the biopsychosocial religion and health study (brhs) · the biopsychosocial religion and health...
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The Biopsychosocial Religionand Health Study (BRHS)AKA Adventist Religion & Health Study
Funding from the NIH: National Institute of AgingPrimary Investigators: Gary Fraser (PI) and Jim Walters (Co-PI)Co-investigators: Denise Bellinger, Terry Butler, Jerry Lee, Kelly
Morton, Eric Walsh, Colwick Wilson, Christopher Ellison (Universityof Texas)
Consultants: Neal Krause, University of Michigan, Ann Arbor; HaroldKoenig, Duke University; William Strawbridge, University ofCalifornia, San Francisco; Arthur A Stone, State University of NewYork, Stony Brook;Teresa Seeman, University of California, LosAngeles; and David Williams, Harvard University;
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Cohort Profile: The biopsychosocial religion andhealth study (BRHS) Jerry W Lee; Kelly R Morton;James Walters; Denise L Bellinger; Terry L Butler;Colwick Wilson; Eric Walsh; Christopher G Ellison;Monica M McKenzie; Gary E Fraser
(In Press) International Journal of Epidemiology
Presentation based in part on:
Advanced Access:http://ije.oxfordjournals.org/cgi/content/extract/dyn244v1
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Specific AimsTo examine manifestations of religious experience and theirpossible associations with quality of life, CHD and all-causemortality in Seventh-day Adventists, a group characterizedby general good health outcomes and considerablediversity in lifestyle.
To investigate whether these manifestations of religiousexperience have different associations with quality of life,CHD and all-cause mortality in African and EuroAmericans; and
To examine the possible relationships of thesemanifestations of religious experience to biochemical andphysiological indicators of stress, immune system function,coronary artery disease and aging.
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Our basic model
AllostaticLoad
Morbidity,Mortality,
and Qualityof Life
Positive
Negative
CumulativeRisk
Exposure
Positive
Negative
ReligionRelated
Behaviors,Beliefs,
andEmotions
Lifestyle,Psycho-
logical andSocial
Mediatorsof Health
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Cumulative Risk Exposure
Aggregates risk exposure acrossPhysical risks such as
PovertyPoor housing qualityViolence exposure
Psychosocial risk such asPoor parental bondPoor marital bondPoor job satisfaction
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Allostatic Load
Allostasis—achieving biological stabilitythrough change. May involve changes inmultiple biological and behavioral systems.Allostatic load—cumulative burden that bothacute and lifetime stress place on theorganism.Primarily assessed by a combination ofbiologic, biometric, physical performance andcognitive function measures.
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Our basic model
AllostaticLoad
Morbidity,Mortality,
and Qualityof Life
Positive
Negative
CumulativeRisk
Exposure
Positive
Negative
ReligionRelated
Behaviors,Beliefs,
andEmotions
Lifestyle,Psycho-
logical andSocial
Mediatorsof Health
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Two arms of the studyPsyMRS
Psychosocial Manifestations of Religion20 page questionnaire sent to a randomsample of AHS-2 participants
BioMRSBiological Manifestations of ReligionBiometric, biologic, cognitive function andphysical performance measures
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Sampling plan
AHS-2100,000
PsyMRS10,000
BioMRS500
PsyMRS3,000
BioMRS400
PsyMRS2,400
BioMRS320
Year 1 Year 4
PossibleFollow-up Grant
Year 7
On-going Mortality and Morbidity monitoring by AHS-2carried out on all participants.
Note: Current year 1 enrollment is 10,988 in PsyMRS and 508 in BioMRS.
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PsyMRS—Questionnaire Assessmentof
Cumulative Risk ExposureReligious/spiritual commitment, attitudes,beliefs, and behaviorsPsychosocial and lifestyle mediators of areligion/health connectionQuality of life indicatorsControl variables (including demographics)
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Cumulative Risk ExposureEarly relationships
Father love & abuseMother love & abuse
Risky family (of origin)Adult relationships
Spouse or partner positiveSpouse or partner negative
Trauma HistoryLast year, 1 to 5 years ago,more than 5 years ago, totalimpact
Jobstresscontrolsatisfaction
Unfair treatment (gender,race, age, religion, other)
LifetimeEveryday discrimination
HousingGrowing upCurrent
Difficulty meetingexpenses
Under 1818 to 35Last year
Perceived Stress
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Religious/spiritual commitment,attitudes, beliefs, and behaviors
Church attendanceCongregational activityPercent co-religionist contactSpouse & Children’s religionChildren’s church schoolingCongregational sense of communityReligious support
Emotional Support ReceivedEmotional Support GivenNegative InteractionAnticipated Support
PrayerConfessionHabitMeditation/Contemplative
GratitudeForgivenessSpiritual meaning in LifeIntrinsic religiosity (DUREL)Loving versus controlling God
Positive and negative religious copingControl:
Self-directedCollaborativePassive DeferralActive surrender
Meaning;Benevolent ReappraisalPunishing God ReappraisalComfort:
Seeking Spiritual SupportSpiritual Discontent
TransformationSabbath keeping
