Philip Moons1, Koen Luyckx2, Jessie Dezutter2, Adrienne H Kovacs3, Corina Thomet4, Werner Budts5, Junko Enomoto6, Maayke A Sluman7, Hsiao-Ling Yang8, Jamie L Jackson9, Paul Khairy10, Raghavan Subramanyan11, Luis Alday12, Katrine Eriksen13, Mikael Dellborg14, Malin Berghammer15, Bengt Johansson16, Andrew S Mackie17, Samuel Menahem18, Maryanne Caruana19, Gruschen Veldtman20, Alexandra Soufi21, Susan M Fernandes22, Kamila White23, Edward Callus24, Shelby Kutty25, Silke Apers26. 1. KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa. Electronic address: Philip.Moons@kuleuven.be. 2. School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium. 3. Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada; Knight Cardiovascular Institute, Oregon Health & Science University, Portand, OR, USA. 4. Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland. 5. Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium. 6. Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan. 7. Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. 8. School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan. 9. Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA. 10. Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada. 11. Pediatric Cardiology, Frontier Lifeline Hospital, Dr. K. M. Cherian Heart Foundation, Chennai, India. 12. Division of Cardiology, Hospital de Niños, Córdoba, Argentina. 13. Adult Congenital Heart Disease Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 14. Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Adult Congenital Heart Unit, Sahlgrenska University Hospital, Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden. 15. Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Health Sciences, University West, Trollhättan, Sweden. 16. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. 17. Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada. 18. Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia. 19. Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta. 20. Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 21. Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France. 22. Stanford University School of Medicine, Department of Pediatrics and Medicine, Division of Pediatric Cardiology and Cardiovascular Medicine, Palo Alto, CA, USA. 23. Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA. 24. Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy. 25. Adult Congenital Heart Disease, Center University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE, USA. 26. KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.
Abstract
AIMS: Religion and spirituality can be resources for internal strength and resilience, and may assist with managing life's challenges. Prior studies have been undertaken primarily in countries with high proportions of religious/spiritual people. We investigated (i) whether being religious/spiritual is an independent predictor of patient-reported outcomes (PROs) in a large international sample of adults with congenital heart disease, (ii) whether the individual level of importance of religion/spirituality is an independent predictor for PROs, and (iii) if these relationships are moderated by the degree to which the respective countries are religious or secular. METHODS AND RESULTS: APPROACH-IS was a cross-sectional study, in which 4028 patients from 15 countries were enrolled. Patients completed questionnaires to measure perceived health status; psychological functioning; health behaviors; and quality of life. Religion/spirituality was measured using three questions: Do you consider yourself religious or spiritual?; How important is religion, spirituality, or faith in your life?; and If religious, to what religion do you belong?. The country level of religiosity/secularity was appraised using data from the Gallup Poll 2005-2009. General linear mixed models, adjusting for patient characteristics and country differences were applied. Overall, 49.2% of patients considered themselves to be religious/spiritual. Being religious/spiritual and considering religion/spirituality as important in one's life was positively associated with quality of life, satisfaction with life and health behaviors. However, among patients living in more secular countries, religion/spirituality was negatively associated with physical and mental health. CONCLUSION: Religiosity/spirituality is an independent predictor for some PROs, but has differential impact across countries.
AIMS: Religion and spirituality can be resources for internal strength and resilience, and may assist with managing life's challenges. Prior studies have been undertaken primarily in countries with high proportions of religious/spiritual people. We investigated (i) whether being religious/spiritual is an independent predictor of patient-reported outcomes (PROs) in a large international sample of adults with congenital heart disease, (ii) whether the individual level of importance of religion/spirituality is an independent predictor for PROs, and (iii) if these relationships are moderated by the degree to which the respective countries are religious or secular. METHODS AND RESULTS: APPROACH-IS was a cross-sectional study, in which 4028 patients from 15 countries were enrolled. Patients completed questionnaires to measure perceived health status; psychological functioning; health behaviors; and quality of life. Religion/spirituality was measured using three questions: Do you consider yourself religious or spiritual?; How important is religion, spirituality, or faith in your life?; and If religious, to what religion do you belong?. The country level of religiosity/secularity was appraised using data from the Gallup Poll 2005-2009. General linear mixed models, adjusting for patient characteristics and country differences were applied. Overall, 49.2% of patients considered themselves to be religious/spiritual. Being religious/spiritual and considering religion/spirituality as important in one's life was positively associated with quality of life, satisfaction with life and health behaviors. However, among patients living in more secular countries, religion/spirituality was negatively associated with physical and mental health. CONCLUSION: Religiosity/spirituality is an independent predictor for some PROs, but has differential impact across countries.