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Spirituality, Religion, and Clinical Outcomes in Patients Recovering From an Acute Myocardial Infarction

From the Department of Psychiatry and Behavioral Sciences (J.A.B., M.A.B., F.J.K., P.S.), Duke University Medical Center, Durham, North Carolina; Department of Psychiatry (G.I.), University of Miami, Miami, Florida; School of Education (C.T.), Stanford University, Stanford, California; Department of Community Medicine (L.P.), Rush-Presbyterian Hospital, Chicago, Illinois; Department of Psychology (M.B.), Yale-New Haven Veterans Administration Hospital, New Haven, Connecticut; National Heart Lung and Blood Institute (S.C.), Bethesda, Maryland; and Department of Biostatistics (D.C.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Address correspondence and reprint requests to James Blumenthal, Box 3119, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710. E-mail: Blume003{at}mc.duke.edu

Objective: To assess the prospective relationship between spiritual experiences and health in a sample of patients surviving an acute myocardial infarction (AMI) with depression or low social support.

Methods: A subset of 503 patients participating in the enhancing recovery in coronary heart disease (ENRICHD) trial completed a Daily Spiritual Experiences (DSE) questionnaire within 28 days from the time of their AMI. The questionnaire assessed three spirituality variables—worship service/church attendance, prayer/meditation, and total DSE score. Patients also completed the Beck Depression Inventory to assess depressive symptoms and the ENRICHD Social Support Inventory to determine perceived social support. The sample was subsequently followed prospectively every 6 months for an average of 18 months to assess all-cause mortality and recurrent AMI.

Results: Of the 503 participants who completed the DSE questionnaire at the time of index AMI, 61 (12%) participants either died or sustained a recurrent MI during the follow-up period. After adjustment for gender, education level, ethnicity, and a composite medical prognosis risk score derived specifically for the ENRICHD trial, we observed no relationship between death or nonfatal AMI and total spirituality as measured by the DSE (p = .446), worship service attendance (p = .120), or frequency of prayer/meditation (p = .679).

Conclusion: We found little evidence that self-reported spirituality, frequency of church attendance, or frequency of prayer is associated with cardiac morbidity or all-cause mortality post AMI in patients with depression and/or low perceived support.

Key Words: coronary heart disease • religion • spirituality • depression • social support

Abbreviations: AMI = acute myocardial infarction; BDI = Beck Depression Inventory; CHD = coronary heart disease; DSE = Daily Spiritual Experiences scale; ECG = electrocardiogram; ENRICHD = Enhancing Recovery In Coronary Heart Disease; ESSI = ENRICHD Social Support Inventory; HR = hazard ratio.