1
Lithuanian University of Health Sciences
Faculty of Medicine MF VI
Samah Ballal
The correlation between religion/spirituality and
depression among LUHS students
Department of Psychiatry
Submitted in partial fulfilment of the requirements for the degree of
Master of Medicine
Scientific Supervisor:
Benjaminas Burba, MD, PhD, Professor
June 2016
Kaunas
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TABLE OF CONTENTS
1. Summary ………3
2. Acknowledgments………...4
3. Conflicts of interest……….5
4. Ethics Committee Clearance……….5
5. Abbreviations……….5
6. Introduction……….6
7. Aim and objectives……….7
8. Literature review………8-12 9. Research methodology and methods………..13-14 10. Results……….15-19 11. Discussion……….20-22 12. Conclusions………..22
13. Practical recommendations………..23 14. References………24-27
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SUMMARY
Author: Samah Ballal
Scientific supervisor: Benjaminas Burba MD, PhD, Professor
Research title: The correlation between religion/spirituality and depression among LUHS students. Aim: To evaluate the correlation between religion/spirituality and depression among university students of different ethnicities, backgrounds and religious belief
Objectives of the study: 1.To evaluate sociodemographic characteristics of the individual surveyed. 2. To assess the existence of depressive symptoms among the individuals surveyed. 3. To find out their religious beliefs. 4. To find the relationship between religion/ spirituality and depression
Methodology: A cross sectional study was employed with the aim of pursuing a primarily quantitative methodological approach. This was conducted in the form of questionnaire with closed ended questions. 98 International students from different faculties and different years from LUHS were randomly selected. After consent from the individual surveyed, he/she was anonymously evaluated for their sociodemographic, religious beliefs and the existence of depressive symptoms analysed.
Results: 66.3% of respondents were female and 33.7% male.77.6% are believers in God and 22.4% are non-believers. 45.6% claimed religion was an important aspect in their life and of those 45.6%, 71.4% are practicing their religion. 38% said religion was not important to them and 15% where borderline. 67.3% of the respondents have no/mild depression, 27.6% have moderate and 5.1% have severe depression. If using statistics alone, believers were similar to non-believers, with regards to the prevalence of depression (P value 0.735). However if looking at the surveys as a whole we can deduce that religion has a positive effect on health as 84.1% of the believers admit that religion gives them a more positive outlook on life and 96.8% of think religion affects the outcome of depression in a positive way i.e. religious coping. Almost 80% of non-believers, however, believe that their disbelief makes them more optimistic. Having said that 68.1% of them think that religion affects the outcome of depression positively. And 66% of them believe religious coping should be used be psychiatrist in aiding recovery. Conclusion: There are certainly an exceptional amount of factors that contribute to the risk of
depression including R/S. On an individual basis, believers tend to be happier, feeling more fulfilled than non-believers, leading to lower rates of depression. This can be attributed to having meaning in one’s life and believing that NLE are a test from God. Also religious involvement allows one to be surrounded by a supportive community and prevents isolation. In this study religious or spiritual involvement and depression correlation is insignificant, statistically. However R/S involvement seems to be related to depression in one way or another. Given the worldwide prevalence of both depression and R/S, researchers and clinicians need to have a greater understanding of how R/S effects mental health.Recommendations: A greater number of participants is required to improve the statistics
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ACKNOWLEDGEMENTS
I would like to express my deepest appreciation to Dr. Benjaminas Burba for his patience, guidance and encouragement throughout my final year project. His efforts and excellent teaching enabled me to develop an understanding and interest of the subject. I would also like to thank Edita Sakyte who helped me with all the statistical analysis of my data. I am deeply grateful for her kindness, sound advice and help during my research.
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CONFLICT OF INTEREST
“the author reports no conflicts of interest”.
BIOETHICS CLEARANCE
‘The correlation between religion/ spitirtulaity and depression among LUHS students’ Nr. BEC – MF - 63
2015-10-28
ABBREVIATIONS
WHO – World health organisation R/S – Religion/Religiosity or Spirituality NLE – Negative life events
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INTRODUCTION
Religion is a complex topic that many people have tried to define its meaning. It is an aspect of life and a way of living for many people. Because it crosses so many different boundaries in human experience, religion is difficult to define. Attempts have been made, however, and every theory
inevitably has its limitations. Each view contributes to our understanding of this complex phenomenon. One scholar defines religion as playing ‘a fundamental role and significance on human existence. It marks off what is special and true, provides order and structure and sets forth the project and goals for humanity’. It’s worth noting that according to the World Gallup Poll, 92% of people in 32 different developing countries stated religion was an important aspect of daily living [6]. According to the Pew centre 83.5% of the world’s populations is involved in a form of religious or spiritual practice and atheism is quite rare.
