(July 10, 2009) - Women with breast cancer who feel angry at God or are disillusioned with their faith are more likely to experience depressive symptoms, lower life satisfaction and worse overall mental health than those who have a positive religious or spiritual outlook, such as looking to God for strength and guidance, according to a new study published in the Journal of Palliative Medicine.

Clinicians should be aware that patients with serious illness who are in the midst of a religious or spiritual struggle are at further risk of diminished well-being and may benefit from a clergy referral, said lead author Randy Hebert, MD, Medical Director of Forbes Hospice, part of the West Penn Allegheny Health System.

“Religion is an important coping mechanism for many women dealing with a breast cancer diagnosis, and clinicians may want to respectfully inquire about their patients’ religious beliefs so that they can intervene appropriately to help women at risk,” said Dr. Hebert, who is also Vice Chief of the Division of Hospice and Palliative Medicine at The Western Pennsylvania Hospital and The Western Pennsylvania Hospital – Forbes Regional Campus.

Dr. Hebert’s study, “Positive and Negative Religious Coping and Well-Being in Women with Breast Cancer,” enrolled 198 women with early-stage (I or II) breast cancer and 86 women with later-stage (IV) breast cancer. Recruited from a number of hospitals in western Pennsylvania, participants were interviewed at the time of entry into the study, and eight to 12 months later.

Positive religious coping was measured by the statements “I’ve been working together with God as partners to get through this problem” and “I’ve been looking to God for strength, support and guidance.” Negative religious coping reflected the statements “I’ve been wondering if God has abandoned me” and “I’ve been expressing anger at God for letting this happen to me.”

While negative religious coping predicted a worse overall emotional and mental health, positive religious coping was not associated with any measure of well-being.

Unlike many other studies that have explored how religious coping affects a patient’s well-being, this study controlled for variables such as age and ethnicity, social support, cancer stage and personality attributes such as hostility or cynicism.

The study has implications for both clinicians and counselors, Dr. Hebert said.

“Clinicians often don’t broach the subject of religious and spiritual coping with their seriously ill patients, even though most want their physicians to be aware of their beliefs. Our study suggests that engaging patients about their religious or spiritual beliefs may be extremely beneficial, particularly when anger and disillusionment with one’s faith is present,” Dr. Hebert said.

The study’s findings also indicate that counselors may want to consider the potential implications of negative religious coping when developing interventions. People may feel less angry if they come to believe that God did not cause the illness, or view God’s intentions as positive.

In addition to Dr. Hebert, the study was authored by Bozena Zdaniuk, Ph.D., of the Center for Urban and Social Research at the University of Pittsburgh; Richard Schulz, Ph.D. of the Department of Psychiatry, University of Pittsburgh and Michael Scheier, Ph.D., of the Department of Psychology, Carnegie Mellon University.