The question, ‘Does religion (or spirituality) cause physical health benefits?’ may be given at least four diverging interpretations in terms of causal path diagrams. In common usage, the question may be interpreted to indicate that religion causally influences health by: (1) any mechanism, including well-established factors such as social support and improved health behaviors; (2) additional mechanisms, such as enhanced positive psychological states (e.g. faith, hope, inner peace) acting through psychoneuroimmunologic or psychoneuroendocrinologic pathways; (3) offering psychological strength for acquiring or maintaining positive health behaviors; or (4) causally influencing health by distant healing or intercessory prayer. We review historical confusion between these interpretations, arguing that disentangling them is important for collaborative health care, promotion and research.
Allport, G. W. , & Ross, M. J. (1967). Personal religious orientation and prejudice. Journal of Personality and Social Psychology, 5(4), 432-443.
2.
American Psychiatric Association . (1994). Diagnostic and statistical manual of mental disorders: DSM-IV, 4th edn.Washington, DC: American Psychiatric Association.
3.
Astin, J. A. , Harkness, E., & Ernst, E. (2000). The efficacy of ‘distant healing’: A systematic review of randomized trials. Annals of Internal Medicine, 132(11), 903-910.
4.
Bahr, S. J. , Maughan, S. L., Marcos, A. C., & Li, B. (1998). Family, religiosity, and the risk of adolescent drug use. Journal of Marriage and the Family, 60(4), 979-992.
5.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman.
6.
Barnard, D. , Dayringer, R., & Cassel, C. K. (1995). Toward a person-centered medicine: Religious studies in the medical curriculum. Academic Medicine, 70(9), 806-813.
7.
Barrow, J. G. , Quinlan, C. B., Cooper, G. R., Whitner, V. S., & Goodloe, M. H. R. (1960). Studies in athero sclerosis. III. An epidemiologic study of athersclerosis in Trappist and Benedictine monks: A preliminary report. Annals of Internal Medicine, 52, 368-377.
8.
Bem, D. J. , & Honorton, C. (1994). Does psi exist? Replicable evidence for an anomalous process of information transfer. Psychological Bulletin, 115(1), 4-18.
9.
Berkman, L. F. , & Breslow, L. (1983). Health and ways of living: The Alameda County Study. New York: Oxford University Press.
10.
Berkman, L. F. , & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda county residents. American Journal of Epidemiology, 109(2), 186-204.
11.
Boomsma, D. I. , de Geus, E. J., van Baal, G. C., & Koopmans, J. R. (1999). A religious upbringing reduces the influence of genetic factors on disinhibition: Evidence for interaction between genotype and environment on personality. Twin Research, 2(2), 115-125.
12.
Brega, A. G. , & Coleman, L. M. (1999). Effects of religiosity and racial socialization on subjective stigmatization in African-American adolescents. Journal of Adolescence, 22(2), 223-242.
13.
Byrd, R. C. (1988). Positive therapeutic effects of intercessory prayer in a coronary care unit population. Southern Medical Journal, 81(7), 826-829.
14.
Campbell, C. (1999). Action as will-power. Sociological Review, 47(1), 48-61.
15.
Cassel, J. (1976). The contribution of the social environment to host resistance: The fourth Wade Hampton Frost lecture. American Journal of Epidemiology, 104(2), 107-123.
16.
Chatters, L. M. (2000). Religion and health: Public health research and practice. Annual Review of Public Health, 21, 335-367.
17.
Cole, B. S. , & Pargament, K. I. (1999). Spiritual surrender: A paradoxical path to control. In W. R. Miller (Ed.), Integrating spirituality into treatment (pp. 179-198). Washington, DC: American Psychological Association.
18.
Conti, J. M. (1999). The effects of intercessory prayer and transpersonal positive visualization on a hemodialysis population. PhD dissertation, University of Massachusetts.
19.
Davis, J. A. (1985). The logic of causal order. Newbury Park, CA: Sage.
20.
Dombeck, M. T. (1998). The spiritual and pastoral dimensions of care in interprofessional contexts. Journal of Interprofessional Care, 12(4), 361-372.
21.