Depression is one of the most common mental health issues and according to the WHO 1 in 15 people suffer from depression in the European region. In Lithuania 21,500 patients are currently being treated for depression by mental health care specialists (according to the Eurobarometer survey). The WHO also believes by the year 2020, major depressive disorder will be the second most debilitating disorder in the world. It is a disorder that affects your mood, causes a loss of interest in activities that one previously found enjoyable and causes individuals to become highly irritable. Due to the high prevalence of depression, the study of depression and its correlations is very important. In this study, a questionnaire was completed by LUHS students and this was used to assess the correlation between R/S and depression. Data analysed revealed that on an individual; basis religion and religious involvement such as prayer and church attendance instantaneous led to people feeling happier. And people tended to turn to religion to help them cope with stressful situations and NLE. However on a statistical analysis there was an insignificant correlation between the R/S and depression
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AIM
To evaluate the correlation between religion/spirituality and depression among university students of different ethnicities, backgrounds and religious belief
OBJECTIVES OF THE STUDY
1. To evaluate sociodemographic characteristics of the individual surveyed.
2. To assess the existence of depressive symptoms among the individuals surveyed 3. To find out their religious beliefs
4. To find the relationship between religion/ spirituality and depression
The object of research: International students of LUHS.
Sampling and data collection method: 200 International students from different faculties and different years (proportionately) from LUHS will be randomly selected. After consent from the individual surveyed, he/she will be anonymously evaluated for their religious beliefs and existence of depressive symptoms analysed.
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LITERARY REVIEW
B. Larson, S. Levin and G. Koenig were some of the pioneers who began investigating
religion/spirituality as an aspect of medicine. They saw the positive effects of religion and conducted a series of studies analysing the relationship between religious involvement and mental health in adults. Since their work, there has been a large body of research and investigation into this field and the res-ults regarding this topic are conflicting. There have been many studies that reported a positive
relationship, meaning that those who were more religious were less likely to have depression [Smith, McCullough, & Poll, 2003][1] and have greater levels of happiness, life contentment and overall well-being [Lewis & Cruise, 2006; Koenig, McCullough & Larson, 2001][2]. More recent studies
however have shown a negative relationship [Hill & Pargament, 2003][4], emphasising that not all forms of religiousness are related to mental health and well being
Michael B King in his article ‘Conceptualizing spirituality for medical research and health service provision’ quotes Koenig’s definition of religion as [4]
‘And organised system of beliefs, practices, rituals and symbols designed to facilitate closeness to the sacred or transcendent (God, higher power or ultimately truth/reality)?’ [4]
Although this definition of religion is rather simplistic it is the one that is adopted here due to the difficulty in defining religion because it is a multidimensional phenomenon.
Spirituality is ‘the personal quest for understanding to the ultimate questions about life, about
meaning, and about relationship with the sacred or transcendent, which may (or may not) lead to arise from the development of religious rituals and the formation of a community?’ [4]
Religion and spirituality are sometimes regarded interchangeable however both of these are not synonyms for each other, one does not have to be religious in order to be spiritual. Having said that, since we are discussing research, we will be using them interchangeably because they are similar in that they both involve a relationship with the transcendent. Also whenever spirituality is assessed, its assessed using questions measuring religion. [5,6]
Between the years 1962 and 2010 there have been 444 quantitative studies investigating the relationship between R/S and depression, or the impact of using religious intervention on depression. 414 of these studies were observational studies and the remaining 30 were clinical trials. Results showed that 61% of the studies found less depression and quicker recovery from depression with religious intervention. 6% of studies found the opposite. I will now discuss some of these studies in detail.
Psychiatrist epidemiologists at Columbia University carried out an interesting study to discover whether religiosity can protect against depression in high risk individuals [7] ie. Those whose parents
9 suffered from depression. Researcher found that those who indicated that religion was an important factor in their life were 73% less likely to get depression. And among the high risk group (i.e. those whose parents had depression) were 90 % less likely to get depression. This study is relatively accurate because it was a 10 year prospective study and factors such as age gender, history of depression and risk status were also controlled. Researchers took it one step forward by investigating differences in relationships between R/S and future depressive episodes based on level of exposure to NLE or life stressors [8]. Follow up revealed high risk patients (i.e. parents had depression) with religious attendance (praying, bible reading, church attendance etc.) who had a lot of exposure to NLE were 76% less likely to get major depression. The above findings highlight the importance of R/S involvement as it may protect against depression in high risk individuals, individuals with a lot of exposure to NLE or both.
