to address the loss-oriented aspects of grief and bereavement of relatives and relate these to the support they may have received from their dying relative's caring professionals.Materials and methodsPeople from Germany who experienced bereavement during the COVID-19 pandemic were enrolled in a cross-sectional study between July 2021 and May 2022, using standardized questionnaires (i.e., ICG, Inventory of Complicated Grief; BGL, Burdened by Grief and Loss scale; WHO-5, WHO-Five Wellbeing Index; and 5NRS, perception of burden related to the pandemic).ResultsMost participants (n = 196) had the opportunity to visit their relatives before death (59%). When this was not possible, being burdened by grief and loss was significantly higher (Eta2 = 0.153), while this had no significant influence on complicated grief or psychological wellbeing. Furthermore, 34% of participants felt well-supported by the treatment/care team. Their own support was moderately correlated with BGL scores (r = −0.38) and marginally with ICG scores (r = −15). Regression analyses showed that complicated grief symptoms as the dependent variable were predicted by (low) psychological wellbeing, relational status, and the perception of COVID-19-related burden (R2 = 0.70). In contrast, BGL as the dependent variable can be best explained by the perception of emotional affections because of restricted visits shortly before their death, by the (short) duration of visits before death, and by the relational status (R2 = 0.53). Although both were interconnected (r = 0.44), their predictor pattern was different.ConclusionBeing able to visit dying relatives was important for the mourning and bereavement processes. This emotional aspect was more relevant to the normal, non-pathological grief and loss processes than to complicated grief processes. Support from their dying relatives' treatment/care team was highly relevant to the mourning process, but the visiting relatives often lacked information about additional resources such as psychologists or pastoral care professionals or had limited access to them.

BackgroundDuring the COVID-19 pandemic, differences in responses and behaviors were observed among specific groups. We aimed to address how people with an anthroposophical worldview behaved with respect to the perception of burden, fears, and wellbeing. As it is an integral part of their lifestyle and convictions, we addressed the influence of wondering awe and gratitude and perception of nature and times of mindful quietness as resources to cope.MethodsIn two cross-sectional surveys with standardized instruments, participants were recruited in 2020 (n = 1,252) and 2021 (n = 2,273).ResultsPsychological wellbeing was much higher than in other studied groups and populations, with slightly lower scores in 2021 compared to the 2020 sample (Eta2 = 0.020), while the perception of the COVID-19-related burden and fear of the future were low in 2020 with a slight increase in 2021 (Eta2 = 0.033 and 0.008, respectively). Their transcendence conviction was negatively related to fears of their own infection or the infection of others. Best predictors of their wellbeing were low burden and awe/gratitude, while the best predictors of their burden were low wellbeing and lack of social contacts.ConclusionCompared to the general population in Germany, the anthroposophical lifestyle and related convictions may have buffered some of the COVID-19-related burden and helped them to stabilize their psychological wellbeing.

BackgroundSpiritual struggles affect the wellbeing of religious people. Among them are strugglers with God which is perceived as non-responsive and distant. These perceptions were so far analyzed predominantly in Western societies with a Christian background, but not in Muslims from Iran. The aim of this study was to determine the predictors of spiritual dryness among cancer patients in Iran during the COVID-19 pandemic.MethodsCross-sectional study with standardized questionnaires (i.e., Spiritual Dryness Scale, WHO-5, BMLSS-10, Awe/Gratitude Scale) among 490 cancer patients (mean age 49.50 ± 14.92 years) referring to the selected educational hospitals in Tehran (the capital of Iran), who were selected through convenience sampling and based on the inclusion criteria, enrolled between December 2020–May 2021. Data analysis was done using SPSS software version 26 and the statistical methods including calculating the mean and the standard deviation, correlation coefficients, as well as regression analysis.ResultsThe overall experience of spiritual dryness was perceived regularly in 10.2% of Iranian cancer patients, sometimes in 22.9%, rarely in 22.9%, and never in 43.3%. The mean ± SD was 25.66 ± 5.04, and the scores ranged from 10 to 55. A higher score means greater spiritual dryness. The strongest predictors of spiritual dryness were praying activities Furthermore, the perception of burden due to the pandemic was positively correlated with spiritual dryness. Moreover, each 1 unit increase in its score changed the spiritual dryness score by 0.2 units. The regression of spirituality-related indicators, demographic-clinical variables, and health-related behaviors accounted for 21, 6, and 4% of the total SDS variance, respectively. These findings show that with an increase in praying, performing daily prayers, and the indicators related to spirituality, spiritual dryness will decrease. Most patients were able to cope with these phases often or even regularly, while 31.1% were never or rarely only able to cope.ConclusionThe results of this study showed that in times of crisis, cancer patients’ faith and confidence in God could be challenged. It is not the disease itself which seems to be associated with this form of crisis, but their religious practices. Therefore, it is necessary to support these patients during their struggle, especially as spirituality is one of the best approaches to cope with the disease.

Previous studies indicate that perceptions of nature and thought-provoking silence can have positive consequences for individual functioning. The purpose of the present study was to assess the relationships between religious coping (assessed with the Brief RCOPE), perceptions of nature and silence (a subscale of the Perception of Change Questionnaire), well-being (the World Health Organization's five-item Well-Being Index) and life satisfaction (the Brief Multidimensional Life Satisfaction Scale). An online questionnaire was completed between 2021–2022 by 1,010 Polish Catholics ages 18 to 73, 61% of whom were women. Structural equation modeling showed that positive religious coping was positively related to well-being (β = 0.08, p = 0.011) and life satisfaction (β = 0.22, p < 0.001). In contrast, negative religious coping was related to reduced well-being (β = −0.07, p = 0.040) and life satisfaction (β = −0.25). In addition, more frequent perceptions of nature and reflective times of silence partially mediated the associations of positive religious coping with well-being (β = 0.04, p = 0.011) and life satisfaction (β = 0.04, p = 0.008). The data might suggest that interventions that help people develop an ability or awareness for nature as an exceptional encounter and may help to strengthen the ways they can utilize their religiosity as a resource and thus contribute to well-being and life satisfaction among Catholics.

