Journal of Religion and Health, Vol. 27, No. l, Spring 1988
Spiritual and E m o t i o n a l D e t e r m i n a n t s of Health JANET
A. MICHELLO
A B S T R A C T : Within our present health care system, there is a growing movement that argues
that our perceptions of health and illness are in need of change. This change includes redefining what we mean by health in terms of the whole person--the emotional, social, and spiritual dimensions of our being, as well as the physical. An increasing number of health professionals and social scientists believe our concepts of health and illness must consider all these aspects of life. It is believed that the quality of life may be enhanced by such perceptions of health, which include social and spiritual factors. Using data from the 1985 Akron Area Survey--The Subjective Quality of Life in the Akron Area--this study explores the effects of spiritual well-being and emotional wellbeing on health satisfaction. Results indicate that emotional and spiritual factors do significantly contribute to the subjective evaluation of health, especially for individuals who are physically limited.
L i t e r a t u r e w i t h i n t h e f i e l d o f m e d i c a l s o c i o l o g y i n d i c a t e s t h a t h e a l t h is p o s i t i v e l y r e l a t e d to a v a r i e t y o f l i f e c i r c u m s t a n c e s . T h e p u r p o s e o f t h i s s t u d y is to examine the relation between an individual's emotional and spiritual wellb e i n g a s o n e life c i r c u m s t a n c e w h i c h c a n a f f e c t a n i n d i v i d u a l ' s s a t i s f a c t i o n with health. In the United States, health has typically been viewed by medical profess i o n a l s a s a n a b s e n c e o f d i s e a s e - - " a s t a t i c p e r f e c t e d s t a t e o f b e i n g . ''1 T h i s o v e r s i m p l i f i e d d e f i n i t i o n is b e i n g a n d h a s b e e n d e b a t e d . F o r e x a m p l e , t h e World Health Organization no longer defines health as an absence of disease, but as a state of complete physical, mental, and social well-being. 2 Dubos t a k e s t h i s d e f i n i t i o n f u r t h e r a n d r e f e r s to h e a l t h a s a d a p t i n g to a n e v e r - c h a n g ing biological and social environment. 3 Yet in spite of the definition of health, w e h a v e c o m e t o r e c o g n i z e t h a t h e a l t h is a f f e c t e d b y a v a r i e t y o f life circumstances. Since the first epidemiological surveys in the nineteenth century, income, Janet A. Michello is a doctoral student in the Department of Sociology at The University of Akron in Akron, Ohio. An earlier draft of this paper was presented at the joint session of the Association for the Sociology of Religion and the American Sociological Association, August 20, 1986. The author would like to thank Margaret Poloma, Ph.D., The University of Akron, and Mark Tausig, Ph.D., The University of Akron, for their helpful comments. 62
9 1988 Institutes of Religion and Health
Janet A. Michello
63
sex, race, and ethnicity have been reported to be associated with physical and mental health. In addition, morbidity and mortality statistics show significant differences when comparing and contrasting demographic variables. Yet another life circumstance that can potentially affect satisfaction with health is that of spiritual well-being. Within the past decade, the study of health is beginning to be investigated by researchers in the sociology of religion. The history of the relation between religion and health is nearly as long as the history of humankind. 4 However, the examination of the relation between religious behavior and health is in its infancy. 5 Although its role in health-related behavior often has been recognized, most health studies have gone no deeper into religious behavior than to classify subjects by religion or creed2 Some researchers have gone a step further and have explored the role of health and church attendance. For example, Comstock and Partridge investigated frequency of church attendance and coronary disease mortality, 7 and Graham and his co-authors explored frequency of church attendance and blood pressure elevation. 