Religion and Spirituality in Psychiatry

Consultation-Liaison Psychiatry 195Diagnostic Interview Survey (which makes diagnosesusing the Diagnostic and Statistical Manualof Mental Disorders, Third Edition, DSM-III , criteria).(9)Intrinsic religiosity (IR) at baseline wasmeasured using an established ten-item intrinsicreligiosity scale. Patients were followed for an averageof forty-seven weeks, and baseline predictors ofspeed of depression remission were analyzed usingCox proportional hazards regression. After controllingfor baseline physical, psychological, andsocial characteristics, for every ten-point increaseon the IR scale (that ranged from ten to fifty), therewas a 70 percent increase in the speed of remission(Hazard Ratio = 1.70, 95% Confidence Interval =1.05–2.75). As in the earlier study, among a subgroupof patients whose physical illness was eithernot improving or was getting worse (n = 48), effectswere particularly strong. For those patients, everyten-point increase on the IR scale predicted over a100 percent increase in speed of depression remission(HR 2.06, 95% CI 1.02–4.15).In a second much larger study, researchers systematicallyidentified 1,000 medical inpatientswith depressive disorder. All subjcet were overage 50 and had congestive heart failure and/orchronic pulmonary disease.(10) Depressive disorderwas diagnosed using the Structured ClinicalInterview for Depression (SCID). Detailed informationwas obtained on depression, psychiatricand social characteristics, physical health, andreligious involvement. Patients were followed afterdischarge (over twelve weeks for those with minordepression; over twenty-four weeks for those withmajor depression). Again, Cox proportional hazardsregression was used to examine the independenteffects of religious involvement on timeto depression remission, controlling for baselinecharacteristics. Of the 1,000 depressed patientsidentified at baseline, follow-up data on depressioncourse was obtained on 87 percent.Results indicated that patients who attendedreligious services and participated in othergroup-related religious activities remitted fromtheir depressions significantly faster than did lessreligiously involved patients. This effect persistedafter controlling for other baseline characteristicsand could not be explained by social support.More important, patients with a combination offrequent religious attendance, prayer, scripturereading, and high intrinsic religiosity (14 percentof the sample) went into remission 53 percentfaster than other patients (HR = 1.53, 95% CI1.20–1.94, p = 0.0005, n = 839) after controllingfor multiple baseline demographic, psychological,social, and medical predictors. Social supportexplained only 15 percent of this effect. Basedon these results, investigators concluded thatdepressed medical inpatients who were highlyreligious (as determined by multiple indicatorsof religious involvement), particularly thoseinvolved in religious community activities, remittedfaster from depression than other patients.5. SUICIDAL THOUGHTSAND BEHAVIORChronic medical illness is associated with highrates of successful suicide, even though contactwith medical providers may be frequent.These patients are often reluctant to share suicidalthoughts with their physicians because ofthe stigma that depression carries with it. Otherpatients may try to recruit their medical providersto assist them in committing suicide, whichcan prompt referral to a psychiatrist for evaluationand management.In some cases, suicidal (or homicidal) thoughtsmay be prompted by religious delusions. For example,a mother developed the religious delusion thather two young children would be forever damnedto hell if she did not kill them. She drowned bothchildren in the bathtub. Another example is thatof a young man who felt extreme religious guilt fornot living up to his religious ideals. He reasonedthat if he killed himself, then this would be sufficientpunishment to prevent his eternal damnationfor the sins he had committed. He hung himselfin his garage. Certain radical fundamentalists (forexample, extremist Muslim groups) may favorsuicide and homicide as an act of service to God.Most religious doctrines and teachings in almostevery major religion around the world, however,discourage suicide. This is particularly true for suicideas a solution to personal suffering.