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Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: a Terror Management Perspective Janine Siegel Walden University

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Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: a Terror Management Perspective Janine Siegel Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: A Terror Management Perspective Janine Siegel Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Medicine and Health Sciences Commons, and the Social Psychology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Janine Siegel has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Ellen Levine, Committee Chairperson, Psychology Faculty Dr. John Astin, Committee Member, Psychology Faculty Dr. Elisha Galaif, University Reviewer, Psychology Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: A Terror Management Perspective by Janine D. Siegel MA, Graduate Theological Union, 1999 BA, Northern Illinois University, 1985 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University May 2015 Abstract Facing imminent death can be an unremitting problem for hospice patients who lack psychological support for existential concerns that contribute to depressive symptoms and suffering. According to terror management theory, spiritual and religious beliefs are a common means of coping with mortality at the end of life, and few studies have considered how hospice patients feel about their impending death. This was a quantitative, cross-sectional study that examined whether spirituality and religious coping moderated the relationship between imminent death concerns and depressive symptoms in 54 hospice patients. Participants completed a self-administered survey that included the Templer Death Anxiety scale, Brief RCOPE, Hospital Anxiety and Depression scale, and Functional Assessment of Chronic Illness Therapy Spiritual Well-Being scale. Data analyses included multiple regression, Pearson correlation, independent sample t tests, and Cronbach’s alpha test of reliability. Spirituality and religious coping did not significantly moderate the relationship between imminent death concerns and depressive symptoms. Total spirituality, meaning, and peace were significant predictors of depressive symptoms. A recommendation is to develop more research using terror management theory with participants such as hospice patients who are directly facing their imminent death. Positive social change is promoted by highlighting the importance of discussing death and dying with hospice patients, and recognizing religion and spirituality as valid influences to psychological health. This study’s findings could lead to further research in developing psychological interventions that target depression and minimize existential distress for patients at the end of life. Spirituality, Religious Coping, and Depressive Symptoms in Hospice Patients: A Terror Management Perspective by Janine D. Siegel MA, Graduate Theological Union, 1999 BA, Northern Illinois University, 1985 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University May 2015 Acknowledgments I would like to thank Ellen Levine, PhD, for her patient attentiveness and steadfast accompaniment throughout this project, and the staff and management of the hospice that served as the research site who expressed interest and support of this study. A special acknowledgment goes to the hospice patients who agreed to participate in this research. They offered heartfelt feedback about their experiences in order to help the rest of us who will eventually confront our mortality. Table of Contents List of Tables ....................................................................................................................... v Chapter 1: Introduction to the Study ................................................................................... 1 Background .................................................................................................................... 3 Depressive Symptoms at the EOL ........................................................................... 5 Death Concerns, Religion, and Spirituality ............................................................. 6 Problem Statement ......................................................................................................... 9 Purpose of Study .......................................................................................................... 10 Research Questions and Hypotheses ........................................................................... 11 Nature of Study ............................................................................................................ 13 Theoretical Base: TMT ................................................................................................ 15 TMT Hypotheses ................................................................................................... 17 Definition of Terms ..................................................................................................... 18 Assumptions ................................................................................................................ 20 Scope and Delimitations .............................................................................................. 21 Limitations ................................................................................................................... 22 Biases.. ................................................................................................................... 24 Significance of Study .................................................................................................. 25 Implications for Positive Social Change ..................................................................... 26 Summary and Transition ............................................................................................. 30 Chapter 2: Literature Review ............................................................................................ 32 Research Related to Method .................................................................................. 34 i Literature Search Strategy ..................................................................................... 34 Overview of TMT ........................................................................................................ 35 Primary Hypotheses of TMT ................................................................................. 37 Relationship of TMT and the Present Study ......................................................... 43 TMT and Religion ....................................................................................................... 44 The Existential Function of Religion and Spirituality ........................................... 45 TMT and Health .......................................................................................................... 51 Empirical Evidence: TMHM ................................................................................. 52 TMT, Religion, and Health ......................................................................................... 55 TMT Critique ............................................................................................................... 56 Spirituality at the EOL ................................................................................................. 59 Spiritual Concerns ................................................................................................. 59 Spirituality and Depressive Symptoms ................................................................. 61 Religious and Spiritual Coping ................................................................................... 64 Stress and Coping Theory ..................................................................................... 64 Religious and Spiritual Coping at the EOL ........................................................... 65 Positive Religious Coping ..................................................................................... 67 Negative Religious Coping .................................................................................... 71 Summary and Transition ............................................................................................. 74 Chapter 3: Research Method ............................................................................................. 76 Research Design and Approach ................................................................................... 77 Methodology ................................................................................................................ 79 ii Setting and Sample ................................................................................................ 79 Sample Size and Power Analysis .........................................................................
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