Not only can religion be helpful in combating depression, religion can also be used as a coping mechanism during depression and a form of treating patients. Research conducted in Malaysia amongst religious Muslims demonstrated the latter. Two groups of 32 depressed patients in each group were used. One group received psychotherapy as well as teachings and lessons derived from the Quran and Islamic prayer, whereas the control group received psychotherapy only. Patients who received both types of treatment were actually shown to improve at a faster rate than those in the control group [9]. Similarly a study was conducted in the Centre for Psychiatric Rehabilitation at Boston University, where 157 patients with mental health disorders including major depression, were surveyed [10]. They were asked about the alternative health care practices they used to help them cope with their illness. It was found that greater than 50% of those with major depression and schizophrenia used religious/ spiritual activity to help them cope. One last study which demonstrated how religion can be used as a coping mechanism was carried out on an 81 year old woman with a chronic illness and a strong faith [11] Many people with chronic illnesses often fall into depression and this article describes how faith, prayer and hope have helped the woman get through the roller coaster of life and push forward in all her difficulties.
I’ve emphasised religious coping, and this poses the question, how is religion used as a coping mechanism? Religious coping can be of 2 types, positive religious coping and negative
religious coping. Ken Pargament (2010) discusses these in his study ‘Religion and coping: The current state of knowledge’ [12]. His theory of positive religious coping is that life stressors can be
‘religiously reframed as part of God’s plan and thus can be transformed into benign events’ .Negative life events can also be reframed as being a lesson or a reward from God or even as an opportunity to get closer to the Divine. However another study by Loewenthal et al. 2001 observed that religious coping was ineffective [13]. Having looked more closely at this study, it should be noted that results could have been skewed by a few reasons. The volunteers surveyed had to asses themselves i.e. grade
10 themselves according to whether they were depressed and the degree of this depression. This self-diagnosis technique is misleading as some individuals could simply be sad and not clinically
depressed. A diagnosis of clinical depression needs to be mad by a mental health professional and not just by anybody. Also 20% of the candidates belonged to no religion and therefore the score of any positive religious coping is automatically reduced.
Furthermore a study conducted by Koenig and Peterson on patients 60 years or above were screened for depressive symptoms. 94/111 patients were diagnosed with depressive disorder (DSM- III criteria) using the Depression scale. After discharge, the patients were followed up 4 times and
religious variables were examined as predictors of time to remission. Results of this study reinforced the positive effects of R/S as the latter was shown to predict faster speed of remission of depression in 54% of patients. Interestingly, intrinsic religiosity; meaning a person’s whole view and approach to life is based upon religion, was more significant to remission speed. Church attendance, private/perosnal prayer and other religious activates were not as significant. Two other studies which involved Koenig, supported these findings. ie. Faster speed of remission from depression in hospitalised patients
experiencing the stress of medical illness. [14-16]. From the latter studies we can deduce that it would be highly beneficial for mental health care professionals to attempt to understand the religious factors influencing health in order to provide a more compassionate and comprehensive care.
Most research carried out regarding this topic focused on Christianity. Over the past few years more research has been carried out on Islam [Abu Raiyah and Khalil 2009][17], Judaism [Rosmarin et al.2009 ][18] [Kennedy GJ and Keiman HR][19] and Hinduism [Tarakeshwar, Pargament and Mahoney 2003][20-21]. The latter studies suggest that those who are religious have better indices of mental health. The reason for these positive effects has to do mainly with a supportive relationships with God [Dein 2006][22]. Also it’s worth emphasising, that, these studies suggested that religious beliefs impact differently on mental health according to the faith group of an individual Let’s discuss briefly findings about Judaism. Kennedy GJ and Keiman HR [19 as before] found that people of Jewish decent, have a twofold increase in the prevalence of depression as compared to Catholics. The researchers discovered this was the case for Jews who were not actively religious. These findings can actually be due to a number of reasons. One reasons may be due to the fact that Jewish people are more likely to report any symptoms of depression to psychiatrists rather than look for other means such as alcohol for coping with their emotional and psychological problems (thereby giving the impression of higher depressive rates)
I would also like to add, that, overall it is very difficult to measure how religious a person is. Therefore there are limitations to some of the above studies. Individuals go through spiritual highs and lows and this can greatly affect the results (those studies that are longer take this into account).
