It's less about the ideas and more about the meaning attributed.

Many studies have documented significant associations between spirituality and mental, physical and func-tional health in chronically ill adults (Koenig, 2012; Hill & Pargament, 2003). Spirituality is usually considered as a positive resource that may modulate coping with health problems (Kirby et al., 2004; Krause, 2003; Thune-Boyle et al., 2006; Davison & Jhangri, 2013; Delgado, 2007). However, some findings also suggest that spirituality might also negatively influence health outcomes. “Religious struggle” (e.g.: feeling punished or abandoned by God) has been associated with increased mortality in elderly patients (Pargament et al., 2001; Pargament et al., 2004). Similarly, “spiritual distress”, that may be defined as the presence of unmet spiritual needs (Monod et al., 2012; Carpenito, 2004) or “low spiritual well-being” have been associated with depression, desire for hastened death in end-of-life patients and potential harmful effects on patients’ prognosis and quality of life (Astrow et al., 2007; Grant et al., 2004; McClain et al., 2003; Rodin et al., 2009). Based on these observa- tions, the need to carefully assess the spirituality dimension among patients is increasingly acknowledged.