BackgroundThe COVID-19 pandemic with its lockdowns affected social relations and mental health conditions of people worldwide. We aimed to analyze the relevance of nature and times of silence as resources to cope with the pandemic. Of interest were how experiences of nature and times of silence are related to the perception of wondering awe and gratitude and psychological wellbeing and how these have changed during the different phases of the pandemic. Finally, we asked whether Nature/Silence would mediate the link between Awe/Gratitude and wellbeing.MethodsA cross-sectional survey with standardized questionnaires (i.e., PCQ, GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of the COVID-19 pandemic was conducted. The total sample of 5,155 participants from Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 years.ResultsDirectly after the first lockdown, Nature/Silence and Awe/Gratitude scores were high and decreased along with wellbeing with the onset of the second lockdown in winter 2020, while perceived burden constantly increased. Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses revealed that wellbeing as a dependent variable was predicted best by corona-related perception of burden, Awe/Gratitude, reflection of life, and Nature/Silence and further by perceived changes in terms of relationships and spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a significant predictor for Nature/Silence (β = 0.55, p< 0.0001) and wellbeing (β = 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in the data. The direct influence of Awe/Gratitude on wellbeing was estimated as β = 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link between Awe/Gratitude and wellbeing was significant, too (β = 0.03, p < 0.0001), explaining 25% of the total effect.ConclusionNature/Silence and Awe/Gratitude were used as relevant resources during the pandemic, although they cannot fully buffer the negative effects of the social restrictions that resulted in decreases in wellbeing and increases in perceived burden. Perception of nature as a sensitizer of positive experiences particularly during difficult phases of life could be trained to stabilize wellbeing and thus to contribute to public health.

BackgroundThe global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale (DRS), a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life.Materials and MethodsThe Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, cross-sectional, online survey at a large university in Germany, students, healthcare professionals (HCP) and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations.Results1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales (CFI 0.945, SRMR 0.045, RMSEA 0.055). Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales (Spearman’s rho ranging from 0.31 to 0.52).ConclusionFurther conceptual work for death awareness to explore the construct’s stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic.

Abstract Background During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected ‘extra time’ there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic. Methods An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ). Results Within the number of respondents (n = 1277), women were predominating (67.5%). Participants’ mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: (1) Nature/Silence/Contemplation (Cronbach’s alpha = .87), (2) Spirituality (Cronbach’s alpha = .83), (3) Relationships (Cronbach’s alpha = .80), (4) Reflection on life (Cronbach’s alpha = .74), (5) Digital media usage (Cronbach’s alpha = .74). Strongest changes were observed for Relationships and Nature/Silence/Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person’s perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants’ wellbeing was explained best by low perceived burden and high life satisfaction (R2 = .46). Awe/gratitude, perceived changes in terms of Nature/Silence/Contemplation and low Reflections of live are further variables that would predict a person’s wellbeing among the COVID-19 pandemic. Conclusions During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons’ wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples’ life.

Introduction: During the first lockdown of the COVID-19 pandemic, several medical students volunteered as assistants in hospitals, public health departments, and other healthcare services to support and substitute permanent staff. The underlying motivations to help are unclear. Therefore, we aimed to assess medical students' motivations and influencing variables such as perceived stress and burden, compassion, and indicators of spirituality.Materials and Methods: Cross-sectional survey (convenience sample) from May to June 2020, directly after the first lockdown, among medical students with standardized instruments. One of them is the 12-item Motivations to Help Scale (MtHS) which was designed to fit to the population of medical students.Results: Among the 731 completers, 52% were working as volunteers during the pandemic in different medical areas, most in hospitals and only a few in other areas (9% in public health departments, 6% in outpatient services), 37% would have liked to work but did not get an appropriate employment, and 21% did not intend to voluntarily support the hospital staff. Their mental burden during work was rather low, while they were somewhat affected by the personal fate of the patients. With respect to their motivations to volunteer as measured with the MtHS, Altruistic Intentions/Helping (Cronbach's alpha = 0.898) scored highest, followed by Practical Application/Learning (Cronbach's alpha = 0.808), while Role Testing/Recognition (Cronbach's alpha = 0.702) scored lowest. Those who volunteered had significantly higher scores for Altruistic Intentions/Helping and Practical Application/Learning, while the different phases of medical study (preclinical phase, clinical phase, and higher semester) had no influence on the extent of the students' motivation. The motivations to help were not at all or only marginally (inversely) related to indicators of stress and burden, while Altruistic Intentions/Helping was weakly related to affections by patients' fate.Conclusions: Medical students' intention to support healthcare professionals as supplementary assistants were both prosocial and proself motivated. With this opportunity to practically apply their current knowledge and to improve their skills and competences, volunteering students might be more motivated for their further studies and their future career as compassionate medical doctors.

Reports to date indicate that the COVID-19 pandemic outbreak has negatively impacted mental health in the general population. On the other hand, positive associations of mental resilience and well-being have been widely demonstrated. The objective of this study was to assess the links between resilience (Brief Resilience Scale), persistent thinking about COVID-19 (Obsession with COVID-19 Scale), coronavirus anxiety (Coronavirus Anxiety Scale), and well-being (World Health Organization's 5-item Well-being Index) using serial mediation. The study considered online survey data from 1,547 Poles aged 18–78 (62% of whom were women). Bootstrap sampling analysis revealed that persistent thinking about COVID-19 (M1) and coronavirus anxiety (M2) partially mediate the relationship between resilience and well-being. The results of this study indicate that persistent thinking may be dysfunctional for mental health, as it inflates pandemic anxiety and disrupts well-being. Moreover, practitioners should focus on interventions enhancing resilience in order to reduce negative mental effects during the spread of a pandemic infectious disease.

During the COVID-19 pandemic most people had to cope with the negative implications of the lockdowns, and perceived times of social isolation and loneliness, and thus low wellbeing. Among the best predictors of positive changes of pandemic related attitudes and behaviors was the experience of pausing in wondering awe with subsequent feelings of gratitude. As these observations came from a secular society with a Christian background, we now aimed to analyzed to what extend Jewish people from Israel were experiencing such moments of wondering awe during the COVID-19 pandemic, and how these perceptions are related to their psychological wellbeing. For that purpose, between June and July 2021 a cross-sectional survey with standardized questionnaires was applied among 147 participants from Jerusalem. Those with high wellbeing and those who can rely on their faith as a resource to cope with the pandemic were more intensively perceiving moments of Awe/Gratitude. Awe/Gratitude and a low perception of COVID-19 related stressors were the best predictors of participants’ psychological wellbeing. Against our expectation, Awe/Gratitude was not significantly associated with the experience of nature and enjoying reflective times of silence. Both resources, Awe/Gratitude as a an experiential aspect of spirituality and Nature/Silence as a source to encounter the sacred in one’s life, are relevant and should be supported.

