Duke Religion Index Research Articles

Social support and religiosity in bipolar disorder individuals in euthymic phase

ABSTRACT The primary purpose of this study was to evaluate the association between social support and religiosity in bipolar disorder patients in the recovery phase of the disorder. We assessed 180 bipolar outpatients with the Medical Outcomes Study Social Support Scale and the Duke Religion Index. Most of the bipolar disorder outpatients did not attend group activities. We did not find any correlation between total social support and religiosity domains, but higher non-organizational religiosity was associated with higher emotional/informational functional social support. Finally, we found that non-organizational religiosity was positively correlated with emotional/informational functional social support. Further research might explore better understanding social support and religiosity through its different dimensions.

The role of spirituality and religiosity on the suicidal ideation of medical students.

There is solid evidence that spirituality and religiousness may reduce the suicidal ideation of individuals. However, studies are scarce on medical students. To investigate the relationship between spirituality, religiousness, and suicidal ideation among Brazilian medical students. This is a cross-sectional study including Brazilian medical students. Sociodemographic and health variables, suicidal ideation (item 9 of the Beck Depression Inventory - BDI), spiritual and religious Coping (Brief SRC), religiousness (Duke Religion Index), spiritual well-being - Meaning, Peace and Faith (FACIT SP-12), and depressive (PHQ-9) and anxiety (GAD-7) symptoms were assessed. A total of 353 medical students were included, 62.0% presented significant depressive symptoms, 44.2% presented significant anxiety symptoms, and 14.2% presented suicidal ideation. In the adjusted Logistic Regression models, meaning (OR = 0.90, p = .035) and faith (OR = 0.91, p = .042) were associated with lower suicidal ideation, while negative spiritual and religious coping was associated with greater suicidal ideation (OR = 1.08; p = .006). There was a high prevalence of suicidal ideation among Brazilian medical students. Spirituality and religiousness were associated with suicidal ideation in two different directions. These findings could help educators and health professionals to understand suicidal ideation among medical students, helping in the development of preventive strategies to mitigate such problem.

Which Protective Factors Are Associated with the Mental Health of Syrian Students in Germany? A Register-Based Cross-Sectional Study

The aim of this online, register-based cross-sectional study was to investigate the frequency of psychological distress and protective factors among 136 Syrian students in Germany. The survey measured depression and anxiety (Patient Health Questionnaire-4), post-traumatic stress (Impact of Event-Scale-6), as well as resources social support (ENRICHD Social Support Instrument), optimism (Optimism-Pessimism-2 Scale) and religiosity (Duke Religion Index). A total of 26.50% of the sample were female. A total of 38.93% met criteria for clinically relevant depressive respectively generalized anxiety symptoms and 15.72% showed prominent PTSD scores. Participants screened positive for mental distress reported significantly less social support (p = 0.001) and less optimism (p = 0.002) than participants without mental distress. In multiple regression analyses, higher levels of feeling welcome in Germany, social support and intrinsic religiosity were significantly associated with lower levels of depression and generalized anxiety. Significant associations with lower PTSD levels were found with higher levels of social support and optimism. The results show that Syrian students in Germany are more psychologically burdened compared to other Syrian refugee samples, except for PTSD. This suggests that besides the stress caused by flight and trauma, stressors such as studying and social isolation could be considered as additional impediments for mental health and require intervention measures.

Development of an Instrument to Assess Spirituality: Reliability and Validation of the Attitudes Related to Spirituality Scale (ARES).