11 religion due to some discrepancies [22]. They claim that not much work was done on non-religious individuals and also atheist and agnostics. These individuals’ beliefs and mental health associations also need to be addressed and studied. Another fault in these studies is the selection biases that occurs in recruiting subjects. This fault was addressed by Hwang [Hwang, Hamer and Cragun 2009][23] . Here Hwang emphasise the importance of including atheists as a control group in a study which attempts to find the relationship between religion and mental health.
In another study researchers looked at how ‘religious believes and practices influenced the psychological health of catholic priests’. 15 Priests who practice their faith and promised celibacy and obedience were ‘studied’. How this influenced their psychological health was reviewed. By the end of the study it was clear that religion affected the lives of the priests in a positive and negative way. Two (13%) of the 15 participants claimed that celibacy lead them to feelings of depression due to a lack of an intimate relationship with one person or having a family [24]. This feeling of loneliness which lead to depression was also demonstrated in 2 other studies. Hoge, Shields, & Soroka 1993: Isacco et al., 2014) [25-26]. However the literature on priests psychological health is inconclusive, because in another study which took a sample of 2,482 priests found that a relationship with God was the 2nd most important factor that contributed to their happiness [Rossetti, 2011][27]. Some other research has stated that the level of depressive disorder was 7 times higher amongst priests than the general public. (Knox, Virginian, Thull & Lombardo, 2005)[28]
Finally in an article by Prakash B Behere and colleagues, its focuses on religion and mental health in an Indian population [29]. This adds greatly to the research topic because Hinduism focuses more on spirituality. In Hinduism, God has a unique meaning. In religions like Islam- Christianity – Judaism, God is the creator of the heavens and the earth and all that it contains. In these religions God resides outside the world which he created. However, participants of the Hindu religion believe that God is within them. This rather interesting philosophy is transcendent because it focus more on
spirituality rather than religion. Living a spiritual life is living your life through an open heart, through love. It also allows oneself to align with the values of tolerance, acceptance, harmony, cooperation and reverence for life. This teaching of a connection to a spiritual side is important to Hindus because they believe that the surface of all physical problems is a spiritual solution. Belief system of Hindus in India is spirituality is the core foundations of life. However to an outsider Hinduism continues to present bewildering beliefs and customs that often contradict each other. In this study the researchers found like many other studies the positive correlations between religion and how stresses and strains as well as the ‘unknown’ about life was better accepted by believers rather than non-believers. However what I would like to highlight here is that, researchers found that depression was quite common in India and there was often a feeling of guilt among Indian depressed patients. Hindu’s admitted that their feelings of guilt were attributed to a sin committed in the past. Sin and repentance is a foreign concept in the
12 Hindu religion. They believe in karma (belief that whatever you do comes back to you, e.g. if you do something good, something good will happen to you, and vice versa.), which can cause some
symptoms of depression if one committed a major sin.
Earlier I mentioned how Pargament in his study mentioned positive religious coping. However Pargament also mentions negative religious coping. Some religious people see illness or other NLE events as a punishment from God or they even question God’s abilities and power. This view has actually been linked with more depression and a poorer quality of life in a study of hospitalised patients. Other studies demonstrated the negative impacts of religion. Wijingaards- De Mejj [30] and colleagues conducted a 2 year prospective study in the Netherlands, where 219 couples who suffered the painful loss of a child where followed through the recovery process. Surprisingly those with religious affiliation where at a higher risk of experiencing depression than those without a religious affiliation. This is because, religion focuses on and places great importance on family life. Therefore people who have family issues especially issues related to children and marital problems where at a greater risk of feelings of guilt and getting depression.
Attending religious services was also carefully analysed in a study in Rhode Island [31]. It actually found that among males, NOT attending religious services actually led to a less likely risk of depression by 44%. As a matter of fact those who stopped attending were at an even lower risk. Thus among those who suffered the loss of a child in the Netherlands and young men in Rhode Island, R/S involvement was actually associated with a greater risk of depression.
In conclusion, it is safe to say that although religion has both positive and negative
associations, it has more positive than negative associations with regards to depression. Religious/ spiritual people have a lower risk of getting depression as I’ve previously demonstrated in the above studies. Also interventions that include using the patients religious beliefs have shown to reduce
depressive symptoms in some clinical trials, more research needs to be done on this. These results pose a question as to why religion helps so many patients with medical and psychiatric illness. R/S faith provides a sense of meaning and purpose to life and is associated with positive emotions and optimism. This allows people to cope in difficult circumstances and many of life’s stresses. In many religious books such as the Bible and the Quran, we can derive lessons from role models and this helps in acceptance of one’s own suffering. Individuals also put their trust in the Divine, this reduces the need for personal control and thus is a coping mechanism. And one of the greatest and most beneficial advantage of religion is that it’s available at any time, any place, and regardless of one’s financial status, physical, mental or social circumstance.
