Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program

• Published in: Journal of affective disorders 2019-04, Vol.249, p.127-135
• Main Authors: Currier, Joseph M., Foster, Joshua D., Witvliet, Charlotte vanOyen, Abernethy, Alexis D., Root Luna, Lindsey M., Schnitker, Sarah A., VanHarn, Karl, Carter, Janet
• Format: Article
• Language: English
• Subjects: Mental health; Religion; Spiritual struggle; Spirituality; Spiritually integrated care
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2019.02.012

•Roughly one-half of patients in this inpatient sample reported at least one form of spiritual struggle in Exline et al.’s (2014) framework at the time of their admission (divine, morality, ultimate meaning, interpersonal, demonic, doubting).•With the exception of perceived issues with demonic forces or supernatural evil, all spiritual struggles assessed in the study were generally associated with worse mental health status at both intake and discharge.•When considering the relative importance of specific spiritual struggles, issues with ultimate meaning emerged as a particularly salient indicator for greater MDD symptom severity and poorer positive mental health across the two assessments.•When accounting for other forms of spiritual struggles, latent change score analyses revealed patients who experienced a reduction in ultimate meaning struggles were uniquely probable to experience improvements in their mental health status over the treatment program. Persons contending with serious mental health difficulties often experience struggles with religious faith and/or spirituality that may also demand clinical attention. However, research has not examined the relative importance of specific forms of spiritual struggles in mental health status or treatment outcomes of psychiatric patients. Focusing on 217 adults who completed a spiritually integrated inpatient program, this study examined (1) which struggles in Exline et al.’s (2014) framework (Divine, Morality, Ultimate Meaning, Interpersonal, Demonic, and Doubting) represented the most salient indicators of major depressive disorder (MDD) symptomatology and positive mental health (PMH) and (2) whether alleviation of these struggles predicted improvements in patients’ mental health status over the treatment period. Greater severity of spiritual struggles was generally associated with worse MDD symptomatology and less PMH at intake and discharge. However, when weighing the role of varying forms of struggles, issues with ultimate meaning emerged as a salient indicator of mental health status at the two assessments as well as longitudinal changes in both MDD symptomatology and PMH. This sample was recruited from acute stabilization units in a single spiritually integrated behavioral health center with a general affiliation with Christianity. Hence, treatment periods were relatively brief in some cases and findings might not generalize to other psychiatric programs or settings. Findings highlight the utility of