(McClatchy-Tribune Information Services) -- Feeling angry with or abandoned by God increases depression in women with breast cancer, according to a survey by Pittsburgh doctors, which advises clinicians to ask patients questions about their religion and guide them to use spirituality to cope.

The yearlong survey of 284 patients explored the relationship between "religious coping" and well-being. The results, published in the Journal of Palliative Medicine, indicate that doctors should listen for "red flag" comments such as, "Why is God punishing me?"

"That's a sign for clinicians that these patients are feeling abandoned," said Dr. Randy Hebert, medical director of Forbes Hospice and lead author of the report.

Hebert and co-authors at the University of Pittsburgh and Carnegie Mellon University found that most women with breast cancer draw strength from religion, though 15 percent of survey respondents reported feeling abandoned or angry, with more symptoms of depression.

"When someone is depressed, it's a cumulation of things," Hebert said. "If you're depressed because you have no money, that's hard to fix. If you're depressed because you have cancer, that's pretty hard to fix. ... But if you're depressed because you think God abandoned you, that's something we can do something about."

Janet Schaffran, an interfaith chaplain at Forbes Hospice, counsels patients to consider God much like a parent who would not give cancer to a child as punishment.

Kathy Purcell, executive director of the Susan G. Komen for the Cure's Pittsburgh affiliate, has seen positive outcomes for breast cancer patients who turn to religion for strength, and said depression in women who don't is a plausible result.

"That's not a nice feeling," said Purcell. "So it isn't surprising that that affects their coping and emotional health."

Copyright (C) 2009, The Pittsburgh Tribune-Review