Religious and spiritual factors are increasingly being examined in psychiatric research. Religious beliefs and practices have long been linked to hysteria, neurosis, and psychotic delusions. However, recent studies have identified another side of religion that may serve as a psychological and social resource for coping with stress. After defining the terms religion and spirituality, this paper reviews research on the relation between religion and (or) spirituality, and mental health, focusing on depression, suicide, anxiety, psychosis, and substance abuse. The results of an earlier systematic review are discussed, and more recent studies in the United States, Canada, Europe, and other countries are described. While religious beliefs and practices can represent powerful sources of comfort, hope, and meaning, they are often intricately entangled with neurotic and psychotic disorders, sometimes making it difficult to determine whether they are a resource or a liability.
Can J Psychiatry. 2009;54(5):283-291.
* Religious beliefs and practices may be important resources for coping with illness.
* Religious beliefs may contribute to mental pathology in some cases.
* Psychiatrists should be aware of patients' religious and spiritual beliefs and seek to understand what function they serve.
* My review of recent studies is selective, not systematic.
* Studies without statistically significant findings are not discussed.
* Clinical applications are not addressed.
Key Words: religion, spirituality, depression, anxiety, psychosis, substance abuse
Abbreviations used in this article
5-HT 5-hydroxytryptamine (serotonin)
5-HT1A 5-beta hydroxytryptamine receptor 1
CASA National Center on Addiction and Substance Abuse
MADRS Montgomery-Asberg Depression Rating Scale
MDD major depressive disorder
RCT randomized controlled trial
RS religion and (or) spirituality
Despite spectacular advances in technology and science, 90% of the world's population is involved today in some form of religious or spiritual practice.1 Nonreligious people make up less than 0.1% of the populations in many MiddleEastern and African countries. Only 8 of 238 countries have populations where more than 25% say they are not religious, and those are countries where the state has placed limitations on religious freedom. Atheism is actually rare around the world. More than 30 countries report no atheists (0%) and in only 12 of 238 countries do atheists make up 5% or more of the population. In Canada, 12.5% of the population are nonreligious and 1 .9% atheist.
Evidence for religion playing a role in human life dates back 500 000 years ago when ritual treatment of skulls took place during China's paleolithic period.2 Why has religion endured over this vast span of human history? What purpose has it served and does it continue to serve? I will argue that religion is a powerful coping behaviour that enables people to make sense of suffering, provides control over the overwhelming forces of nature (both internal and external), and promotes social rules that facilitate communal living, cooperation, and mutual support.
Until recent times, religion and mental health care were closely aligned.3 Many of the first mental hospitals were located in monasteries and run by priests. With some exceptions, these religious institutions often treated patients with far more compassion than state-run facilities prior to 19thcentury mental health reforms (reforms often led by religious people such as Dorothea Dix and William Tuke). In fact, the first form of psychiatric care in the United States was moral treatment, which involved the compassionate and humane treatment of people with mental illness - a revolutionary notion at a time when patients were often put on display and (or) housed in despicable conditions in the back wards of hospitals or prisons. …