Frontiers in Psychiatry
Ilaria Coppola1*, Nadia Rania1*, Rosa Parisi2* and Francesca Lagomarsino1*
01 April 2021
nbcnews
Abstract
During the COVID-19 pandemic in Italy, people and families experienced a new and sudden situation that forced them to stay in their homes for a long period (February 25- May 26).
In this context, many people found themselves in great difficulty, not only because of the fear of contagion or the economic problems deriving from the closure of production activities but also because the virus profoundly changed the way of life in society.
The “Social distancing” concept became central in all personal relationships, including close family relationships.
In this situation, our paper seeks to understand the role of spirituality and religiosity in reacting to this difficult situation and in particular on the physical and psychological health of the people involved.
The data we present here are part of a multidisciplinary research with a quantitative theoretical framework.
As the data was collected during the first Italian lockdown, a total of 1,250 adults from all over Italy participated in the on-line questionnaire.
Among the main results it emerged that the participants perceived lower levels of spiritual well-being and mental health than the pre-pandemic situation with a significant gender difference; in fact, women perceived lower mental health than men.
At the same time, it is evident that spirituality and religious practices are a protective factor connected not only with psychological and mental but also physical health.
Finally, it appears evident that the family is a protective factor with respect to mental health, even in a period so full of stress factors, those who did not live alone and especially those who had to take care of small children reported higher perceived mental health and a greater ability to activate coping resources.
… it is evident that spirituality and religious practices are a protective factor connected not only with psychological and mental but also physical health.
… it appears evident that the family is a protective factor with respect to mental health, even in a period so full of stress factors
ORIGINAL PUBLICATION (excerpt)
Introduction
The catastrophic and unstoppable nature of COVID-19 has produced a series of devastating effects from an economic, social and psychological point of view at a global level.
At different times and with different strategies, the whole world is tackling the challenges dictated by the pandemic, implementing physical distancing and the partial or general closure of shops, sports centers, schools, community centers and religious institutions, also encouraging, where possible, smart-working ( 1).
In this way, points of reference and crucial meeting places for socialization and also for the performance of religious functions, which are such necessary pillars for mutual support in general, and even more fundamental in this complex period, have been lacking.
Despite this, the population, demonstrating resilience and marked adaptation skills, immediately implemented compensatory strategies to cope with the social isolation into which they were forced: in fact, innumerable initiatives were created online to offer solidarity physical, psychological and spiritual well-being.
Online communities came together to practice recreational, sports and spiritual-religious activities “together.”
Moreover, Yang et al., for example, argue how the use of 360° virtual tour offer a tourist experience in a moment in which the directives are to stay at home; this type of activity can, therefore, help reduce the stress caused by the pandemic ( 2).
These activities, particularly of a religious nature, made it possible to reduce the physical distances imposed by forced isolation without putting people’s health at risk ( 3, 4), helping to reduce the negative effects of isolation, particularly in older people ( 5, 6).
For many people, spiritual and religious practices give meaning, purpose and constitute a supportive community ( 7, 8).
While, on the one hand the online initiatives managed to mitigate the negative effects of this situation, on the other, the restrictions adopted, while managing to slow down the infection, did not lead to the reduction of deaths, at least in some areas of the world where they continue to be high: today there are 1.18 million victims worldwide, of which 277.135 in Europe alone and unfortunately the statistics vary considerably day after day ( 9).
Religion and Spirituality: Same Chromatic Scale?
As Thunè-Boyle et al. ( 14) underline, religion and spirituality appear as parts of the same chromatic scale.
Although religion and spirituality represent, in fact, two different constructs, they are nevertheless strictly interconnected and difficult to separate ( 15).
Furthermore, the literature highlights how they are the reference point for the life of many people, especially in times of difficulty ( 16– 20).
Although religion and spirituality represent, in fact, two different constructs, they are nevertheless strictly interconnected and difficult to separate ( 15).
… the literature highlights how they are the reference point for the life of many people, especially in times of difficulty
Religiosity has been defined as a multidimensional construct, oriented toward institutions and traditions ( 21), considered as a system of beliefs and practices ( 22) and defined by norms, rules, dogmas and rituals, uniting people who share the same creed ( 18).
