The Influence Of Religion And Spirituality On Rehabilitation Outcomes Among Traumatic Brain Injury Survivors

The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as coping resources in a sample of traumatically brain injured adults. Furthermore, various mechanisms by which religion and spirituality may affect outcome were explored. The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). Participants subjectively reported on their religious/spiritual beliefs and psychosocial resources in coping as well as their current physical and psychological status. Significant others reported objective rehabilitation outcomes. The majority of the participants with brain injury were male (76%), African American (75%) and Christian (76%). The results indicate that public religious practice was not a unique predictor of any outcome measures after accounting for demographic and injury-related characteristics. Existential well-being (a sense of meaning and purpose in life) was not a unique predictor for any outcome, but religious well-being (a sense of connection to a higher power) was a unique predictor for life satisfaction, distress and functional ability. Social support was found to partially explain the relationship between religious well-being and both SO report of functional outcome and self-reported level of distress, though an independent relationship remained. Similarly, ability to find benefit, emotion-focused coping and perceived detriment from trauma each partially explained the relationship between religious well-being and psychological outcomes, whereas task-oriented coping partially explained the relationship between religious well-being and functional outcome. Overall health behavior profile partially explained the relationship between religious well-being and life satisfaction and religious well-being and functional outcome. After accounting for general coping style, perceived benefit from trauma was a unique predictor for psychological outcomes, whereas perceived detriment and negative religious coping were unique significant predictors only for life satisfaction. The findings of this project indicate that specific facets of religious and spiritual belief systems do play direct and unique roles in predicting rehabilitation outcomes. Furthermore, the influence of religion and spirituality on rehabilitation outcomes is partly due to its indirect effects on social support and coping. Notably, a self-reported individual connection to a higher power was an extremely robust predictor of both subjective and objective outcome

Influence of depression, anxiety and stress on cognitive performance in community-dwelling older adults living in rural Ecuador: Results of the Atahualpa Project

Aim To assess the relationship between cognitive status and self‐reported symptoms of depression, anxiety and stress of older adults living in an underserved rural South American population. Methods Community‐dwelling Atahualpa residents aged ≥60 years were identified during a door‐to‐door census, and evaluated with the Depression Anxiety Stress Scale‐21 (DASS‐21) and the Montreal Cognitive Assessment (MoCA). We explored whether positivity in each of the DASS‐21 axes was related to total and domain‐specific MoCA performance after adjustment for age, sex and education. Results A total of 280 persons (59% women; mean age, mean age 70 ± 8 years) were included. Based on established cut‐offs for the DASS‐21, 12% persons had depression, 15% had anxiety and 5% had stress. Mean total MoCA scores were significantly lower for depressed than for not depressed individuals (15.9 ± 5.5 vs 18.9 ± 4.4, P < 0.0001). Depressed participants had significantly lower total and domain‐specific MoCA scores for ion, short‐term memory and orientation. Anxiety was related to significantly lower total MoCA scores (17 ± 4.7 vs 18.8 ± 4.5, P = 0.02), but not to differences in domain‐specific MoCA scores. Stress was not associated with significant differences in MoCA scores. Conclusion The present study suggests that depression and anxiety are associated with poorer cognitive performance in elderly residents living in rural areas of developing countries. Geriatr Gerontol Int 2015; 15: 508–514