This study aims to analyze the association between religious attendance, self-reported religiousness, depression, and several health factors in 170 older adults from a Brazilian outpatient setting. A comprehensive assessment was conducted including sociodemographic characteristics, religious attendance, self-reported religiousness, functional status, depression, pain, hospitalization, and mental status. After adjusting for sociodemographics, (a) higher self-reported religiousness was associated with lower prevalence of smoking, less depressive symptoms, and less hospitalization and (b) higher religious attendance was only associated with less depressive symptoms. Religiousness seems to play a role in depression, smoking, and hospitalization in older adults from a Brazilian outpatient setting. Self-reported religiousness was associated with more health characteristics than religious attendance.
Older adults have higher levels of religious involvement than younger adults [
In addition, religiousness seems to have an impact on older adults’ health as well. According to several studies, religiousness and spirituality were associated with lower prevalence of depression [
However, studies dealing with the impact of religiousness in older medical outpatients, particularly in countries outside North America and Europe, are not frequent in the medical literature.
In Brazil, there are approximately 16.2 million older adults; 95% of the population have a religious affiliation (Catholics and Protestant Evangelicals in majority) and 37% attend religious services at least once a week [
Previous studies in Brazil have found an association between religiousness, alcohol, and mental health in older groups [
We seek to analyze the association between religious attendance, self-reported religiousness, depression, and several health factors in older adults from a Brazilian outpatient setting.
A cross-sectional study was conducted at the general medical outpatient clinic of the São Paulo Air Force Hospital, Brazil, between February 2007 and December 2007. The São Paulo Air Force Hospital (SPAFH), Brazil provides care for the Brazilian Air Force in the state of São Paulo (region in South Eastern Brazil with approximately 40 million inhabitants) and treats military personnel, retired military, and dependents of current and retired military. Data were extracted from a study regarding implementation of a comprehensive geriatric assessment (CGA) in general practice [
All patients who consented and saw general practitioners during this period were included. A patient was eligible if he or she was aged 60 years or older, was cognitively well (capable of answering the questions) and physically well enough to undergo the evaluation. After fully explaining the procedures and obtaining written informed consent from the patient, a general practitioner conducted a CGA. The present study was approved by the Ethics Committee of São Paulo Air Force Hospital.
Further details regarding the original study procedures and methodology can be found in a previous publication [ sociodemographic data (sex, age, race, marital status, and education); number of medical diagnosis and medications in use; smoking and drinking habits (prevalence and frequency); depression (using Geriatric Depression Scale-15 validated into Portuguese) [ cognition (using mini mental state evaluation validated into Portuguese) [ activities of daily living (using Katz Scale) [ self-reported sleep problems were evaluated through the question “Do you have sleep problems” with yes/no answers; hospitalization in previous 6 months (yes/no); physical activity (prevalence and frequency)—physical inactivity was considered in those exercising less than twice a week per 30 minutes; pain rating (using a visual analogic scale, graded from 0 to 10, in which zero means no pain and 10 very severe pain); social support was evaluated through the question “Do you have someone to count on when you’re down?” with yes/no answer; religiousness was measured through religious attendance (extrinsic) question obtained from the Duke Religion Index validated into Portuguese [
Data analysis was performed using SPSS 17.0 for Windows. First, we conducted bivariate analyses (chi-square for categorical variables and
Logistic regression models were performed in order to assess the relation between religiousness (dichotomized) and health factors. All significant variables in bivariate analyses were included in multivariate models that controlled for gender, age, marital status, social support, functional status, and education.
Finally, a linear regression model (Table
The level of significance was 0.05 and the confidence interval was 95%.
One hundred and eighty seven patients attended to the clinic. From these, 17 were excluded: 8 because of incomplete physical or mental health data, 2 did not consent, and 7 patients were younger than the age of 60.
The final sample consisted of 170 elderly patients. There was a predominance of females (65.9%), with a mean age of 75.7 years old (range: 60 to 97) and 8.1 years of education. Most patients lived in the city of São Paulo, 54 (31.8%) were retired military personnel and 116 (68.2%) were dependents/spouses of retired or current military personnel.