Religiosity has been defined as a multidimensional construct, oriented toward institutions and traditions, considered as a system of beliefs and practices and defined by norms, rules, dogmas and rituals, uniting people who share the same creed .
Many authors have highlighted how those who are faced with adverse personal life situations — such as a disease like cancer ( 23, 24) or the death of a loved one ( 25– 27), particularly troubled migration paths ( 28, 29) or events involving the wider community such as earthquakes, tsunamis ( 30) tend to be more religious.
As reported by Galen ( 31), the effects of religiosity on well-being seem to be related more to social support, a healthy lifestyle and the idea of existential certainty, than to the religious content of the beliefs in themselves; it would seem, in fact, that a large part of the advantage of religious individuals derives from being members of social groups.
Many authors have highlighted how those who are faced with adverse personal life situations …or events involving the wider community such as earthquakes, tsunamis tend to be more religious.
…it would seem, in fact, that a large part of the advantage of religious individuals derives from being members of social groups.
Spirituality, on the other hand, is seen as a more intimate dimension ( 18), a larger construct, an individual effort to discover the sacred or meaning of life ( 22) without confessional constraints ( 21, 32).
Furthermore, it is defined by Puchalski et al. ( 33) as essential for humanity, a dimension, therefore, which contains within it philosophical, cultural and religious beliefs and practices.
Spirituality, on the other hand, is seen as a more intimate dimension, a larger construct, an individual effort to discover the sacred or meaning of life without confessional constraints.
… it is defined by Puchalski et al. as essential for humanity, a dimension, therefore, which contains within it philosophical, cultural and religious beliefs and practices.
Spiritual Wellbeing and Mental Health
Spirituality, a source of comfort, support and meaning ( 7), instills the idea of a sense of belonging and existential interconnectedness, promoting mental health ( 34).
In the literature, in fact, the accent has been placed on the association that exists between having spirituality and having a greater perception of well-being, physical and mental health ( 7, 19, 34, 34– 37).
A particularly important aspect is related to coping, or the function performed by spiritual well-being in the management of stressful events.
Spiritual coping can be understood as cognitive and behavioral efforts to find or maintain meaning, purpose and connection in the face of difficult situations ( 38).
Spirituality, a source of comfort, support and meaning , instills the idea of a sense of belonging and existential interconnectedness, promoting mental health.
Furthermore, some authors over the years have argued that faith and spirituality can also be perceived as a source of resilience both from a physical, psychological and mental point of view ( 7, 39).
Especially in stressful situations, faith and spirituality seem to also act positively ( 3, 40, 41) on the immune system, particularly for older people ( 3, 40) who are also those most involved in religious and/or spiritual activities ( 15).
…some authors over the years have argued that faith and spirituality can also be perceived as a source of resilience both from a physical, psychological and mental point of view…
Especially in stressful situations,
Furthermore, spiritual well-being is defined as a state that connects the mind and body of the individual, society, intelligence and health, supporting the individual in his/her attitudes and life goals ( 42).
According to Ellison ( 43), moreover, spiritual well-being includes both a psycho-social dimension and a more religious dimension, a unifying force that aims to integrate the physical, emotional and social dimensions of health.
… spiritual well-being is defined as a state that connects the mind and body of the individual, society, intelligence and health, supporting the individual in his/her attitudes and life goals.
… moreover, spiritual well-being includes both a psycho-social dimension and a more religious dimension, a unifying force that aims to integrate the physical, emotional and social dimensions of health.
A study by Saiz et al. ( 44) demonstrated that spirituality in people with heart failure has broader associations with measures of psychosocial and physical symptoms than belonging to a religious organization and that religious affiliation alone did not emerge as a reliable predictor for health benefits.
Indeed, it was even counterproductive: in fact they found that those who belonged to a religious organization, but with a low level of spirituality, perceived a state of anxiety and greater emotional fatigue.
The literature also highlights how spiritual well-being is significantly higher in women than in men ( 34, 45).
… spirituality in people with heart failure has broader associations with measures of psychosocial and physical symptoms than belonging to a religious organization and that religious affiliation alone did not emerge as a reliable predictor for health benefits.