8 Studies such as these support the contention that religious activity may provide social support and act as a buffer against certain illnesses. Also from the social support perspective, additional studies have viewed religion as a type of social support that may encourage preventive health. For example, Medalie and others found in their study of first myocardial infarctions that the more religious developed fewer infarcts? However, considering spiritual well-being and not church attendance or church affiliation as a factor in the medical and health disciplines may be difficult for many health professionals to accept. Dunn notes that for those reared in the Western culture, a deep cleavage exists between the realm of the spirit and that of the body.1~However, in order for high-level wellness to be achieved, physicians must take into account spiritual as well as physical considerations if they are to do an effective job of helping patients achieve good health of body and mind. "No person can be well physically if he is sick spiritually."" This view of the interconnectedness between the body and spirit is supported by others such as Benson, ~2 Reisser and others, ~3 and Tubesing. 14 Benson states that our potential for well-being is shaped by the negative or positive ways we think. He views medical and scientific research as demonstrating that the things we touch, taste, and measure frequently need to take a back seat to what we perceive or believe to be real. According to this view, it is how we interpret reality that is important. If individuals truly believe in their personal philosophy or faith, they may well be capable of achieving remarkable feats of mind and body.'5 Reisser and his co-authors note for nearly all of human history the diagnosis and treatment of the body have belonged to the realm of the supernatural. 1~It has been only recently that the study of the human body has been separated from a supernatural overlay. As a result, treatment and prevention of physical problems involve physicians, hospitals, drugs, surgery--products of the scientific advances of our time. However, in the past several years, our health care
Journal of Religion and Health
64
system has been under attack from the media, government, and consumer. In addition, there has been a growing movement that argues the present health care system has lost touch with the human soul and spirit. This movement, the holistic health movement, focuses on treating the health care seeker as a unique, whole, priceless being. A person is body, mind, and spirit. 17 Tubesing, TM like Dunn, 19 calls for a redefinition of health and illness in the context of a broader view of the quality of life to include the whole p e r s o n - - t h e mental, emotional, and spiritual sides of life, in addition to the physical. Tubesing seeks to promote holistic health centers that use an interdisciplinary team of health professionals by treating the whole person. This approach requires searching with the individual all dimensions of life (physical, emotional, intellectual, spiritual, interpersonal) for causes and symptoms of disease. Tubesing believes the health care of the future must be based on the premise that illness and health are functions of every respect of life. The medicine of the future will not separate body, mind, and spirit, but will treat the person taking his or her will and belief system seriously. Tubesing envisions the future of medicine to supplement traditional treatments such as medications, surgery, and x-rays with friendship, love, and worship. He foresees the spiritual side of life as the organizing principle--central to health and the meaning of life. 2~ Thus, we can from the aforementioned studies deduce the significance of religious beliefs for satisfaction with health. Yet from studies that have analyzed the relation between spirituality and satisfaction with health, this relation is unclear. For example, Campbell and other and Andrews and Withey all included religiosity items that correlated with measures of well-being and life satisfaction. However, Andrews and Withey reported a positive association between religiosity and life satisfaction, whereas Campbell and his co-authors reported a negative association. Hadaway then reanalyzed the data and reported a positive relationship2 In addition, numerous religiosity studies are limited methodologically. For instance, many of the samples have primarily consisted of specific groups that are not generalizable to the larger population--for example, using college students 22 or community volunteers ~3 as the sample population. Furthermore, the operational definition of spiritual well-being has not been consistent. 24 Thus, this study proposes to lend clarification to such shortcomings in an effort to ascertain the relation between a dimension of spirituality and satisfaction with health.
