October 1, 2000
Psychiatric Times.
No. 10
The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental Health
David B. Larson, M.D., M.S.P.H., Susan S. Larson, M.A.T., and Harold G. Koenig, M.D., M.H.Sc.
Dr. Larson is president of the National Institute for Healthcare Research and adjunct professor in the department of psychiatry and behavioral science at Duke University Medical Center and Northwestern University Medical School.
Ms. Larson is a science journalist, co-author of The Forgotten Factor in Physical and Mental Health: What Does the Research Show? and writes "Research Reports" for the National Institute for Healthcare Research.
Dr. Koenig is associate professor of psychiatry and medicine at Duke University.
Suicide Prevention
Surging suicide rates plague the United States, especially among adolescents. One in seven deaths among those 15 to 19 years of age results from suicide. According to the National Center for Health Statistics, suicide rates in this age group have soared 400% from 1950 to 1990.
One study of 525 adolescents found that religious commitment significantly reduced risk of suicide (Stein et al., 1992). Adolescent suicide has also been linked to prior depression. Another study of adolescents found that frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory (Wright et al., 1993). High school students of either gender who attended church infrequently and had low spiritual support had the highest rates of depression, often at clinically significant levels.
How significantly might religious commitment prevent suicide? One early large-scale study found that people who did not attend church were four times more likely to kill themselves than were frequent church-goers (Comstock and Partridge, 1972). Stack (1983) found rates of church attendance predicted suicide rates more effectively than any other evaluated factor, including unemployment. He proposed several ways in which religion might help prevent suicide, including enhancing self-esteem through a belief that one is loved by God and improving moral accountability, which reduces the appeal of potentially self-destructive behavior.
Many psychiatric inpatients indicate that spiritual/religious beliefs and practices help them to cope. Lindgren and Coursey (1995) reported 83% of psychiatric patients felt that spiritual belief had a positive impact on their illness through the comfort it provided and the feelings of being cared for and not being alone it engendered.
Yet Kehoe and Gutheil (1994), evaluating suicide assessment instruments, recently observed, "Although religion is noted as a highly relevant factor in suicide literature, the number of religious items included on assessment scales approaches zero." They noted the need to recognize and include religion/spirituality in suicide prevention, treatment and care.
Potential Harmful Effects
Psychiatry still needs more research and clearer hypotheses in differentiating between the supportive use of religion/spirituality in finding hope, meaning, and a sense of being valued and loved versus harmful beliefs that may manipulate or condemn.
For example, in assessing multiple personality disorder, Bowman (1989) described rigid religious families whose harsh parenting practices border on abuse. Children from these families harbored negative images of God. Josephson (1993) described individual psychopathology linked with families whose enmeshment, rigidity and emotional harshness were supported by enlisting spiritual precepts.
Sheehan and Kroll (1990) studied 52 seriously mentally ill hospitalized patients diagnosed with major depression, schizophrenia, manic episode, personality disorder and anxiety disorder. Almost one-fourth of them believed their sinful thoughts or acts may have contributed to the development of their illness. Without the psychiatrist inquiring about potential religious concerns, these beliefs would remain unaddressed, potentially hindering treatment until discovered and resolved. Collaboration with hospital chaplains or clergy may help in some of these instances of spiritual problems or distress.
Conclusion
Religious/spiritual commitment may enhance recovery from depression, serious mental or physical illness, and substance abuse; help curtail suicide; and reduce health risks. More longitudinal research with better multidimensional measures will help further clarify the roles of these factors and whether they are beneficial or harmful.
References
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Benson P (1992), Religion and substance use. In: Religion and Mental Health, Schumaker JF, ed. New York: Oxford University Press, pp211-220.
Bowman ES (1989), Understanding and responding to religious material in the therapy of multiple personality disorder. Dissociation: Progress in the Dissociative Disorder 2:232-239.
Brizer DA (1993), Religiosity and drug abuse among psychiatric inpatients. Am J Drug Alcohol Abuse 19(3):337-345.
Comstock GW, Partridge KB (1972), Church attendance and health. J Chronic Dis 25(12):665-672.
Desmond DP, Maddux JF (1981), Religious programs and careers of chronic heroin users. Am J Drug Alcohol Abuse 8(1):71-83.
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Sheehan W, Kroll J (1990), Psychiatric patients' belief in general health factors and sin as causes of illness. Am J Psychiatry 147(1):112-113.
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Stein D, Witztum E, Brom D et al. (1992), The association between adolescents' attitudes toward suicide and their psychosocial background and suicidal tendencies. Adolescence 27(108):949-959.
Wright LS, Frost CJ, Wisecarver SJ (1993), Church attendance, meaningfulness of religion on, and depressive symptomatology among adolescents. Journal of Youth and Adolescence 22(5):559-568.
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