Background: Spirituality is a multidimensional construct which includes religious, existentialistic, and relational issues and has different layers such as faith as the core, related attitudes and conviction, and subsequent behaviors and practices. The perceptive aspects of spirituality such as wondering awe are of relevance for both, religious and non-religious persons. These perceptions were related to perceiving the Sacred in life, mindful awareness of nature, others and self, to compassion, meaning in life, and emotional wellbeing. As awe perceptions are foremost a matter of state, it was the aim (1) to empirically analyze the frequency of wondering awe perceptions (i.e., with respect to gender, age cohorts, religious or non-religious persons) and (2) to qualitatively analyze a range of triggers of awe perceptions.Methods: Data from 7,928 participants were analyzed with respect to the frequency of Awe/Gratitude perceptions (GrAw-7 scale), while for the second part of the study responses of a heterogeneous group of 82 persons what caused them to perceive moments of wondering awe were analyzed with qualitative content analysis techniques.Results: Persons who experience Awe/Gratitude to a low extend were the youngest and had lowest wellbeing and lowest meditation/praying engagement, while those with high GrAw-7 scores were the oldest, had the highest wellbeing, and were more often meditating or praying (p

Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) using individual participant data meta-analysis we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had “some” influence on their patients’ health (CI95%) (81.8%–84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%–95.5%). Across all samples 649 (16%; 14.9%–17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%–25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.

Background: During the COVID-19 pandemic, people reported about fears, depressive states, and phases of loneliness. However, there have also been positively experienced changes in terms of awareness of nature, reflection of life, more intensive relationships, meaningful digital media usage to connect with others, and interest in spirituality. We were interested in the dynamics of these indicators directly after the first lockdown, the summer months and during the second wave of the pandemic with its second lockdown, and how they relate to the perceived restrictions, fears, and worries.Method: Survey with standardized questionnaires, i.e., Perceived Changes Questionnaire, WHO-Five Well-being Index, Brief Multidimensional Life Satisfaction Scale, Awe/Gratitude scale. Participants were categorized as cohort 1 (June 2020; n = 1,333), cohort 2 (July to September 2020, n = 823), and cohort three (October 2020 to January 2021, n = 625).Results: Participants perceived changes in specific attitudes and behaviors, which have impacted their well-being and life satisfaction. Compared to their experiences directly after the first wave of the pandemic (cohort 1), well-being (Hedge's g = 0.83) and life satisfaction (g = 0.63) decreased during the second wave (cohort 3) and participants' stressors increased (g = −0.94). At the same time, positive perceptions such as Nature/Silence/Contemplation (g = 0.67), Spirituality (g = 0.62), Relationships (g = 0.55), and Digital media usage declined (g = 0.31), but not Reflections on life (g = −0.03). In cohort 3, the proportion of persons relying on their faith as a strong hold was declining also in nominally religious persons. Awe/Gratitude was among the best predictors of perceived positive changes, indicating a resource which is nevertheless declining during the second wave of the pandemic (g = 0.60).Conclusions: Several perceptions, attitudes, and behaviors have changed, particularly during the second wave of the pandemic, which had a strong influence on psychological health. Although Awe/Gratitude was confirmed as the best predictor of perceived positive changes, this resource may not buffer against the negative outcomes of the pandemic but helps to recognize the still positive aspects in life. There is a need for new and not yet defined public health communities that could focus on persons which are affected in their physical, mental, social, and spiritual health and well-being due to the pandemic.

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be “spellbound at the moment” and to become “quiet and devout,” indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor.Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020.Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a “stronghold in difficult times” (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R2 = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = −0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of β = 0.15 (p < 0.001) and an indirect effect of β = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is β = 0.18 (p < 0.001), and the indirect effect is β = 0.11 (p < 0.001).Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply “touch” a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being.

Introduction: There is a gap in healthcare literature related to the spiritual competence of physicians and nurses practicing in South Asian Muslim communities. To fill that gap, the Spiritual Care Competence Questionnaire (SCCQ) was applied which was developed to address multi-professional spiritual care competences. Materials and Methods: A cross-sectional study among 294 health professionals (61% physicians, 17% nurses, and 22% other professions) in 10 hospitals in Punjab, Pakistan. Results: The highest scoring competences were “Dealing with patients/Communication competences”, while “Team Spirit” scored lowest. There were no gender related differences, but there were effects related to professions. “Team Spirit”, “Dealing with patients/Communication competences”, and “Empowerment competences” scored significantly higher in nurses as compared to physicians and other health care professionals, while there were no significant differences for their “Perception/Documentation competences”. These competences were not relevantly related to the intensity of their prayer/meditation activity. Conclusions: Health care professional from Punjab were preferred to tolerate the pain and the suffering of patients and their relatives rather than to talk about spiritual care issues. Their spiritual care competences were less developed. Thus, there is a clear need for further specific education and training of health professionals.

BackgroundDuring the COVID-19 pandemic, the Working Group “Prevention and Integrative Oncology” (PRIO) in the German Cancer Society has initiated flash interviews and surveys. One of these stated increasing rates of fears and mental stress of tumor patients. Now we aimed to analyze whether tumor patients did perceive changes in their attitudes and behaviors related to their relationships, awareness of nature and quietness, interest in spiritual issues, or feelings of worries and isolation. A further point of interest was how these perceived changes could be predicted, either by meaning in life, spirituality as a resource to cope, perceived fears and worries, or particularly by their wellbeing.Materials and MethodsOnline survey with standardized questionnaires (i.e., WHO-Five Well-being Index (WHO5), Meaning in Life Questionnaire (MLQ), Spiritual and Religious Attitudes to cope with illness (SpREUK-15), Gratitude/Awe scale (GrAw-7)) among 292 tumor patients (72% men; mean age 66.7 ± 10.8 years; 25% < 60 years, 33% 60-70 years, 41% > 70 years) from Germany between May 6 to June 10, 2020.ResultsPatients´ wellbeing (WHO5) scores were in the lower range (14.7 ± 6.0); 35% scored < 13, indicating depressive states. Wellbeing was significantly higher in older persons and lower in younger ones (F=11.1, p

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients’ satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P < .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P < .01). Pearson’s correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = −0.60). Qualitative feedback confirmed patients’ benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients’ satisfaction and qualitative feedback they help refine treatment.