Research design and methods Data for this study came from the Fall 1985 Akron Area Survey (Summit County, Ohio). Adult household members were interviewed on the telephone after they were selcted using a random digit dialing procedure. The interviews were conducted by undergraduate and graduate students in the De-
Janet A. Michello
65
partment of Sociology, The University of Akron. The total number of completed interviews was 560. Sixty percent of the sample were women and 87 were white. This racial distribution is consistent with the population of Summit County. The age range was 18 to 95 with a mean of 36. Fifty percent of the sample were married, 15% divorced or separated, 10% widowed, and 20% never married. Fifty-four percent were Protestant, 25% Catholic, 1% Jewish, and the remainder classified as Other. The income range was "less t h a n $5,000" to "$50,000 or more" with a mean of $20,000. Forty percent had a high school diploma, and 20 had completed college or postgraduate studies. This study is based on Gray and Moberg's conceptualization of spiritual well-being as including all people, even if they practice no personal pieties and/or have no use for religious institutions?5 In his writings, Moberg consistently refers to the NICA (National Interfaith Coalition on Aging, 1975) definition of spiritual well-being as "an affirmation of life in a relationship with God, self, community, and environment t h a t nurtures and celebrates wholeness. ''~ Conceptualizing spiritual well-being as applicable to all people removes this study from focusing on religious groups such as church membership, church participation, church activities, and moves it toward the inclusion of a population regardless of any religious affiliation. This approach also includes people who are non-Christian in their b e l i e f s - - a n approach infrequently taken, since most religiosity studies have focused on various Christian denominations or groups. Therefore, this view assumes "all people are spiritual. ''27 Moberg recognizes t h a t religion and spiritual well-being are not synonymous or unidimensional. He suggests tapping various dimensions of spiritual well-being and constructing varying indices. 28 The single item "relationship with God" is used in this study to measure one dimension of spiritual well-being. This view of spirituality is consistent with Moberg's concept of spiritual well-being and Cornwall and his co-authors in their spiritual commitment scale. The independent variable, "relationship with God," was measured by asking respondents how they would describe their personal relationship with God on a scale of one to seven (coded: 1 = "distant" to 7 = "close"). Two dimensions (independent variables) of emotional well-being are used in this study. The first dimension, "existential well-being," consisted of two i t e m s - - l i f e direction and purpose. Respondents were asked to respond to a four-point scale (coded: 1 ="strongly disagree;" 2 = " s o m e w h a t disagree;" 3 = "somewhat agree;" and 4 = "strongly agree") for the following two questions: (1) "I feel a sense of well-being about the direction my life is headed" (life direction), and (2) "I believe there is some real purpose for my life" (purpose). These two items formed a scale with a reliability of alpha = .64. The second dimension of emotional well-being, "depressed mood," was measured by a set of items from the CES-D Scale2 ~ Respondents were asked to describe on a scale of one to seven, "How frequently during the past
Journal of Religion and Health
66
year you have f e l t . . . ": "depressed"; "lonely"; "sad"; "tense"; and "fearful." These five items were coded 1 = "all the time" to 7 = "never." They formed a scale with a reliability of a l p h a = .80. These two dimensions of emotional well-being are conceptually separate21 "Existential well-being" refers to the respondents' score on positive affect, and "depressed mood" refers to the respondents' score on negative affect. Life direction and purpose ("existential well-being") refer to perceiving life as worthwhile and meaningful,32 and "depressed mood" refers to subjectively feeling blue, depressed, lonely, sad. 33 The dependent variable, "satisfaction with health," was a subjective measure assessed by asking respondents to rate their health satisfaction on three seven-point scales: (1) "miserable" to "enjoyable;" (2) "disappointing" to "rewarding"; and (3) "dissatisfied" to "satisfied" (coded: 1-7). These items formed a scale with a reliability of a l p h a = .94. Subjective measures of health have frequently been used in quality-of-life studies24 A control variable was also included in this study. Since physical limitation could have a significant impact on one's level of health satisfaction, the respondents were asked the question, "Do you have any health problems or conditions t h a t have limited the amount or kind of work t h a t you can do?" (dummy coded: 0 = no and 1 = yes) Demographic variables were the respondents' age, race, income, and sex. Race and sex were coded as dummy variables (blacks and males were coded zero). As previously mentioned, these demographic measures have been included in numerous social-epidemiologic studies.
