Spirituality, religious affiliation, and health in Germany: a cross-sectional study including Bayesian network modeling.

BACKGROUND

Spirituality has been proposed as a relevant dimension of health, yet its distribution in the general population and its associations with health-related factors remain insufficiently characterized. This study examined how self-reported spirituality and religious affiliation are distributed in Germany and how they are associated with chronic disease burden, health-related quality of life, nutrition-related attitudes, and attitudes toward traditional, complementary, and integrative medicine (TCIM).

METHODS

We conducted an anonymous cross-sectional online survey of adults living in Germany aged 18-75 years (N = 4,065). Self-reported spirituality and religious affiliation were assessed alongside sociodemographic variables, Sinus-Milieus®, health status, chronic health conditions, nutrition-related attitudes, TCIM attitudes, and health-related quality of life. Group differences were analyzed using chi-square and Wilcoxon tests. Multivariable regression models examined correlates of healthy nutrition and EQ-5D-5L. In addition, a Bayesian Network was used to explore conditional dependencies among 37 variables (n = 4,013).

RESULTS

Overall, 896 participants (22.0%) self-identified as spiritual, and 2,076 (51.1%) reported a religious affiliation. Women were overrepresented among spiritual participants (60.8%). Spirituality differed significantly by gender, age, Sinus-Milieus®, religious affiliation, overall health status, and health-related quality of life. Cross-classification of spirituality and religious affiliation yielded four groups: religious and spiritual (14.2%), spiritual but not religious (7.9%), religious but not spiritual (36.9%), and neither religious nor spiritual (41.1%). The proportion of participants identifying as spiritual increased with the number of chronic diseases. In multivariable analyses, spirituality, but not religious affiliation, was associated with healthy nutrition. In the multivariable EQ-5D-5L model, only overall health status and chronic disease burden remained significant.

CONCLUSIONS

In this large German adult online sample, spirituality showed distinct socio-cultural patterning and was associated with nutrition-related attitudes, TCIM attitudes, and greater chronic disease burden. However, spirituality was not independently associated with health-related quality of life after adjustment for health status and chronic disease burden. Bayesian Network modeling offered an exploratory framework for examining these relationships. Further studies using more differentiated measures of spirituality and religion are needed in order to better understand, classify, and scientifically frame this complex field in a cross-disciplinary manner.