Dubos, R. J. (1959). Mirage of health: Utopias, progress, and biological change, 1st edn.New York: Harper.
22.
Duckro, P. N. , Magaletta, P., & Wolf, A. (1997). Health behavior in religious communities. In S. G. David (Ed.), Handbook of health behavior research, vol. 3: Demography, development, and diversity (pp. 305-322). New York: Plenum.
23.
Dull, V. T. , & Skokan, L. A. (1995). A cognitive model of religion’s influence on health. Journal of Social Issues, 51(2), 49-64.
24.
Ellison, C. G. , & Anderson, K. L. (2001). Religious involvement and domestic violence among US couples. Journal for the Scientific Study of Religion, 40(2), 269-286.
25.
Ellison, C. G. , & Levin, J. S. (1998). The religion-health connection: Evidence, theory, and future directions. Health Education and Behavior, 25(6), 700-720.
26.
Emmons, R. A. (1999). The psychology of ultimate concerns: Motivation and spirituality in personality. New York: Guilford.
27.
Fetzer Institute/National Institute on Aging Working Group . (1999). Multidimensional measurement of religiousness/spirituality for use in health research. Kalamazoo, MI: Fetzer Institute.
28.
Flinders, T. , Gershwin, M., & Flinders, R. (1994). The RISE response: Illness, wellness, and spirituality. New York: Crossroads.
29.
Frank, J. (1975). The faith that heals. Johns Hopkins Medical Journal, 137(3), 127-131.
30.
Fredrickson, B. L. , & Levenson, R. W. (1998). Positive emotions speed recovery from the cardiovascular sequelae of negative emotions. Cognition and Emotion, 12(2), 191-220.
31.
Friedman, H. S. , Tucker, J. S., Schwartz, J. E., Martin, L. R., Tomlinson-Keasey, C., Wingard, D. L., & Criqui, M. H. (1995). Childhood conscientiousness and longevity: Health behaviors and cause of death. Journal of Personality and Social Psychology, 68(4), 696-703.
32.
Galton, F. (1872). Statistical inquiries into the efficacy of prayer. Fortnightly Review, 18, 125-135.
33.
Goodwin, J. S. , & Goodwin, J. M. (1984). The tomato effect. Rejection of highly efficacious therapies. Journal of the American Medical Association, 251(18), 2387-2390.
34.
Gorsuch, R. L. (1995). Religious aspects of substance abuse and recovery. Journal of Social Issues, 51(2), 65-83.
35.
Gould, S. J. (1999). Non-overlapping magisteria (reprinted from Leonardo’s Mountain of clams and the diet of worms, 1998). Skeptical Inquirer, 23(4), 55-61.
36.
Greenland, S. , Pearl, J., & Robins, J. M. (1999). Causal diagrams for epidemiologic research. Epidemiology, 10(1), 37-48.
37.
Harris, W. S. , Gowda, M., Kolb, J. W., Strychacz, C. P., Vacek, J. L., Jones, P. G., Forker, A., O’Keefe, J. H., & McCallister, B. D. (1999). A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Archives of Internal Medicine, 159(19), 2273-2278.
38.
Hathaway, W. L. , & Pargament, K. I. (1990). Intrinsic religiousness, religious coping, and psychosocial competence: A covariance structure analysis. Journal for the Scientific Study of Religion, 29(4), 423-441.
39.
Hendershot, G. E. (1983). Coitus-related cervical cancer risk factors: Trends and differentials in racial and religious groups. American Journal of Public Health, 73(3), 299-301.
40.
Hill, P. C. (2001). Spiritual transformation: Forming the habitual center of personal energy. Presidential Address to Division 36 (Psychology of Religion) of the American Psychological Association, 26 August 2001, San Francisco, CA.
41.
House, J. S. , Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.
42.
House, J. S. , Robbins, C., & Metzner, H. L. (1982). The association of social relationships and activities with mortality: Prospective evidence from the Tecumseh Community Health Study. American Journal of Epidemiology, 116(1), 123-140.
43.
Hummer, R. A. , Rogers, R. G., Nam, C. B., & Ellison, C. G. (1999). Religious involvement and US Adult mortality. Demography, 36(2), 273-285.
44.