Results The results of this study are based on the research hypothesis t h a t there is a direct relation between satisfaction with health and spiritual and emotional well-being. Table 1 reports the mean scores for all variables. The first column represents all cases combined, and columns 2 and 3 are cases of individuals reporting no health limitation and health limitation respectively. A comparison of the health limited and not limited groups indicate t h a t having a limitation t h a t interferes with normal work or daily activities has a negative impact on scores of health satisfaction, depressed mood, and existential well-being. In addition, the limited group consists of more females, more blacks, lower income and older individuals. However, the limited group scored higher on the relationship with God variable (closer relationship with God). In order to investigate these findings and discern whether the variable, "health limitation," was confounding the relation between spiritual wellbeing, emotional well-being, and satisfaction with health, multiple regression analyses were conducted. Table 2 reports the unstandardized and standardized beta coefficients and R 2 for: (1) the not limited group; and (2) the health limited
Janet A. Michello
67
TABLE 1 Mean Scores. All Variables All C a s e s (N = 507) Health Limitation c Health Satisfaction D e p r e s s e d Mood Existential Well-Being R e l a t i o n s h i p w i t h God Race ~ Sex b Income Age
.205 5.286 4.678 3.452 5.290 .892 .600 5.018($20,000) 6.170 (40)
Not Health Limited (N = 403)
6.162 4.757 3.458 5.199 .896 .581 5.352 ($22,000) 5.536 (38)
Health Limited (N = 104)
4.526 4.372 3.428 5.644 .875 .673 3.721 ($15,000) 8.625 (55)
a. d u m m y coded 0 = black; 1 = w h i t e b. d u m m y coded 0 = m a l e ; 1 = f e m a l e c. d u m m y coded 0 - n o t h e a l t h limited; 1 = h e a l t h l i m i t e d
group. As indicated, when the emotional well-being variables ("existential well-being" and "depressed mood") and the spirituality variable ("relationship with God") are entered into the regression equation with the demographic variables, none of the demographic factors are significant for either the health limited group or the not limited group. Both the emotional well-being variTABLE 2 Predictive Measures o f Health Satisfaction from Emotional Well-Being, Spiritual Well-Being, and Demographic Factors. Not H e a l t h L i m i t e d (N = 403) Unstandardized Betas Age Race a Sex b Income Existential Well-Being D e p r e s s e d Mood Relationship w i t h God (constant) *p
Spiritual and E m o t i o n a l D e t e r m i n a n t s of Health JANET
A. MICHELLO
A B S T R A C T : Within our present health care system, there is a growing movement that argues
that our perceptions of health and illness are in need of change. This change includes redefining what we mean by health in terms of the whole person--the emotional, social, and spiritual dimensions of our being, as well as the physical. An increasing number of health professionals and social scientists believe our concepts of health and illness must consider all these aspects of life. It is believed that the quality of life may be enhanced by such perceptions of health, which include social and spiritual factors. Using data from the 1985 Akron Area Survey--The Subjective Quality of Life in the Akron Area--this study explores the effects of spiritual well-being and emotional wellbeing on health satisfaction. Results indicate that emotional and spiritual factors do significantly contribute to the subjective evaluation of health, especially for individuals who are physically limited.