The present study investigated the efficacy of the REACH Forgiveness psychoeducation program for the first time in Indian college students and examined theoretically-based predictors of program response based on the model of relational spirituality and forgiveness. This was an intervention experiment that spanned 5 weeks and included three measurement occasions (weeks 1, 3, 5) and two separate deliveries of the forgiveness intervention (weeks 2 and 4). Participants were N = 124 students at Karnatak University in Darwha, India (100 Hindu; 18 Muslim, 5 Christian, and 1 Jain). This was a manualized, secular intervention led by a trained facilitator in a group, psychoeducational format. Measures included forgiveness and unforgiveness as well as assessments of positive and negative affective states and spirituality. Participants who received immediate forgiveness training showed significant and large positive changes in forgiveness and unforgiveness, as well as, more positive affect and increased self-esteem in contrast to wait-list comparisons. Perceiving one’s offender as having a similar spirituality to oneself was a consistent predictor of response to the REACH Forgiveness program. Specifically, perceiving the offender as having a similar spirituality was related to less growth of unforgiveness and more growth in empathy, positive affect, and emotional forgiveness as a result of the psychoeducational program. The REACH Forgiveness psychoeducational approach is efficacious in an Indian college student sample, and some relational spirituality variables are important predictors of response to the program. Future studies should consider the role of Indian culture in promoting forgiveness and possibly tailor the intervention to suit the significant proportions of Hindus and Muslims in India.

Abstract Stress is an important co-factor for the genesis and maintenance of many diseases and is known to have an effect on gene expression via epigenetic regulation. MicroRNAs (miRNAs) appear to function as one of the key factors of this regulation. This is the first study to investigate the response of 11 stress-associated miRNAs in human saliva - as a non-invasive source - in an experimental condition of acute psychological stress, and also their correlation with established psychological (subjective stress perception), physiological (heart rate and heart rate variability) and biochemical stress parameters (salivary cortisol and alpha-amylase). 24 healthy participants between 20 and 35 years of age were investigated, using the Trier Social Stress Test (TSST) to induce acute psychological stress. Stress-associated changes were significant for miR-20b, -21 and 26b, and changes in miR-16 and -134 were close to significance, recommending further research on these miRNAs in the context of stress reactions. Significant correlations with alpha-amylase suggest their integration in sympathetic stress regulation processes. Additionally, our results demonstrate the TSST as a reliable tool for studying salivary miRNAs as non-invasive indicators of epigenetic processes in acute psychological stress reactions.

Abstract Background Spinal disc herniation is a frequently occurring degenerative disease of the spine. Many patients undergoing surgery suffer from radicular pain, known as memory pain, beginning from the third post-operative day. This results in the prescription of high-dose opioid medications. In homeopathy, Hypericum perforatum is known as a remedy for unbearable, shooting or jabbing pain especially when neural damage is involved. Reduction of pain after application of H. perforatum has been observed in previous studies. This study is aimed to investigate whether homeopathic H. perforatum in a potentisation of C200 leads to the reduction of post-operative pain and a decrease of pain medication compared to placebo. Methods/design This is a monocentric, double-blind, randomised placebo-controlled trial conducted at the Department of Neurosurgery at the Community Hospital Herdecke, Germany. One hundred study participants are being recruited from inpatients undergoing elective, monosegmental, lumbar microdiscectomy surgery. Patients are randomly allocated to receive homeopathic treatment or placebo in addition to usual pain management after surgery. The primary clinical outcome is pain reduction after 3 days of inpatient care as measured by pain reduction of subjective pain on a 100-mm Visual Analogue Scale (VAS) at the third post-operative day. Statistical analysis will be carried out by means of a covariance model with adjustment for baseline values and patient expectation for all randomised patients. Discussion This study is the first trial of classical homeopathy that will evaluate the efficacy of homeopathic H. perforatum after monosegmental spinal microdiscectomy. We intend to clarify the potential of homoeopathic H. perforatum to reduce surgery-associated pain. Trial registration German Clinical Trials Register, ID: DRKS00007913. Registered on 17 October 2014. EudraCT – Nr: 2013–001383-31. Data sets from the German Clinical Trials Register (DRKS, Deutsches Register Klinischer Studien) are updated every 4 weeks automatically to the International Clinical Trials Registry Platform of World Health Organisation: http://apps.who.int/trialsearch/. Responsibilities Sponsor: Witten/Herdecke University Alfred-Herrhausen-Straße 50 58,448 Witten Deputy of the sponsor: Dr. Wolfgang Eglmeier (Head of Centre for Clinical Trials Witten/Herdecke) Alfred-Herrhausen-Straße 50 58,448 Witten E-mail: wolfgang.eglmeier@uni-wh.de Principal investigator: Prof. Dr. med. Wolfram Scharbrodt Community Hospital Herdecke Department for Neurosurgery Gerhard-Kienle-Weg 4 58,313 Herdecke w.scharbrodt@gemeinschaftskrankenhaus.de Project coordination: Christa Raak Faculty for Health (Department for Integrative and Anthroposophic Medicine) University Witten/Herdecke gGmbh Gerhard-Kienle-Weg 4 58,313 Herdecke christa.raak@uni-wh.de Project manager/data analysis/biometry: Prof. Dr. Thomas Ostermann Faculty for Health (Department for Psychology and Psychotherapy) University Witten/Herdecke gGmbh Alfred-Herrhausen-Straße 50 58,448 Witten thomas.ostermann@uni-wh.de

Abstract Background Hospital staff experience high level of work stress and they have to find strategies to adapt and react to it. When they perceive emotional exhaustion and job dissatisfaction in response to constant work stress, one reaction might be emotional withdrawal. This emotional distancing can be seen as an adaptive strategy to keep ‘functionality’ in the job. Both, perception of emotional exhaustion and emotional distancing as a strategy, can be operationalized as ‘Cool Down’. We assume that work stress associated variables are positively associated with Cool Down reactions, while internal and external resources are negatively associated and might function as a buffer against emotional distancing. Moreover, we assume that the perception of stress and work burden might be different between nurses and physicians and women and men, but not their cool down reactions as a strategy. Methods Anonymous cross-sectional survey with standardized instruments among 1384 health care professionals (66% nurses, 34% hospital physicians). Analyses of variance, correlation and also stepwise regression analyses were performed to analyze the influence of demands and resources on Cool Down reactions. Results As measured with the Cool Down Index (CDI), frequency and strength of Cool Down reactions did not significantly differ between women and men, while women and men differ significantly for their burnout symptoms, stress perception and perceived work burden. With respect to profession, Cool Down and stress perception were not significantly different, but burnout and work burden. For nurses, “Emotional Exhaustion” was the best CDI predictor (51% explained variance), while in physicians it was “Depersonalization” (44% explained variance). Among putative resources which might buffer against Cool Down reactions, only team satisfaction and situational awareness had some influence, but not self-efficacy expectation. Conclusion The perceptions of emotional exhaustion and distancing of nurses and physicians (and women and men) seems to be different, but not their adaptive Cool Down reactions. Data would support the notion that a structural approach of support would require first to control and eliminate work stressors, and second a multifaceted approach to strengthen and support hospital staff’s resources and resilience.

