Spiritual Dimension in Neurological and Neurodegenerative Diseases: A Systematic Mapping Review

Vol.:(0123456789) Journal of Religion and Health https://doi.org/10.1007/s10943-022-01683-6 1 3 ORIGINAL PAPER Spiritual Dimension inNeurological andNeurodegenerative Diseases: ASystematic Mapping Review RocíodeDiego‑Cordero1 · IreneMartos‑Lorite2 · JuanVega‑Escaño1,3 Accepted: 7 October 2022 © The Author(s) 2022 Abstract Previous studies have shown the benefits of spirituality/religiosity with regard to health and quality of life for people. The high prevalence of neurological disorders, which are the main diseases that cause disability and dependency around the world, makes neurological disorders especially relevant. This systematic mapping review aimed to map the knowledge of spirituality experienced by people with neurological/neurodegenerative disorders and its influence on outcomes and the ability to cope with the disease. Following specified methodological criteria, a total of 13 articles were selected. The spiritual dimension should be considered a fundamental component of the quality of life and well-being of neurological patients as it can significantly influence their ability to cope with their disease. Keywords Coping· Faith· Quality of life· Neurological/neurodegenerative diseases· Religiosity· Spirituality· Spiritual practices· Well-being * Juan Vega-Escaño jv[email protected]; juanv[email protected] Rocío de Diego-Cordero [email protected] Irene Martos-Lorite [email protected] 1 Research Group PAIDI-CTS 969 Innovation inHealthCare andSocial Determinants ofHealth, Department ofNursing, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, Seville, Spain 2 Department ofNursing, Faculty ofNursing, Physiotherapy andPodiatry, University ofSeville, Seville, Spain 3 Spanish Red Cross Nursing School, University ofSeville, Seville, Spain Journal of Religion and Health 1 3 Introduction Some one billion people worldwide suffer from neurological disorders and more than 6 million people die each year from strokes. It is currently estimated that around 50 million people worldwide suffer from dementia, with nearly 8 million new cases diagnosed each year. (Alzheimer’s is the leading cause of dementia and can contribute to 60–70% of cases.) Similarly, more than 50 million people have epilepsy, and it is estimated that more than 10% of the world population suffers from migraine episodes at some time (World Health Organization, 2006). The care received by patients with neurological diseases is diverse, there are many neurological treatments, depending on the pathology suffered by the patient. However, the purpose of therapy is comprehensive neurological care that combines the pharmacological treatment of the disease with neurorehabilitation. Neurological rehabilitation is a complex care procedure that therefore requires the existence of a highly specialized and properly trained multidisciplinary team (Vidal-Samsó, 2020). Spiritual health is fundamentally characterized by an adequate lifestyle, connection with others, asking about the meaning and purpose of life, and transcendence. Furthermore, it directly affects physical, mental, and social health; it can be perceived in the behavior of people, and it can be promoted and improved (Ghaderi etal., 2018). The attention to spiritual health has gained important recognition in recent times and is considered by many researchers as one of the fundamental aspects of people’s health. Spiritual health has been found to lead to better mental health and positively influence physical health (Ghaderi etal., 2018). Similarly, spirituality is associated with better health, greater well-being, and quality of life, even promoting adaptation to illness and accelerating recovery (Guirao Goris, 2013). Although it is necessary to address it at any time in life, people’s spiritual needs tend to appear more frequently and even intensify in crisis situations, such as those experienced by a terminal patient, near death, or a critical patient and their families. In this way, spiritual care becomes a fundamental tool to provide comprehensive and humanized care to the patient (de Brito etal., 2013; Ho etal., 2018). In recent decades, the relationship between spirituality and human health has become an important object of study, reflecting the growing number of published scientific studies that investigate this relationship. In most studies, a positive correlation is shown between the adoption of religious beliefs or spirituality and improved health (Sarrazin Martínez, 2021). Spiritual involvement in coping with various manifestations of chronic disease has been shown to have many benefits. Evidence suggests that spiritual practices help decrease the production of hormones that reduce the number of immune cells and are associated with stress. On the other hand, in addition to promoting a healthier lifestyle, religion helps relieve pain because it increases the number of neurotransmitters involved in this control (Gomes et al., 2019). Furthermore, previous studies have suggested that attending church one or more times a week was associated with lower scores on pain measures (Harrison etal., 2005). Figure1 summarizes this content and represents the topic of the article in an attention-grabbing way. 1 3 Journal of Religion and Health However, a terminological confusion about terms “spirituality” and “religiosity” continues. Previous studies have indicated that spirituality and