L i t e r a t u r e w i t h i n t h e f i e l d o f m e d i c a l s o c i o l o g y i n d i c a t e s t h a t h e a l t h is p o s i t i v e l y r e l a t e d to a v a r i e t y o f l i f e c i r c u m s t a n c e s . T h e p u r p o s e o f t h i s s t u d y is to examine the relation between an individual's emotional and spiritual wellb e i n g a s o n e life c i r c u m s t a n c e w h i c h c a n a f f e c t a n i n d i v i d u a l ' s s a t i s f a c t i o n with health. In the United States, health has typically been viewed by medical profess i o n a l s a s a n a b s e n c e o f d i s e a s e - - " a s t a t i c p e r f e c t e d s t a t e o f b e i n g . ''1 T h i s o v e r s i m p l i f i e d d e f i n i t i o n is b e i n g a n d h a s b e e n d e b a t e d . F o r e x a m p l e , t h e World Health Organization no longer defines health as an absence of disease, but as a state of complete physical, mental, and social well-being. 2 Dubos t a k e s t h i s d e f i n i t i o n f u r t h e r a n d r e f e r s to h e a l t h a s a d a p t i n g to a n e v e r - c h a n g ing biological and social environment. 3 Yet in spite of the definition of health, w e h a v e c o m e t o r e c o g n i z e t h a t h e a l t h is a f f e c t e d b y a v a r i e t y o f life circumstances. Since the first epidemiological surveys in the nineteenth century, income, Janet A. Michello is a doctoral student in the Department of Sociology at The University of Akron in Akron, Ohio. An earlier draft of this paper was presented at the joint session of the Association for the Sociology of Religion and the American Sociological Association, August 20, 1986. The author would like to thank Margaret Poloma, Ph.D., The University of Akron, and Mark Tausig, Ph.D., The University of Akron, for their helpful comments. 62
9 1988 Institutes of Religion and Health
Janet A. Michello
63
sex, race, and ethnicity have been reported to be associated with physical and mental health. In addition, morbidity and mortality statistics show significant differences when comparing and contrasting demographic variables. Yet another life circumstance that can potentially affect satisfaction with health is that of spiritual well-being. Within the past decade, the study of health is beginning to be investigated by researchers in the sociology of religion. The history of the relation between religion and health is nearly as long as the history of humankind. 4 However, the examination of the relation between religious behavior and health is in its infancy. 5 Although its role in health-related behavior often has been recognized, most health studies have gone no deeper into religious behavior than to classify subjects by religion or creed2 Some researchers have gone a step further and have explored the role of health and church attendance. For example, Comstock and Partridge investigated frequency of church attendance and coronary disease mortality, 7 and Graham and his co-authors explored frequency of church attendance and blood pressure elevation. 8 Studies such as these support the contention that religious activity may provide social support and act as a buffer against certain illnesses. Also from the social support perspective, additional studies have viewed religion as a type of social support that may encourage preventive health. For example, Medalie and others found in their study of first myocardial infarctions that the more religious developed fewer infarcts? However, considering spiritual well-being and not church attendance or church affiliation as a factor in the medical and health disciplines may be difficult for many health professionals to accept. Dunn notes that for those reared in the Western culture, a deep cleavage exists between the realm of the spirit and that of the body.1~However, in order for high-level wellness to be achieved, physicians must take into account spiritual as well as physical considerations if they are to do an effective job of helping patients achieve good health of body and mind. "No person can be well physically if he is sick spiritually."" This view of the interconnectedness between the body and spirit is supported by others such as Benson, ~2 Reisser and others, ~3 and Tubesing. 14 Benson states that our potential for well-being is shaped by the negative or positive ways we think. He views medical and scientific research as demonstrating that the things we touch, taste, and measure frequently need to take a back seat to what we perceive or believe to be real. According to this view, it is how we interpret reality that is important. If individuals truly believe in their personal philosophy or faith, they may well be capable of achieving remarkable feats of mind and body.'5 Reisser and his co-authors note for nearly all of human history the diagnosis and treatment of the body have belonged to the realm of the supernatural. 1~It has been only recently that the study of the human body has been separated from a supernatural overlay. As a result, treatment and prevention of physical problems involve physicians, hospitals, drugs, surgery--products of the scientific advances of our time. However, in the past several years, our health care
Journal of Religion and Health