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RESEARCH METHODS AND METHODOLOGY
A cross sectional study was employed with the aim of pursing a primarily quantitative methodological approach. This was conducted in the form of a questionnaire with closed ended questions in order to assess the religious beliefs of the participants and also whether their depressed or not. Before
undertaking this questionnaire, consent was received from the LUHS Bioethics committee for this study. Surveys were sent out amongst LUHS foreign students and 98 completed forms were received. The questionnaire employed in this study is made up of 4 sections:
Section 1: Sociodemographic
Section 2: Depression Questionnaire
Most depression questionnaires are very similar, having looked at many of them, I created a summary questionnaire which suited my study and allowed me to detect/ diagnose any signs or symptoms of depression as well as group the individuals into 3 groups:
a. No or mild depression b. Moderate depression c. Severe depression
Section 3:
Consisted of questions which were relevant to those who belonged to a religion. It entailed the
respondent to answer questions that were tailored to obtain information about ones beliefs, feelings and attitude towards God.
Section 4: Control group
This section was for those who didn’t belong to a religion (i.e. Atheist/ Agnostic). This group was necessary as the control group.
Participations selection:
A total of 99 LUHS foreign students took part in this study .The sample collected was completely randomised (no gender selection, no specific age group, ethnicity religion etc ).This is necessary for religious experience and affiliation however it also has its drawback because we are not entirely sure the number of depressed patients.
14 Statistical data analysis was performed using data collection and analysis SPSS 20.0
(Statistical Package for Social Science for Windows) package . The mean of depression scores with a deviation MV (SD) was presented. Student’s (t) test was applied to compare average values of depression scores in two independent groups. ANOVA test was used to compare mean values in more than two groups. The distributions of respondents in several groups were evaluated by χ2 test. The difference between groups was considered as statistically significant when p<0.05.
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RESULTS
98 LUHS students were assessed. Statistical data analysis was performed using data collection and analysis SPSS 20.0 (Statistical Package for Social Science for Windows) package . The mean of depression scores with a deviation MV (SD) was presented. Student’s (t) test was applied to compare average values of depression scores in two independent groups. ANOVA test was used to compare mean values in more than two groups. The distributions of
respondents in several groups were evaluated by χ2 test. The difference between groups was considered as statistically significant when p<0.05.
Table 1. Sociodemographic characteristics of the study participants
Characteristic N (%) Male 33 (33,7%) Female 65 (66,3%) Age group 17-21 38 (39,2%) 22+ 59 (60,8%) Relationship status Single 64 (66%) In a relationship/ married 33 (34%) Faculty Medicine 85 (87,6%) Dentistry 7 (7,2%) Pharmacy 1 (1%) Veterinary 2 (2,1%) Public Health 2 (2,1%) Nationality N % European 65 66.3 African 6 6.1 Middle Eastern 16 16.3 Asian 11 11.2
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Table 2. Characteristics regarding religion of the study participants
Characteristic N (%)
Religious background
Believer (Christianity, Islam, Hinduism,
Judaism, Buddhism) 76 (77,6%)
Atheist/ Agnostic 22 (22,4%)
Is religion a very important aspect of
one's life?