Background: Several instruments that measure spirituality present overlaps with positive emotions, impacting the interpretation of their findings. In order to minimize these problems, we aimed to develop, assess the reliability and validate a new scale to evaluate spirituality.Methods: The instrument was designed using a theoretical framework minimizing tautological issues (i.e., Koenig’s framework), a qualitative study investigating the definitions of spirituality, the development of the first version of instrument by experts’ meetings and a qualitative cognitive debriefing. Then, the instrument was examined for its content validity by a multidisciplinary group of judges and was pilot-tested in two different groups – less religious (medical students – n = 85) and more religious (practicing religious members – n = 85). Finally, psychometric properties and validity were assessed.Results: The developed Attitudes Related to Spirituality Scale (ARES) is a self-report 11-item instrument using five-level Likert items. ARES presented appropriate psychometric properties revealing excellent internal consistency (alpha = 0.98) and temporal stability (ICC = 0.98). Likewise, ARES was strongly correlated with other validated R/S instruments (i.e., Duke Religion Index and Brief Multidimensional Measure of Religiousness/Spirituality) and was able to discriminate higher and lower religious groups. In the exploratory factor analysis, a unidimensional structure of the scale was described. Fit indices for the scale demonstrated good fit in the unidimensional model.Conclusion: The ARES is a reliable, valid and stable one-dimension instrument that is appropriate for use in the Portuguese-speaking population.Descriptors: Spirituality; Scale; Factorial Analysis; Instrument; Measure; Psychometrics.

The role of spirituality and religiosity on suicidal ideation of homeless people in a large Brazilian urban center

BackgroundSuicidal ideation is an important mental health issue among homeless people. Despite the fact that spirituality and religiousness (S/R) have been associated with lower levels of suicide behavior, there is little evidence on this relationship among homeless individuals. Thus, this study aims to investigate the association between S/R and suicidal ideation among homeless people living in a large Brazilian city. MethodsThis cross-sectional study included 456 homeless individuals living in Sao Paulo, Brazil. Logistic and linear regression models were used to determine the role of religious and spiritual beliefs (Duke Religion Index, FACIT SP-12 and Brief-RCOPE) on suicidal ideation, after adjustements. ResultsMost participants were male (75%) with a mean age of 44.53(SD 12.62) years. A total of 49.6% had significant depressive symptoms and the prevalence of suicidal ideation was 29.8%. In the adjusted logistic regression, higher levels of religiousness (organizational, nonorganizational and intrinsic), positive religious/spiritual coping, peace and meaning were associated with a lower suicidal ideation. The same results were found when using linear regression models. LimitationsLong questionnaires can be factors of inhibition and fatigue for the participants. Suicidal ideation was based on a single question. ConclusionOur results revealed a high prevalence of suicidal ideation and depression in our sample. Religiousness and spirtuality were important factors in the life of homeless individuals, being negatively associated with suicidal ideation. These results could make healthcare professionals aware of the importance of addressing S/R issues in this vulnerable population.

The Khoekhoegowab Personality Inventory: The Comparative Validity of a Locally Derived Measure of Traits.

Objective: This study explores a personality inventory derived from the results of an indigenous lexical study of personality. From the 272 most commonly used personality descriptors in Khoekhoegowab, the most-spoken of extant Khoesan click languages of southern Africa, an 11-factor model of personality-trait structure was identified. Here, the Khoekhoegowab Personality Inventory (KPI) was created based on those results. Its psychometric properties, the convergent and divergent validity of its scales, and its incremental validity over Big Five and Six traits for predicting physical and mental health, religious practice and attitudes, and income are reported.Methods: Two to five key terms were selected for each of 10 KPI scales: Temperance, Prosocial Diligence, Gossip, Honesty/Morality, Temper, Implacability, Humility, Vanity, Resiliency vs. Agitation, and Courage vs. Fear. These 38 total items were administered to a large sample of adult speakers of Khoekhoegowab in Namibia (N = 632), together with five imported inventories translated into Khoekhoegowab: the 30-item Questionnaire Big Six (QB6), General Self-Reported Health, the Cascades Mental Health Assessment, the Satisfaction with Life Scale, the Duke Religion Index. The properties and intercorrelations of KPI subscales are explored, and their predictive ability for the other variables is compared to that of the QB6.Results: Due to the small number of items on each scale, poor internal consistency was anticipated, but the KPI scales' properties were somewhat better than those of the QB6. R-square change by the inventories as a whole, after accounting for age and gender, indicted that the KPI scales explained more variance than the QB6 scales in almost all criterion variables. Replication of established associations for Big Six traits was mixed: associations were largely as expected for Resiliency, Conscientiousness, and Honesty, but less so for Agreeableness and Extraversion.Conclusions: The KPI had some advantages over the QB6 in predicting physical and mental health. In particular, the four items of Resiliency vs. Agitation predicted lower scores on all physical and mental problem scales. Given psychological-care needs in Namibia, this might be used as a non-intrusive screener. Measurement challenges common to both surveys are discussed, possible solutions, and the utility of higher-order structures are discussed.

