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Espiritualidade e Sade
Uma reviso no sistemtica daliteratura. Por Eno Filho
02/08/1
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Declarao de Conflito de Interesse
Tenho f religiosa.
Sou cristo.
Fao parte do Movimento dos Focolares, ummovimento internacional de origem catlica,de carter ecumnico (diversas igrejas),interreligioso (tambm budistas, muulmanos,
judeus, hindus), e de pessoas com credoshumanistas no religiosos, como ateus ouagnsticos.
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O que espero/no espero
No espero parecer saber tudo sobre o tema, quetem recente cidadania cientfica.
No espero demonstrar nada sobre Deus. Ele no um objeto/sujeito de estudo cientfico.
Espero compartilhar uma suspeita levantadapelos estudos: na populao geral, a busca doTrancendente com a inclinao para afraternidade universal podem tornar a vida daspessoas mais felizes (e mais longas). Depois,podemos discutir implicaes clnicas dessahiptese.
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Nessa perspectiva:
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Como medir espiritualidade?
Definir espiritualidade de um modo vago demais(valorizar conexes humanizadas, serotimista) traz confuso entre preditor e
desfecho nas pesquisas. Pessoas que no se identificam com a
espiritualidade, como ateus humanistas, podemreivindicar as mesma definies vagas para si.
Em aplicao clnica, espiritualidade pode serdefinida de modo flexvel, compartilhado com aspessoas. Para pesquisa, difcil definir e medir.
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Definindo para refletir:
espiritualidade X religio
Religio envolve crenas, prticas e rituais
concernentes ao sagrado, pensado como
Deus ou a Realidade Primeira, vividas no seio
de tradies que congregam e organizam
pessoas.
Como nesta definio no se incluem
resultados, religio pode ser correlacionadacom desfechos em sade.
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Como religio afeta Sade?
Religion
Mental
Health
Social
Support
Health
Behaviors
Stress
Hormones
Immune
System
Autonomic
Nervous
System
Disease
Detection &
Treatment
Compliance
Smoking
High Risk Behaviors
Alcohol & Drug Use
Infection
Cancer
Heart Disease
Hypertension
Stomach &
Bowel Dis.
Accidents
& STDs*
Geneticsusceptibility,Gender,
Age,Race,Education
,Income
Liver & Lung
Disease
Stroke
ChildhoodT
raining
AdultDecisions
ValuesandCharacter
AdultDecisions
Model of Religion's Effects on HealthHandbook of Religion and Health (Oxford University Press, 2001)
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Vejamos alguns estudos
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BENEFICIAL THAN RECEIVING IT:
Results From a Prospective Study of Mortality
R li i d W ll b i i Old Ad lt
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Religion and Well-being in Older Adults
Religious categories based on quartiles (i.e., low is 1st quartile, very high is 4th quartile)
Low Moderate High Very High
Church Attendance or Intrinsic Religiosity
Well-being
The Gerontologist 1988; 28:18-28
Religion and Well-being in Older Adults
Religious categories based on quartiles (i.e., low is 1st quartile, very high is 4th quartile)
Low Moderate High Very High
Church Attendance or Intrinsic Religiosity
Well-being
The Gerontologist 1988; 28:18-28
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Religion and Depression in Hospitalized Patients
Geriatric Depression ScaleInformation based on results from 991 consecutivel admitted atients differences si nificant at
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0 4 8 12 16 20 24
Weeks of Followup
0
20
40
60
80
100
ProbabilityofNon-Remission
%
Other Patients
Highly Religious (14%)
diagnosis
845 medical inpatients > age 50 with major or minor depression
HR=1.53, 95% CI=1.20-1.94, p=0.0005, after control for
demographics, physical health factors, psychosocial
stressors, and psychiatric predictors at baseline
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Church Attendance and Anxiety Disorder(anxiety disorder within past 6 months in 2,964 adults ages 18-89)
Koenig et al (1993). Journal of Anxiety Disorders 7:321-342
Young (18-39) Middle-Aged (40-59) Elderly (60-97)
AnxietyDiso
rder
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Low Attendance High Attendance Low Attendance High Attendance77
78
79
80
81
AverageDiastolicBloodPressure
* Analyses weighted & controlled for age, sex, race, smoking,
education, physical functioning, and body mass index
Low Prayer/Bible Low Prayer/Bible High Prayer/Bible High Prayer/Bible
p
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Rezando o tero e recitando mantras
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Effect of rosary prayer and yoga mantras on
autonomic
cardiovascular rhythms: comparative study
BMJ 2001;323:14469
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A Randomized, Wait-List Controlled Clinical
Trial: The Effect of a Mindfulness Meditation-
Based Stress Reduction Program on Mood andSymptoms of Stress in Cancer Outpatients
Psychosomatic Medicine 62:613622 (2000)
F f Att d t R li i S i
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Frequency of Attendance at Religious Services,
Hypertension, and Blood Pressure: The Third National
Health and Nutrition Examination Survey
causalidade
reversa?
Mortality From Heart Disease and Religious Orthodoxy
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Mortality From Heart Disease and Religious Orthodoxy
(based on 10,059 civil servants and municipal employees)
Kaplan-Meier life table curves (adapted from Goldbourt et a l 1993. Cardiology 82:100-121)
Follow-up time, years
Survivalprobability
MostOrthodox
Non-Believers
Differences remain significant after
controlling for blood pressure,
diabetes, cholesterol, smoking,weight, and baseline heart disease
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Six-Month Mortality After Open Heart Surgery
-
0
5
10
15
20
25
%Dead
(2 of 72)
(7 of 86) (2 of 25)
(10 of 49)
(232 patients at Dartmouth Medical Center, Lebanon, New Hampshire)
Hi Religion
Hi Soc Support
Hi Religion
Lo Soc Support
Lo Religion
Hi Soc Support
Lo Religion
Lo Soc Support
Hi Religion
Hi Soc Support
D R li i Ob P t
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Does Religious Observance Promote
Health? Mortality in Secular vs Religious
Kibbutzim in Israel
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Religious Involvement and Mortality: A
Meta-Analytic Review
A meta-analysis of data from 42 independent samples
(125,826 participants) examining the association of a measure
of religious involvement and all-case mortality is reported.
Religious involvement was significantly associated with lower
mortality (odds ratio = 1.29; 95% confidence interval: 1.20-
1.39), indicating that people high in religious involvement
were more likely to be alive at follow-up than people lower inreligious involvement.
Conclusions did not appear to be due to publication bias.
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Religious Attendance: More Cost-
Effective Than Lipitor?
J Am Board Fam Med 2006;19:1039.
Results: Weekly attendance at religious services accounts for an additional 2 to 3 life-
years com- pared with 3 to 5 life-years for physical exercise and 2.5 to 3.5 life-years
for statin-type agents. The approximate cost per life-year gained was between
$2,000 and $6,000 for regular exercise, $3,000 and $10,000 for regular religious
attendance, and between $4,000 and $14,000 for statin-type agents.
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Resumindo
Espiritualidade/religio afetam a sade,
aparentemente de modo positivo.
As pessoas parecem desejar que os
profissionais de sade conheam suas
necessidades espirituais.
Os profissionais de sade tem estudado,
pesquisado e publicado a respeito.
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Para seguir estudando
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MUITO OBRIGADO!
enofilho@uol.com.br
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Ah, encontramos o Sean!
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