BACKGROUND & AIMS: :This study examines the prevalence of religiosity, death anxiety, and hope in a sample of New Zealand community hospice patients in the last 6 months of life. It explores the factors triggering distress or hope and examines whether religiosity is protective against death anxiety for this population. Early studies showed religious faith helps relieve death anxiety, but later work suggests this may only be the case in societies which are generally religious. Very little research has been conducted on this topic in New Zealand, from which recent censuses indicate is an increasingly secular country. If religion is not an important source of hope for dying, it is important to explore what factors do help relieve existential anxiety and to consider their clinical relevance. This study confirmed that organized religion was not a major support factor. Yet several people who declared themselves nonreligious scored highly for intrinsic religiosity and were among the most hopeful participants. This could suggest that spirituality may be more relevant than organized religion in relieving existential distress. The main source of hope for most participants was joyful memories and meaningful relationships. Fear of being a burden and of causing family suffering were the most significant causes of distress. Systematic spiritual assessment for all patients, not just those with a declared religious faith, a biography service, and psychotherapy, may all have a role in managing death anxiety at the end of life. Further work with larger and more diverse populations would be needed to confirm these findings.

背景与目标： : 这项研究调查了新西兰社区临终关怀患者在生命的最后6个月中的宗教信仰，死亡焦虑和希望的患病率。它探讨了引发困扰或希望的因素，并研究了宗教信仰是否可以防止该人群的死亡焦虑。早期研究表明，宗教信仰有助于缓解死亡焦虑，但后来的研究表明，只有在一般宗教的社会中，情况才可能如此。在新西兰，关于这一主题的研究很少，最近的人口普查表明，新西兰是一个日益世俗的国家。如果宗教不是死亡的重要希望来源，那么重要的是要探索哪些因素有助于缓解生存焦虑并考虑其临床相关性。这项研究证实，有组织的宗教不是主要的支持因素。然而，有几个宣称自己不信教的人在固有的宗教信仰方面得分很高，并且是最有希望的参与者之一。这可能表明，在缓解生存困境方面，灵性可能比有组织的宗教更重要。对大多数参与者来说，希望的主要来源是快乐的回忆和有意义的关系。害怕成为负担和造成家庭痛苦是造成痛苦的最重要原因。对所有患者进行系统的精神评估，而不仅仅是那些具有宣布的宗教信仰，传记服务和心理治疗的患者，都可能在生命结束时管理死亡焦虑中发挥作用。需要与更大和更多样化的人群进行进一步的工作来证实这些发现。

BACKGROUND & AIMS: :Dreams are defined as a religion of the mind in the sense that they can re-ligare--i.e. unite in a complex relationship--the components involved in the construction of the mind and its representation. The paper discusses the processes of splitting and projective identification which are manifested in dreams and appear to be essential for the transformation of emotional experiences, the acquisition of knowledge and mental growth. On the basis of clinical findings, a revision of Freud's theory of dreams is proposed: the concept of an internal world dominated by good and bad parent figures suggests a theological function for dreams connected with a state of necessity. Dreams represent a real experience which, in analysis, becomes a representation of the internal organization in its immediate present. For this reason, work on dreams makes it possible to acquire knowledge of one's internal objects and of their relationship with the Self. The work on the internal world offered by dreams is made possible by the recovery of memory, the agency responsible for a fusion between current reality and that of infancy as reactivated in the transference. Finally, some aspects of the processes active in dreams are discussed, which make them similar to poetic texts.

背景与目标： : 梦被定义为一种思想宗教，因为它们可以重新信仰 -- 即团结在一个复杂的关系中 -- 参与心灵建构及其表征的组成部分。本文讨论了分裂和投射识别的过程，这些过程在梦中表现出来，似乎对于情感体验的转变，知识的获取和心理成长至关重要。根据临床发现，提出了对弗洛伊德梦理论的修订: 由父母的好坏主导的内部世界的概念提出了梦与必要状态有关的神学功能。梦想代表了一种真实的体验，在分析中，它成为内部组织在其当下的代表。因此，在梦中工作可以获得有关内部对象及其与自我关系的知识。梦所提供的内部世界的工作是通过记忆的恢复而得以实现的，记忆是负责当前现实与婴儿期之间融合的机构，在转移中被重新激活。最后，讨论了在梦中活跃的过程的某些方面，使其类似于诗歌文本。