Indeed, it was even counterproductive
Religion and spirituality, therefore, are particularly fundamental and worthy of study in this highly complex period: COVID-19 and its physical, social and psychological consequences represent a challenge for the mental well-being of the entire world population ( 37, 49).
Religion and spirituality, therefore, are particularly fundamental and worthy of study in this highly complex period:
COVID-19 and its physical, social and psychological consequences represent a challenge for the mental well-being of the entire world population
Death in Modern Society and Its Rituals: From the Religious Dimension to Psychological Well-Being
Loewenthal and Dein ( 58) emphasize how religious rituals offer a range of positive mental health benefits, from reduced anxiety to meaning in life and a sense of community.
Moreover, as reported by Willard et al. ( 59), institutional religious practices sometimes affect subjective well-being even more than personal belief or individual spirituality.
Finally, the lack of rituals can compromise the ability to connect with the deceased ( 10), strongly affecting the restoration of well-being in those who remain and who must face mourning their loss without moments of sharing with a wider relational network. which can offer support.
“The absence of ritual, such as a funeral, often results in disenfranchised grief, and lacking social or cultural recognition impairs support resources that assist the grieving process” [( 13). p. 80].
The process of mourning requires a complex convergence of affective responses, cognitive, behavioral, physical and spiritual adaptations that take shape through rituals and flow into an individualized equilibrium that is a source of well-being.
The Pandemic in Italy: Images of Collective Death and Missed Rites
The pandemic has produced a shock of reality, progressively exposing us to the awareness of an extreme risk, that of death, as a collective community experience, typical of situations of war and natural catastrophes, as opposed to an individual one, in which the experience of passing away acquired the tragedy of an individual and family history.
The death curve in the representation of the disease by experts has become the daily account of the pandemic.
In just 1 day, on March 28, 2020, in Lombardy alone, the most affected region of northern Italy, there were 542 deaths from COVID-19.
The idea of the end took possession of us with an unprecedented emotional impact through the images from the city of Bergamo, the epicenter of one of the worst affected areas of Italy, of the dead closed in anonymous coffins, without names, without flowers, lined up in church on their last journey in solitude to the afterlife.
Coffins, also in Bergamo, transported on military trucks in convoy through the streets of the deserted city, where the living were forced to stay at home, experiencing physical and spiritual distancing from loved ones who were denied the last farewell, so as to safeguard public health, eliminating the rite of the public and collective funeral that restores humanity to such a painful moment for families.
Above all, the silence and emptiness in which this convoy took place was striking.
The sense of suspension of time, of loneliness, of lack of reality burst into our lives through the images that came to us from TV and social media and embody that fear, which progressively, starting from the onset of the pandemic, has turned into terror and bewilderment.
The pandemic, from being a word of difficult scientific meanings, now acquires a precise, full and absolute meaning: Death.
The people who die, as well as the people who remain, relatives, family members, friends and the many spectators who feel part of an “existential community of destiny” ( 60), are all condemned to isolation, besides loneliness, faced with the triumph of the deadly virus.
According to Migliorati ( 61), death in the first period of the pandemic broke out as “aseptic death,” separated from the individual experience and projected into an anonymous dimension of collective death.
In the first period of lockdown, in fact, the dead and their relatives were out of the narrative.
In this way, the narrative of death reduced the mournful event, albeit in its tragic nature, to a “side effect” of the pandemic, one of the many dimensions, perhaps even negligible.
After all, “they are all elderly, the average age is 81 years old, they all had previous pathologies” [( 61). p 40].
The most effective symbolic image of this narrative was the juxtaposition between COVID-19 and war.
The pandemic was recounted as a war with its victims (especially the elderly), its heroes (especially the health personnel), its generals, ready to save us with their field strategies (the government, virologists, experts).
In short, in the pandemic, death essentially broke into an interpretative scheme that saw a shift of death along the nature-culture continuum toward nature in the sign of the removal of the corpse, away from culture, capable of transcending death through ritual ( 57).
