Measuring “Spirituality”

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To the Editor:I was pleased to see the article on the challenges of measuring spirituality in mental health research (Koenig, 2008). I applaud Koenig's concern with the slippery slope of the word “spirituality” and his cautions in that regard. I sympathize with his concern regarding the conflation of general positive emotions with spirituality. Many of the scales he mentions do that. However, I take serious issue with his lumping together a variety of measures as all problematic in that regard, especially Underwood's Daily Spiritual Experience Scale (“Underwood's DSES,” to differentiate it from a recent depression measure with the same initials).The Underwood DSES is a 16-item scale extensively used in health research (see for references to published studies and translations) and has been put on the General Social Survey, so it has random population data (Ellison and Fan, 2007; Underwood, 2006). It was developed using extensive theoretical and qualitative research with a variety of demographic groups (Underwood, 2006). Koenig himself has used the scale in studies of depression and hospital utilization (Koenig et al., 2004a, b). It has never claimed to be a measure of spirituality, but does measure one multifaceted aspect of spirituality, ordinary spiritual experience. The items in the scale stretch beyond psychological well-being and religious beliefs. Drawing originally from the depths of the Judeo-Christian tradition, it was refined in its development to address religiously embedded spirituality, but also leave room for responses by those who do not feel a current connection with organized religion. My published papers on the scale emphasize that most spirituality is embedded in a religious tradition and the language used in the scale reflects that. This scale, which I developed with qualitative interviews and testing in a wide variety of settings, has continued to flourish. I get about one inquiry a week on the scale—from places such as China, Korea, India, Germany, Lithuania, Greece, Puerto Rico, Northern Ireland as well as from the US.There are 16 items in the scale. (I do not recommend the use of a 6-item version of the scale which was included in the multidimensional measure, even though it correlates highly with the full version, as it was not based on psychometric analysis, changes wording, combines items, and leaves out various facets.) Contrary to Koenig's claim, Underwood's DSES does not measure “peace” in the sense that might be equated with mental or emotional calm, but the specific item on peace is “I feel deep inner peace or harmony” (response on a Likert scale for 15 of the items range from “ many times a day” to “never or almost never”). In the interviews developing the scale, people reported having this experience even when in the midst of depression, or chronic anxiety (Underwood, 2006). Another claim Koenig makes is that the scale addresses gratitude, which is not a specific measure of spirituality for him. However, the item on Underwood's DSES is “I feel thankful for my blessings,” with the same Likert frequency responses. (This item was cited incorrectly in Koenig’s article.) That item is not just a general feeling of gratitude, but an acknowledgment of a response to blessings, with the implicit assumption that blessings come from God, or a transcendent being. So much of scripture and worship involves this kind of gratitude. The scale also includes items such as “I feel God's presence” and “I ask for God's help in the midst of daily activities,” both of which address the kind of spirituality which Koenig thinks is important to address.

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