Spiritual well-being shows up in health data, and so does spiritual struggle

Key takeaways

• In a Harvard study of 74,534 nurses, women who attended religious services more than once a week had a 33% lower risk of dying over about 16 years than women who never attended.
• Spiritual struggle points the other way: older hospital patients who felt abandoned by God or blamed the devil for their illness had a higher risk of death over two years.
• About 21% of U.S. adults call themselves spiritual but not religious, and 40% feel deep spiritual peace at least weekly, according to a 2023-24 Pew survey.
• These findings come from observational studies, so no one can yet say that attending services or praying causes better health.
• As of its 2023 hospital manual, the Joint Commission told hospitals to accommodate patients’ religious and other spiritual services, so you can ask for spiritual support whatever you believe.

Between January 1996 and March 1997, researchers from Duke University and Bowling Green State University asked 596 hospitalized patients, all 55 or older, how they were coping spiritually with their illness¹². Then they waited two years to see who lived.

Most of the patients were Christian². The questions that mattered most were quiet ones. Patients’ answers to one statement, “wondered whether God had abandoned me,” predicted a higher risk of dying, even after the researchers accounted for their physical and mental health¹.

During the same years, Harvard researchers were tracking more than 74,000 nurses³. Women who went to religious services more than once a week turned out to have a one-third lower death rate than women who never went.

Side by side, those studies reveal a pattern. The life of the spirit shows up in health data, in both directions.

This guide covers how researchers measure the spirit, what the largest studies found, why a link isn’t proof, and what hospitals should offer. Each claim is rated on a four-level evidence scale.

Researchers measure the spirit with questionnaires, not scans

Spiritual well-being is usually described as a sense of meaning, inner peace and connection to something larger than yourself. No blood test or scan can see it, so researchers ask about it.

One of the most widely used tools is the FACIT-Sp, published by Peterman and colleagues in 2002⁵. It has 12 statements. People rate each one from 0 (“not at all”) to 4 (“very much”), for a total score between 0 and 48.

The FACIT-Sp began as an add-on to a cancer quality-of-life survey⁵. Later studies found that it splits into three parts: meaning, peace and faith. It doesn’t require belief in God, so religious and nonreligious people can both answer it.

It has limits. Answers are self-reported, and a 2022 study of seriously ill patients at the NIH Clinical Center noted that its own sample lacked diversity⁵. A score can tell you how someone feels. It can’t tell you whether their beliefs are true.

Researchers measure the hard side, too. In 2014, a team led by psychologist Julie Exline of Case Western Reserve University published the Religious and Spiritual Struggles Scale⁶. It covers six kinds of struggle, which fall into two rough groups.

• Struggles with the sacred: anger at God or feeling let down by God (divine), fear that evil forces are at work in your life (demonic), and nagging uncertainty about whether your beliefs are true (doubt).
• Struggles with people and purpose: feeling judged or hurt by religious people or groups (interpersonal), guilt over falling short of your own principles (moral), and a sense that your life lacks deep purpose (ultimate meaning).

Most Americans call themselves spiritual, and 1 in 5 skip religion

The Pew Research Center’s Religious Landscape Study surveyed 36,908 U.S. adults between July 2023 and March 2024⁷. It found that the share of Americans who identify as Christian has fallen from 78% in 2007 to 62%.

Spirituality hasn’t faded the same way. In the survey, 53% of adults called themselves both spiritual and religious, and 21% said they were spiritual but not religious⁸. Another 5% were religious but not spiritual, and 21% were neither.

The share who call themselves “very spiritual” rose a little, from 28% in 2017 to 32%⁸. Among people with no religious affiliation, 37% said they were spiritual but not religious.

Pew also asked how often people feel certain things⁹. Forty percent said they feel deep spiritual peace and well-being at least once a week. That figure was 49% among Christians and about one in five among the unaffiliated.

Other experiences were more widely shared. About 62% of adults feel strong gratitude every week, and 61% feel awe at the beauty of nature⁹.