In short, in the pandemic, death essentially broke into an interpretative scheme that saw a shift of death along the nature-culture continuum toward nature in the sign of the removal of the corpse, away from culture, capable of transcending death through ritual
What happens when funerals are suspended? When the dead and their relatives go through the tragic passing alone?
Because this is what happened during the lockdown in Italy: the dead were taken away alone, without a worthy accompaniment, and the living locked in their homes could not meet for worthy rituals that could ease that sudden and devastating pain and share it with people who cared.
Thus, it follows that pain has no right of expression through those socially and culturally shared rituals ( 13); and it is precisely the absence of rituals that contributes to aggravating both the experience of mourning ( 13, 62) and the feelings of guilt and responsibility dictated by the conflict between what the victim’s wishes were and what the state allowed ( 63).
The experience of death during COVID-19 goes far beyond situations of death by natural catastrophe in which the bodies are missing.
In our case the relatives, reduced to members of the larger community that mourned their dead, witness the death of loved ones shut away in their homes.
The tragedy of the suspension of rituals in the period of COVID-19 crossed with the tragedy of having to overcome the event alone, at home.
The pandemic has pushed the condition of loneliness, not only of the dying but also of the relatives, toward the most tragic of its epilogs.
Experiments were attempted to alleviate the sense of loneliness and isolation in the face of death.
For example, the creativity of a hospital chaplain in one of the most affected cities in northern Italy (Bergamo) allowed many relatives to participate remotely in the funeral ceremony via mobile phones.
A coffin, a parish priest, a cell phone. All that remains of funeral participation in a period of forced isolation and media coverage of reality.
As Dei ( 64) states “perhaps the most inhuman aspect of this experiment of suspended sociality to which we are forced, even more cruel than the dystopian imaginary fanned by those philosophers who fear our reduction to bare life, is the denial of the rituals appointed to accompany the condolences” [( 64). p 2].
The pandemic has pushed the condition of loneliness, not only of the dying but also of the relatives, toward the most tragic of its epilogs.
A cruelty that became more and more specific in the tragedy of a mourning event suspended, not overcome, entangled in the event of death, when with the passing of the weeks, toward the end of the lockdown period, from the indistinct magma of a collective death the personal stories, the family tragedies, the many faces of the dead and the remaining relatives emerged.
At this point it was clear that the patriotic community which mourns its dead is unable to give meaning to the pain of the proximate community of family members, friends for the loss of a loved one.
Aims
Given the large number of people infected and of deaths in Italy caused by the COVID-19 pandemic, this research focuses on the spiritual well-being and psychological impact of the general population during the lockdown.
We believe that is important to deepen our knowledge of the perception of spiritual well-being and mental health so as to develop interventions and support people, to be ready for similar future events in order to reduce the negative consequences of a possible second wave of the virus.
We wish to pursue two main objectives.
The first is to further investigate how spiritual well-being dimension was faced by Italian adults during the first weeks of lockdown subsequent to the COVID-19 outbreak.
The second is to explore psychological mental health in terms of the psychological impact of the pandemic.
We also set out to analyze if there were differences in the perception of spiritual well-being and mental health compared to the pre-pandemic data in the general population.
The relationships between spiritual and psychological aspects were also investigated and how these two dimensions are associated with demographic variables (such as age, gender, level of education, marital status), socio-relational variables (such as people lived with, work situation, presence of children, religious beliefs) and the nearness with the COVID-19 disease, for example knowing someone who was infected or who died of coronavirus.
We also assume that as spiritual well-being increases the perception of positive mental health increases and that socio-demographic variables, such as gender and age affect spiritual well-being and mental health.
Materials and Methods
See the original publication.
Results
See the original publication.
Discussion
With regard to demographic variables, in relation to gender, it emerges that women perceive higher levels of spiritual well-being, in line with previous research ( 34, 45).
In particular, women perceive greater Faith and belief than men. According to some authors, the higher scores of women’s spiritual well-being could be linked to the fact that women have different experiences and coping strategies to men and also to the fact that religious norms and beliefs are more compatible with roles, characteristics and behaviors socially attributed to women ( 34, 77, 78).
