Religious Explanatory Models in Patients with Psychosis: A Three-Year Follow-Up Study

Abstract

Background/Aims: Spirituality and religiousness have been shown to be highly prevalent in patients with psychosis. Yet the influence of religious denomination as it affects coping methods and/or as an explanatory model for illness and treatment remains to be determined. This study aims (1) to investigate if religious denomination is associated with explanatory models, (2) to assess the evolution over time of these explanatory models, and (3) to examine the relationship between these explanatory models and the spiritual vision of treatment and adhesion to such treatment. Sampling and Methods: Of an initial cohort of 115 outpatients, 80% (n = 92) participated in a 3-year follow-up study. The evolution of their religious explanatory models was assessed in order to evaluate if religious denomination, as a meaning-making coping tool, is associated with the patients’ explanatory models. Finally, we examined the relationship between these representations and the patients’ spiritual visions of treatment and treatment adhesion. Results: A spiritual vision of the illness (as part of an explanatory model) was more frequent in patients with psychosis for whom the subjective dimension of religion was important. However, there was no association between the patients’ religious denomination and their spiritual vision of the illness. The analyses showed that the various contents of spiritual visions of illness were not positive or negative per se; instead, they depended on how this religious vision was integrated into the person’s experience. Examining longitudinal aspects of coping showed that the spiritual vision sometimes changed, but was not associated with clinical or social outcome. Conclusions: For patients with psychosis, explanatory models frequently involve a religious component which is independent of denomination and likely to change over time. Clinicians should address this issue on a regular basis, by asking patients about their explanatory model before trying to build a bridge with the medical model.

Narrative insight in psychosis: The relationship with spiritual and religious explanatory frameworks

“…Consistent with other studies described above (e.g., Drinnan & Lavender, ; Huguelet et al ., ), an open definition of spiritual/religious beliefs was used, and participants responded to the question ‘Have religious or spiritual beliefs ever been important to you?’…”

“…Whilst this definition is more inclusive than analogous studies requiring 'objective' identification of people who meet diagnostic criteria according to trained cliniciansand would potentially not differentiate people who would be diagnosed with 'schizophrenia' from people whose experiences could result from 'other physical explanations'it is theoretically coherent within our critical realist approach; we posit that the meaning-making of the experiences is likely to be sufficiently similar whatever context they arise. Consistent with other studies described above (e.g., Drinnan & Lavender, 2006;Huguelet et al, 2010), an open definition of spiritual/religious beliefs was used, and The terms reported here are in the participants' own words, although with regard to the diagnoses, there are clearly based on labels given to them by health professionals. The authors do not wish to imply an acceptance of categorical frameworks with regard to either religious identity or mental health diagnoses.…”

“…Numerous studies demonstrate how people from various cultural or ethnic backgrounds are more likely to use spiritual explanations as a predominant factor in their understanding of psychosis (e.g., Pakistani – Zafar et al ., ; UK Black African or Black Carribean – Codjoe, Byrne, Lister, McGuire, & Valmaggia, ). Spiritual explanatory models of illness were assessed longitudinally by Huguelet, Mohr, Gilliéron, Brandt, and Borras (); using five a priori factors, they found that when conceptualized as an explanatory model rather than a coping style, each factor could be either positive or negative, dependent upon how the participant integrated the framework into their experience. They found that the nature of explanatory frameworks changed over time, but found no association between the kind of framework adopted and clinical outcome.…”

Is God's call more than audible? A preliminary exploration using a two‐dimensional model of theistic/spiritual beliefs and experiences

“…However of those experiencing AHs with religious content, 45% reported that their spirituality helped in understanding, accepting, and coping with their illness. Although self‐reported religiosity had previously been shown to help psychosis sufferers explain their illness (Fallot, ), a small 3‐year prospective study failed to find any effect of faith on prospective social or clinical outcomes (Huguelet, Mohr, Gilliéron, Brandt, & Borras, ). Together with documented methodological deficiencies in nearly all prior studies (i.e., cross‐sectional, small samples, and no comparison control groups; see Galvez et al., ) and the possibility that spirituality and PA may be non‐causally related by‐products of shared neurological features, Huguelet et al.…”

Integration of Spirituality and Religion in the Care of Patients with Severe Mental Disorders

“…Given the clinical significance of S/R for patients with schizophrenia (i.e., the salience of positive and negative spiritual/religious coping and its associations with psychopathology, psychosocial functioning, substance use, suicidal attempts, adherence to psychiatric treatment [20,[49][50][51]; the reciprocal influences of the illness and the spiritual journey [52,53]; and the role of spirituality in recovery [20,35], we planned a pilot spiritual group for those patients.…”