Intervenções religiosas e espirituais em saúde física
Introdução: O crescimento de pesquisas na área de saúde e espiritualidade/religiosidade (E/R) tem sido exponencial. Mais recentemente pode-se observar também um desenvolvimento de estudos sobre intervenção espiritual/religiosa (IER) como tratamento complementar em saúde, cujo objetivo é estimular essa dimensão para benefícios clínicos. Objetivo: Revisar as pesquisas de IER em saúde física salientando os pontos mais importantes e relevantes. Material e Métodos: O presente trabalho foi fundamentado em uma recente publicação de revisão sistemática sobre IER em saúde física. Resultados: Após a triagem de mais 4000 artigos científicos, foram selecionados 30 que abordaram IER em desfechos físicos/clínicos utilizando metodologia científica rigorosa. As IER apresentaram foco espiritual ou religioso e suas técnicas de abordagem foram variadas. Os desfechos incluíram qualidade de vida, perda de peso e atividade física, dor, promoção de comportamento saudável e outros. Com relação aos resultados clínicos, os tamanhos de efeito variaram de insignificantes à relevantes, dependendo do desfecho e da população, porém nenhum estudo apresentou um desfecho negativo que contraindicasse a IER. A metodologia dos ensaios clínicos se mostrou adequada às propostas não-farmacológicas, com necessidade de atenção a itens específicos e relevante para minimizar vieses. Conclusão: Os resultados clínicos das IER parecem promissores como tratamento complementar em saúde. A diversidade de população, desfechos e protocolos de IER deve ser explorada e fundamentada em embasamento científico. Futuras pesquisas podem se basear em novas diretrizes resultantes dos atuais estudos com vistas a aprofundar e melhor caracterizar o impacto das IER nos tratamentos complementares em saúde.
ALLEN, J. J. B. et al. Acupuncture for depression: a randomized controlled trial. Journal of clinical psychiatry, 2006.
ANDERSON, K. J.; PULLEN, C. H. Physical activity with spiritual strategies intervention: a cluster randomized trial with older African American women. Research in gerontolical nursing, v. 6, n. 1, p. 11–21, 2013.
ARRIOLA, K. et al. Project ACTS: an intervention to increase organ and tissue donation intentions among African Americans. Health education behavior, v. 37, n. 2, p. 264–274, 2010.
BINAEI, N. et al. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families. Iranian journal of nursing midwifery research, v. 21, n. 1, p. 77–83, 2016.
BORMANN, J. E. et al. Effects of spiritual mantram repetition on HIV outcomes: a randomized controlled trial. Journal of behavior medicine, v. 29, n. 4, p. 359–376, 2006.
BORMANN, J. E. et al. A Spiritually Based Group Intervention for Combat Veterans with Posttraumatic Stress Disorder: feasibility study. Journal of holistic nursing, p. 109-116, 2008.
BORMANN, J. E. et al. Effects of faith/assurance on cortisol levels are enhanced by a spiritual mantram intervention in adults with HIV: a randomized trial. Journal of psychosomatic research, v. 66, n. 2, p. 161–171, 2009.
BOUTRON, I. et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of internal medicine, v. 148, n. 4, p. 295–309, 2008.
BREITBART, W. et al. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology, v. 19, n. 1, p. 21–28, 2010.
BREITBART, W. et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of clinical oncology, v. 30, n. 12, p. 1304–1309, 2012.
BURKHART, L.; SCHMIDT, W. Measuring effectiveness of a spiritual care pedagogy in nursing education. Journal of professional nursing, v. 28, n. 5, p. 315–321, 2012.
CRAMER, H. et al. Yoga for multiple sclerosis: a systematic review and meta-analysis. PLoS one, v. 9, n. 11, p. e112414, 2014.
DJURIC, Z. et al. A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. Journal of the national medicam association, v. 101, n. 6, p. 552–564, 2009.