In our sample, there was a predominance of females in their mid 70s, in accordance with the findings of other studies conducted in Brazil’s elderly population [
Subjects had an average 9.07 (
Sociodemographic, health, and religious variables of the study sample.
Patients’ baseline characteristics | |
---|---|
Age ( |
75.75 ( |
Gender | |
Female | 112 (65.9%) |
Male | 58 (34.1%) |
Number of medical diseases | 9.07 ( |
Years of education ( |
8.1 ( |
Activities of daily living | |
Totally dependent | 13 (7.6%) |
Partially dependent | 5 (2.9%) |
Independent | 152 (89.4%) |
Alcohol use | |
Occasionally | 36 (21.2%) |
Alcoholic | 12 (7.1%) |
Dementia | 33 (19.4%) |
Depression | 56 (32.9%) |
Hospitalization in previous 6 months | 33 (19.4%) |
Physical activity | 67 (39.4%) |
Presence of Pain | 70 (41.7%) |
Self-reported sleep problems | 90 (52.9%) |
Smoking | 30 (17.6%) |
Religious attendance | |
Never | 75 (46%) |
Less than once a week | 15 (9.2%) |
Once a week or more | 73 (44.8%) |
Importance of religion in life | |
Not important | 33 (20.2%) |
Somewhat important | 27 (16.6%) |
Very important | 103 (60.3%) |
SD: standard deviation.
Concerning religious aspects, 98 (60.1%) were Roman Catholics, 23 (14.1%) Evangelical Protestants, 19 (11.7%) Spiritists, and only 4 (2.5%) did not indicate a religious affiliation. These results are in line with the last national survey in which the most frequent affiliations were Catholicism (68%) and Protestant/Evangelicals (23%). Nevertheless, in our study we found a high percentage of Spiritists (11.7%) compared to the Brazilian population (2.5% were Spiritists) [
Bivariate analysis can be found in Table
Factors associated with religiousness using bivariate analysis, Air Force Hospital of São Paulo-Brazil, 2007.
Health variables | Religious attendance | Importance of religion to life | ||||||
---|---|---|---|---|---|---|---|---|
Less than once a week | Once a week or more |
|
Odds-ratio (95% CI) | Not or somewhat important | Very important |
|
Odds-ratio (95% CI) | |
Any alcohol use | 35.6% | 20.5% | 0.035* | 2.13 (1.04–4.35) | 36.7% | 24.3% | 0.092 | 1.80 (0.90–3.60) |
Dementia | 20.0% | 11.0% | 0.110 | 2.03 (0.82–4.98) | 23.3% | 11.7% | 0.054 | 2.30 (0.98–5.39) |
Presence of depression | 41.1% | 21.9% | 0.009* | 2.48 (1.24–4.98) | 48.3% | 23.3% | 0.001* | 3.07 (1.55–6.09) |
Hospitalization in previous 6 months | 21.1% | 13.7% | 0.213 | 1.68 (0.72–3.89) | 30.0% | 10.7% | 0.001* | 3.58 (1.55–8.25) |
Physical activity | 36.7% | 46.6% | 0.203 | 0.66 (0.35–1.24) | 31.7% | 46.6% | 0.061 | 0.53 (0.27–1.03) |
Pain | 43.3% | 39.7% | 0.641 | 1.16 (0.61–2.17) | 41.7% | 41.7% | 0.991 | 0.99 (0.52–1.99) |
Self-reported sleep problems | 55.6% | 45.2% | 0.185 | 1.51 (0.81–2.81) | 51.7% | 50.5% | 0.882 | 1.04 (0.55–1.98) |
Smoking | 20.0% | 12.3% | 0.193 | 1.77 (0.74–4.23) | 26.7% | 10.7% | 0.008* | 3.04 (1.30–7.09) |
*Statistically significant chi-square test (
After adjusting for sociodemographic aspects (Table
Health factors associated with higher religiousness (logistic regression)#.