religiosity are related and overlapping, varying according to the cultural context and the dynamic quality of the spirituality itself (de Brito Sena etal., 2021). In addition, this overlap supports the belief that religious traditions should be understood by health professionals, particularly in clinical practice and in the training of health professionals (Puchalski & Larson, 1998). Previous studies have shown the benefits of spirituality/religiosity in the health and quality of life of people, which, together with the high prevalence of neurological disorders and being the main diseases that cause disability and dependency around the world, make it especially approach relevance. Makros and McCabe (2003) published an article about research consisting of two studies that aimed to explore the role of religious and spiritual variables in the psychological adjustment and quality of life of people with Multiple Sclerosis (MS). They pointed out that the strongest and most consistent finding in these studies was that the meaning derived from personal belief systems was a strong predictor of psychological adjustment and quality of life. However, until now, few have delved into spiritual care in these situations of illness. Therefore, this systematic mapping review aimed to map the knowledge of spirituality experienced by people with neurological/neurodegenerative disorders and its influence on results and the ability to cope with the disease. Fig. 1 Conceptual framework Journal of Religion and Health 1 3 Methods Search Strategy A systematic mapping review of the literature was performed between February and April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for systematic reviews (Page et al., 2021). Due to the fact that registration is not mandatory, the protocol review and review were not registered. The databases used for this bibliographic review were PubMed, Scopus, and Web of Science. The interface through which the databases were searched was Ovid and the dates of coverage (where this information is provided) were from April 1 to 21, 2022. The search strategy was designed based on the DeCS/MeSH descriptors, finally using the following descriptors combined with the Boolean operators "AND" and "OR" for its elaboration: ("neurological disorders" or "neurological disease") AND (spirituality or religion or faith or belief system) AND (religion or religious or religiousness or religions or religiosity or spiritual or spirituality or faith). The full line-by-line search strategy run in each database can be seen in Table1. Two authors (Author 2 and Author 3) independently replicated the search strategy in these three electronic databases and another author (Author 2) reviewed the reference lists of the selected articles, and Author 3 made a review of the gray literature in the Information System on Gray Literature in Europe (OpenGrey). Mendeley software (version 1.19.4) was used for the organization of references in this review. Inclusion andExclusion Criteria forSelected Articles The eligibility criteria were based on the PICOTS question: P (participant: people with neurological/neurodegenerative disorders), I (intervention: spiritual/ religious interventions), C (comparison: between spiritual interventions and waiting list or non-spiritual interventions), O (outcome: the results and coping with the disease), T (time: any follow-up for the intervention), and S (study design: reviews, randomized or non-randomized clinical trials, and literature reviews). Study Selection andData Extraction After the search, all references were imported via the Mendeley software version 1.19.8. Then, two authors (Author 2 and author 3) independently selected the studies that met the inclusion and exclusion criteria. Initially duplicate records were eliminated, and then, titles and abstracts were reviewed. The discrepancies were resolved by Author 1. An analysis and synthesis table has also been prepared with the essential information from each included result (Table2). 1 3 Journal of Religion and Health Table 1 Search strategy Databases Search strategy Query Selected studies PubMed ("Neurological disorders" or "neurological disease") AND (spirituality or religion or faith or belief system) AND (religion or religious or religiousness or religions or religiosity or spiritual or spirituality or faith) ("Neurological disorders"[All Fields] OR "neurological disease"[All Fields]) AND ("spiritual"[All Fields] OR "spiritualism"[MeSH Terms] OR "spiritualism"[All Fields] OR "spirituality"[MeSH Terms] OR "spirituality"[All Fields] OR "spiritualities"[All Fields] OR "spirituality s"[All Fields] OR "spiritually"[All Fields] OR "spirituals"[All Fields] OR ("religion"[MeSH Terms] OR "religion"[All Fields] OR "religions"[All Fields] OR "religion s"[All Fields]) OR ("faith"[All Fields] OR "faithful"[All Fields] OR "faithfulness"[All Fields] OR "faiths"[All Fields]) OR (("belief s"[All Fields] OR "culture"[MeSH Terms] OR "culture"[All Fields] OR "belief"[All Fields] OR "beliefs"[All Fields]) AND ("drug delivery systems"[MeSH Terms] OR ("drug"[All Fields] AND "delivery"[All Fields] AND "systems"[All Fields]) OR "drug delivery systems"[All Fields] OR "system"[All Fields] OR "system s"[All Fields] OR "systems"[All Fields]))) AND ("religion"[MeSH Terms] OR "religion"[All Fields] OR "religions"[All Fields] OR "religion s"[All Fields] OR ("religious"[All Fields] OR "religiously"[All Fields] OR "religiousness"[All Fields]) OR ("religious"[All Fields] OR "religiously"[All Fields] OR "religiousness"[All Fields]) OR ("religion"[MeSH Terms] OR "religion"[All Fields] OR "religions"[All Fields] OR "religion s"[All Fields]) OR "religiosity"[All Fields] OR ("spiritual"[All Fields] OR "spiritualism"[MeSH Terms] OR "spiritualism"[All Fields] OR "spirituality"[MeSH Terms] OR "spirituality"[All Fields] OR "spiritualities"[All Fields] OR "spirituality s"[All Fields] OR "spiritually"[All Fields] OR "spirituals"[All Fields]) OR ("spiritual"[All Fields] OR "spiritualism"[MeSH Terms] OR "spiritualism"[All Fields] OR "spirituality"[MeSH Terms] OR "spirituality"[All Fields] OR "spiritualities"[All Fields] OR "spirituality s"[All Fields] OR "spiritually"[All Fields] OR "spirituals"[All Fields]) OR ("faith"[All Fields] OR "faithful"[All Fields] OR "faithfulness"[All Fields] OR "faiths"[All Fields])) 22 SCOPUS ALL ("Cognitive architectures") AND AUTHOR-NAME (smith) TITLE-ABS-KEY (*somatic complaint wom?n) AND PUBYEAR AFT 1993 SRCTITLE (*field ornith*) AND VOLUME (75) AND ISSUE (1) AND PAGES (53–66) 26 WOS ("Neurological disorders" or "neurological disease") AND (spirituality or religion or faith or belief system) AND (religion or religious or religiousness or religions or religiosity or spiritual or spirituality or faith) (All Fields) 48 Journal of Religion and Health 1 3 Table 2 Results Author Year/Country Design and sample Aims Main results Giovagnoli etal., 2019/Italy Quasi-experimental n = 199 neurological patients n = 66 healthy subjects (control group) To evaluate spirituality in patients with chronic brain pathologies, with the aim of clarifying its specificity and impact on quality of life A significantly lower level of spirituality and quality of life was observed in sick patients compared to healthy subjects Giovagnoli etal., 2009/Italy Quasi-experimental n = 72 neurological patients n = 45 healthy subjects (control group) To explore the role of spirituality in determining quality of life in chronic neurological disorders The findings support that personal dimensions, such as spirituality, are fundamental components of subjective well-being in chronic neurological patients and that they significantly influence quality of life, even to a greater extent than other variables related to health and disease McNulty etal., 2004/USA Cross-sectional descriptive observational n = 50 multiple sclerosis patients To examine the role of spiritual wellbeing as a mediator and moderator between perceived uncertainty and psychosocial adaptation in multiple sclerosis (MS) Higher perceived uncertainty and lower spiritual well-being were associated with a worse adaptation to multiple sclerosis, even after demographic variables were considered. Therefore, it is concluded that spiritual well-being positively influences adaptation to multiple sclerosis and also acts to reduce the impact of uncertainty on adaptation Meyer etal., 2012/USA Literature review To assess the efficacy of yoga and its therapeutic benefits in major neurological and psychiatric conditions Studies show that yoga can be a beneficial complementary treatment for various neurological and psychiatric disorders Mooventhan & Nivethitha, 2017/India Literature review To review the effect of yoga on various neurological disorders Yoga can be considered an effective aid for patients with neurological diseases such as stroke, Parkinson’s disease, multiple sclerosis, epilepsy, Alzheimer’s disease, dementia, headache, myelopathy, neuropathy 1 3 Journal of Religion and Health Table 2 (continued) Author Year/Country Design and sample Aims Main results Pretorius & Joubert, 2014/South Africa Qualitative study n = 10 multiple sclerosis patients To explore the personal experiences of people with multiple sclerosis (MS) in the South African context Religion turned out to be for the participants one of the main sources of help to cope with multiple sclerosis; along with others such as social support, mobility aids, and having knowledge about the disease Redfern & Coles, 2015/UK Literature review To describe the effects of Parkinson’s Disease (PD) on religious faith and spirituality An apparent decline in religious and spiritual practices was found in PD as a result of dopaminergic degeneration. On the contrary, the possible positive benefits of disorders such as PD on spiritual development are shown and, vice versa, the possible help in coping with an illness that religious faith can offer Rogers & MacDonald, 2015/USA Literature review To learn about the benefits and potential role of yoga as an alternative treatment for symptom control in people with multiple sclerosis (MS) The findings support yoga as a safe and effective means of managing MS symptoms Tedrus & Pereira, 2020/Brazil Quasi-experimental n = 169 adults with epilepsy n = 55 healthy subjects (control group) To analyze the relationship of intrinsic religiosity (IR) with clinical variables of epilepsy, the occurrence of depressive symptoms, and the quality of life of adults with epilepsy The IR was higher in people with epilepsy compared to the control group. The absence of depressive symptoms was associated with a higher IR. Higher IR was also associated with left hemisphere epileptiform activity and temporal lobe epilepsy Journal of Religion and Health 1 3 Table 2 (continued) Author Year/Country Design and sample Aims Main results Thygesen etal., 2017/Denmark Cohort study n = 476 patients with chronic neurological disorders To analyze