Takeaway
Patients’ community participation can be a powerful determinant of health—an essential part of your assessment and care plan. Try asking, “Are you part of a faith community, and how is it affecting you right now?”
Lifelong Learning in Clinical Excellence | October 17, 2025 | 3 min read
By Warren Kinghorn, MD, ThD, Duke University School of Medicine & Duke Divinity School
Mr. B looked dejected and exasperated. “It’s been so tough, Doc. These are people I’ve known 20, 30 years. We’ve shared life together, raised our kids together. And now nobody wants to talk to each other.”
He was talking about his church—and rated it number one on the list of stressors that was perpetuating his depression and anxiety. For years, church had been at the center of Mr. and Ms. B’s life in their rural North Carolina community. It was central to their weekly schedule, an anchor of meaning, the source of most of their friendships, the recipient of a good bit of their money. It was where they knew others and were known by others, in grief and in joy. They called it their “family.” And now the church, like so many American protestant Christian congregations, was splitting over questions of sexuality and LGBTQ+ inclusion. Mr. B had opinions about that issue, but that wasn’t the source of his sadness. It was rather the fact that he was losing his community.
We sat together in his lament and grief. “It’s hard, “ I said, “To lose those you love. It’s hard to lose your family.”
In recent years, clinicians have become more adept and practiced at taking a “spiritual history” when we’re getting to know patients. Tools like the FICA Spiritual History Tool and the HOPE Approach to Spiritual Assessment have formed us to gently probe patients’ spiritual lives with broad-based questions such as “Do you consider yourself to be spiritual?” (FICA Tool) or “What are your sources of hope, strength, comfort, and peace?” (HOPE Approach). There’s nothing wrong with these questions. But when we start with broad questions about individual personal belief, we risk never getting to specific questions about patients’ participation in religious communities.
That would be a big miss. Religious communities are important for many of our patients—and for some patients like Mr. B, at the center of their lives. Moreover, as epidemiologist Tyler VanderWeele has argued, religious community participation—especially attendance at religious services—isn’t only a powerful predictor of well-being across many health domains, but also a stronger predictor of well-being than self-assessed spirituality/religiosity or private religious/spiritual practices. VanderWeele reports that weekly religious service attendance is associated in longitudinal studies with a 25-35% reduction in overall mortality over 10-15 years, 20-30% lower incidence of depression, and three to six-fold lower rates of death by suicide. Religious communities are salient sources of social connection, narratives of meaning and purpose, and encouragement around positive health-related behaviors.
But the opposite can be true also. As with Mr. B, conflict-ridden religious communities can pass on anxiety and stress to their participants. Abusive religious communities can precipitate and perpetuate profound harm. Frequently, as with most human communities, religious communities can be sites of joy as well as of pain, neither all-good or all-bad, but meaningful and complex.
When I take a spiritual history, I start by asking broad questions like those above, but Mr. B and other patients have taught me to ask follow-up questions about religious communities. Modifying a question from the FICA Tool, I might ask, “Are you part of a religious or spiritual community?” If the answer is yes, I might say, “Tell me more about what that community means to you, and how it’s a part of your life.”
As I listen, I learn amazing things about my patients, and about religious communities and practices previously unknown to me. But most of all, I learn something important about what and whom my patients love and where they find hope, even in the hard situations when love has been betrayed and hope seems distant. And in doing so, I am grateful for the trust that we build together.
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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.