This matters for health research. Most big studies measure attendance at services, because it’s easy to count. Millions of people tend their spirit in other ways, and science knows far less about them.

The strongest health data link longer life to showing up

The Harvard nurse study is the best-known example. Researchers led by Shanshan Li and Tyler VanderWeele followed 74,534 women in the Nurses’ Health Study from 1996 to 2012³. None had heart disease or cancer at the start.

Women who went more than once a week had a 33% lower risk of dying during the study than women who never went³. The drop was 26% for weekly attenders and 13% for those who went less than weekly. On average, the most frequent attenders lived about five months longer⁴.

Their death rates from heart disease and from cancer were lower, too, by 27% and 21%³.

The researchers then asked why. Social support explained about 23% of the link, and not smoking explained about 22%³. Fewer depressive symptoms explained 11%, and optimism 9%. No single factor explained most of it.

A second Harvard study looked at “deaths of despair,” meaning deaths from suicide, drug overdose or alcohol¹⁰. It followed 66,492 female nurses and 43,141 male health professionals for 16 to 26 years. Women who attended services at least weekly had a 68% lower risk of these deaths than women who never attended. For men, the risk was 33% lower.

In 2022, researchers led by Tracy Balboni and Tyler VanderWeele reviewed 215 studies of spirituality and health outcomes for the journal JAMA¹¹. An expert panel rated the evidence as strong that frequent attendance is linked to lower death rates, less depression, less suicidal behavior and less substance use. Pooled across studies, attenders had about a 27% lower risk of dying.

Spiritual struggle is the other side of the ledger

Back at Duke, higher overall scores on the struggle questions predicted a higher risk of death, though the increase was modest¹. Three items stood out: wondering whether God had abandoned them, questioning God’s love, and deciding the devil had caused the illness.

Duke’s news release put the added risk tied to these feelings at 19% to 28%². Neither the release nor the study summary says exactly what those percentages compare, so read them as a direction, not a precise size¹.

A follow-up of 268 patients added detail¹². Over two years, people who sought spiritual support or saw their illness in a hopeful religious light tended to improve. People who saw illness as God’s punishment, or who were at odds with their faith community, tended to decline. Those who kept struggling over time seemed most at risk.

Harold Koenig, a Duke psychiatrist on the team, called struggle a normal part of grief². Most people, he said, work through it and reconnect with God and their community. The worry is the smaller group that stays stuck.

In a 2021 summary, Exline reports that every type of struggle tracks with more depression, anxiety and stress⁶. A sense that life has lost its purpose shows the strongest link to mental health problems, loneliness among them. Doubt turns out to be one of the most common struggles.

The arrows run both ways⁶. Hard events and mental health problems tend to come before new spiritual struggles, and the struggles in turn come before worsening depression and anxiety. Struggle can also open a door to growth, Exline writes, especially for people who treat it as a normal part of life and confide in someone they trust.

Why a link is not proof

Every study above is observational. Researchers watched what people did; they didn’t assign anyone to worship. That leaves real room for other explanations.

Reverse causation is the first. People who are already sick may stop attending services, which would make attenders look healthier⁴. The Harvard team tried to handle this by measuring attendance again and again over time and adjusting for health. Still, no statistical method fully replaces a randomized trial, where people are assigned by chance.

The people studied are a narrow slice. The nurse studies involved mostly white Christian health professionals, a fairly health-conscious group⁴. Results may differ for other faiths, other countries and people with less income. The Duke sample was about 95% Christian².

Funding deserves the same scrutiny you’d give a drug-company study. The 2016 Harvard analysis was supported in part by a John Templeton Foundation grant, alongside federal funding for the nurse study itself⁴. Exline notes that Templeton funded two of her struggle projects as well⁶.

That doesn’t make the findings wrong. It’s a reason to read the methods closely.

Even the authors warn against overreading. The Harvard team wrote that their results don’t mean doctors should prescribe religious attendance³.