Religiosity is Associated with Motivation to Start and Stop Smoking Among Adolescent Students in Brazil.

This study aimed to estimate associations between adolescents' religiosity and their motivation to start and stop smoking. A school survey was carried out in Midwestern Brazil. Participants were never-smokers (n = 2073) and smokers (n = 116) aged 13-19 who answered a questionnaire. Religiosity was measured with the Duke Religion Index, and motivation with questions based on the Prime Theory of Motivation. Organizational, non-organizational, and intrinsic religiosity were associated with motivation to start smoking among never-smokers. Intrinsic religiosity was associated with smokers' motivation to quit. Findings indicate the protective role of religiosity in the motivational system that prompts smoking initiation and cessation during adolescence.

Does religiosity in persons with schizophrenia influence medication adherence

Background:Little information is available regarding the effect of religiosity and spirituality on medication adherence in patients with schizophrenia.Aim:This study aimed to evaluate the association of medication adherence with different aspects of religiosity and spirituality in patients with schizophrenia.Materials and Methods:One hundred patients with schizophrenia were evaluated on religiousness measure scale and Duke Religion Index (DUREL); Brief Religious Coping Scale (Brief RCOPE); World Health Organization Quality of Life Spirituality, Religiosity, and Personal Beliefs (WHOQoL-SRPB); and Brief Adherence Rating Scale (BARS).Results:A higher level of religiosity as assessed by the religiousness measure scale, private religious activities and intrinsic religiosity as per DUREL, positive religious coping, and all the domains of WHOQOL-SRPB was associated with better medication compliance as assessed by the percentage of doses of medications consumed in the last 1 month as evaluated by using BARS.Conclusion:The present study suggests that a higher level of religiosity and spirituality were associated with better medication compliance.

Avaliação da espiritualidade/religiosidade e opinião de residentes sobre a participação em um módulo de espiritualidade e integralidade

Objective : Although training in spirituality and health is being widely discussed worldwide, in Brazil it still seems to be slower, especially in graduate courses. The present study evaluated spirituality/religiosity, the opinion of residents about training in spirituality and the Transversal Module of Spirituality and Integrality. Methods : This is an exploratory, descriptive, cross-sectional study with a quantitative approach with a sample of 55 residents. The data were obtained through a semi-structured and self-administered questionnaire including the Duke Religion Index (DUREL) and Spirituality Self Rating Scale (SSRS). The data were analyzed with the aid of the Software Statistical Package for the Social Sciences (SPSS) in version 13.0 for Windows. The study was approved by the Research Ethics Committee of Faculdade Pernambucana de Saúde with CAAE: 16559619.2.0000.5569 and opinion number: 3,495.64. Results : Most of the 55 residents declared themselves to be female, with an average age of 25.41 years, white and Catholic. Regarding teaching in health and spirituality, the majority (65.45%) believes that the resident’s preparation in spirituality is quite important. Regarding the spirituality and comprehensiveness module, the majority (94.55%) considered it very good and all stated that the content brought them contributions. On the DUREL scale, the majority (41.82%) sometimes attend temples or churches, the majority (38.18%) read sacred books, prayers or prayers daily. The SSRS scale, which assesses the spiritual orientation score, obtained an average of 23.43 (SD = 4.87). Conclusion : Residents showed a low religiosity suggesting that the development of spiritual awareness during professional training remains a challenge. High spiritual guidance, in turn, suggests that residents consider issues relevant to their spiritual dimensions to be important, although with difficulty in applying them to their own lives. Finally, training in spirituality proved to be relevant, contributing positively to the residents’ professional practice.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study.

