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Spirituality Tied to Higher Depression, Anxiety Rates

Although more clinicians are considering patients' religion and spirituality in their initial evaluation than in the past, these issues may need to be revisited at various times during psychiatric treatment.

Does religiousness, defined as participation in organized-religion worship services, affect people's emotional equilibrium? The limited research that has been conducted on the subject suggests that it can counter depression. Less clear, however, is what impact, if any, religiousness has on anxiety (Psychiatric News, July 7).

A study in the September Canadian Journal of Psychiatry adds a new twist to the question of whether religiousness affects people's emotional states. It has linked religiousness with lower rates of both depression and anxiety, yet has found that spirituality— the search for a meaning to life—is associated with higher rates of both maladies.

The Canadian Community Health Survey: Mental Health and Well-Being was conducted in 2002 with a large, representative population of about 37,000 Canadians aged 15 or older. Marilyn Baetz, M.D., an associate professor of psychiatry at the University of Saskatchewan, and coworkers used data from the survey for their study. This appears to be one of the largest sample sizes ever used to explore interactions between religion, spirituality, and mental illness.

Baetz and her colleagues first determined how religious and how spiritual respondents to the survey had been. Respondents' religiousness was defined by how often they worshiped in an organized-religion setting (with 1 indicating "never" and 5 "once weekly or more"). Participants' spirituality was defined by how important a search for a meaning to life was for them (with 1 indicating "none" and 4 indicating "high").

The researchers also looked for links between religiousness and spirituality and sociodemographic variables. They found that there was a strong, positive link between both religiousness and spirituality with older age, higher education, and greater social support. In contrast, there was an inverse association between religiousness and income and between spirituality and income.

In addition, women were more religious and spiritual. Married individuals were more religious than nonmarried individuals, and those who were separated, divorced, or widowed were the most spiritual.

Controlling for sociodemographic characteristics, Baetz and her colleagues also determined, using DSM-IV criteria, the chances of respondents' having any of four affective disorders—major depression, manic episodes, panic disorder, and social phobia—depending on ow religious or spiritual they were.

Religiousness was significantly associated with lower odds of lifetime depression, which ties in with what other researchers have found; thus, religiousness may protect against depression. The researchers said, however, that the cross-sectional nature of the data precludes a firm answer about causation.

Religiousness was significantly linked with lower number of lifetime manic episodes. Thus religiousness may also offer protection against bipolar disorder similar to that against unipolar depression, they speculated.

Religiousness was also significantly tied to lower lifetime panic disorder and lower lifetime social phobia. Thus, it may help protect against these two disorders, but perhaps not as much as it shields people from depression and bipolar disorder, the investigators noted.

The study results regarding spirituality and affective disorders were the opposite of those for religiousness. Spirituality was significantly linked with higher lifetime odds of having depression, manic episodes, and social phobia. Spirituality was also coupled with higher lifetime odds of having panic disorder, although this connection was not statistically significant.

This "clear difference in the association of spiritual values with psychiatric disorders compared to worship frequency" surprised her, Baetz told Psychiatric News.

Thus, spirituality may help set the stage for depression, bipolar disorder, social phobia, and panic disorder, or it may result from having such illnesses, the researchers suggested. Baetz said she favors the latter explanation. "I think that it really speaks to the fact that psychiatric disorders are similar to other serious, often chronic illnesses that cause people to search for meaning and look outside themselves for answers, though they may not be involved in formal organizational religious behaviors...."

This investigation "is a significant contribution to the literature on the roles of religion and spirituality in psychiatry," Mary lynn Dell, M.D., M.T.S., Th.M., said in an interview. Dell is an associate professor of psychiatry at Emory University and an Episcopalian minister. "It may even be a gem, in that the authors have taken great care to present their findings without overinterpreting the data or reading too much into possible clinical implications.... As a psychiatric educator, I especially appreciate and agree with the authors' point that while it is certainly a good thing that more clinicians are considering patients' religion and spirituality in the initial evaluation, this area needs to be revisited during the course of their illness.... Religion and spirituality are not static components of personhood."

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