The relation between religion and (or) spirituality (RS), and mental health has shown generally positive associations; however, it is a complex and often emotion-laden field of study. We attempt to examine potential mechanisms that have been proposed as mediators for the RS and mental health relation. We also examine more philosophical areas including patient and physician opinions about inclusion of RS in patient care, and ethical issues that may arise. We review suggested guidelines for sensitive patient inquiry, and opportunities and challenges for education of psychiatrists and trainees. We also study practical ways to incorporate psychospiritual interventions into patient treatment, with specific reference to more common spiritual issues such as forgiveness, gratitude, and altruism.
Can J Psychiatry. 2009;54(5):292-301.
* RS may impact mental health through multiple dimensions including the biological, psychological, and social realms.
* Mental illness is a time when personal resources are challenged and RS may be a clinically significant positive or negative source of coping.
* Education about RS and mental health will inform clinicians about ways of inquiry, potential issues to address, and ethics of the interaction.
* There is limited research into practical psychospiritual interventions in psychiatrically ill populations.
* The research has just begun to examine the complexity of proposed mechanisms from a multidimensional perspective.
* Measures of RS are often assessed in ways that may blur differences that exist between faith traditions.
Key Words: religion, spirituality, mechanisms, ethics, education, clinical implications
Abbreviations used in this article
MDD major depressive disorder
PFC prefrontal cortex
PTSD posttraumatic stress disorder
RS religion and (or) spirituality
In general, research has shown RS positively affects mental health outcomes, as noted by Koenig.1 Although largely reporting on US studies, an increasing body of literature on the effects of spirituality on mental health from numerous countries, including Canada,2-6 indicates the findings apply across boundaries and religions.
However, the literature is dominated by a spirituality that finds its expression through religious observance. From a practical perspective, this raises the question of the clinical relevance of these findings for people who are not necessarily religiously observant. The relevance could be demonstrated by an exploration of the putative mechanisms through which spirituality may exert its affect. This perspective is important for a population such as Canada's, where, during the last decades, the percentage of Canadians who report regular church attendance has decreased dramatically.7 Fifty years ago, Canada had a larger proportion of its population attending religious services than the United States; this proportion has since noticeably dropped, positioning Canada about halfway between the United States and European countries.7
Two major trends are apparent. First, a smaller percentage of Canadians attended religious services at least monthly in 2004, compared with 1985 (32% and 41%, respectively).8 Second, according to 2001 census data,9 the proportion of the population identifying with a religion other than Christianity is increasing, largely owing to immigration, while the proportion of the population classified as Catholic or Protestant decreased from the previous decade. Statistics of religious affiliation alone do not tell the whole story. Bibby's research10 on the sociology of religion in Canada suggests a modest upswing in the number of people adhering to some of the faith communities, while the number of nominally religiously adherent people is decreasing. Further, while a person may not affiliate with a faith commumty, they may still identify with a church for certain religious rituals (for example, weddings and funerals). …