BACKGROUND & AIMS: PURPOSE:Spirituality and religion affect patient health. This topic is often not included in medical resident education. We aimed to evaluate resident knowledge, attitudes, and skill regarding spirituality, religion, and medicine and to develop, implement, and evaluate a curriculum to improve these measures. METHODS:Internal medicine residents at a large, urban academic center were surveyed to determine their baseline knowledge, attitudes, and skill regarding spirituality and religion (37.4% response rate, n = 46/123). A lecture and discussion-based curriculum was implemented over 1 year, followed by another survey (41.4% response rate, n = 51/123); χ2 statistic was used to compare pre- and postsurveys to evaluate the curriculum. RESULTS:Baseline resident attitudes toward spirituality, religion, and medicine were high with most agreeing chaplains are valuable in patient care (93.5%) and that patient spiritual and religious beliefs can affect health (93.5%). Resident self-reported knowledge and skill were low with few knowing the training chaplains receive (4.3%) or reporting competence taking a spiritual history (15.2%). After the curriculum, resident self-reported knowledge increased regarding the role of chaplains (56.5%-80.4%, P = .011) and the training chaplains receive (4.3%-27.5%, P = .002). No significant postcurriculum change was seen in attitudes or skill. CONCLUSIONS:Most internal medicine residents have positive attitudes toward spirituality, religion, and medicine. They do not have adequate knowledge or skill to care for patients in this area, however. Implementation of a curriculum in spirituality, religion, and medicine improved resident self-reported knowledge. Future work should focus on revising the curriculum to better improve resident knowledge and skill.

背景与目标：

BACKGROUND & AIMS: :A growing body of research has tied religion to problematic sexual behavior in both positive and negative ways. On the one hand, religious belief and engagement buffer against incidence and severity of problematic sexual behavior, but on the other hand religiously affiliated individuals who engage in such behavior tend to experience spiritual struggles (negative religious coping) and poor psychosocial outcomes. No published empirical studies have examined these variables among adult Jewish males. In the present study, 94 adult Jewish males completed measures of religious belief/practice, positive religious coping, spiritual struggles, and problematic sexual behavior. General and positive aspects of Jewish religiosity were unrelated to problematic sexual behavior. By contrast, spiritual struggles were tied to higher levels of problematic sexual behavior, but only for individuals who were raised as Orthodox Jews. Surprisingly, this latter finding was independent of current Orthodox affiliation. These results suggest that a religious Jewish upbringing, irrespective of current religious identity, can moderate ties between sexual behavior and spirituals struggles.

背景与目标： : 越来越多的研究以积极和消极的方式将宗教与有问题的性行为联系在一起。一方面，宗教信仰和参与可以防止有问题的性行为的发生率和严重性，但另一方面，从事这种行为的宗教附属人士往往会经历精神斗争 (消极的宗教应对) 和不良的社会心理结果。没有发表的实证研究对成年犹太男性的这些变量进行了检查。在本研究中，有94名成年犹太男性完成了宗教信仰/实践，积极的宗教应对，精神斗争和有问题的性行为的措施。犹太宗教的一般和积极方面与有问题的性行为无关。相比之下，精神斗争与更高水平的有问题的性行为有关，但仅适用于作为东正教犹太人长大的个人。令人惊讶的是，后一种发现与当前的东正教隶属关系无关。这些结果表明，无论当前的宗教身份如何，宗教上的犹太教养都可以缓和性行为与精神斗争之间的联系。

BACKGROUND & AIMS: :This study examined how religion is involved in achieving a sense of personal control in a situation that evokes feelings of distress and vulnerability. One hundred and fifty family members, waiting in the hospital while their relative underwent coronary artery bypass surgery, completed a survey about their methods of coping, event-specific outcomes, and adjustment (depression and anxiety). As predicted, religious methods of coping designed to achieve control predicted outcomes and adjustment beyond the effects of non-religious coping measures and traditional general measures of religiousness. A collaborative approach to religious coping, in which the individual shares the responsibility for coping with God, was particularly associated with better outcomes. However, the religious coping measures were also associated with higher self-reported levels of depression and anxiety. Exploratory path analyses suggested that anxiety and depression may be stressors in themselves, eliciting religious coping responses which, in turn, lead to specific outcomes. These findings underscore the practical and empirical value of a closer, more detailed analysis of the roles of religion in coping with uncontrollable life stressors.