Idler, E. L. (1995). Religion, health, and nonphysical senses of self. Social Forces, 74(2), 683-704.
45.
Idler, E. L. , & Kasl, S. V. (1992). Religion, disability, depression, and the timing of death. American Journal of Sociology, 97(4), 1052-1079.
46.
Idler, E. L. , & Kasl, S. V. (1997). Religion among disabled and nondisabled persons. II. Attendance at religious services as a predictor of the course of disability. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 52(6), S306-S316.
47.
James, W. (1961 [1902]). The varieties of religious experience: A study in human nature. New York: Collier.
48.
Jarvis, G. K. , & Northcott, H. C. (1987). Religion and differences in morbidity and mortality. Social Science and Medicine, 25(7), 813-824.
49.
Kiecolt-Glaser, J. K. , & Glaser, R. (1995). Psychoneuroimmunology and health consequences: Data and shared mechanisms. Psychosomatic Medicine, 57(3), 269-274.
50.
Kleinman, A. , & Becker, A. E. (1998). ‘Sociosomatics’: The contributions of anthropology to psychosomatic medicine. Psychosomatic Medicine, 60(4), 389-393.
51.
Koenig, H. G. , Cohen, H. J., George, L. K., Hays, J. C., Larson, D. B., & Blazer, D. G. (1997). Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults. International Journal for Psychiatry in Medicine, 27(3), 233-250.
52.
Koenig, H. G. , Idler, E., Kasl, S., Hays, J. C., George, L. K., Musick, M., Larson, D. B., Collins, T. R., & Benson, H. (1999). Religion, spirituality, and medicine: A rebuttal to skeptics. International Journal for Psychiatry in Medicine, 29, 123-131.
53.
Koenig, H. G. , McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. New York: Oxford University Press.
54.
Krause, N. (1995). Assessing stress-buffering effects: A cautionary note. Psychology and Aging, 10(4), 518-526.
55.
Krause, N. (1997). Religion, aging, and health: Current status and future prospects. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 52(6), S291-S293.
56.
Krieger, N. (1994). Epidemiology and the web of causation: Has anyone seen the spider?Social Science and Medicine, 39(7), 887-903.
57.
Kurtz, P. (1999). Shall skeptical inquiry be applied to religion?Skeptical Inquirer, 23(4), 24-28.
58.
Levin, J. S. (1996a). How prayer heals: A theoretical model. Alternative Therapies in Health and Medicine, 2(1), 66-73.
59.
Levin, J. S. (1996b). How religion influences morbidity and health: Reflections on natural history, salutogenesis and host resistance. Social Science and Medicine, 43(5), 849-864.
60.
Levin, J. (2001). God, love, and health: Findings from a clinical study. Review of Religious Research, 42(3), 277-293.
61.
Levin, J. S. , & Markides, K. S. (1986). Religious attendance and subjective health. Journal for the Scientific Study of Religion, 25(1), 31-40.
62.
Levin, J. S. , & Schiller, P. L. (1987). Is there a religious factor in health?Journal of Religion & Health, 26(1), 9-36.
63.
Levin, J. S. , & Vanderpool, H. Y. (1987). Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Social Science and Medicine, 24(7), 589-600.
64.
Levin, J. S. , & Vanderpool, H. Y. (1989). Is religion therapeutically significant for hypertension?Social Science and Medicine, 29(1), 69-78.
65.
Lukoff, D. , Turner, R., & Lu, F. (1992). Transpersonal psychology research review: Psychoreligious dimensions of healing. Journal of Transpersonal Psychology, 24(1), 41-60.
66.
Matthews, D. A. , McCullough, M. E., Larson, D. B., Koenig, H. G., Swyers, J. P., & Milano, M. G. (1998). Religious commitment and health status: A review of the research and implications for family medicine. Archives of Family Medicine, 7(2), 118-124.
67.
Matthews, G. , & Wells, A. (1996). Attentional processes, dysfunctional coping, and clinical intervention. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research, applications (pp. 573-601). New York: Wiley.
68.
McCullough, M. E. , Hoyt, W. T., Larson, D. B., Koenig, H. G., & Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19(3), 211-222.
69.
