The National Study on Stress, Spirituality, and Health: Investigating the Biological Mechanism through which Spirituality Affects Health across Diverse Religious, Racial, and Ethnic Communities
Moderator - Alexandra E. Shields, PhD (Associate Professor of Medicine, Harvard Medical School; Director, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities; Associate Member, Broad Institute of MIT and Harvard)
Panelists -
Nicholas Spence, Ph.D. (Research Fellow, Harvard Medical School and Massachusetts General Hospital)
Ying Zhang, PhD, BMed (Director of Data Assets and Analysis, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities Massachusetts General Hospital)
Erica T. Warner, ScD, MPH (Assistant Professor of Medicine, Massachusetts General Hospital and Harvard Medical School)
Alexandra E. Shields, PhD (Moderator)
A plethora of studies have documented associations of various measures of religiosity and spirituality (R/S) and diverse health outcomes over the years, yet the field of R/S research has been hampered by the lack of robust and adequately powered studies including nationally representative samples, the lack of prospective research designs through which we can make causal inferences, and the lack of consensus in the field regarding which R/S measures are most important to collect or how best to assess the robustness of potential R/S measures. The newly-formed National Consortium on Psychosocial Stress, Spirituality, and Health addresses these limitations in the field of R/S research. In particular, this Consortium builds its research upon the most powerful epidemiological data assets in our nation, prospective cohort studies, representing billions of dollars of investment over decades of clinical, demographic, epidemiological, and environmental data collected by these cohorts tracking diverse subpopulations and diverse clinical phenotypes. In this panel, we present analyses conducted as part of the first research study from our Consortium: The National Study on Psychosocial Stress, Spirituality, and Health (SSSH).
•The National Study on Psychosocial Stress, Spirituality, and Health: Protocol and Study Design
Nicholas Spence, PhD
Psychosocial stress has emerged as a central social and environmental stressor that “gets under the skin” to increase disease risk. Two mechanisms through which we hypothesize psychosocial stressors will have a negative effect on health are DNA methylation of genes along the hypothalamic pituitary adrenal (HPA) axis and accelerated telomere shortening. Supportive influences, however, such as psychosocial support, R/S, and emotional and religious coping, may have mediating effects that attenuate the negative impact of psychosocial stress on health. In collaboration with six of the nation’s leading prospective cohort studies (Black Women’s Health Study, The University of Illinois at Chicago Cohort of Patients Family and Friends, The Mediators of Atherosclerosis in South Asians Living in America [MASALA] Study, Nurses’ Health Study II, and The Strong Heart Study), as well as 3 Brazilian cohort studies (Baependi Study, Advento Study, and ELSA Brazil Study), this empirical analysis will be the first to investigate whether accelerated telomere shortening and DNA methylation of HPA axis genes are useful biomarkers for internal spiritual resources used to cope with stressful experiences, and will be the first study to assess the role of R/S in the risk of hypertension and mortality within the context of prospective, gene-environment studies. The diversity of our participating cohorts will also allow us to complete these analyses in one of the largest (N=28,000) and most diverse consortium of participants assembled to date to understand the biological mechanisms of R/S and health, comprising a multi-ethnic sample of Black, Hispanic/Latino, South Asian, Native American, white, and native Brazilian participants.
•Results from the SSSH Religiosity and Spirituality Survey: Developing Analytic Approaches to Identify Meaningful Clusters and Priority Measures
Ying Zhang, PhD, BMed
SSSH investigators developed and administered to nine racially and ethnically diverse international prospective cohort studies a comprehensive 80-item R/S survey to assess the effect of R/S and psychosocial stress on a variety of health conditions. Given the diversity of religion and spirituality across these cohorts, we hypothesize that there will be significant differences across racial and ethnic groups within the SSSH, with implications for different health outcomes. To assess the biological mechanisms linking psychosocial stress, resilience (R/S), and health outcomes across these cohorts, we developed an efficient analytical modeling strategy, which we present here, that is built upon these 80 survey items. The modeling strategy utilizes two components: (1) a panel of experts to qualitatively examine our R/S survey to assess items for potential consolidation, based on conceptual consensus; and (2) the data reduction technique Principal Components Analysis, which identifies the patterns and interrelationships among R/S items that explain the most variability, through which we will quantitatively identify the best combination, or key subsets, of R/S measures. These two complimentary approaches will provide guidance for the use of R/S measures from our survey in the epidemiological analyses of the SSSH.
•Decelerated Aging: Are Religious and Spiritual Practices and Beliefs Associated with Longer Telomere Length in a Multi-Ethnic Population?