背景与目标： : 这项研究考察了在引起痛苦和脆弱感的情况下，宗教如何参与实现个人控制感。一百五十名家庭成员在其亲属接受冠状动脉搭桥手术时在医院等待，完成了有关其应对方法，特定事件结果和调整 (抑郁和焦虑) 的调查。正如预测的那样，旨在实现控制的宗教应对方法预测结果和调整超出了非宗教应对措施和传统的一般宗教措施的影响。宗教应对的协作方法尤其与更好的结果相关，在这种方法中，个人分担应对上帝的责任。然而，宗教应对措施也与较高的自我报告的抑郁和焦虑水平相关。探索性路径分析表明，焦虑和抑郁本身可能是压力源，引起宗教应对反应，进而导致特定的结果。这些发现强调了对宗教在应对无法控制的生活压力源中的作用进行更详细，更详细的分析的实践和经验价值。

BACKGROUND & AIMS: :This article reviews the risk and protective factors, symptom presentation, and the significant interface of spirituality and religion of depression in African American and black Caribbean children and adolescents and their families. The article provides practical implications for diagnosis and treatment of depression in this special population of youth.

背景与目标： : 本文回顾了非裔美国人和黑人加勒比地区儿童和青少年及其家庭的抑郁症的风险和保护因素，症状表现以及精神和宗教的重要联系。本文为这一特殊的青年人群的抑郁症的诊断和治疗提供了实际意义。

BACKGROUND & AIMS: PURPOSE:To assess primary care residents' beliefs regarding the role of spirituality and religion in the clinical encounter with patients. METHOD:In 2003, at a major midwestern U.S. teaching institution, 247 primary care residents were administered a questionnaire adapted from that used in the Religion and Spirituality in the Medical Encounter Study to assess whether primary care house officers feel they should discuss religious and spiritual issues with patients, pray with patients, or both, and whether personal characteristics of residents, including their own spiritual well-being, religiosity, and tendency to use spiritual and religious coping mechanisms, are related to their sentiments regarding spirituality and religion in health care. Simple descriptive, univariate, and two types of multivariable analyses were performed. RESULTS:Data were collected from 227 residents (92%) in internal medicine, pediatrics, internal medicine/pediatrics, and family medicine. One hundred four (46%) respondents felt that they should play a role in patients' spiritual or religious lives. In multivariable analysis, this sentiment was associated with greater frequency of participating in organized religious activity (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.20-1.99), a higher level of personal spirituality (OR 1.05, 95% CI 1.02-1.08), and older resident age (OR 1.11, 95% CI 1.02-1.21; C-statistic 0.76). In general, advocating spiritual and religious involvement was most often associated with high personal levels of spiritual and religious coping and with the family medicine training program. Residents were more likely to agree with incorporating spirituality and religion into patient encounters as the gravity of the patient's condition increased (p < .0001). CONCLUSIONS:Approximately half of primary care residents felt that they should play a role in their patients' spiritual or religious lives. Residents' agreement with specific spiritual and religious activities depended on both the patient's condition and the resident's personal characteristics.

背景与目标：

BACKGROUND & AIMS: :Developing scientifically sound and clinically meaningful case formulations is so challenging that it may verge on becoming a "lost art." Pressures (scientific, economic, and cultural) remain that prevent child and adolescent psychiatrists from getting a complete understanding of the patient and family. Including a strong consideration of data related to religion, spirituality, and worldview may seem only to complicate an already arduous task. The clinician who includes these factors in treatment is faced with decisions of when to discuss these issues, how to discuss them and in what depth, and finally, when to refer to a religious/spiritual professional. Nonetheless, the importance of these factors in the lives of many children and families leaves no option but to address them as directly as possible. It is well worth the effort and, in many cases, will open new areas for clinical improvement in patients.

