Religion and Spirituality in Psychiatry

Religion/Spirituality and Mood Disorders 103pietistic orthodox Calvinist tradition, and thereare empirical indications that the rates of depressionin these communities are twice as high comparedto other rural communities.(23)3.6. PentecostalsThe possible adverse effects of religious beliefsare not exclusive to pietistic orthodox Calvinistsand may also pertain to a certain extent toPentecostals. In a population-based study inNorth Carolina, Meador and colleagues (24)reported three times as high a risk for majordepression among members of Pentecostal congregationsas among members of other churches,after adjustment for several possible confounderssuch as life events and social support. One possibleexplanation the authors suggested was thatespecially depressed people may be particularlyapt to affiliate themselves with the Pentecostals.A similarity between orthodox Calvinists andPentecostals may be that their communities oftencombine a pietistic way of believing and strong,possibly over-regulating social networks.3.7. Religious DiscontentIn the literature on depression, a highly relevanttype of relationship is the one between religiousdiscontent , also referred to as religious struggle ornegative religious coping , and depression. Thereis a reported link between criticism of God or asense of being abandoned by God and higher levelsof depressive symptoms.(25, 26) This researchwas carried out among samples of somaticallyill hospitalized patients or older adults. The linkbetween religious discontent and depressivesymptoms is generally twice as strong as the onebetween intrinsic religious motivation or churchattendance and depressive symptoms. Most studiesnonetheless only included positive aspects ofreligiousness. Smith and colleagues (11) concludein their extensive meta-analysis that researchersshould devote more attention to negative formsof religiousness. Prospective research could forexample shed light on whether feelings of religiousdiscontent decrease or even disappear ifa depression ends, or if they represent, in fact, arisk factor for recurrent depression.4. LIFE COURSE PERSPECTIVESSo far there exists considerable scientific evidencefor a multifaceted relationship between religiousnessand depression. The findings should be understoodin their context, as is apparent from the verydifferent samples, ranging from the communitystudies, samples of older people, hospitalizedsomatically ill patients, or psychiatric inpatients. Ofcourse, knowledge of the religious tradition in thegeographical region where studies have been performedis crucial to understand the types of relationships.A related perspective pertains to the ageof the participants under study, the cohort in whichthey grew up, and their current stage of life. Is religionequally important throughout one’s course oflife? What can we learn from the few studies carriedout among children and adolescents?4.1. The Varieties of Religious DevelopmentIndividualization and secularization have permeatedthe Western world in the past century.Greater freedom has evolved to make choicesto which extent a religious way of life fits toone’s course of life, which will also relate toand depend on one’s social roles and familyties, personal inclinations, character traits, andspheres of interest. It would be good to havegreater insight into the choices people makewith respect to spirituality and religion. In theirstudy on The Varieties of Religious Developmentin Adulthood , (27) McCullough and colleaguessuggest that religiousness does not follow onegeneral trajectory throughout life, as seems to besuggested by higher levels of religiousness in laterage. They conducted an empirical analysis, focusingon the importance of religion, in a sample ofmore than a thousand young Californians understudy since 1940 with follow-up assessments forup to fifty years later. The results revealed threetrajectories of religiousness: (1) about 40 percentof the sample followed a pattern starting withintermediate levels of religiousness that increase