An amendment to this paper has been published and can be accessed via the original article.

Context: Cancer-related fatigue (CRF) is one of the most burdensome symptoms in breast cancer survivors (BCSs), accompanied by reduced health-related quality of life (HRQOL). Objectives: This study investigated the influence of a multimodal therapy (MT; psychoeducation, eurythmy therapy, painting therapy, and sleep education/restriction), or a combination therapy (CT; MT plus aerobic training [AT]) on HRQOL in BCS with chronic CRF in comparison with AT alone. Methods: One hundred and twenty-six BCSs with CRF were included in a pragmatic comprehensive cohort study and allocated either per randomization or by preference to MT, CT, or AT. The EORTC QLQ-C30 core questionnaire was used to measure HRQOL. All analyses on HRQOL parameters were done in an explorative intention. Results: Patients were assigned to MT (n = 44), CT (n = 54), or AT (n = 28). CT was significantly superior to AT after 10 weeks of intervention (T1) in improving physical function. MT was found to have significant superiority over AT at T1 and T2 for physical functioning, emotional functioning, insomnia, and financial problems as well as role functioning, cognitive, social functioning, and fatigue 6 months later (T2). Conclusion : A multimodal approach appears to be a suitable concept for BCS with chronic CRF. A confirmatory study with larger samples should demonstrate the superiority of MT and adapted CT in HRQOL compared with the current treatment AT found in these explorative analyses.

Spiritual care has been a growing focus in international healthcare research over the last decades. The approaches to spiritual care are many and derive from many different medical fields and different cultural contexts and often remain unknown across healthcare areas. This points to a potential knowledge gap between existing instruments and the knowledge and use of them cross-disciplinarily and cross-culturally, and thus best practice insights are not sufficiently shared. This article contributes to the growing field of spiritual care by providing an overview of the various approaches (henceforth instruments) to assess patients’ spiritual needs in view of improving spiritual care. This was done through a scoping review method. The results of the review were collected and catalogued and presented here as ‘The Catalogue of Spiritual Care Instruments’. The included instruments derive from a wide range of geographical contexts and healthcare areas and are aimed at patients and healthcare professionals alike, clearly showing that spiritual care is a focus in healthcare internationally. However, it also shows the difficulties of defining spiritual care, the importance of local contexts, and the difficulties of cross-cultural validity. The catalogue contains 182 entries and is available as an interactive platform for the further development of spiritual care internationally.

The Spiritual Needs Questionnaire (SpNQ) measures psychosocial, existential, and spiritual needs in clinical contexts. The objective was to confirm its factor structure in Brazil, comparing the results of its validation for Portuguese in Rio de Janeiro, under similar sampling conditions, in João Pessoa (Paraíba-Brazil), among 157 HIV(Human Immunodeficiency Virus)+ patients, most of them men (49%) (women = 35%; other = 16%), aged between 30 and 49 years (53.5%). From exploratory factor analysis and internal consistency analysis a structure of five factors (or components) was obtained: Religious Needs (α = 0.73), Inner Peace and Family Support Needs, gathered (α = 0.64), Existential Needs (α = 0.49) and two new factors instead of “Giving/Generativity Needs”, being Social Recognition Needs (α = 0.54), referring explicitly to religious practices, with items formerly found in the Religious Needs factor, and Time Domain: Reflection and Clarification Needs (α = 0.57), which group only two items (item 4, “reflection on the past” (formerly in the Inner Peace component) and item 5, “resolution of outstanding problems”). The institutional religiosity perceived in the composition of the Social Recognition Needs component shows that these patients differentiate “religiosity” from “spirituality”. The Religious Needs component was formed with items from the “spirituality” construct definition. The most important component was Inner Peace and Family Support Needs, a relevant coping strategy in this disease. The results met proper validity criteria, and SpNQ proved to be sensitive and appropriate to situations of cultural and clinical diversity between samplings.

Background: Sometimes prayer life can be difficult even for very religious persons, who may experience phases of “spiritual dryness”, which may have a negative effect on their well-being. Methods: To address this topic, we analyzed three contrasting groups of persons (religious brothers and sisters (RBS), n = 273; Catholic lay persons (CLP), n = 716; other lay persons (OLP), n = 351) with standardized measures and investigated how often indicators of spiritual dryness were perceived within these groups and how the perception that private prayers go unanswered could be a result of this. Results: Spiritual dryness was highest in RBS compared to RLP and OLP. For RBS, perception of being “spiritually empty” was the best predictor of prayers going unanswered, indicating emotional/spiritual exhaustion, while in OLP, the perception that God is “distant” was the best predictor, indicating that, particularly in this (younger) group, spiritual doubt is of particular relevance. For CLP, feeling that God is distant, feeling abandoned by God, and feeling “spiritually empty” were similarly relevant predictors of feelings that prayers go unanswered. Conclusions: This knowledge may help psychologists/psychotherapists, pastoral workers, and spiritual advisors to differentiate the underlying causes of spiritual dryness (in terms of “discernment”) and thus support persons struggling with God, their faith, and life.

The item response theory (IRT), or latent trace theory, is based on a set of mathematical models to complement the qualitative analysis of the items in a given questionnaire. This study analyzes the items of the Spiritual Needs Questionnaire (SpNQ) in the Portuguese version, applied to HIV+ patients, with R Studio 3.4.1, mirt statistical package, to find out if the items of the SpNQ possess appropriate psychometric qualities to discriminate between respondents as to the probability of marking one answer and not another, in the same item, showing whether or not the questionnaire is biased towards a pattern of response desired by the researcher. The parameters of discrimination, difficulty, information, and the characteristic curve of the items are evaluated. The reliable items to measure the constructs of each of the five dimensions of the SpNQ of this HIV+ sample (Religious Needs; Inner Peace and Family Support Needs; Existential Needs; Social Recognition Needs; and Time Domain Needs) are presented, as well as the most likely response categories, depending on the latent trace level of the individuals. The questionnaire items showed satisfactory discrimination and variability of difficulty, confirming the good psychometric quality of SpNQ.