Erica T. Warner, ScD, MPH
Telomeres are repetitive DNA sequences at the ends of chromosomes that prevent physical deterioration of the chromosome during cell division. Because telomere length shortens with each replication, telomere length is considered an important biological marker of aging. Longer telomeres are often associated with better health, including reduced risk of cardiovascular disease and cancer, as well as increased life expectancy. Given previous work demonstrating that R/S factors such as religious service attendance and religious coping are associated with reduced risk of hypertension and all-cause mortality, we hypothesize that telomere length is a biological mechanism through which R/S may operate to improve health outcomes. We will investigate this hypothesis using data on a multi-ethnic and religiously diverse population drawn from several U.S. and Brazil-based cohorts, including the Black Women’s Health Study, Nurses’ Health Study II, and MASALA. A subset of participants from each cohort completed a questionnaire in 2016-2017 that assessed over 80 R/S items. Relative telomere length was determined using a modified, high throughput version of the quantitative real-time polymerase chain reaction (PCR) telomere assay, with analyses for all the U.S.-based cohorts conducted at the same laboratory. Preliminary results suggest that participants who were very religious or spiritual had longer telomeres. Volunteering at church was also associated with longer telomere length.
• Developing New Platforms to Advance Research on Spirituality and Health
Alexandra E. Shields, PhD
Our work in the SSSH is based on the hypothesis that R/S mediates the biological impact of psychosocial stress on the body. In pursuing this line of research, it is therefore critical not only to know which R/S measures are available across prospective cohort studies, but also which measures of psychosocial stress are available in order to combine data across these cohorts for analyses that require large sample sizes. To this end, we believe that comprehensively mapping all psychosocial and R/S measures for more than 20 of the nation’s leading cohorts, and making these available in one searchable online database, will facilitate collaboration across cohorts in assembling multi-cohort studies, and will enable researchers to ask sophisticated questions about the role of R/S in health. Working with bioinformatics experts at Harvard Medical School, we have already developed the R/S Atlas, which is an online searchable database of all R/S measures currently available within these 20 cohort studies. We are now integrating all psychosocial measures assessed in these 20 cohorts to expand our R/S Atlas to a larger Psychosocial Atlas. This database includes searchable information on each measure, whether it was assessed as a single-item or as part of a larger scale, years in which it was assessed, and other information about the cohort in which the measures were assessed such as sample size, race/ethnicity, gender, and whether DNA and geocoded data are available for additional analyses.
Panelists -
Nicholas Spence, Ph.D. (Research Fellow, Harvard Medical School and Massachusetts General Hospital)
Ying Zhang, PhD, BMed (Director of Data Assets and Analysis, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities Massachusetts General Hospital)
Erica T. Warner, ScD, MPH (Assistant Professor of Medicine, Massachusetts General Hospital and Harvard Medical School)
Alexandra E. Shields, PhD (Moderator)
A plethora of studies have documented associations of various measures of religiosity and spirituality (R/S) and diverse health outcomes over the years, yet the field of R/S research has been hampered by the lack of robust and adequately powered studies including nationally representative samples, the lack of prospective research designs through which we can make causal inferences, and the lack of consensus in the field regarding which R/S measures are most important to collect or how best to assess the robustness of potential R/S measures. The newly-formed National Consortium on Psychosocial Stress, Spirituality, and Health addresses these limitations in the field of R/S research. In particular, this Consortium builds its research upon the most powerful epidemiological data assets in our nation, prospective cohort studies, representing billions of dollars of investment over decades of clinical, demographic, epidemiological, and environmental data collected by these cohorts tracking diverse subpopulations and diverse clinical phenotypes. In this panel, we present analyses conducted as part of the first research study from our Consortium: The National Study on Psychosocial Stress, Spirituality, and Health (SSSH).
