Religion and Spirituality in Psychiatry

Religion/Spirituality and Mood Disorders 101associated with slightly higher levels of mentaldistress (46 studies) and persona l devotionwith lower levels of mental distress (35 studies).Following a different strategy with 147 studiesand focusing on depressive symptoms, Smith,McCullough, and Poll (11) report slightly moredetailed findings. Again, intrinsic religious motivationwas associated with lower levels of depressivesymptoms, but the association between themeasures of religious behavior and depressivesymptoms were not significant. Moreover, Smithand colleagues identified both a weak main effectand a slightly more pronounced stress-buffereffect for people facing problems in old age.Furthermore, post-hoc analyses revealed thataspects reflecting a critical attitude toward religion,extrinsic religious motivation, and negativereligious coping (for example, blaming God fordifficulties) were associated with higher levels ofdepressive symptoms. The results of the metaanalysessuggest a main protective as well as astress-buffer effect, but it should be emphasizedthat causal interpretations are not warranted.3.2. PrayerIn meta-analyses and reviews, prayer is often categorizedas religious behavior, but private prayershould not be confused with public religious participation.Prayer does not only involve the privateaspect of contemplation, but the frequencyof private prayer by far exceeds that of religiousbehavior in the context of attending services.Although prayer is viewed as an essential elementof religiousness, only a limited number of studieshave been conducted on prayer or other privatereligious behavior and depression, and the resultsare mixed. One possible reason for the conflictingresults may have to do with the process of copingitself. People intensify their praying in times ofadversity, which is when depressive symptomsand other signs of distress develop as well. Ifprayer is successful as a coping strategy, it canfacilitate the recovery from depressive symptomsover time. Ai and colleagues illustrated this principle(12) with their observation that, retrospectively,prayer related to higher levels of depressivesymptoms in the period immediately followingcoronary bypass surgery, but this association wasreversed after one year of follow-up.Another perspective on prayer has to do withits perceived importance among patients admittedto a mental hospital. In a small sample (N = 50)of psychiatric inpatients in the United States,Fitchett and colleagues (13) described that prayerremained important for 80 percent of the patients,almost two-thirds of whom suffered from mooddisorders. The percentage was similar in a comparisonsample of medical and surgical patients.It is uncertain whether prayer is a successful strategyfor coping religiously with depression, but thefact that people pray very often suggests that theystrongly adhere to it. In a U.S. sample studied inNorth Carolina, the frequency of prayer amongolder adults with major depression was 80 percentweekly or more (14) compared to 46 percent in anAustralian sample.(15) Despite these differences,the rates of prayer are substantial. Prayer did notrelate to depressive symptoms in these studies.3.3. Recovery from DepressionSeveral studies describe associations betweenaspects of religiousness and the outcome ofdepression. In three studies among (older)subjects with depression, intrinsic religiousmotivation, (16) salience of religion, (17) and positivereligious coping (14) were associated witha better depression outcome. Church attendancehad no significant association with the depressionoutcome in either of the above studies. However,in a large study among 1,000 hospitalized adultswith pulmonary or cardiovascular disease andconcurrent major depression, Koenig (18) didnot observe a significant association betweenintrinsic religiousness and remission of depression.Church attendance, however, predicted ashorter recovery time, after multivariate adjustmentfor health and social support. Higher levelsof religiousness can thus be assumed to predict abetter depression outcome among older patientsor subjects with a serious physical condition. Thequestion remains as to whether the severity ofthe depression was similar between people still