Presence of depression | Hospitalization in previous 6 months | No consumption of alcohol | Smoking | |
---|---|---|---|---|
Adjusted OR (95% CI) | Adjusted OR (95% CI) | Adjusted OR (95% CI) | Adjusted OR (95% CI) | |
Religious Attendance | ||||
Once a week or more | 0.28 (0.12–0.64)* |
1.04 (0.39–2.78) |
1.29 (0.19–8.45) |
0.41 (0.14–1.17) |
Less than once a week | Wald: 9.118, |
Wald: 0.007, |
Wald: 0.071, |
Wald: 2.772, |
Importance of religion to life | ||||
Very important | 0.19 (0.08–0.44)* |
0.34 (0.13–0.85)* |
1.02 (0.23–4.49) |
0.28 (0.10–0.77)* |
Not or somewhat important | Wald: 15.210, |
Wald: 5.273, |
Wald: 0.001, |
Wald: 6.073, |
#All significant variables in the bivariate model were included for multivariate logistic model, controlled by gender, age, marital status, social support, functional status, and education.
*Statistically significant.
GDS scores and religious aspects (linear regression)#.
|
Std. error | Beta standardized |
| |
---|---|---|---|---|
Religious attendance | −1.045 | 0.225 | −0.339 | <0.001* |
Importance of religion to life | −1.010 | 0.306 | −0.271 | <0.001* |
#The relation between GDS scores and religious aspects was also included in a linear regression, controlled by gender, age, marital status, social support, functional status, and education.
*Statistically significant.
If we consider lower religiousness as the reference, we will find that: (a) lower self-reported religiousness was associated with a higher prevalence of smoking (OR: 3.47 (1.29–9.36]), higher prevalence of depression (OR: 5.13 (2.25–11.68)) and more hospitalization in previous 6 months (OR: 2.89 (1.16–7.15)); (b) low religious attendance was only associated with a higher prevalence of depression (OR: 3.48 (1.55–7.85)).
In a separate group analysis, Roman Catholics with higher religious attendance (OR: 0.26 (0.08–0.78),
Less depressive symptoms (lower GDS scores) were also associated with higher religious attendance (Beta: −1.045,
Religious and spiritual beliefs are important aspects for older Brazilian adults’ lives that may have positive or negative effects on health. In our sample, we found a predominance of Roman Catholics (almost two-thirds), followed by Evangelical Protestants and spiritists, which is consistent with previous Brazilian studies [
Bivariate analysis showed that lower religious attendance was associated with greater depression and alcohol use. These results persisted only for depression in the logistic regression model.
Self-reported religiousness, however, was associated with less depression, greater physical activity, less hospitalization in the previous 6 months, and less smoking. After controlling, other variables such as depression, hospitalization in previous 6 months, and smoking remained significant.
Religiousness was not associated with dementia, presence of pain, and sleep problems.
The relationship between spirituality/religiousness and depression is well known in the literature. Studies have shown that higher spirituality/religiousness levels are associated with less depression [
The findings from the present study are consistent with those from another Brazilian study [
Another important health outcome was hospitalization in the previous 6 months. Some international studies—prospective [
In the present study, lower tobacco use was also associated with higher levels of religiousness, similar to the findings of other studies [
Our findings obtained from this military setting are in line with other military international studies. McLaughlin et al. [
Another interesting finding is the difference between religious attendance and self-reported religion. Almost 45% of the patients attended religious services at least once a week, similar to other studies [
In other words, attendance is more related to an extrinsic religiousness whereas self-reported religiousness is more related to intrinsic religiousness. According to Allport’s work [
Study limitations must be considered while evaluating these results. First, the study is cross-sectional, not allowing cause-effect conclusions. Second, different from other Brazilian studies, this sample had a mean of 8.1 years of education, higher than other studies conducted in Brazil. This is probably explained by the setting, a military hospital with higher educated patients. Third, the study has examined a simplistic construct of religiousness (using self-reported religiousness and religious attendance). Forth, the study analysis evaluated a fairly high number of comparisons. Nevertheless, when a more stringent level of significance would have been chosen (
Nevertheless, the present study has some strengths that should be highlighted: (a) the replication of a research on religiousness and depression in a different cultural setting than most of the research available, (b) the adjustment for social support, and (c) the adjustment for physical health status.
Finally, we believe that studies conducted in different cultures, such as South American countries, are necessary to understand the impact of religiousness and spirituality in older adults. Similar to other international studies, religiousness may have a protective effect against depression, smoking, and hospitalization in older adults from this Brazilian outpatient setting.