McCullough, M. E. , & Snyder, C. R. (2000). Classical source of human strength: Revisiting an old home and building a new one. Journal of Social & Clinical Psychology, 19(1), 1-10.
70.
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171-179.
71.
McMichael, A. J. (1999). Prisoners of the proximate: Loosening the constraints on epidemiology in an age of change. American Journal of Epidemiology, 149(10), 887-897.
72.
Melnechuk, T. (1985). Why has psychoneuroimmunology been controversial? Proponents and skeptics at a scientific conference. Advances in Mind-Body Medicine, 2(4), 22-38.
73.
Meyer, I. H. , & Schwartz, S. (2000). Social issues as public health: Promise and peril. American Journal of Public Health, 90(8), 1189-1191.
74.
Miller, T. Q. (1997). Statistical methods for describing temporal order in longitudinal research. Journal of Clinical Epidemiology, 50(10), 1155-1168.
75.
Miller, W. R. (1998). Researching the spiritual dimensions of alcohol and other drug problems. Addiction, 93(7), 979-990.
76.
Miller, W. R. , & Thoresen, C. E. (1999). Spirituality and health. In W. R. Miller (Ed.), Integrating spirituality into treatment: Resources for practitioners (pp. 3-18). Washington, DC: American Psychological Association.
77.
Miller, W. , & Thoresen, C. E. (in press). Spirituality and health: An emerging research field. American Psychologist.
78.
Oman, D. , Hedberg, J., Downs, D., & Parsons, D. (in press). A transcultural spiritually-based program to enhance professional caregiving self-efficacy. Complementary Health Practice Review.
79.
Oman, D. , Kurata, J. H., Strawbridge, W. J., & Cohen, R. D. (2002). Religious attendance and cause of death over 31 years. International Journal for Psychiatry in Medicine, 32(1), 69-89.
80.
Oman, D. , & Reed, D. (1998). Religion and mortality among the community-dwelling elderly. American Journal of Public Health, 88(10), 1469-1475.
81.
Oman, D. , & Thoresen, C. E. (in press). Spiritual modeling: A key to spiritual and religious growth?The International Journal for the Psychology of Religion.
82.
Oxman, T. E. , Freeman, D. H. Jr, & Manheimer, E. D. (1995). Lack of social participation or religious strength and comfort as risk factors for death after cardiac surgery in the elderly. Psychosomatic Medicine, 57(1), 5-15.
83.
Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice. New York: Guilford.
84.
Park, C. L. , & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115-144.
85.
Plante, T. G. , & Sherman, A. C. (Eds.) (2001). Faith and health: Psychological perspectives. New York: Guilford.
86.
Poloma, M. M. , & Gallup, G. H. (1991). Unless you forgive others: Prayer and forgiveness. In Varieties of prayer (pp. 85-106). Philadelphia, PA: Trinity.
87.
Post, S. G. , Puchalski, C. M., & Larson, D. B. (2000). Physicians and patient spirituality: Professional boundaries, competency, and ethics. Annals of Internal Medicine, 132(7), 578-583.
88.
Powell, L. H. , Shahabi, L., & Thoresen, C. E. (in press). Religion/spirituality: Linkages to physical health. American Psychologist.
89.
Rabin, B. S. (1999). Religion in medicine [letter]. Lancet, 353(9166), 1803-1804.
90.
Ribisl, K. M. , & Humphreys, K. (1998). Collaboration between professionals and mediating structures in the community: Toward a ‘third way’ in health promotion. In S. A. Shumaker & E. B. Schron (Eds.), The handbook of health behavior change, 2nd edn (pp. 535-554). New York: Springer.
91.
Richards, T. A. , Acree, M., & Folkman, S. (1999). Spiritual aspects of loss among partners of men with AIDS: Postbereavement follow-up. Death Studies, 23(2), 105-127.
92.
Roland, C. G. (1970). Does prayer preserve?Archives of Internal Medicine, 125(4), 580-581 passim.
93.
Roush, W. (1997). Herbert Benson: Mind-body maverick pushes the envelope [news]. Science, 276(5311), 357-359.
94.
Rozanski, A. , Blumenthal, J. A., & Kaplan, J. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99(16), 2192-2217.
