A Comparison of Two Spirituality Instruments and Their Relationship With Depression and Quality of Life in Chronic Heart Failure
Accepted 29 August 2009.
Abstract
Spirituality is a multifaceted construct related to health outcomes that remains ill defined and difficult to measure. Spirituality in patients with advanced chronic illnesses, such as chronic heart failure, has received limited attention. We compared two widely used spirituality instruments, the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp) and the Ironson-Woods Spirituality/Religiousness Index (IW), to better understand what they measure in 60 outpatients with chronic heart failure. We examined how these instruments related to each other and to measures of depression and quality of life using correlations and principal component analyses. The FACIT-Sp measured aspects of spirituality related to feelings of peace and coping, whereas the IW measured beliefs, coping, and relational aspects of spirituality. Only the FACIT-Sp Meaning/Peace subscale consistently correlated with depression (r=−0.50, P<0.0001) and quality of life (r=0.41, P=0.001). Three items from the depression measure loaded onto the same factor as the FACIT-Sp Meaning/Peace subscale (r=0.43, −0.43, and 0.71), whereas the remaining 12 items formed a separate factor (Cronbach's alpha=0.82) when combined with the spirituality instruments in a principal component analysis. The results demonstrate several clinically useful constructs of spirituality in patients with heart failure and suggest that psychological and spiritual well-being, despite some overlap, remain distinct phenomena.
bDivision of General Internal Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
cDivision of Health Care Policy and Research, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
dColorado Health Outcomes Program, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
eDepartment of Psychiatry, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
fSection of General Internal Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
gDepartment of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
hDivision of Psychosocial Medicine, National Jewish Health, Denver, Colorado, USA
Addresscorrespondence to: David Bekelman, MD, MPH, Denver VA Medical Center, Research (151), 1055 Clermont Street, Denver, CO 80220, USA.
This study was funded by the Johns Hopkins Center for Complementary and Alternative Medicine; the National Center for Complementary and Alternative Medicine, National Institutes of Health; and the University of Colorado Denver Hartford/Jahnigen Center of Excellence in Geriatric Medicine. The views in this article are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs.
ABSTRACT