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Cancer. 2015 Nov 1;121(21):3769-78. doi: 10.1002/cncr.29350. Epub 2015 Aug 10.

A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer.

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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.
Department of Educational Psychology, University of Texas at Austin, Austin, Texas.
Health Outcomes and Behavior Department, Moffitt Cancer Center, Tampa, Florida.
School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
Department of Psychology, University of Notre Dame, Notre Dame, Indiana.
Department of Psychology, University of Connecticut, Storrs, Connecticut.
Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, North Carolina.
Behavioral Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Religion, Health and Human Values, Rush University Medical Center, Chicago, Illinois.


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.


anxiety; cancer; depression; distress; meta-analysis; quality of life; religion; spirituality

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