64
system has been under attack from the media, government, and consumer. In addition, there has been a growing movement that argues the present health care system has lost touch with the human soul and spirit. This movement, the holistic health movement, focuses on treating the health care seeker as a unique, whole, priceless being. A person is body, mind, and spirit. 17 Tubesing, TM like Dunn, 19 calls for a redefinition of health and illness in the context of a broader view of the quality of life to include the whole p e r s o n - - t h e mental, emotional, and spiritual sides of life, in addition to the physical. Tubesing seeks to promote holistic health centers that use an interdisciplinary team of health professionals by treating the whole person. This approach requires searching with the individual all dimensions of life (physical, emotional, intellectual, spiritual, interpersonal) for causes and symptoms of disease. Tubesing believes the health care of the future must be based on the premise that illness and health are functions of every respect of life. The medicine of the future will not separate body, mind, and spirit, but will treat the person taking his or her will and belief system seriously. Tubesing envisions the future of medicine to supplement traditional treatments such as medications, surgery, and x-rays with friendship, love, and worship. He foresees the spiritual side of life as the organizing principle--central to health and the meaning of life. 2~ Thus, we can from the aforementioned studies deduce the significance of religious beliefs for satisfaction with health. Yet from studies that have analyzed the relation between spirituality and satisfaction with health, this relation is unclear. For example, Campbell and other and Andrews and Withey all included religiosity items that correlated with measures of well-being and life satisfaction. However, Andrews and Withey reported a positive association between religiosity and life satisfaction, whereas Campbell and his co-authors reported a negative association. Hadaway then reanalyzed the data and reported a positive relationship2 In addition, numerous religiosity studies are limited methodologically. For instance, many of the samples have primarily consisted of specific groups that are not generalizable to the larger population--for example, using college students 22 or community volunteers ~3 as the sample population. Furthermore, the operational definition of spiritual well-being has not been consistent. 24 Thus, this study proposes to lend clarification to such shortcomings in an effort to ascertain the relation between a dimension of spirituality and satisfaction with health.
Research design and methods Data for this study came from the Fall 1985 Akron Area Survey (Summit County, Ohio). Adult household members were interviewed on the telephone after they were selcted using a random digit dialing procedure. The interviews were conducted by undergraduate and graduate students in the De-
Janet A. Michello
65
partment of Sociology, The University of Akron. The total number of completed interviews was 560. Sixty percent of the sample were women and 87 were white. This racial distribution is consistent with the population of Summit County. The age range was 18 to 95 with a mean of 36. Fifty percent of the sample were married, 15% divorced or separated, 10% widowed, and 20% never married. Fifty-four percent were Protestant, 25% Catholic, 1% Jewish, and the remainder classified as Other. The income range was "less t h a n $5,000" to "$50,000 or more" with a mean of $20,000. Forty percent had a high school diploma, and 20 had completed college or postgraduate studies. This study is based on Gray and Moberg's conceptualization of spiritual well-being as including all people, even if they practice no personal pieties and/or have no use for religious institutions?5 In his writings, Moberg consistently refers to the NICA (National Interfaith Coalition on Aging, 1975) definition of spiritual well-being as "an affirmation of life in a relationship with God, self, community, and environment t h a t nurtures and celebrates wholeness. ''~ Conceptualizing spiritual well-being as applicable to all people removes this study from focusing on religious groups such as church membership, church participation, church activities, and moves it toward the inclusion of a population regardless of any religious affiliation. This approach also includes people who are non-Christian in their b e l i e f s - - a n approach infrequently taken, since most religiosity studies have focused on various Christian denominations or groups. Therefore, this view assumes "all people are spiritual. ''27 Moberg recognizes t h a t religion and spiritual well-being are not synonymous or unidimensional. He suggests tapping various dimensions of spiritual well-being and constructing varying indices. 