DURU, O. K. et al. Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. Journal of the american geriatrics society, v. 58, n. 10, p. 1863–1869, 2010.
ELIAS, A. C. et al. The biopsychosocial spiritual model applied to the treatment of women with breast cancer, through RIME intervention (relaxation, mental images, spirituality). Complementary therapies in clinical practice, v. 21, n. 1, p. 1–6, 2015.
FEUILLE, M.; PARGAMENT, K. Pain, mindfulness, and spirituality: a randomized controlled trial comparing effects of mindfulness and relaxation on pain-related outcomes in migraineurs. Journal of health psychology, v. 20, n. 8, p. 1090–1106, 2015.
FITZGIBBON, M. L. et al. Results of a faith-based weight loss intervention for black women. Journal of the national medical association, v. 97, n. 10, p. 1393–1402, 2005.
GONCALVES, J. P. B. et al. Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials. Psychological medicine, v. 45, n. 14, p. 2937–2949, 2015.
GONCALVES, J. P. D. et al. Complementary religious and spiritual interventions in physical health and quality of life: a systematic review of randomized controlled clinical trials. Plos one, v. 12, n. 10, p. 21, 2017.
GUILHERME, C. et al. Effect of the “spiritual support” intervention on spirituality and the clinical parameters of women who have undergone mastectomy: a pilot study. Religions, v. 7, n.16, p. 1-11, 2016.
HOLT, C. L. et al. Spiritually based intervention to increase colorectal cancer awareness among african americans: intermediate outcomes from a randomized trial. Journal of health Communication, v. 17, n. 9, p. 1028–1049, 2012.
HOLT, C. L.; LEE, C.; WRIGHT, K. A spiritually based approach to breast cancer awareness: cognitive response analysis of communication effectiveness. Health communication, v. 23, n. 1, p. 13–22, 2008.
HOOK, J. N. et al. Empirically supported religious and spiritual therapies. Journal of clinical psychology, v. 66, n. 1, p. 46–72, 2010.
HUGUELET, P. et al. A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatric services, v. 62, n. 1, p. 79–86, 2011.
JAFARI, N. et al. The effect of spiritual therapy for improving the quality of life of women with breast cancer: a randomized controlled trial. Psychology health & medicine, v. 18, n. 1, p. 56–69, 2013.
JOHNSON, B. R. et al. A systematic review of the religiosity and delinquency literature: a research note. Journal of contemporary criminal justice, v. 16, n. 1, p. 32–52, 2000.
KELLY, J. F. et al. Spirituality in recovery: a lagged mediational analysis of alcoholics anonymous’ principal theoretical mechanism of behavior change. Alcoholism: clinical expperimental research, v. 35, n. 3, p. 454–463, 2011.
KIRK-SANCHEZ, N. J.; MCGOUGH, E. L. Physical exercise and cognitive performance in the elderly: current perspectives. Clinical interventions in aging, v. 9, p. 51-62. 2013.
KOENIG, H. G. et al. Religious vs. conventional cognitive behavioral therapy for major depression in persons with chronic medical illness: a pilot randomized trial. Journal of nervous and mental disease, v. 203, n. 4, p. 243–251, 2015.
KOENIG, H.; KING, D.; CARSON, V. Handbook of religion and health. Oxford university press, 2012.
KRUKOWSKI, R. A. et al. Obesity treatment tailored for a Catholic faith community: a feasibility study. Journal of health psychology, v. 15, n. 3, p. 382–390, 2010.
LIBERATI, A. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. British medical journal, v. 339, p. b2700, 2009.
LUCCHETTI, G.; LUCCHETTI, A. L. Spirituality, religion, and health: over the last 15 years of field research (1999-2013). The international journal of psychiatry in medicine, v. 48, n. 3, p. 199–215, 2014.
MARGOLIN, A. et al. A controlled study of a spirituality-focused intervention for increasing motivation for HIV prevention among drug users. AIDS education and prevention, v. 18, n. 4, p. 311–322, 2006.