differences in the incidence of different chronic neurological diseases in a cohort of Danish Adventists and Baptists compared to the general Danish population The standardized incidence rate (SIR) of dementia or Alzheimer’s disease decreased significantly for members of both religious communities characterized by lifestyle recommendations. However, the SIR of Parkinson’s disease and epilepsy was not significantly different compared to the general population Vancini etal., 2016/Brazil Literature review To know the impact of faith, spirituality, and religiosity as complementary treatments for neurological disorders, especially epilepsy Spiritual and religious practice can be an active coping and therapeutic strategy to support traditional therapies for people with epilepsy and other neurological disorders Wade etal., 2018/USA Cross-sectional descriptive observational study n = 354 patients with neurological disorders To examine the associations between religiosity, spirituality, and happiness in adults living with neurological disorders Secular or existential spiritual beliefs (SWBS ES) are strongly associated with both the Pemberton Happiness Remembered Index (PHI R) and the Pemberton Experienced Happiness Index (PHI E) Yamout etal., 2013/Lebanon Prospective observational study n = 201 multiple sclerosis patients To assess the role of different demographic, clinical, physical, social, economic, and psychological parameters in the perception of patients with multiple sclerosis about their quality of life Religiosity was identified as one of the main predictors of general quality of life. Other determining factors were depression, social support, level of education, and place of residence, as well as employment and level of fatigue 1 3 Journal of Religion and Health According to the methods described by Grant and Booth (2009) risk of bias assessment was not conducted for the mapping review. Records identified through database searching (n = 159) Scopus n= 29 PubMed n= 79 WOS n= 51 Identification Records after duplicates removed (n = 107) Records excluded after applying inclusion criteria (n = 32) Screening Records screened (n =75) Full text articles excluded after reading the abstract, title or full text if applicable (n=61) Full-text articles assessed for eligibility (n = 74) Eligibility Studies included in qualitative synthesis (n = 13) Studies included in the literature review (n = 13) Included Fig. 2 Flowchart Journal of Religion and Health 1 3 In this way, although most of the studies that investigated this relationship describe that these variables were considered, in others they were not indicated in the studies. Finally, no evaluation of the quality of the included review studies has been performed, which limits their value in making recommendations in clinical practice. Conclusions Spirituality in patients with a neurological disorder seems to be closely related to a higher quality of life and emotional well-being. The spiritual dimension is an important aspect in adaptation and coping with neurological diseases, considering religious faith as a resource that can help these patients accept and cope with their condition. There is a lower incidence of some neurological disorders in patients with strong religious beliefs and practices compared to the general population, with the lifestyles recommended by certain religions being a protective factor against the development of certain diseases and health problems. In addition, spiritual practices such as yoga have been shown to have positive effects and to be an effective aid in the treatment of some neurological disorders. However, it is necessary to take the appropriate measures to avoid possible adverse effects when performing advanced yoga practices. Implications forClinical Practice These findings have important implications for clinical practice. In the present review, spirituality has been identified as an important aspect in the adaptation and coping with neurological diseases. This is particularly important for healthcare management, as they should be aware of the importance of this dimension for professional health. Providing spiritual support could be important strategies to incorporate into healthcare settings. Spiritual dimension is considered a fundamental component of the quality of life and well-being of neurological patients and significantly influences their ability to cope with the disease. For this reason, it is necessary that the care provided to these patients has a comprehensive approach that, in addition to the control of symptoms, addresses personal aspects such as spirituality. Finally, the lack of randomized controlled trials in this review draws attention to the lack of solid evidence that spiritual and religious interventions were capable of modifying the approach of neurological diseases. More studies are definitely needed to incorporate the consolidated observational findings into clinical practice. 1 3 Journal of Religion and Health Funding Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research received no specific grant from any funding agency in the public, commercial, or not-for- profit sectors. Declarations Conflict of interest No conflict of interest has been declared by the author(s). 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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/. References Badenes, A., & Ausín, B. (2021). 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