Background: In missions, soldiers are confronted with difficult situations which may impair their physical and mental health. As the resulting problems are commonly regarded as stigmata, soldiers may obviate talking about their experiences and try to oppress them. It was aim of this study to clarify whether soldiers do perceive needs to reflect back on life, to seek release from “open aspects” of their life, and to talk with others about fears and worries, to forgive others or to be forgiven. Further we intended to clarify whether these needs were related to stress perception, post-traumatic stress disorders (PTSD) symptoms and reduced life satisfaction on the one hand, and religious trust as a resource to cope on the other hand.Methods: Cross-sectional survey of 1,097 German soldiers (92% men). Existential/spiritual needs and mental health indicators, including stress perception, PTSD symptoms, life satisfaction, were assessed using standardized questionnaires.Results: For 30% of soldiers it was important to reflect on life, 23% had a strong need to clarify open aspects of life, 30% had a strong need to talk with others about their fears and worries, 13% had strong needs to forgive, and 13% had a strong need to be forgiven. Soldiers' needs to clarify open (and probably conflicting) aspects of life were moderately related to their intention to forgive others and to be forgiven (rs > 0.35). Soldiers treated in the hospital for psycho-mental trauma had significantly higher needs scores than soldiers still serving on active duty, particularly for the need to talk with others (F = 39.1; p < 0.0001) and to be forgiven (F = 26.0; p < 0.0001). Across all soldiers the best predictors of these needs were PTSD symptoms and stress perception, albeit with relatively weak predictive power (βs < 0.25; R2s < 0.24).Conclusions: The process of life reflection and subsequent intention to solve conflicting situations and experiences can be considered a process of coping with one's own failures, guilt, and mistakes. It should be noted that these needs were significantly stronger in soldiers with trauma. Addressing unmet needs may help them to communicate and to reject the stigma of “weakness.”

Body awareness is an attentional focus on and awareness of internal body sensations. This study aimed to validate German versions of the Body Awareness Questionnaire (BAQ) and the Body Responsiveness Questionnaire (BRQ) in chronic pain patients and to assess their associations with pain-related variables and to assess their responsiveness to intervention. The instruments were translated to German and administered to 512 chronic pain patients (50.3±11.4 years, 91.6% female) to assess their factor structure and reliability. Cronbach's α for the BAQ total score was 0.86. Factor analysis of the BRQ revealed the two factors Importance of Interoceptive Awareness (Cronbach's α = 0.75) and Perceived Connection (Cronbach's α = 0.75) and the single-item Suppression of Bodily Sensations. The BAQ was independently associated with lower mindfulness, self-esteem, stress, and depression; Importance of Interoceptive Awareness with mindfulness, self-acceptance, self-esteem, and physical contact; Perceived Connection with self-acceptance, vitality, and lower sensory pain; Suppression of Bodily Sensations with lower self-esteem, physical contact, and higher depressive symptoms. After a 10-week multimodal mind-body program (n = 202), the BAQ and Importance of Interoceptive Awareness increased and pain intensity and Suppression of Bodily Sensation decreased. In conclusion, body awareness and body responsiveness are associated with pain-related variables in patients with chronic pain. Mind-body interventions may positively influence both pain and body awareness, hinting at a potential mechanism of action of these interventions to be tested in further research.

This paper gives a summary of findings from studies using the five-item Reliance on God’s Help (RGH) scale, which was developed a decade ago as an integral part of a comprehensive measure to differentiate between external and internal adaptive coping strategies. It has been used for both healthy and diseased persons. We will summarize data on internal reliability scores and the distribution of mean values for the respective items in the different study samples. Also, we will present a structural equation model (SEM) to confirm the scale’s validity. Our analysis shows that the RGH scale is a short, valid, and reliable measure of a person’s strong basic trust in God (faith), regardless of what life brings. The items do not address aspects such as well-being, inner peace, or specific moods. Thus, it is important to note that the RGH scale was not per se associated with indicators of well-being or health-related quality of life, indicating distinct dimensions.

Este artículo presenta una síntesis de un estudio sobre los posicionamientos egocéntricos en la adolescencia realizado en tres contextos escolares diferentes. El análisis permitió determinar que el posicionamiento egocéntrico puede ser mejor determinado a través de dos predictores: el sentido del propio bienestar (eudemonismo) y la convicción de que "la lástima ajena previene tomar iniciativas propias". Estos dos factores fueron correlacionados con la satisfacción del contexto escolar específico, la orientación espiritual y la idea de ayudar a otros. Los posicionamientos y los ideales éticos difieren entre los estudiantes de los tres contextos escolares: colegios Waldorf, colegios cristianos y colegios estatales. Los resultados confirman que la tendencia egocéntrica fue significativamente inferior en el grupo femenino de adolescentes. Este artículo invita a reflexionar sobre el papel que juega el contexto escolar en el proceso de desarrollo de la etapa adolescente a la adulta de los estudiantes.

To analyse how patients with chronic diseases would interpret their illness, and how these interpretations were related to spirituality/religiosity, life satisfaction, and escape from illness, we performed a cross-sectional survey among patients with chronic diseases from Poland (n = 275) using standardized questionnaires. Illness was interpreted mostly as an Adverse Interruption of life (61%), Threat/Enemy (50%), Challenge (42%), and rarely as a Punishment (8%). Regression analyses revealed that escape from illness was the best predictor of negative disease perceptions and also strategy associated disease perceptions, and a negative predictor of illness as something of Value, while Value was predicted best by specific spiritual issues. Patients’ religious Trust and partner status were among the significant contributors to their life satisfaction. Data show that specific dimensions of spirituality are important predictors for patients’ interpretation of illness. Particularly the fatalistic negative perceptions could be indicators that patients may require further psychological assistance to cope with their burden.

In order to measure a wide spectrum of organized and private religious, spiritual, existential and philosophical practices, the SpREUK-P (SpREUK is the German language acronym of “Spirituality/Religiosity and Coping with Illness”) questionnaire was developed as a generic instrument. To account for the fact that institutional religiosity declines, not only in Europe, and to explore the alternative use of various existing esoteric and spiritual resources, the instrument also addresses non-religious forms of spiritual practices. Previously, it was tested in a more secular context and was found to be of relevance for atheistic/agnostic individuals. Now we intended to apply the instrument to 275 Polish individuals with chronic diseases (100% Catholics, 74% women, mean age 56 ± 16 years). The factorial structure of the SpREUK-P’s Polish version was similar to the primary version, but lacked an exclusive “spiritual (mind-body) practices” subscale. Factor analysis revealed four main factors, which would explain 67% of the variance, i.e., religious practices (Cronbach’s alpha = 0.90), humanistic practices (alpha = 0.87), existentialistic practices (alpha = 0.80) and gratitude/awe (alpha = 0.80). The correlation pattern underlines construct validity. Interestingly, in Polish individuals, existentialistic practices did not significantly differ between religious and non-religious individuals (nor between men and women), while all other forms of spiritual practices did differ significantly.

