PSYCHO-ONCOLOGY Psycho -Oncology 8: 429–438 (1999) EXPLORING THE RELATIONSHIPS AMONG SPIRITUAL WELL-BEING, QUALITY OF LIFE, AND PSYCHOLOGICAL ADJUSTMENT IN WOMEN WITH BREAST CANCER SIAN P. COTTON a , ELLEN G. LEVINE b, *, CORY M. FITZPATRICK a , KRISTIN H. DOLD a and ELISABETH TARG b a Breast Cancer Personal Support and Lifestyle Interention Trial, California Pacific Medical Center, San Francisco, CA, USA and Uniersity of California, San Francisco, CA, USA b California School of Professional Psychology, Alameda, CA, USA SUMMARY This study examined the relationships among spiritual well-being, quality of life, and psychological adjustment in 142 women diagnosed with breast cancer who were participating in a larger study designed to compare the efficacy of two psychosocial support programs. Participants were given a set of questionnaires that measured spiritual well-being, quality of life, and adjustment to cancer. Results revealed a positive correlation between spiritual well-being and quality of life, as well as significant correlations between spiritual well-being and specific adjustment styles (e.g. fighting spirit). There was also a negative correlation between quality of life and use of a helpless/hopeless adjustment style, and a positive correlation between quality of life and fatalism. In regression analyses, after controlling for demographic variables and adjustment styles, spiritual well-being contributed very little additional variance in quality of life. These findings suggest that while spiritual well-being is correlated with both quality of life and psychological adjustment, the relationships among these variables are more complex and perhaps indirect than previously considered. Copyright © 1999 John Wiley & Sons, Ltd. INTRODUCTION The scientific literature strongly supports the no- tion that religious commitment can enhance one’s health. In a review of over 200 studies, positive relationships were documented between religious commitment and physical and functional status, reduced extent of psychopathology, greater emo- tional well-being, improved coping, and strength- ened social support (Matthews et al., 1993; Matthews and Larson, 1995). Overall, these stud- ies show that religious/spiritual beliefs typically play a positive role in adjustment and greater health (Larson and Greenwold-Milano, 1995; Fitchett et al., 1996; Matthews, 1997). Spirituality has been defined by Ross (1995) in terms of three primary areas: meaning and pur- pose, the will to live, and belief and faith in self, others, and God. It may be that spirituality influ- ences recovery from illness through a deeper un- derstanding of life’s meaning or purpose, or an enhanced will to live. This study is the first of a series of studies hoping to further elucidate the ways in which spirituality may influence the heal- ing process and aid clinicians in recognizing the interconnections between mind, body, and spirit. Spiritual well -being (SPWB) Viewed as a multidimensional construct that incorporates both existential and religious dimen- sions (Ellison, 1983), SPWB has been associated with several indicators of well-being, including self-esteem, assertiveness, and meaning/purpose in life (Mickley et al., 1992; Koenig, 1997). Addi- tionally, higher SPWB in cancer patients has been shown to correspond with lower levels of anxiety (Kaczorowski, 1989), good health habits (Kurtz et al., 1995), hope (Mickley et al., 1992), and higher life satisfaction (Yates et al., 1981). What is not as clear, however, is the impact of a patient’s SPWB on other aspects of her/his well-being, including * Correspondence to: 1701 Divisadero St., Suite 150, San Francisco, CA 94115, USA. Tel.: +1 (415) 885-7491; fax: +1 (415) 885-3766; e-mail: elevine@cooper.cpmc.org CCC 1057–9249/99/050429 – 10$17.50 Copyright © 1999 John Wiley & Sons, Ltd.