•The National Study on Psychosocial Stress, Spirituality, and Health: Protocol and Study Design
Nicholas Spence, PhD
Psychosocial stress has emerged as a central social and environmental stressor that “gets under the skin” to increase disease risk. Two mechanisms through which we hypothesize psychosocial stressors will have a negative effect on health are DNA methylation of genes along the hypothalamic pituitary adrenal (HPA) axis and accelerated telomere shortening. Supportive influences, however, such as psychosocial support, R/S, and emotional and religious coping, may have mediating effects that attenuate the negative impact of psychosocial stress on health. In collaboration with six of the nation’s leading prospective cohort studies (Black Women’s Health Study, The University of Illinois at Chicago Cohort of Patients Family and Friends, The Mediators of Atherosclerosis in South Asians Living in America [MASALA] Study, Nurses’ Health Study II, and The Strong Heart Study), as well as 3 Brazilian cohort studies (Baependi Study, Advento Study, and ELSA Brazil Study), this empirical analysis will be the first to investigate whether accelerated telomere shortening and DNA methylation of HPA axis genes are useful biomarkers for internal spiritual resources used to cope with stressful experiences, and will be the first study to assess the role of R/S in the risk of hypertension and mortality within the context of prospective, gene-environment studies. The diversity of our participating cohorts will also allow us to complete these analyses in one of the largest (N=28,000) and most diverse consortium of participants assembled to date to understand the biological mechanisms of R/S and health, comprising a multi-ethnic sample of Black, Hispanic/Latino, South Asian, Native American, white, and native Brazilian participants.
•Results from the SSSH Religiosity and Spirituality Survey: Developing Analytic Approaches to Identify Meaningful Clusters and Priority Measures
Ying Zhang, PhD, BMed
SSSH investigators developed and administered to nine racially and ethnically diverse international prospective cohort studies a comprehensive 80-item R/S survey to assess the effect of R/S and psychosocial stress on a variety of health conditions. Given the diversity of religion and spirituality across these cohorts, we hypothesize that there will be significant differences across racial and ethnic groups within the SSSH, with implications for different health outcomes. To assess the biological mechanisms linking psychosocial stress, resilience (R/S), and health outcomes across these cohorts, we developed an efficient analytical modeling strategy, which we present here, that is built upon these 80 survey items. The modeling strategy utilizes two components: (1) a panel of experts to qualitatively examine our R/S survey to assess items for potential consolidation, based on conceptual consensus; and (2) the data reduction technique Principal Components Analysis, which identifies the patterns and interrelationships among R/S items that explain the most variability, through which we will quantitatively identify the best combination, or key subsets, of R/S measures. These two complimentary approaches will provide guidance for the use of R/S measures from our survey in the epidemiological analyses of the SSSH.
•Decelerated Aging: Are Religious and Spiritual Practices and Beliefs Associated with Longer Telomere Length in a Multi-Ethnic Population?
Erica T. Warner, ScD, MPH
Telomeres are repetitive DNA sequences at the ends of chromosomes that prevent physical deterioration of the chromosome during cell division. Because telomere length shortens with each replication, telomere length is considered an important biological marker of aging. Longer telomeres are often associated with better health, including reduced risk of cardiovascular disease and cancer, as well as increased life expectancy. Given previous work demonstrating that R/S factors such as religious service attendance and religious coping are associated with reduced risk of hypertension and all-cause mortality, we hypothesize that telomere length is a biological mechanism through which R/S may operate to improve health outcomes. We will investigate this hypothesis using data on a multi-ethnic and religiously diverse population drawn from several U.S. and Brazil-based cohorts, including the Black Women’s Health Study, Nurses’ Health Study II, and MASALA. A subset of participants from each cohort completed a questionnaire in 2016-2017 that assessed over 80 R/S items. Relative telomere length was determined using a modified, high throughput version of the quantitative real-time polymerase chain reaction (PCR) telomere assay, with analyses for all the U.S.-based cohorts conducted at the same laboratory. Preliminary results suggest that participants who were very religious or spiritual had longer telomeres. Volunteering at church was also associated with longer telomere length.
• Developing New Platforms to Advance Research on Spirituality and Health
Alexandra E. Shields, PhD
Our work in the SSSH is based on the hypothesis that R/S mediates the biological impact of psychosocial stress on the body. In pursuing this line of research, it is therefore critical not only to know which R/S measures are available across prospective cohort studies, but also which measures of psychosocial stress are available in order to combine data across these cohorts for analyses that require large sample sizes. To this end, we believe that comprehensively mapping all psychosocial and R/S measures for more than 20 of the nation’s leading cohorts, and making these available in one searchable online database, will facilitate collaboration across cohorts in assembling multi-cohort studies, and will enable researchers to ask sophisticated questions about the role of R/S in health. Working with bioinformatics experts at Harvard Medical School, we have already developed the R/S Atlas, which is an online searchable database of all R/S measures currently available within these 20 cohort studies. We are now integrating all psychosocial measures assessed in these 20 cohorts to expand our R/S Atlas to a larger Psychosocial Atlas. This database includes searchable information on each measure, whether it was assessed as a single-item or as part of a larger scale, years in which it was assessed, and other information about the cohort in which the measures were assessed such as sample size, race/ethnicity, gender, and whether DNA and geocoded data are available for additional analyses.