MCCAULEY, J. et al. A randomized controlled trial to assess effectiveness of a spiritually-based intervention to help chronically ill adults. The international journal of psychiatry in medicine,v. 41, n. 1, p. 91–105, 2011.
MCCULLOUGH, M. E. Research on religion-accommodative counseling: review and meta-analysis. Journal of counseling psychology, v. 46, n. 1, p. 92–98, 1999.
MENEGATTI-CHEQUINI, M. C. et al. A preliminary survey on the religious profile of Brazilian psychiatrists and their approach to patients’ religiosity in clinical practice. British journal of psychiatry open, v. 2, n. 6, p. 346–352, 2016.
MOHER, D. et al. CONSORT 2010 Explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. Journal of clinical epidemiology, v. 63, n. 8, p. e1-37, 2010.
MORITA, T. et al. Meaninglessness in terminally ill cancer patients: a randomized controlled study. Journal of pain and symptom management, v. 37, n. 4, p. 649–658, 2009.
OH, P. J.; KIM, Y. H. Meta-analysis of spiritual intervention studies on biological, psychological, and spiritual outcomes. Journal of Korean academy of nursing, v. 42, n. 6, p. 833–842, 2012.
OMAN, D. et al. Passage meditation improves caregiving self-efficacy among health professionals: a randomized trial and qualitative assessment. Journal of health psychology, v. 13, n. 8, p. 1119–1135, 2008.
OMAN, D.; HEDBERG, J.; THORESEN, C. E. Passage meditation reduces perceived stress in health professionals: a randomized, controlled trial. Journal of consulting and clinical psychology, v. 74, n. 4, p. 714–719, 2006.
PIDERMAN, K. M. et al. Spiritual quality of life in advanced cancer patients receiving radiation therapy. Psychooncology, v. 23, n. 2, p. 216–221, 2014.
PROPST, L. R. et al. Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. Journal of consulting and clinical psychology, v. 60, n. 1, p. 94–103, 1992.
ROSMARIN, D. H. et al. A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community, delivered via the Internet. Journal of anxiety disorders, v. 24, n. 7, p. 799–808, 2010.
SLOAN, R. P.; BAGIELLA, E.; POWELL, T. Religion, spirituality, and medicine. Lancet, v. 353, n. 9153, p. 664–667, 1999.
SMITH, T. B.; BARTZ, J.; RICHARDS, P. S. Outcomes of religious and spiritual adaptations to psychotherapy: a meta-analytic review. Psychotherapy research, v. 17, n. 6, p. 643–655, 2007.
VAN TULDER, M. et al. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine v. 28, n. 12, p. 1290–1299, 2003.
VANDENBROUCKE, J. P. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. International journal of surgery, v. 12, n. 12, p. 1500–1524, 2014.
WACHHOLTZ, A. B.; PARGAMENT, K. I. Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of behavioral medicine, v. 28, n. 4, p. 369–384, 2005.
WACHHOLTZ, A. B.; PARGAMENT, K. I. Migraines and meditation: does spirituality matter? Journal of behavioral medicine, v. 31, n. 4, p. 351–366, 2008.
WINGOOD, G. M. et al. Comparative effectiveness of a faith-based HIV intervention for African American women: importance of enhancing religious social capital. American journal of public health, v. 103, n. 12, p. 2226–2233, 2013.
WU, L. F.; KOO, M. Randomized controlled trial of a six-week spiritual reminiscence intervention on hope, life satisfaction, and spiritual well-being in elderly with mild and moderate dementia. International journal of geriatric psychiatry, v. 31, n. 2, p. 120–127, 2016.
Copyright (c) 2018 Juliane Piasseschi de Bernardin Gonçalves, Homero Vallada
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Seção de Primeira Publicação
Os autores mantém os direitos autorais e concedem à HU Revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.