28 The single item "relationship with God" is used in this study to measure one dimension of spiritual well-being. This view of spirituality is consistent with Moberg's concept of spiritual well-being and Cornwall and his co-authors in their spiritual commitment scale. The independent variable, "relationship with God," was measured by asking respondents how they would describe their personal relationship with God on a scale of one to seven (coded: 1 = "distant" to 7 = "close"). Two dimensions (independent variables) of emotional well-being are used in this study. The first dimension, "existential well-being," consisted of two i t e m s - - l i f e direction and purpose. Respondents were asked to respond to a four-point scale (coded: 1 ="strongly disagree;" 2 = " s o m e w h a t disagree;" 3 = "somewhat agree;" and 4 = "strongly agree") for the following two questions: (1) "I feel a sense of well-being about the direction my life is headed" (life direction), and (2) "I believe there is some real purpose for my life" (purpose). These two items formed a scale with a reliability of alpha = .64. The second dimension of emotional well-being, "depressed mood," was measured by a set of items from the CES-D Scale2 ~ Respondents were asked to describe on a scale of one to seven, "How frequently during the past
Journal of Religion and Health
66
year you have f e l t . . . ": "depressed"; "lonely"; "sad"; "tense"; and "fearful." These five items were coded 1 = "all the time" to 7 = "never." They formed a scale with a reliability of a l p h a = .80. These two dimensions of emotional well-being are conceptually separate21 "Existential well-being" refers to the respondents' score on positive affect, and "depressed mood" refers to the respondents' score on negative affect. Life direction and purpose ("existential well-being") refer to perceiving life as worthwhile and meaningful,32 and "depressed mood" refers to subjectively feeling blue, depressed, lonely, sad. 33 The dependent variable, "satisfaction with health," was a subjective measure assessed by asking respondents to rate their health satisfaction on three seven-point scales: (1) "miserable" to "enjoyable;" (2) "disappointing" to "rewarding"; and (3) "dissatisfied" to "satisfied" (coded: 1-7). These items formed a scale with a reliability of a l p h a = .94. Subjective measures of health have frequently been used in quality-of-life studies24 A control variable was also included in this study. Since physical limitation could have a significant impact on one's level of health satisfaction, the respondents were asked the question, "Do you have any health problems or conditions t h a t have limited the amount or kind of work t h a t you can do?" (dummy coded: 0 = no and 1 = yes) Demographic variables were the respondents' age, race, income, and sex. Race and sex were coded as dummy variables (blacks and males were coded zero). As previously mentioned, these demographic measures have been included in numerous social-epidemiologic studies.
Results The results of this study are based on the research hypothesis t h a t there is a direct relation between satisfaction with health and spiritual and emotional well-being. Table 1 reports the mean scores for all variables. The first column represents all cases combined, and columns 2 and 3 are cases of individuals reporting no health limitation and health limitation respectively. A comparison of the health limited and not limited groups indicate t h a t having a limitation t h a t interferes with normal work or daily activities has a negative impact on scores of health satisfaction, depressed mood, and existential well-being. In addition, the limited group consists of more females, more blacks, lower income and older individuals. However, the limited group scored higher on the relationship with God variable (closer relationship with God). In order to investigate these findings and discern whether the variable, "health limitation," was confounding the relation between spiritual wellbeing, emotional well-being, and satisfaction with health, multiple regression analyses were conducted. Table 2 reports the unstandardized and standardized beta coefficients and R 2 for: (1) the not limited group; and (2) the health limited
Janet A. Michello
67
TABLE 1 Mean Scores. All Variables All C a s e s (N = 507) Health Limitation c Health Satisfaction D e p r e s s e d Mood Existential Well-Being R e l a t i o n s h i p w i t h God Race ~ Sex b Income Age
.205 5.286 4.678 3.452 5.290 .892 .600 5.018($20,000) 6.170 (40)
Not Health Limited (N = 403)
6.162 4.757 3.458 5.199 .896 .581 5.352 ($22,000) 5.536 (38)
Health Limited (N = 104)
4.526 4.372 3.428 5.644 .875 .673 3.721 ($15,000) 8.625 (55)
a. d u m m y coded 0 = black; 1 = w h i t e b. d u m m y coded 0 = m a l e ; 1 = f e m a l e c. d u m m y coded 0 - n o t h e a l t h limited; 1 = h e a l t h l i m i t e d
group. As indicated, when the emotional well-being variables ("existential well-being" and "depressed mood") and the spirituality variable ("relationship with God") are entered into the regression equation with the demographic variables, none of the demographic factors are significant for either the health limited group or the not limited group. Both the emotional well-being variTABLE 2 Predictive Measures o f Health Satisfaction from Emotional Well-Being, Spiritual Well-Being, and Demographic Factors. Not H e a l t h L i m i t e d (N = 403) Unstandardized Betas Age Race a Sex b Income Existential Well-Being D e p r e s s e d Mood Relationship w i t h God (constant) *p