To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice. We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice. The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S. Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

ESPERANÇA DE MULHERES EM TRATAMENTO QUIMIOTERÁPICO PARA O CÂNCER DE MAMA

Objetivo: analisar a esperança de mulheres em tratamento quimioterápico e os fatores relacionados.Método: estudo observacional, seccional, quantitativo, realizado em um serviço de quimioterapiade um hospital universitário do Nordeste do Brasil, entre março e setembro de 2018. Foramentrevistadas 55 mulheres em tratamento quimioterápico para câncer de mama. Foram aplicadosa Escala de Bem-Estar Espiritual, Questionário de Esperança de Herth e o Índice de religiosidadede DUKE.Resultados: a religiosidade e o bem-estar espiritual apresentaram-se como fatores preditoresde esperança significativos (p=0,024), correspondendo magnitude do efeito sobre a variáveldependente considerada de pequeno valor preditivo (f²=0,29), explicando 22,6% (R²) docomportamento da variável. O bem-estar espiritual foi a única variável previsora isolada paraesperança (β=0,439; t=3,376; p=0,001).Conclusão: a principal variável preditora da esperança foi o bem-estar espiritual. A esperançamostrou-se independente de fatores sociodemográficos e do tratamento.

How Korean Psychiatric Staff Deal with Religious and Spiritual Issues of Patients: What Is Professional?

In contrast to other secularized countries, religious and spiritual needs and/or aspects of patient-centred-care are hardly studied in South Korea, even less in the context of psychiatry and psychotherapies. This study investigates religious and spiritual values of Korean psychiatric staff, and their experiences as well as considerations regarding their patients’ religious and spiritual aspects in clinical settings. In 2015, we surveyed psychiatric staff in Daegu and suburban areas using Korean versions of the Duke Religion Index and a questionnaire on Religion and Spirituality in Medicine: Physicians’ Perspectives by F. Curlin. Six clinics participated in our research. A total of 328 questionnaires were distributed. Ultimately, 270 fully completed questionnaires were analysed (return rate: 82.3%). Regarding religious and spiritual values, Korean psychiatric staff does not differ considerably from the average of the Korean population. However, there are significant moderate correlations between their own religious and spiritual attitudes, and their consideration as well as behaviors related to religious and spiritual aspects of their patients. In addition, there is evidence of an unconscious bias which influences treatment. These results call for more professional attention and self-reflective training.

Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study.

Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training. This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST) were used. A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline. Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.

Religiousness is associated with lower levels of anxiety, but not depression, in medical and nursing students.

To evaluate the association between religious and spiritual beliefs, anxiety and depression in medical and nursing students. A cross-sectional study was carried out with medical and nursing students from a Brazilian university. Students were randomly selected and filled out a questionnaire that contained sociodemographic, religious (Duke Religion Index), spirituality (Self-spirituality rating scale) and mental health - depression and anxiety (Hospital Anxiety and Depression Scale) data. Linear regression models were used to evaluate the association of R/E with mental health, with adjustments for sociodemographic variables. A total of 187 students (90.7%) were included in the study, 56.1% female, an average of 23 years old, and 69% were enrolled in the medical program. Of the students, 29.4% attended religious services once a week or more often, 10.7% had private religious activities once a day or more often, and the indexes of intrinsic religiosity and spirituality were moderate. In the linear regression, adjusted for sociodemographic variables, the religious attendance was the only factor associated with lower levels of anxiety (Beta: -0.178, p=0.026). The other dimensions of religiousness or spirituality were not associated with levels of anxiety and depression. The present study showed that only the religious attendance was associated with the mental health of the medical and nursing students. These results demonstrate that some students use religious support in an attempt to minimize the negative effects of their university life. This support seems to be more effective when it involves participation in religious social activities in relation to private activities.