In relation, instead, to mental health, women show a lower perceived level of mental health, which confirms a constant of the previous literature ( 79– 81) and also relates to the period COVID-19 ( 49, 82– 84).
With regard to the age variable, the data showed that the younger participants (18–24 years old) experienced a lower level of spiritual well-being, in particular Faith and belief and Meaning of life than people belonging to other age groups.
In fact, from the literature it emerges that elderly people in particular benefit from religious practices and spiritual activities that positively affect their general well-being ( 3, 41).
With regard to the marital status variable, the research also shows that singles have a lower level of spiritual well-being (in particular Faith and belief and Meaning of life) and mental health than those who are married or living together.
This may be dictated by the fact that living as a couple can be considered a source of support in a lockdown situation in which social relations are limited to mere electronic contact ( 87, 88).
Analyzing the socio-relational variables, it emerged that those who live with friends and/or roommates perceive a lower level of spiritual well-being and in particular Meaning of life, than those who live alone or with family.
This could also be due to age, a variable that was found to be negatively correlated with spiritual well-being; in fact, those who lived with friends or roommates were university students.
Still in relation to the variable people with the subject lives, as regards mental health no significant differences emerged; this may be due to the fact that compared to the pre-pandemic period all the participants, regardless of the people they lived with during the lockdown, were significantly affected by the situation.
Instead, in relation to the current job situation, it emerged that those who lost their jobs or had been laid off perceived lower levels of spiritual well-being, and in particular of Faith and belief, than those whose work situation had remained the same as before the lockdown or had switched to smart working.
This is in line with that strand of literature which argues that people living in crisis situations perceive a low level of spiritual well-being ( 76).
The fact that a difference with respect to mental health does not emerge may be due to the fact that the pandemic emergency situation led the participants to share the same destiny as regards their state of health, in which the working variable did not assume a significant weight at least in the initial stages of the emergency; an aspect that now, on the other hand, appears decidedly more salient and that the ever-increasing riots and protests in various countries are highlighting as a problematic condition.
Furthermore, with respect to the children/no children variable, it emerged that those who do not have children perceive lower levels of spiritual well-being, in particular Faith and belief and Meaning of life than those who have children, this may be due to the fact that those who have children rely more on faith and spirituality.
Carter ( 89) argues that for many families being involved in the congregation and their own spirituality are a source of strength, support and social support in the path of life together.
Indeed, in the literature it has been found that the majority of families in the world, both within and beyond religious belief systems, use different forms of expression to satisfy their spiritual needs, particularly when facing adversity ( 20).
Although spirituality and religion are two different constructs, literature shows strong correlations and overlaps; therefore, especially considering the high percentage of believers in our sample, it is evident that religion and church attendance in Italy, despite having decreased from the 1960s to today ( 90) still has a significant role and is probably even more fundamental for coping with this pandemic period ( 30), which may be more evident in families with children.
Furthermore, the data also showed that those who do not have children have perceived lower levels of mental health than those who have.
This finding is not confirmed in the research carried out in this pandemic situation by Pirutinsky et al. ( 37), who found that positive religious coping, intrinsic religiosity and trust in God were strongly correlated with less stress and more positive impact; Bentzen again ( 30), argues how people use religion to cope with the emotional stress caused by COVID-19, arguing how religiosity increases in response to unpredictable natural disasters, such as the COVID-19 crisis.
Finally, just as also found in the literature ( 3, 30, 34, 35, 41) the data showed that there is a relationship between spiritual well-being and mental health: from the analysis, in fact, it emerged that those who reported a lower level of spiritual well-being perceived a worse level of mental health.
Finally, with regard to spiritual well-being, the data showed that mental health is the major predictor, while gender and age are moderate predictors.
In fact, as also seen from the data reported previously and from the literature, age ( 3) and gender ( 34) have a significant impact on the perception of spiritual well-being.
Mental health, on the other hand, appears to be affected to a greater extent by spiritual well-being and to a lesser extent by gender.
These data are confirmed by previous research which highlighted how spirituality and religious practices are
- a protective factor and closely connected to physical and mental health ( 3, 35, 41),
- as well as being a source of physical and psychological resilience ( 7, 39)
- and helping the development of coping strategies in people who experienced stressful life situations ( 34, 41),
- mitigating mood disorders such as depression and anxiety ( 19, 39).