Claim	Evidence level	What the research shows
Frequent service attendance is linked to lower death rates	Strong evidence	Consistent across large cohorts; about 27% lower risk in pooled studies311
Attendance is linked to fewer suicides and overdose deaths	Strong evidence	Expert panel rating, plus large cohorts of health professionals1011
Attending services causes longer life	Not enough evidence	No randomized trials; illness and other factors could explain part of the link34
Spiritual struggle predicts worse health	Promising but early	Modest risks in a few cohorts; effects run in both directions1612
Private spirituality brings the same benefits as community worship	Not enough evidence	Few studies separate the two; social support explains part of the attendance link3
Spiritual care in serious illness is linked to better end-of-life outcomes	Strong evidence	Expert panel rating, mostly from observational studies, so cause isn’t proven11

Hospitals are supposed to ask about your spirit

Spiritual needs are common in serious illness, and they are often missed. In the 2022 JAMA review, studies found that 50% to 96% of seriously ill patients wanted spiritual care, yet 49% to 91% did not receive it¹¹. Unmet spiritual needs were linked to poorer quality of life.

The panel’s top recommendation for serious illness was to build spiritual care into routine medical care¹¹. It also urged training for care teams and the involvement of specialists such as chaplains.

The Joint Commission, which accredits hospitals, put some of this into its standards. Penn Medicine’s pastoral care department compiled the relevant rules from the July 2023 edition of the hospital manual¹³. Hospitals had to respect patients’ values and beliefs and accommodate their right to religious and other spiritual services. Assessments for substance use treatment, and for emotional and behavioral disorders, had to include the patient’s religion and spiritual beliefs.

The details shift over time. A Joint Commission FAQ for home care programs, last reviewed in 2022, says spiritual needs should be evaluated for people receiving end-of-life care or substance use treatment, and leaves the method to each organization¹⁴. Yet the February 2023 hospital manual dropped a separate item on spiritual needs at the end of life, according to the Penn compilation¹³. We could not confirm which of these rules remain in the current hospital manual, so ask your own hospital what it offers.

Chaplains are the trained specialists, but not every hospital has them. In 2003, about 59% of U.S. hospitals reported chaplaincy services, according to an analysis of American Hospital Association surveys by Wendy Cadge and colleagues¹⁵. Church-run and larger hospitals were far more likely to offer them than small, rural or government hospitals.

The 2003 figure is the most recent national count we could verify.

What to say if you want spiritual support in the hospital

• “Is there a chaplain or spiritual care team here? I’d like a visit.”
• “I’m not religious, but I’m struggling with what this diagnosis means. Is there someone I can talk to?”
• “My faith shapes how I make medical decisions. Can we note that in my chart?”
• “Can my own pastor, priest, imam, rabbi or spiritual teacher visit, and what are the rules?”
• “I’d like a few quiet minutes to pray or meditate before the procedure. Can we plan for that?”

A weekly check-in for your own spiritual well-being

Researchers look at meaning, peace and connection, and they watch for struggle. You can use the same four ideas for a private weekly check-in. This is a way to notice change before it becomes a crisis, not a validated test.

1. Meaning. Ask yourself what you did this week that felt worthwhile. If nothing comes to mind, choose one small act for next week that fits your values, such as calling someone who lives alone.
2. Peace. Ask when you felt settled and what was happening at the time. Then repeat that setting on purpose: a walk, a prayer, quiet before breakfast.
3. Connection. Ask who you shared something real with. In the nurse study, social support explained nearly a quarter of the attendance link³. Plan one shared activity: a service, a study group, a volunteer shift or a meal.
4. Struggle. Ask whether doubt, guilt or a loss of purpose is weighing on you. If so, name one person you trust enough to tell, a step Exline links to growth⁶.
5. Trend. Give each area a score from 0 to 10 and jot it down. If struggle stays high for several weeks, or meaning stays near zero, treat that as a signal to reach out, not as a failure.

Why this fits a natural-health life

Many natural-health readers already see health as more than the body. Spiritual well-being fits that view. It costs nothing, needs no product, and grows from practices far older than any supplement.