Spiritual Fitness for Military Veterans: A Curriculum Review and Impact Evaluation Using the Duke Religion Index (DUREL)

Suicide rates among military veterans exceed those found in the general population. While the exact reasons for these high rates are unknown, contributing factors may include the military's perceived rejection of patient identities, creating barriers to mental health care within the clinical sector and a mandate for prevention programs. Spiritual fitness has emerged over the last decade as an important concept in human performance optimization and is included among holistic approaches to developing and maintaining mentally fit fighting forces. In attempts to better understand the role that spiritual fitness and religion play in mitigating and/or reducing suicide risk among veterans, the aims of this study were twofold (1) to assess the utility of the Duke Religion Index as a psychometric instrument for use with veterans completing spiritual fitness training and (2) to offer a post-intervention process evaluation of the spiritual fitness module from one resilience program offered to military veterans of Iraq and Afghanistan in 2016. Twenty-eight attendees at the JRWI Wellness Resilient Leadership Retreat completed post-retreat surveys to assess their satisfaction with the coursework and specifically, to assess the spiritual fitness module of the resiliency retreat's curriculum. In total, the research team reviewed 25 completed post-intervention survey responses (89.3% response rate). Descriptive statistics indicated that respondents (n = 25) were subjectively religious, defined as belief in a higher power practiced in ritualized ways. Over half of program participants indicated they (a) attended religious meetings at least once a week and (b) engaged in private religious activity-such as meditation-at least once a day. Results showed that most program participants reported that the spiritual fitness skills learned during the resilient leadership program were useful (88%) (Z = 3.000, p < 0.001). Additionally, most program participants reported their interest in spiritual exploration was affirmed, renewed, or raised as a result of attending the peer-led resilient leadership program (76%) (Z = 6.000, p = 0.015). Culturally informed prevention programs that emphasize spiritual fitness are indicated for use in veteran outreach and well-being programs. More detailed research is needed to assess curriculum specifics.

Validation of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-Expanded (FACIT-Sp-Ex) Across English and Spanish-Speaking Hispanics/Latinos: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

The validity of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) has been examined in primarily non-Hispanics/Latinos with chronic illness. This study assessed the psychometric properties of the non-illness, expanded FACIT-Sp (FACIT-Sp-Ex) in 5,163 U.S. Hispanic/Latino adults. Measures were interviewer-administered in English or Spanish. Confirmatory factor analyses indicated four factors: Meaning, Peace, Faith, and Relational. The scale demonstrated measurement invariance across English and Spanish. Subscales displayed adequate internal and test-retest reliability. Scores were positively associated with Duke Religion Index (DUREL) subscales. When all subscales were entered in a single model, Meaning and Peace were inversely associated with depressive symptoms and positively associated with HRQOL. Faith was positively associated with depressive symptoms and inversely associated with HRQOL. Relational was not associated with any outcome. FACIT-Sp-Ex subscales were generally more strongly associated than DUREL subscales with well-being. The FACIT-Sp-Ex appears to be a valid measure of spiritual well-being in U.S. Hispanics/Latinos.

The influence of spirituality and religiousness on suicide risk and mental health of patients undergoing hemodialysis

BackgroundDespite the large amount of literature assessing how spiritual and religious beliefs have an impact on mental health and suicide risk in various groups of patients, few studies have investigated patients with chronic kidney disease (CKD). The purpose of this study is to investigate whether spirituality and religiousness (S/R) are associated with the presence of suicide risk as well as whether those beliefs are also associated with the presence of mental health problems in patients undergoing hemodialysis. MethodsCross-sectional study carried out in three Brazilian dialysis units involving hemodialysis patients. The study assessed religiousness (Duke Religion Index); spiritual well-being (FACIT-Sp 12); mental health - depression and anxiety (Mini International Neuropsychiatric Interview–MINI); and risk of suicide (MINI). For analysis, adjusted logistic regression models were applied. ResultsA total of 264 (80.7%) patients were included, 17.8% presented suicide risk, 14.0% presented current major depressive episode, and 14.7% presented generalized anxiety disorder. Concerning spiritual well-being (FACIT-Sp 12), the subscale of “Meaning” was associated with lower risk of suicide, depression, and anxiety. The subscale “Peace” was associated with lower depression and anxiety, whereas the subscale “Faith” was associated with lower suicide risk and depression. Religiousness measures were not associated with the study outcomes. ConclusionSpiritual beliefs were associated with lower suicide risk and better mental health among hemodialysis patients. Factors related to spiritual well-being, such as “meaning”, “peace” and “faith” were more associated with the outcomes studied than religious involvement. Further studies are needed to replicate our findings in different cultural and religious settings.