背景与目标： : 开发科学合理且具有临床意义的病例配方非常具有挑战性，以至于它可能会成为 “失落的艺术”。压力 (科学，经济和文化) 仍然存在，阻止儿童和青少年精神科医生完全了解患者和家庭。包括对与宗教，灵性和世界观有关的数据的强烈考虑似乎只会使已经艰巨的任务复杂化。在治疗中包含这些因素的临床医生面临着何时讨论这些问题，如何讨论这些问题以及在什么深度上以及最后何时提及宗教/精神专业人士的决定。尽管如此，这些因素在许多儿童和家庭生活中的重要性别无选择，只能尽可能直接地解决这些问题。这是非常值得的努力，并且在许多情况下，将为患者的临床改善开辟新的领域。

BACKGROUND & AIMS: :This paper examines the various meanings persons with serious mental illnesses attribute to the concepts of religion and spirituality. In-depth semi-structured interviews were conducted with forty individuals with serious mental illnesses who have incorporated alternative healing practices into their recovery process. The qualitative data analysis revealed that study participants differentially defined religion and spirituality using two sets of descriptors: (a) core characteristics describing the nature of each concept, and (b) functional characteristics describing the impact of religion and spirituality on the individual. Implications for clinical practice and future research on the role of religion and spirituality in recovery are discussed.

背景与目标： : 本文研究了患有严重精神疾病的人归因于宗教和灵性概念的各种含义。对40名患有严重精神疾病的人进行了深入的半结构化访谈，他们将替代治疗方法纳入了康复过程。定性数据分析表明，研究参与者使用两组描述符对宗教和灵性进行了不同的定义 :( a) 描述每个概念性质的核心特征，以及 (b) 描述宗教和灵性对个人影响的功能特征。讨论了对临床实践的影响以及有关宗教和灵性在康复中的作用的未来研究。

BACKGROUND & AIMS: :Cultural psychiatry has been an important contributor to the enhanced dialogue between psychiatry and religion in the past couple of decades. During this time, religion and spirituality have become more prominent in mainstream psychiatry in a number of areas of study and clinical care, including refugee and immigrant health, trauma and loss, psychotherapy, collaboration with clergy, bioethics, and psychiatric research. In looking towards the future, there is a great deal of promise for future enhancement of the study of religion and spirituality in psychiatric education, research, and clinical care.

背景与目标： : 在过去的几十年中，文化精神病学一直是精神病学与宗教之间加强对话的重要贡献者。在此期间，宗教和灵性在许多研究和临床护理领域的主流精神病学中变得更加突出，包括难民和移民健康，创伤和损失，心理治疗，与神职人员的合作，生物伦理学和精神病学研究。展望未来，在精神病学教育，研究和临床护理中，对宗教和灵性研究的未来有很大的希望。

BACKGROUND & AIMS: :Much of the evidence that religion provides a protective factor against completed suicide comes from cross-sectional studies. This issue of the Journal includes a report of a new prospective study. An understanding of the relationship between spirituality, religion and suicide is important in assessing and caring for those at risk.

背景与目标： : 宗教为防止自杀提供了保护因素的许多证据来自横断面研究。本期杂志包括一项新的前瞻性研究的报告。了解灵性，宗教和自杀之间的关系对于评估和照顾处于危险中的人很重要。

BACKGROUND & AIMS: BACKGROUND:The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the three major monotheistic religions. METHODS:We searched MedLine using PubMed in order to retrieve and thematically analyze full-length scholarly journal papers or case reports dealing with religious traditions and end-of-life care. Our search consisted of a string of words that included the most common denominations of the three religions, the standard heading terms used by the National Reference Center for Bioethics Literature (NRCBL), and the Medical Subject Headings (MeSH) used by the National Library of Medicine. Eligible articles were limited to English-language papers with an abstract. RESULTS:We found that while a bibliographic search in MedLine on this topic produced instant results and some valuable literature, the aggregate reflected a selection bias. American writers were over-represented given the global prevalence of these religious traditions. Denominationally affiliated authors predominated in representing the Christian traditions. The Islamic tradition was under-represented. CONCLUSION:MedLine's capability to identify the most current, reliable and accurate information about purely scientific topics should not be assumed to be the same case when considering the interface of religion, culture and end-of-life care.