Sabbath restFrom social pressure/guiltBuilds relationship with GodSacred activitiesSecular activities
Positive and negative eschatologicalattitudes
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Psychosocial and lifestyle mediators of areligion/health connection (Based on Ellison & Levin, 1998)
Health behaviors & lifestyleExerciseDietSleep HoursAll AHS-2 lifestyle indicators
Healthy & Unhealthy BeliefsOptimismPessimism
Positive (& negative) emotionsPositive & negative affectHostilityDepression
Self-esteem & Personal efficacySelf-esteemMastery
Social integration & supportInformational supportInstrumental supportEmotional supportCompanionshipUnwanted advice orintrusionFailure to provide helpUnsympathetic orinsensitive behaviorRejection or neglect
Coping resources & behaviorsThese are included underreligious coping and prayer
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Quality of life indicators
Physical & Mental Health(SF-12)
Physical functioningRole physical (Also SF-36)
Role emotionalBodily painGeneral health (Also SF-36)
VitalitySocial functioningMental Health
SF-12 Composite scoresPhysical HealthMental Health
Life satisfactionMedical History
Diagnosed medicalconditionsPhysical symptomsInfluenzaUpper respiratory infectionSleep problems
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Control variablesGenderAgeIncomeOther demographicsBalanced Inventory of DesirabilityResponding
Self-deceptionImpression Management
Neuroticism
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The Questionnaire
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BioMRS Clinical assessment ofBiometrics
height, weight, body fat (bioimpedance), waist/hip, B/PPhysical performance including
gait, balance, grip strengthCognitive performance
California Verbal Learning Test—over 20 indicators includingShort and long-delay recall, semantic clustering, primacy andrecency, total learning slope, total response bias, intrusions
Independent Activities of Daily Living (IADLs)Blood, Saliva and urine including:
Stress—Waking salivary cortisol, urinary norepinephrine &epinephrineMetabolism—HbA1c, Plasma AlbuminInflammation Markers—Plasma IL-6 & C-reactive proteinLipid Profile —Total and LDL cholesterol, TriglyceridesCreatinine clearanceAdditional blood and urine samples frozen in liquid nitrogen
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AHS-2 linked dataAHS-2 questionnaire (collectedup to 3 years before PsyMRS)
EthnicityEducation: self & parentsOccupationDietExercise & Napping: Week day,Saturday, & Sunday“Female History”Sun exposureAge at baptism, mother’s &fathers religionRearing history (who did it &why)
BiennialhospitalizationquestionnaireMortality
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Samples of possible analyses
Proposed in grant application
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The lifestyle/stress model
HealthyHealthyLifestyleLifestyle
PhysicalPhysicalQuality ofQuality of
LifeLife
ReligiousReligiousAttendanceAttendance
PerceivedPerceivedStressStress
+ +
+
– –
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Prayer and Quality of Life
LifeLifeEventsEvents
+
+
–
–
ComCom--passionatepassionate
PetitionPetition
PetitionPetitionfor selffor self
ConfessionConfession
Meditation/Meditation/ImprovementImprovement
OptimismOptimism
PerceivedPerceivedStressStress
PhysicalPhysicalQuality ofQuality of
LifeLife
Interactions:Interactions:Habit withHabit with
CompassionateCompassionatePetition &Petition &PetitionPetition
Interactions:Interactions:Habit withHabit with
ConfessionConfession& Meditation/& Meditation/ImprovementImprovement
+ +
+
+
+
+
––
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Some possible biological associationsPhysicalPhysical
PerformancePerformance
AllostaticAllostaticLoadLoad
CongregationalCongregationalSupportSupport
PerceivedPerceivedStressStress
++
+
–
–
CortisolCortisol
HgA1cHgA1c
MentalMentalPerformancePerformance–
––
LifetimeLifetimetraumatrauma
+++
ILIL--66CC--reactivereactiveProteinProtein
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Characteristics of the Sample
Compared to the General Social SurveyDavis, J. A., Smith, T. W., & Marsden, P. V. (2007).
General Social Surveys, 1972-2006. Chicago, IL:National Opinion Research Center.
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Gender & Ethnicity
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Education
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Marital Status
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Age
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Church Attendance
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Prayer Frequency
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Physical and Mental Health
Compared to national norms for theSF-12 version 2
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Composite Physical Health (SF-12)Self Report
35
40
45
50
55
60
35 - 44 45 - 54 55 - 64 65 - 74 > 74
Age of Female
Scal
e Sc
ore
35 - 44 45 - 54 55 - 64 65 - 74 > 74
Age of Male
U.S. Norm (n = 2,298)Black SDA (n = 819)White SDA (n = 2,043)
U.S. Norm (n = 3,343)Black SDA (n = 2,231)White SDA (n = 3,544)
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Composite Mental Health (SF-12)Self-Report
3535 - 44 45 - 54 55 - 64 65 - 74 > 74
Age of Female
40
45
50
55
60
Scal
e Sc
ore
35 - 44 45 - 54 55 - 64 65 - 74 > 74Age of Male
U.S. Norm (n = 3,347)Black SDA (n = 2,231)White SDA (n = 3,544)
U.S. Norm (n = 2,297)Black SDA (n = 819)White SDA (n = 2,043)