The data presented give us a significant picture of the mental health situation experienced by the Italian population during the first lockdown and confirm the value of spiritual well-being as a protective factor of people’s general well-being.
However, we would like to outline some limitations of the research.
Due to the contextual situation that involved a forced physical distance, the online questionnaire method seemed, despite the limits that this entails, the only possible strategy to reach a large number of subjects.
Some limitations of the online questionnaire include the non-completion rate caused by the lower level of engagement than the paper questionnaire and the high number of questionnaires in circulation; moreover, a bias may be dictated by the type of careless response also highlighted in the literature ( 94).
This choice of data collection was also confirmed by other researchers in relation to the COVID-19 epidemic ( 82).
Furthermore, another limit, again related to data collection, is the type of sampling used: a random cascade sampling.
Despite the research team’s efforts to reach a large and diverse number of participants, use of the online questionnaire may not have allowed the involvement of some target populations.
In spite of the weaknesses highlighted, this work has among its strengths the fact of being one of the first research studies conducted on the lockdown period related to COVID-19 in Italy which tries to investigate the role of spiritual well-being and its effects on individual well-being in the population with a multidisciplinary approach.
This distance also led to a change in the outlook of some disciplines with a predominantly ethnographic approach, to try to get closer to the issues dealt with in a period such as that of the lockdown in which it was important that research continued to have its role of investigating and seeking knowledge despite non-essential activities having been stopped.
Conclusion
During the COVID-19 pandemic, people and families experienced a new and sudden situation that forced them to stay indoors for a long period of time.
In this context, many people and their families experienced situations of great discomfort, stress and fear related not only to the fear of contagion but also to the economic difficulties for those who saw their income reduced due to the closure of production activities or who experienced situations of loneliness, isolation or conflicts within the home.
The pandemic has profoundly changed the way of life in society, starting from the need for “social distancing” even among close relatives ( 87).
In this context it is very interesting to investigate if and how spirituality has been a form of emotional and psychological support useful for dealing with the loss and anguish of critical moments in life like this.
This appears particularly dramatic for the families of those who died in hospital without being able to have their loved ones near them and without the latter being able to celebrate the funeral rites.
The data from our study show that in the period of the lockdown those who were able to count on important forms of religiosity and spirituality drew mental well-being from these beliefs.
Spirituality helped them to make sense of what was happening and not to feel lost in the face of the radical change in the way of living and conducting social relationships.
Loss, grief, mental health, and spiritual well-being emerge as familiar themes in the lives of many individuals, families, and communities in different contexts.
According to Zhai and Du ( 13) recognizing these individual experiences can enable healthcare professionals to develop personalized strategies to facilitate better adaptation to the situation and therefore promote mental health.
… recognizing these individual experiences can enable healthcare professionals to develop personalized strategies to facilitate better adaptation to the situation and therefore promote mental health.
If looked at from the point of view of clinical practice, therefore, it can be seen that dealing with spirituality becomes fundamental; in fact, this aspect needs to be considered to really provide adequate support to individuals, especially those who manifest themselves as strong and solid.
In this regard, the consideration of spiritual needs is necessary to provide a holistic and people-centered intervention ( 95).
By spiritual needs we mean everything that refers to the need to find meaning, value in one’s life, peace and a sense of connection.
These needs are not necessarily exclusively religious, even those who do not have a religious faith still refer to belief systems that provide feelings of meaning and purpose ( 46) which in this period of the COVID-19 pandemic seem to assume a role and an even deeper meaning in relation to the bewilderment that people are confronted with in the face of such a pervasive, disruptive event creating fragility, fear and daily uncertainties.
References and additional information
See the original publication
Originally published at https://www.frontiersin.org.
About the authors
Ilaria Coppola1*, Nadia Rania1*, Rosa Parisi2* and Francesca Lagomarsino1*
1 Department of Education Sciences, School of Social Sciences,
University of Genoa, Genova, Italy
2 Department of Economics, Management and Territory,
University of Foggia, Foggia, Italy01 April 2021