To cover a wider variety of specific aspects of spirituality, which are of relevance also in secular societies, the ASP (“Aspects of Spirituality”) questionnaire was developed. While it was used so far with healthy adults and with adolescents living in a secular society, it was meanwhile used also with Polish students who were predominantly Catholic. Here we compare the factorial structure of the ASP questionnaire in a sample of 871 German (73% non-religious) and 1,017 Polish adolescents/young adults (50% non-religious despite their Catholic denomination). The factorial structure of the ASP questionnaire with its four scales Religious Orientation: Prayer/Trust in God, Search for Insight/Wisdom, Conscious interactions/Compassion, Transcendence Conviction, were similar in the sample of German students and in the Polish students. By means of confirmatory factor analysis (CFA) we were able to use the number of items of the ASP in its student version (ASP-Students). Overall, the instrument is suited to measure a wide variety of vital aspects of spirituality, both religious and secular forms of spirituality. As the instrument avoids exclusive language and operationalizes also non-formal aspects of spirituality in terms of relational consciousness, it is suited, not only for individuals with a skeptical or a-religious attitude, but also for religious individuals.

The interest in the topic of spirituality as a more or less independent dimension of quality of life is continuously growing [...]

Background. Significant facilitators and barriers to organ donation and transplantation remain in the general public and even in health professionals. Negative attitudes of HPs have been identified as the most significant barrier to actual ODT. The purpose of this paper was hence to investigate to what extent HPs (physicians and nurses) experience such facilitators and barriers in ODT and to what extent they are intercorrelated. We thus combined single causes to circumscribed factors of respective barriers and facilitators and analyzed them for differences regarding profession, gender, spiritual/religious self-categorization, and self-estimated knowledge of ODT and their mutual interaction. Methods. By the use of questionnaires we investigated intricate facilitators and barriers to organ donation experienced by HPs (n=175; 73% nurses, 27% physicians) in around ten wards at the University Hospital of Munich. Results. Our study confirms a general high agreement with the importance of ODT. Nevertheless, we identified both facilitators and barriers in the following fields: (1) knowledge of ODT and willingness to donate own organs, (2) ethical delicacies in ODT, (3) stressors to handle ODT in the hospital, and (4) individual beliefs and self-estimated religion/spirituality. Conclusion. Attention to the intricacy of stressors and barriers in HPs continues to be a high priority focus for the availability of donor organs.

This study aimed to develop a test to measure food-induced emotions suitable for stable food and beverages. All of the experiments were conducted under the conditions of a consumer sensory evaluation according to German standard DIN 10974. Test development included descriptors' derivation and factor analysis as well as a comparison between the new test (empathic food test, EFT) and a hedonic sensory test and an unspecific psychological test, known as a multidimensional mood questionnaire (MDMQ). Nineteen sensory experts derived twelve items using free-choice profiling. After an exploratory factor analyses, ten of the intended twelve items were integrated into two scales. To compare the new questionnaire (EFT) to the MDMQ and a hedonic test, panels of 59 (EFT), 64 (MDMQ) and 63 (hedonic sensory test) untrained individuals described their perceptions after consuming sensorially similar pairs of milk, water, bread and sugar. The benchmark of comparison was the power to discriminate between the food pairs. Test-retest replicability was demonstrated. All three tests presented slight differences in sample preference and effect size depending on the offered products. These findings underscore the need to test new methods with a wide range of products. Further research is needed to investigate the relationship between sensorial perception and emotional response.

Objective: Although there are several reports which support a (negative) association between depression and spirituality/religiosity, the specific nature of the relationships remains unclear. To address whether patients with depressive and/or addictive disorders use this resource at all, we focused on a circumscribed variable of intrinsic religiosity, and analyzed putative associations between intrinsic religiosity, depression, life satisfaction and internal adaptive coping strategies. Methods: We referred to data of 111 patients with either depressive and/or addictive disorders treated in three German clinics. For this anonym cross sectional study, standardized instruments were used, i.e., the 5-item scale Reliance on God’s Help (RGH), Beck’s Depression Inventory (BDI), the 3-item scale Escape from Illness, the Brief Multidimensional Life Satisfaction Scale (BMLSS), and internal adaptive coping strategies as measured with the AKU questionnaire. Results: Patients with addictive disorders had significantly higher RGH than patients with depressive disorders (F = 3.6; p = 0.03). Correlation analyses revealed that RGH was not significantly associated with the BDI scores, instead depressive symptoms were significantly associated with life satisfaction and internal adaptive coping strategies (i.e., Reappraisal: Illness as Chance and Conscious Living). Patients with either low or high RGH did not significantly differ with respect to their BDI scores. None of the underlying dimensions of RGH were associated with depression scores, but with life satisfaction and (negatively) with Escape from illness. Nevertheless, patients with high RGH had significantly higher adaptive coping strategies. Regression analyses revealed that Reappraisal as a cognitive coping strategy to re-define the value of illness and to use it as a chance of development (i.e., change attitudes and behavior), was the best predictor of patients’ RGH (Beta = 0.36, p = 0.001), while neither depression as underlying disease (as compared to addictive disorders) nor patients’ life satisfaction had a significant influence on their RGH. Conclusions: Although RGH was significantly higher in patients with addictive disorders than in patients with depressive disorders, depressive symptoms are not significantly associated with patients’ intrinsic religiosity. Particularly those patients with high intrinsic religiosity seem to have stronger access to positive (internal) strategies to cope, and higher life satisfaction. Whether spirituality/religiosity is used by the patients as a reliable resource may depend on their individual experience during live, their expectations, and specific world-view.

There is a multitude of instruments for measuring religiosity/spirituality. Many of these questionnaires are used or even were developed in the context of studies about the connection between religiosity/spirituality and health. Thus, it seems crucial to note that measures can focus on quite different components along a hypothetical path between stressors and health. We present an instructive model which helps to identify these different components and allows the categorization of instruments of religiosity/spirituality according to their primary measurement intention: intensity/centrality, resources, needs, coping, and quality of life/well-being. Furthermore, we point out possibilities as to how religiosity and spirituality can be differentiated. We argue that the distinction between religiosity and spirituality is important in countries with a more secular background where a growing number of people identify themselves as “spiritual, but not religious”.

