Warning: religion and spirituality linked to depression


By Lara Apps

A new study* published this month in Psychological Medicine reports that people who are religious or spiritual are more likely to become depressed than secular people are. This was a large cohort study conducted over a year in several countries, with the goal of developing risk measures for depression. What’s remarkable about it is that most previous studies have suggested that being religious leads to better mental health. Earlier this year, for example, the media reported on a University of Saskatchewan study that concluded “Attending religious services at least monthly has a protective effect against major depression.” Here is a brief description of the background, method and results from the new study’s abstract:

Background. Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the USA, limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.

Method. Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.

Results. The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the UK, where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.

So what’s going on? Has this study shown that religion and spirituality cause depression? No, and the authors, to their credit, don’t claim this. The most significant finding is that greater spirituality was correlated with greater risk of depression; the authors speculate that one reason for the correlation between religiosity, spirituality, and depression may be that this was a European-based study, and since Europe is more secular than North America, religious and spiritual people have less support and may therefore experience depression. Most previous studies were conducted in North America, in a very different religious context from Europe, so this is a key observation. It’s important to point out that the number of depressed religious and spiritual people was not high — it was about 10% of the study population. Also, about 7% of the non-religious participants experienced depression during the course of the study.

A rash reading of the study, or of the various reports about it, might suggest a causal link. The study authors do not argue that religion and spirituality cause depression, only that it was associated with a higher risk of depression in the participants; therefore, medical professionals should consider religiosity and spirituality as potential risk factors when assessing patients for risk of depression. Despite what some other bloggers have suggested, the study authors do not conclude that anyone needs to reject religion or spirituality in order to avoid depression.

This does, however, present an important challenge to facile assertions regarding the benefits of religion and spirituality. As the authors put it, “These results do not support the notion that religious and spiritual life views enhance psychological well-being.” Considering that this directly contradicts the findings of the University of Saskatchewan study, as well as many other studies, it would be irresponsible to draw any quick conclusions about the mental health risks and benefits of religion and spirituality. Despite headlines like “Religious believers more depressed than atheists,” which distort the study, there is no reason to assume that being non-religious confers immunity against mental illness, any more than we should assume that being religious or spiritual does.

What we absolutely need to do is question the agendas driving these studies and the ways in which they are interpreted by the media and general public. Attempts to prove that religion is good (or bad) for you are part of a long cultural war that stretches back to the anti-clericalism of the 18th century. I’m not saying religion shouldn’t be challenged, or that the authors of these studies see themselves as part of a cultural war. But the very fact that a study like this is being reported by news outlets and blogs shows that there is more at stake than straightforward medical research.

* “Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study.” Authors: B. Leurent, I. Nazareth, J. BelloÅLn-Saamen˜o, M.-I. Geerlings, H. Maaroos, S. Saldivia, I. Sˇvab, F. Torres-GonzaÅLlez, M. Xavier and M. King. In Psychological Medicine (2013), 43, 2109–2120.

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