Does Living on a Prayer Work?

by Jason S. Brinkley, PhD, MA, MS

On the Brink addresses topics related to data, analytics, and visualizations on personal health and public health research. This column explores current practices in the health arena and how both the data and mathematical sciences have an impact. (The opinions and views represented here are the author’s own and do not reflect any group for which the author has an association.)

Jason S. Brinkley, PhD, MA, MS

Religion has been at the forefront of American thinking since the country’s founding, and the 21st century continues to find that a majority of Americans consider matters of religion, spirituality, and faith to be very important to their daily lives. Indeed sources from Pew and the World Value Survey show that America places a much greater emphasis on religion than many of our European and Asian counterparts. But how does one’s faith impact their health? Science and religion tend to find themselves as opposites in a sort of tug of war, but as we will see today, this isn’t necessarily true in modern medicine. Today’s On the Brink explores the modern state of research in religion and health with a special emphasis on prayer.

In recent years, modern medicine has found value in including patients’ religion and spirituality as a part of intervention. The biopsychosocial framework has been around for decades and was once a leading focal point for treating patients and the need for considering physical health, psychological well-being, and the state of one’s social support system in helping individuals get over major issues. This framework has served well in the treatment of not only cancer and major trauma but also mental illness and addictions. Thinking on this framework expanded in the 2000s to include a fourth component and bore forth the biopsychosocial-spiritual framework that incorporated religion and faith as it was deemed especially important in areas such as end of life care. The current major thinking here is that in patient-centered care it is important to consider how spirituality or religiosity impacts their overall care. And while this acknowledgement helps clinicians make culturally sensitive and person-based health decisions, it isn’t an acknowledgement that religion impacts health, only that if a patient believes that religion is important that faith should be considered a part of their health care or recovery.

So if science hasn’t acknowledged that religion directly impacts health, can it say whether individuals who are religious are healthier? Many have tried with mixed results. Most telling is a recent study that explored all-cause mortality and religion among a sample of over 36,000 black women followed from 2005 to 2013. The researchers found that those who attended religious service several times per week had lower mortality versus those who never attended services. But prayer itself was not immediately associated with mortality and as the researchers state, “It is sometimes thought that frequent prayer is indicative of personal and health problems already being present, which might explain the association with higher mortality.” In contrast, other researchers found prayer was associated with lower hospital stays but a third group of researchers found prayer in chronic cardiac patients was not associated with lower mortality rates. Mixed research of this type can be aided by a meta-analysis (which quantifies the overall strength of research across multiple studies), one group did a meta-analysis on the overall effects of prayer synthesizing over a decade of studies and concluded ‘we recommend that further resources not be allocated to this line of research’.

Turning away from spiritual prayer for a moment, science has found great value in mindfulness, which does share many aspects with spiritual prayer but is not immediately tied to a specific religion or faith. Mindfulness has been studied repeatedly in scientific clinical trials and has shown to have significant impact on stress and helps produce positive short- and long-term outcomes in a slew of different health conditions. Modern science has (in general) embraced mindfulness as a useful add-on to any patients‘ current health regimen, and a growing industry of mindfulness coaches is popping up in both the recovery and prevention realms.

So the next important question would logically be whether spiritual prayer offers additional benefits beyond those parts that it has in common with meditation techniques such as mindfulness. One could almost imagine a study that pits the two head-to-head to explore the long-term impact on health. But we run into the problem again posed by the black women’s health researchers. Religiosity and frequent prayer are a function of one’s personal beliefs, culture, and environment — and could be a function of their current health status. They pray because they are already sick and were not necessarily a spiritual person when they were in good health. It is unlikely that a person could just enroll in a study and be assigned to the prayer group and test whether or not it is more or less effective than a non-religious-based mindfulness group. Simply put, the gold standard of medicine is the clinical trial, but a person can’t just be randomized to spirituality and have science test whether that is to be effective.

Science does seem to support, and clinicians are now being advised to be considerate of, patients’ faith as part of their treatment. Current thinking suggests that individuals who are already predisposed towards religious thinking find great personal value in prayer and that the meditative aspects of prayer have known stress-relieving benefits. Faith isn’t currently a forced intervention or even a recommended part of a treatment plan, but for those already faith-inclined, a consideration of religion is an important aspect of ongoing health.

So, does living on a prayer work? The best answer may be to paraphrase Bon Jovi: only if you’re halfway there.

Jason S. Brinkley, PhD, MS, MA is a Senior Researcher and Biostatistician at Abt Associates Inc. where he works on a wide variety of data for health services, policy, and disparities research. He maintains a research affiliation with the North Carolina Agromedicine Institute and serves on the executive committee for the NC Chapter of the American Statistical Association and the Southeast SAS Users Group. Follow him on Twitter. [Full Bio]

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