Instruments Measuring Spirituality in Clinical Research

Abstract

To the Editors—Spirituality and its relationship with well-being and quality of life in patients with somatic diseases is a rapidly developing field of research.1 For the further progress of scientific and clinical knowledge a reliable and valid spirituality questionnaire is indispensable. In their elaborate review Monod et al. have critically discussed available questionnaires, focusing mainly on their psychometric qualities, to assist researchers and clinicians in choosing the most appropriate instrument.2 In our view, they did not lay enough emphasis on two criteria: the misleading inclusion of well-being items and the overrepresentation of religious items in spirituality scales. The inclusion of well-being items presents a problem when studying the relationship between spirituality and mental health. It seems self-evident that one should avoid tautology by refraining from a study into the relationship between spiritual well-being and “general well-being”. However, several studies have in fact undertaken this.1 So, a warning would certainly not be superfluous. Monod et al. did make a distinction between spiritual well-being scales and “general spirituality” scales. It is obvious that spiritual well-being scales include items on well-being. However, the “general spirituality” scales also contain well-being items as is apparent from their second table, namely items that ask about peacefulness, sense of harmony, self-esteem, and happiness. Spirituality questionnaires should be suitable for both religious and non-religious people and, therefore, should contain only a limited number of religious items. Several of the scales discussed by Monod et al. do not fulfill this requirement: for instance the DSES, the Brief Multidimensional Measure of Religiousness/ Spirituality and the INSPIRIT. It is a pity that Monod et al. did not include a valuation of the quality of the items in their discussion - comprehensibility, having a consistent meaning, use of the word ‘spirituality’, number of religious items, inclusion of well-being items - as was done in other recently published reviews.3,4 Bert Garssen, PhD, Helen Dowling Institute, Center for Psycho-oncology, Rubenslaan 190, 3582JJ, Utrecht, The Netherlands (e-mail: bgarssen@hdi.nl) Anja Visser, Msc Eltica de Jager Meezenbroek, Msc Helen Dowling Institute, Center for Psycho-oncology, Utrecht, The Netherlands