Knowledge and perception of breast cancer and its treatment among Malaysian women: Role of religion

Purpose: To investigate the association between religiosity, perceptions, and knowledge of breast cancer and its treatment among women in Malaysia. Methods: Knowledge and perceptions of breast cancer and its treatment were determined via a questionnaire adapted from previous studies. The Duke Religion Index was used to measure participants’ religiosity. The questionnaires were distributed among women in public areas in Kuala Lumpur. Results: A total of 384 women participated in this study. Non-organisational religious activity (NORA; r = -0.113, p < 0.05) and intrinsic religiosity (IR; r = -0.183, p < 0.01) were significantly negatively correlated with knowledge of breast cancer. NORA (r = 0.115, p < 0.05) and IR (r = 0.229, p < 0.01) were positively, significantly correlated with the perception that patients who underwent treatment for breast cancer can enjoy good quality of life. There was also a significant positive correlation between NORA (r = 0.175, p < 0.05) and IR (r = 0.249, p < 0.01) on the statement that spiritual support improves treatment for breast cancer. IR was the only subscale positively, significantly associated with the perception of choosing breast-conserving surgery as a primary treatment choice (r = -0.111, p < 0.05) and dietary therapies (r = 0.126, p < 0.05) or acupuncture (r = 0.120, p < 0.05) as alternative treatments for breast cancer. Conclusion: Religiosity should be considered in improving women’s knowledge and perceptions of breast cancer and its treatment. Keywords: Breast cancer, Knowledge, Perceptions, Religiosity

Religiosity is a moderator of the relationship between impulsivity and internalizing symptoms

Background There is growing interest in the role of religion in psychiatric disorders. Impulsivity is a psychological trait associated with acting without thinking, with a decision process favoring short-term outcomes without further consideration of its consequences, and is a risk factor for the development of mental disorders. Objective In this study, the objective was to analyze the role of religiosity as a possible moderator between the association of impulsivity and internalizing psychiatric symptoms. Methods The hypothesis was assessed in a cross-sectional study enrolling 366 adults evaluated using the abbreviated version of the Barratt Impulsiveness Scale-11, the Self Reporting Questionnaire-20, and the Duke Religion Index. Results Internalizing symptoms were significantly influenced by an interaction between religiosity and impulsivity. Religiosity acted as a protective factor against internalizing symptoms only for participants with high impulsivity. Discussion The results suggest a moderation role of religiosity in the association of impulsivity with internalizing symptoms.

Depression, stress and anxiety in medical students: A cross-sectional comparison between students from different semesters

To compare the prevalence of anxiety, depression, and stress in medical students from all semesters of a Brazilian medical school and assess their respective associated factors. A cross-sectional study of students from the twelve semesters of a Brazilian medical school was carried out. Students filled out a questionnaire including sociodemographics, religiosity (DUREL - Duke Religion Index), and mental health (DASS-21 - Depression, Anxiety, and Stress Scale). The students were compared for mental health variables (Chi-squared/ANOVA). Linear regression models were employed to assess factors associated with DASS-21 scores. 761 (75.4%) students answered the questionnaire; 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms, and 47.1% stress symptoms. Significant differences were found for: anxiety - ANOVA: [F = 2.536, p=0.004] between first and tenth (p=0.048) and first and eleventh (p=0.025) semesters; depression - ANOVA: [F = 2.410, p=0.006] between first and second semesters (p=0.045); and stress - ANOVA: [F = 2.968, p=0.001] between seventh and twelfth (p=0.044), tenth and twelfth (p=0.011), and eleventh and twelfth (p=0.001) semesters. The following factors were associated with (a) stress: female gender, anxiety, and depression; (b) depression: female gender, intrinsic religiosity, anxiety, and stress; and (c) anxiety: course semester, depression, and stress. Our findings revealed high levels of depression, anxiety, and stress symptoms in medical students, with marked differences among course semesters. Gender and religiosity appeared to influence the mental health of the medical students.