95.
Schmitt, M. (1994). USA: Focus on interprofessional practice, education, and research. Journal of Interprofessional Care, 8(1), 9-18.
96.
Schoenbach, V. J. , Kaplan, B. H., Friedman, L., & Kleinbaum, D. G. (1986). Social ties and mortality in Evans County, Georgia. American Journal of Epidemiology, 123(4), 577-591.
97.
Shams, M. , & Jackson, P. R. (1993). Religiosity as a predictor of well-being and moderator of the psychological impact of unemployment. British Journal of Medical Psychology, 66(4), 341-352.
98.
Sicher, F. , Targ, E., Moore, D. II, & Smith, H. S. (1998). A randomized double-blind study of the effect of distant healing in a population with advanced AIDS. Report of a small scale study. Western Journal of Medicine, 169(6), 356-363.
99.
Sloan, R. P. , Bagiella, E., & Powell, T. (1999). Religion, spirituality, and medicine. Lancet, 353(9153), 664-667.
100.
Sloan, R. P. , Bagiella, E., VandeCreek, L., Hover, M., Casalone, C., Hirsch, T. J., Hasan, Y., Kreger, R., & Poulos, P. (2000). Should physicians prescribe religious activities?New England Journal of Medicine, 342(25), 1913-1916.
101.
Smith, J. C. (1986). Meditation, biofeedback, and the relaxation controversy: A cognitive-behavioral perspective. American Psychologist, 41(9), 1007-1009.
102.
Strawbridge, W. J. , Cohen, R. D., Shema, S. J., & Kaplan, G. A. (1997). Frequent attendance at religious services and mortality over 28 years. American Journal of Public Health, 87(6), 957-961.
103.
Strawbridge, W. J. , Shema, S. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health practices, mental health, and stable marriages. Annals of Behavioral Medicine, 23(1), 68-74.
104.
Targ, E. (1997). Evaluating distant healing: A research review. Alternative Therapies in Health and Medicine, 3(6), 74-78.
105.
Thomson, K. S. (1996). The revival of experiments on prayer. American Scientist, 84, 532-534.
106.
Thoresen, C. E. (1999). Spirituality and health: Is there a relationship? [Special issue on spirituality and health.]Journal of Health Psychology, 4(3), 293-300.
107.
Thoresen, C. E. , & Harris, A. H. S. (in press). Spirituality and health: What’s known and what’s needed?Annals of Behavioral Medicine.
108.
Tremblay, P. F. , & Gardner, R. C. (1996). On the growth of structural equation modeling in psychological journals. Structural Equation Modeling, 3(2), 93-104.
109.
Troyer, H. (1988). Review of cancer among 4 religious sects: Evidence that life-styles are distinctive sets of risk factors. Social Science and Medicine, 26(10), 1007-1017.
110.
Tuggle, M. B. (2000). It is well with my soul: Churches and institutions collaborating for public health. Washington, DC: American Public Health Association.
111.
Umberson, D. (1987). Family status and health behaviors: Social control as a dimension of social integration. Journal of Health and Social Behavior, 28(3), 306-319.
112.
Ursin, H. (1998). The psychology in psychoneuroendocrinology. Psychoneuroendocrinology, 23(6), 555-570.
113.
Wallace, J. M. Jr , & Forman, T. A. (1998). Religion’s role in promoting health and reducing risk among American youth. Health Education and Behavior, 25(6), 721-741.
114.
Winemiller, D. R. , Mitchell, M. E., Sutliff, J., & Cline, D. J. (1993). Measurement strategies in social support: A descriptive review of the literature. Journal of Clinical Psychology, 49(5), 638-648.
115.
Yates, J. W. , Chalmer, B. J., St James, P., Follansbee, M., & McKegney, F. P. (1981). Religion in patients with advanced cancer. Medical and Pediatric Oncology, 9(2), 121-128.
116.
Zuckerman, D. M. , Kasl, S. V., & Ostfeld, A. M. (1984). Psychosocial predictors of mortality among the elderly poor. The role of religion, well-being, and social contacts. American Journal of Epidemiology, 119(3), 410-423.
