Psychiatry Residents' Attitudes Toward Spirituality in Psychiatry

Abstract

There is increasing recognition of the importance of addressing spirituality in psychiatry. Studies report that religiosity correlates with greater well-being and social support, and lower rates of depression, anxiety, and substance abuse (1). Leading authorities in psychiatric diagnosis and training have recognized these findings as reflected in diagnostic nosology and training standards. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition introduced a category for religious and spiritual problems (2). Spirituality is mentioned in the training requirements of the Royal College of Physicians and Surgeons of Canada (3) and the practice guidelines of the American Psychiatric Association (4). Studies suggest that training on spirituality improves residents’ attitudes (5), comfort levels, competency (6), and knowledge (7) in this area. Despite these findings, a survey of Canadian psychiatry residency programs showed that most did not offer any didactic teaching, and those that did offered no more than 4 hours (8). This study aimed to explore the attitudes, experiences, and comfort levels of psychiatry residents at McGill University regarding spirituality in psychiatry, and to examine residents’ interest and past learning experiences in this area. An IRB-approved anonymous, paper-based survey was distributed to the residents in the 201022011 academic year. The questionnaire items were generated based on the specific research questions of this study, and a literature review of previous related work. The questionnaire was further developed by consulting two psychiatrists involved in resident education and by having two medical students who had graduated complete it and provide feedback on clarity and length. Most questions were quantitative, providing response options on a Likert scale. Items were conceptually grouped into the following domains with respect to spirituality in psychiatry: self-reported attitudes, experiences in practice, influence on practice, comfort level, relation to CanMEDS (Canadian Medical Education Directives for Specialists) roles, and barriers to discussing spirituality in practice. For the latter two questions, residents were simply asked to select all the items deemed true for them. A few questions addressed demographics and personal spirituality, and two qualitative short-answer questions addressed learning in the area of spirituality and psychiatry. Quantitative data were analyzed, using SPSS GradPack 17 for Windows, to yield descriptive frequencies. Qualitative data were analyzed with a framework-analysis approach, a type of thematic analysis used in research that aims to provide outcomes or recommendations (9). After a general familiarization process, a framework of three themes was identified: knowledge, skills, and attitudes. Data were then coded under these headings by two researchers, and percentage agreement in coding was calculated to ensure reliability. The response rate was 64% (45/70) with 43% male and 57% female respondents. Residents identified as Christian (37%), Jewish (25.9%), Atheist (7.4%) and Muslim (3.7%), and 25.9% were categorized as “other, ”“ unknown,” or “none.” Many considered themselves spiritual-only (37%), whereas very few (5%) reported being religious-only. Many (37.5%) were neither spiritual nor religious, and 20% were both. Only 38.6% of residents had received training on spirituality, but 81.3% of those who did found it beneficial. Further quantitative results are summarized in Table 1. Qualitative data explored the impact of previous training in spirituality and psychiatry on residents and their learning interests for the future. In terms of knowledge, residents reported that training “introduced the topic” and “increased awareness” of the relationship between spirituality and mental health. An important attitudinal change was that residents reported an increase in “comfort approaching the topic” and in the “initiative to question” patients on it. Residents’ skills improved through “coaching on sensitive questioning,” and having the patients’ spiritual history made “more accessible.” Residents were interested in acquiring knowledge and skills that would help them in their “day-to-day care of patients.” They wanted to learn specifically about “different spiritual/religious affiliations/belief systems”, as well as gain a broader understanding of “their potential impact on mental health.” They were also eager to develop skills in taking a “spiritual history” and in integrating spirituality into their conceptualization of cases.