There is need for a brief measure of religiosity that can be included in epidemiological surveys to examine relationships between religion and health outcomes. The Duke University Religion Index (DUREL) is a five-item measure of religious involvement, and was developed for use in large cross-sectional and longitudinal observational studies. The instrument assesses the three major dimensions of religiosity that were identified during a consensus meeting sponsored by the National Institute on Aging. Those three dimensions are organizational religious activity, non-organizational religious activity, and intrinsic religiosity (or subjective religiosity). The DUREL measures each of these dimensions by a separate “subscale”, and correlations with health outcomes should be analyzed by subscale in separate models. The overall scale has high test-retest reliability (intra-class correlation = 0.91), high internal consistence (Cronbach’s alpha’s = 0.78–0.91), high convergent validity with other measures of religiosity (r’s = 0.71–0.86), and the factor structure of the DUREL has now been demonstrated and confirmed in separate samples by other independent investigative teams. The DUREL has been used in over 100 published studies conducted throughout the world and is available in 10 languages.

Background: Research has examined the connection between religiosity, spirituality (SpR) and health, and the potential of these variables to prevent, heal and cope with disease. Research indicated that participation in religious meetings or services was associated with a lower risk of developing oral disease. We intended to test a Hebrew version of the SpREUK 1.1 questionnaire, which is reported to be a reliable and valid measure of distinctive issues of SpR, and to test its relevance in the context of oral illness among a Jewish population. Methods: In order to validate the SpREUK-Hebrew instrument, minor translational and cultural/religious adaptations were applied. Reliability and factor analyses were performed, using standard procedures, among 134 Jewish Israeli subjects (mean age 38.4 years). Results: Analysis of reliability for internal consistency demonstrated an intra-class correlation of Cronbach's alpha = 0.90 for the intrinsic religiosity/spiritual and the appraisal scales, and of 0.90 for the support through spirituality/religiosity scales. Inter reliability agreement by kappa ranged between 0.7 and 0.9. We were able to approve the previously described factorial structure, albeit with some unique characteristics in the Jewish population. Individuals´ time spent on spiritual activity correlated with the SpREUK scales. The instrument discriminated well between religious subgroups (i.e., ultra Orthodox, conventional religious and less-religious). Preliminary results indicate an association between measures of spirituality and oral health. Conclusions: The traditional and cultural adaptation of the tool was found to be appropriate. SpREUK-Hebrew was reliable and valid among a Jewish population. This method could therefore be employed in comparative studies among different cultural and religious backgrounds.

For many patients confronted with chronic diseases, spirituality/religiosity is an important resource for coping. Patients often report unmet spiritual and existential needs, and spiritual support is also associated with better quality of life. Caring for spiritual, existential and psychosocial needs is not only relevant to patients at the end of their life but also to those suffering from long-term chronic illnesses. Spiritual needs may not always be associated with life satisfaction, but sometimes with anxiety, and can be interpreted as the patients’ longing for spiritual well-being. The needs for peace, health and social support are universal human needs and are of special importance to patients with long lasting courses of disease. The factor, Actively Giving, may be of particular importance because it can be interpreted as patients’ intention to leave the role of a `passive sufferer´ to become an active, self-actualizing, giving individual. One can identify four core dimensions of spiritual needs, i.e., Connection, Peace, Meaning/Purpose, and Transcendence, which can be attributed to underlying psychosocial, emotional, existential, and religious needs. The proposed model can provide a conceptual framework for further research and clinical practice. In fact, health care that addresses patients’ physical, emotional, social, existential and spiritual needs (referring to a bio-psychosocial-spiritual model of health care) will contribute to patients’ improvement and recovery. Nevertheless, there are several barriers in the health care system that makes it difficult to adequately address these needs.

In Christian tradition there are many different ‘schools’ of spirituality which address an ‘inner transformation’ referring to an individual experience of the Sacred. The focus of this study was to examine the ‘core’ component of Franciscan spirituality (life according to the Gospel) and the ‘transformative’ components (living with and for others in need and respectful commitment to the creation) in a group of brothers and sisters of the Franciscan family. In particular, the reflection on how this spirituality is connected with the perception of the divine in daily life, with feelings of awe and subsequent gratitude on the one hand and compassion and altruistic behavior on the other, was an essential aspect of the present work. Data from a cross-sectional study with standardized instruments among 388 Franciscan brothers and sisters (mean age 61 ± 25 years) showed that “Living from the Faith” and “Seeking God in Silence and Prayer” scored highest, followed by “Commitment to the Creation” and interpersonal factors such as “Peaceful Attitude/Respectful Treatment” and “Commitment to the Disadvantaged”. In all cases, women achieved significantly higher scores than men (with values of F between 5.3 and 23.5, p < 0.05). These dimensions were moderately to strongly associated with experiential aspects of spirituality (i.e., Perception of the Divine, Gratitude/Awe), particularly “Living from the Faith” (r > 5.0, p < 0.0001). With regard to the prosocial ‘outcomes’ (e.g., Compassion and Altruism), stepwise regression analyses showed that Compassion was best predicted by “Peaceful Attitude/Respectful Treatment” and Gratitude/Awe (both explain 27% of variance), and Altruism was best predicted by “Commitment to the Disadvantaged” and Gratitude/Awe (both explain 21% of variance). Mediator analyses with the standardized z-factor values showed that Gratitude/Awe is also a significant mediator of the effects of the Perception of the Divine (as a further significant predictor of prosocial behaviors) on Compassion (beta = 0.05 ± 0.02, p < 0.01) and Altruism (beta = 0.03 ± 0.02, p = 0.04). Surprisingly, “Commitment to the Disadvantaged” was only weakly linked to “Living from the Faith”. It could be shown that “Living from the Faith” was much more connected to Compassion as an intention rather than to Altruism as an action. “Living from the Faith”, as the fundamental aspect of Franciscan spirituality, mediated the effect of the Perception of the Divine on Compassion (beta = 0.08 ± 0.03, p < 0.01) and Altruism (beta = 0.06 ± 0.03, p = 0.04), as well as mediating the effect of Gratitude/Awe on Compassion (beta = 0.07 ± 0.02, p < 0.01) and Altruism (beta = 0.06 ± 0.02, p < 0.01). However, there are significant differences between more contemplative and charitably engaged Franciscans; “Living from the Faith” scored highest in contemplative brothers and sisters within the different branches of Franciscan orders when compared to more charitably engaged persons, while their “Commitment to the Disadvantaged” was significantly lower. These differences could also be ascribed to the different charisms and missions of the Franciscan branches.