Handbook of Religion and Health Harold G. Koenig, Michael E. McCullough and David B. Larson Oxford University Press 198 Madison Avenue New York, NY 10016-4314 Tele: 212-726-6000 Web site: http://www.oup-usa.org Price: $$65 (Cloth)

In their Handbook of Religion and Health, authors Harold G. Koenig, Michael E. McCullough and David B. Larson take on a Herculean task: to "(1) comprehensively and thoroughly review, critique, and integrate existing research on religion and health, (2) examine the clinical implications of this research, (3) make recommendations for future research, and (4) provide advice on how to design and conduct studies that avoid the flaws and weaknesses of previous work. [p13]."

Over some 712 pages, they do just that. They review, discuss and interpret more than 1200 studies and 400 research reviews, both published and unpublished, conducted during the 20th century that examine the relationships between religion and many aspects of health: a wide range of physical and mental health conditions; the utilization of health services; and health promotion and disease prevention activities. Unlike some publications, they report findings related to religion and health throughout the lifespan, whether positive, negative or neutral. Based on their extensive analysis, they conclude that "religious beliefs and practices rooted within established religious traditions were found to be consistently associated with better health and predicted better health over time [p591]." Given the preponderance of positive findings, they are moved to develop theoretical models to explain how religion might influence health. They also use what they have learned to make significant and serious recommendations about ways in which physicians, nurses, social workers, chaplains, pastoral counselors, researchers, public policy makers and others might integrate these findings into their professional work. Finally, after reiterating the limitations of the research to date, they state their hope that their findings will "stimulate research in the new century that will further our understanding of what appears to be an intimate relationship between religion and health [p592]."

The authors divide their book into eight Parts. Following a helpful introduction, Part 1: Historical Context presents working definitions for the elusive terms "religion" and "spirituality" and offers a fascinating historical timeline of the general relationship between religion, science, and medicine through the ages.

Part 2: Debating Religion's Effects on Health looks at the many sources for two popular beliefs: that religious faith is good for health (chapter 3) and that it has a predominantly negative effect on health (chapter 4). How can such contrary opinions persist? The authors blame a lack of adequate research data, no easy access to existing data, and strong personal bias leading to relevant data being ignored, for the stalemate. Their belief that overcoming the first two of these concerns will make it more difficult for the third to continue is evident-they are researchers, after all. Finally, chapter 5 looks at religious coping from the patient's experience, citing research results that are conclusive: a majority of people cope with their health concerns by turning to their religious beliefs and practices-for many it is their primary coping strategy-and they want physicians to better acknowledge the religious and spiritual concerns related to their patients' health. This may be a tough order to fill: because studies also show that health professionals tend to be less religious than their patients, they may be hard pressed to recognize and value the religious and spiritual needs of those patients, or may feel at a loss as to how to address those needs.

Part 3: Research on Religion and Mental Health and Part 4: Research on Religion and Physical Disorders review and assess an enormous amount of information organized by topic or disease. Indeed, nine chapters each for mental health concerns (eg, well-being, depression, alcohol and drug use, psychoses, etc.) and physical disorders (eg, heart disease, hypertension, cancer, pain and somatic symptoms, etc.) summarize not only the essentials of the disorder (useful for medical laypeople) but also the research related to religion and that disorder. A tenth chapter in each Part, "Understanding Religion's Effects on...Health," summarizes the findings reported in painstaking detail in the previous chapters and then offers a theoretical model of religion's effects on physical or mental health.

Part 5: Religion and Use of Health Services follows a similar format, taking one chapter to explore how religion relates with disease prevention, detection, and treatment compliance; another to examine the relationship between religious activities and use of general medical and mental health services; and a final chapter to develop a theoretical model to explain how religion affects health service use and the implications of this model for a society needing to find ways of reducing its overall healthcare costs.

In Part 6: Clinical Applications, the authors explore the implications their findings hold for health and religious professionals (chapters 29 and 30, respectively) in the "everyday work of caring for patients." They make numerous, concrete recommendations for doctors, nurses, social workers, parish nurses, chaplains, and pastoral counselors. In chapter 30 especially, they document the devastating impact managed care has had on institutional chaplain services and challenge the assumptions behind such cutbacks, arguing "research already conducted is sufficient to support an expanded role for chaplains in hospital settings [p453]." They go on to recommend that chaplains become an integral part of the total healthcare team.

As the title indicates, Part 7: Priorities For Future Research is where the authors set forth their recommendations for areas most needing further research attention (chapter 31), the methods by which this research would best be carried out (chapter 32), and options in scales or tools by which to measure religiosity, spirituality and mysticism (chapter 33). They note within this section common problems and limitations in existing research; their recommendations are in part designed to help future researchers avoid similar error.

Finally, Part 8: Studies On Religion and Health By Health Outcome is a 75-page table in which the more than 1600 studies and reviews analyzed by the authors are referenced. One line of information for each study displays in column format 10 variables (eg, first author and year of study, study design, sampling method used, number of subjects, etc.). The studies are listed by health condition and follow the chapter order in the book. (Missing, unfortunately, is a column listing the page on which the study appears, which would simplify finding it.) A reader thus gains a snapshot view of each study, can easily identify those with some variable of interest, and can reference back to the text to see what the authors have to say about it. Following the table is a brief statement of conclusions and more than 100 pages of references and index.

This outline does not begin to convey the vast amount of information contained in this book. Every time I randomly opened to a page, I found something unanticipated and intriguing. However, its scope is both a strength and drawback. Though the authors do a remarkable job of turning nonstop referencing into a readable format, the sheer volume of detail becomes overwhelming. It is of necessity that each chapter begins with an overview and ends with a summary. Those chapters that essentially are summaries of summaries are also well placed and necessary. This leads, however, to considerable redundancy.

Given the vast quantity of information, it is notable what is missing, or at least receiving less emphasis. I would have found it helpful, for example, to have had more definitions and explanations of statistical terminology and research methodologies appear earlier in the book. Some of that occurs in Part 7 chapter 32, but that is some 479 pages into the book.

All this leads me to wonder if there is not really a book within a book here. Many readers may have been better served had the detailed reviews of Parts 3 and 4 been placed along with the References, Index, and Part 8 in an appendix. This would have allowed the authors to create an even more readable narrative presentation of their overall findings about religion's relationships to mental and physical health, their theoretical models illustrating how religion may influence health, their clinical recommendations and their suggestions for future research. What they have to say in all these areas deserves considered attention by anyone who claims to care about religion and health in this country. Indeed, their findings are so important that perhaps a "lite" version of their work, aimed at a broader audience of nonresearch-oriented health and religious professionals is in order. All this is really a compliment to the authors. Koenig, McCullough, and Larson deserve enormous credit for their significant achievement; their results need to become more broadly known.