背景与目标：

BACKGROUND & AIMS: :A slow but steady trend to decline routine immunization has evolved over the past few decades, despite its pivotal role in staving off life-threatening communicable diseases. Religious beliefs are among the reasons given for exemptions. In the context of an overview of various religious approaches to this issue, this article addresses the Jewish religious obligation to immunize. The latter is nested in the more general obligation to take responsibility for one's health as it is essential to living a morally productive life. Furthermore, the individual's responsibility extends to supporting communal health by contributing to herd immunity. Judaism embraces evidence-based information regarding immunization safety and efficacy and holds the resulting professional guidelines to be religiously binding. From a Jewish perspective, government bodies need to weigh respect for individual autonomy to refrain from immunization against preserving public safety, such that waiving autonomy should be reserved for immediately life-threatening situations. Nurses' knowledge and understanding of the Jewish legal approach as explicated in this article and those of other religions in which similar principles apply (such as Islam and Christianity) can enrich their awareness of how revering God can go hand in hand with an obligation to prevent illness for the self and the community by immunizing.

背景与目标： : 尽管常规免疫在预防威胁生命的传染病方面发挥了关键作用，但过去几十年来，常规免疫减少的缓慢但稳定的趋势已经演变。宗教信仰是豁免的原因之一。在概述解决此问题的各种宗教方法的背景下，本文讨论了犹太宗教免疫义务。后者嵌套在对自己的健康负责的更一般的义务中，因为这对于过上道德上富有成效的生活至关重要。此外，个人的责任扩大到通过促进群体免疫来支持社区健康。犹太教包含有关预防接种安全性和有效性的基于证据的信息，并认为由此产生的专业指南具有宗教约束力。从犹太人的角度来看，政府机构需要权衡对个人自主权的尊重，以避免预防接种，以维护公共安全，因此应在立即威胁生命的情况下保留放弃自主权。护士对本文阐述的犹太法律方法以及适用类似原则的其他宗教 (例如伊斯兰教和基督教) 的知识和理解可以丰富他们对尊敬上帝如何与义务携手并进的认识通过免疫预防自我和社区的疾病。

BACKGROUND & AIMS: OBJECTIVE:Mental health professionals are increasingly aware of the need to incorporate a patient's religious and spiritual beliefs into mental health assessments and treatment plans. Recent changes in assessment and treatment guidelines in the US have resulted in corresponding curricular changes, with at least 16 US psychiatric residency programs now offering formal training in religious and spiritual issues. We present a survey of training currently available to Canadian residents in psychiatry and propose a lecture series to enhance existing training. METHODS:We surveyed all 16 psychiatry residency programs in Canada to determine the extent of currently available training in religion and spirituality as they pertain to psychiatry. RESULTS:We received responses from 14 programs. Of these, 4 had no formal training in this area. Another 4 had mandatory academic lectures dedicated to the interface of religion, spirituality, and psychiatry. Nine programs offered some degree of elective, case-based supervision. CONCLUSION:Currently, most Canadian programs offer minimal instruction on issues pertaining to the interface of religion, spirituality, and psychiatry. A lecture series focusing on religious and spiritual issues is needed to address this apparent gap in curricula across the country. Therefore, we propose a 10-session lecture series and outline its content. Including this lecture series in core curricula will introduce residents in psychiatry to religious and spiritual issues as they pertain to clinical practice.

背景与目标：

BACKGROUND & AIMS: :This first descriptive report on the perspectives, experiences, and actions of clergy relative to terminal patients and their families details a highly emotionally charged complex of interactions. Some 276 clerics from fourteen different bodies provided information on their involvement in death-work, spiritual and personal resources, satisfactions and doubts, pastoral goals and purposes, and their background and outlooks regarding their own demise. Implications of these findings are explored with respect to various forms and contents of training and experience. Psychological versus spiritual roles are of special significance in clergy-patient-family relationships.

背景与目标： : 关于神职人员相对于绝症患者及其家人的观点，经验和行为的第一份描述性报告详细介绍了高度充满情感的互动。来自14个不同机构的约276名牧师提供了有关他们参与死亡工作，精神和个人资源，满意和怀疑，牧民目标和宗旨以及他们对自己的死亡的背景和看法的信息。针对培训和经验的各种形式和内容，探讨了这些发现的含义。心理角色与精神角色在神职人员-患者-家庭关系中具有特殊意义。