Espiritualidade e Saúde HCPA

7/27/2019 Espiritualidade e Sade HCPA

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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!

[email protected]


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Ah, encontramos o Sean!

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Espiritualidade e Saúde HCPA