The research also backs a value many readers hold: community. The strongest data come from people who show up, week after week, alongside others³¹⁰.

Respect cuts both ways. Research can’t tell you which beliefs are true, and it shouldn’t be used to sell faith as a pill. Use it as one more reason to protect what gives your life meaning. Spiritual practice is a companion to medical care, not a replacement for it.

Questions readers ask

The bottom line

Spiritual well-being can be measured, and in large studies it tracks closely with health. People who attend services often tend to live longer and are less likely to die from suicide, overdose or alcohol. People who feel abandoned or punished by God, and stay stuck there, tend to fare worse.

What the research can’t yet show is cause. Treat these findings as a reason to tend your sense of meaning, peace and connection, and to ask for spiritual support when illness strikes. Don’t treat them as a prescription or a promise.

Related reading

• People come to wellness groups for answers and stay for belonging
• What meditation groups can do, and what they can stir up
• Living with a condition that isn’t going away
• How to tell psychiatrists, psychologists and therapists apart

Sources

1. Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. “Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study.” Archives of Internal Medicine, 2001 (abstract via Duke Scholars). scholars.duke.edu
2. Duke Health. “Religious struggle may indicate greater risk of death among elderly.” Duke University Medical Center news release, August 2001. corporate.dukehealth.org
3. Li S, Stampfer MJ, Williams DR, VanderWeele TJ. “Association of Religious Service Attendance With Mortality Among Women.” JAMA Internal Medicine, 2016 (author copy hosted by Harvard). pubmed.ncbi.nlm.nih.gov
4. Harvard T.H. Chan School of Public Health. “Frequent religious service attendance linked with decreased mortality risk among women.” Press release, May 16, 2016. hsph.harvard.edu
5. Ahmad N, Sinaii N, Panahi S, et al. “The FACIT-Sp spiritual wellbeing scale: a factor analysis in patients with severe and/or life-limiting medical illnesses.” Annals of Palliative Medicine, 2022. apm.amegroups.org
6. Exline J. “Religious and spiritual struggles.” Case Western Reserve University, May 5, 2021.
7. Pew Research Center. “Religious Landscape Study: Report.” Pew Research Center, February 26, 2025. pewresearch.org
8. Pew Research Center. “Spiritual and Religious Self-Descriptions.” Pew Research Center, February 26, 2025. pewresearch.org
9. Pew Research Center. “Spiritual Experiences.” Religious Landscape Study, February 26, 2025. pewresearch.org
10. Human Flourishing Program, Harvard University. “Deaths of Despair and the Role of Religion” (on Chen Y, Koh HK, Kawachi I, Botticelli M, VanderWeele TJ, JAMA Psychiatry, 2020). Harvard University, 2020. hfh.fas.harvard.edu
11. Balboni TA, VanderWeele TJ, Doan-Soares SD, et al. “Spirituality in Serious Illness and Health.” JAMA, 2022 (copy hosted by Harvard). pubmed.ncbi.nlm.nih.gov
12. Pargament KI, Koenig HG, Tarakeshwar N, Hahn J. “Religious coping methods as predictors of psychological, physical and spiritual outcomes among medically ill elderly patients: a two-year longitudinal study.” Journal of Health Psychology, 2004 (abstract via Duke Scholars). scholars.duke.edu
13. Penn Medicine Department of Pastoral Care. “Joint Commission Standards Referencing Spiritual or Religious Care” (from the July 1, 2023 Comprehensive Accreditation Manual for Hospitals). University of Pennsylvania Health System, May 2023. uphs.upenn.edu
14. The Joint Commission. “Does the Joint Commission specify what needs to be included in a spiritual assessment?” Standards FAQ, reviewed July 19, 2022. jointcommission.org
15. Cadge W, Freese J, Christakis NA. “The Provision of Hospital Chaplaincy in the United States: A National Overview.” Southern Medical Journal, 2008. humannaturelab.net