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Relationship Between Spiritual Coping and Survival in Patients with HIV.

Ironson, G. (pictured left), Kremer, H., & Lucette, A. (2016).  Journal of General Internal Medicine, 31(9): 1068- 76. doi:10.1007/s11606-016-3668-4

Correspondence Author: Gail Ironson, MD., Ph.D. University of Miami School of Medicine, Email: gironson@aol.com

Background and Objective

Studies of spirituality in initially healthy people have shown a survival advantage, yet there are fewer research studies in the medically ill despite the widespread use of spirituality/religiousness to cope with serious physical illness. In addition, many studies have used limited measures such as religious service attendance. The objective was to examine if, independent of medication adherence, the use of spirituality/religiousness to cope with HIV predicts survival over 17 years.


Design: Longitudinal study started in 1997. Study materials were administered semiannually.

Participants: A diverse sample of 177 HIV patients initially in the mid-stage of disease (150-500 CD4-cells/mm3; no prior AIDS-defining symptoms)

Main Measures: Participants were administered a battery of psychosocial questionnaires and blood draw. They completed interviews and essays to assess current stressors. Spiritual Coping (overall/strategies) was rated by qualitative content analysis of interviews regarding stress and coping with HIV, and essays.


Controlling for medical variables (baseline CD4/viral load) and demographics, Cox regression analyses showed that overall positive spiritual coping significantly predicted survival over 17 years (HR = .56, p =.039). Findings held even after controlling for health behaviors (medication adherence, substance use) and social support.  Particular spiritual coping strategies that predicted longer survival included spiritual practices (HR = .26, p < .001), spiritual reframing (HR = .27, p =.006), overcoming spiritual guilt (HR = .24, p < .001), spiritual gratitude (HR = .40, p =.002), and spiritual empowerment (HR = .52, p =.024), indicating that people using these strategies were 2-4 times more likely to survive.


To our knowledge, this is the first study showing a prospective relationship of spiritual coping in people who are medically ill with survival over such a long time, and also specifically identifies several strategies of spirituality that may be beneficial.