Yes 45 (45,9%)
No 38 (38,8%)
Sometimes 10 (10,2%)
Not sure 5 (5,1%)
Changes in believing in God
I have always been a believer 61 (62,9%) I have always been a disbeliever 21 (21,6%) I used to believe and now I don't believe
in God 13 (13,4%)
I used to disbelieve and now I believe in
God 2 (2,1%) 40% 27% 6% 5% 11% 11%
Religious Background
Chrisitanity Islam Hinduism Judaism Atheistism Agnostic Religion Frequency Percent % Chrisitanity 39 39.8 Islam 26 26.5 Hinduism 6 6.1 Judaism 5 5.1 Atheistism 11 11.2 Agnostic 11 11.217
Table 3. Depression characteristics of the study participants (N=98)
Characteristic N (%) or mean (SD)
Depression scale scores 12,22 (8,47)
Mild (0-14) 66 (67,3%) Moderate (15-28) 27 (27,6%) Severe (29-43) 5 (5,1%) Use of antidepressants Never 88 (90,7%) At least once 9 (9,3%)
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Table 4. Mean (SD) of depression scores by gender, age, relationship status and religion background/ believes
Characteristic Mean SD p value
Male 8.97 6.16 0.006 Female 13.88 9.02 17-21 years of age 14.97 9.32 0.013 22+ years 10.64 7.40 Single 12.64 8.75 0.158 Married/ in a relationship 11.45 8.09 Believers 12.38 7.74 0.735 Atheists/ agnostics 11.68 10.79
Never used antidepressants 12.18 8.49
0.775
Used at least once 11.33 8.08
Yes, religion is important aspect in life 12.47 8.56 0.796
No/ not sure/ sometimes 12.02 8.46
I have always been a believer 12.51 8.02
0,915*
I have always been a disbeliever 11.71 10.38
Changed from believer to disbeliever or vice versa 11.80 8.13
My belief/disbelief makes me more optimistic 12.25 8.22
0,482*
My belief/disbelief makes me more pessimistic 19.00 0.00
Does not change anything 11.53 9.21
There is no life after death 10.72 7.55
0,263*
I believe in heaven and hell 12.06 8.30
I believe in reincarnation 11.91 6.27
Other 19.75 16.68
Religion affects the outcome of depression positively 11.79 7.96
0.299
Religion affects the outcome of depression negatively 14.46 11.81
p-values are calculated by t-test
* p-value is calculated by ANOVA
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Table 5. Associations between depression scores and religion background/believes. Results of linear regression. Adjusted for age, gender and relationship status
Characteristic β p value
Marginal mean
Believers -0.42 0.839 11.98 9.91 14.05
Atheists/ agnostics (ref.) 0.00 12.390 8.67 16.12
Never used antidepressants (ref.) 0.00 12.01 10.09 13.93
Used at least once -0.53 0.864 12.54 6.5 18.58
Yes, religion is important aspect in
one's life -2.14 0.229 10.82 8.05 13.59
No/ not sure/ sometimes (ref.) 0.00 12.96 10.57 15.35 I have always been a believer 0.23 0.922 11.86 9.58 14.15 I have always been a disbeliever 1.52 0.592 13.15 9.33 16.96 Changed from believer to
disbeliever or vice versa (ref.) 0.00 11.63 7.25 16.01 My belief/disbelief makes me
more optimistic -0.95 0.591 11.19 8.89 13.5
My belief/disbelief makes me
more pessimistic 9.82 0.099 21.97 10.71 33.22
Does not change anything (ref.) 0 12.14 9.21 15.07
There is no life after death -6.27 0.153 11.4 8.05 14.75 I believe in heaven and hell -6.12 0.148 11.55 9.04 14.07 I believe in reincarnation -6.28 0.183 11.39 6.56 16.23
Other (ref.) 0 17.67 9.74 25.6
Religion affects the outcome of
depression positively -3.54 0.157 11.52 9.53 13.5
Religion affects the outcome of
depression negatively (ref.) 0 15.06 10.34 19.78
ref. - reference group (regression coefficient is zero)
Marginal mean - avegare score adjusted for age, sex and relationship status
95% CI for marginal mean
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DISCUSSION
Of the 98 LUHS students assessed 66.3 percent were female and 33.7 percent male.77.6 percent are of those surveyed are believer in God and 22.4 percent are non-believers. 45.6 percent claimed religion was an important aspect in their life and of those 45.6 percent 71.4 percent are actually practicing their faith/religion. 38 percent said religion was not important to them and 15% where uncertain or borderline. 67.3 percent of the respondents have mild (the blues) or no depression, 27.6% have moderate depression and 5.1 percent have severe depression. When trying to find the relationship between depression and religion, I found that believers were similar to non-believers with regard to the prevalence of depression (Table 4 – Mean values - 12.38 and 11.68 respectively, P value 0.735). These results reveal no correlation between the two factors and my hypothesis that those who are more religious are less likely to suffer from depression than those who do not belong to a religion was proven false. Through proportions, in my survey, there is a correlation between religion and depression but the data from the statistics (P value) shows there is no significant correlation. So we performed a linear regression analysis controlling for gender, age and relationship status (table 5). Listed are the beta coefficients with corresponding p-values and marginal means (i.e. means adjusted for age, gender and relationship status) with their 95% confidence intervals. Mean scores have changed slightly but still remained statistically insignificant. A cause of this statistical insignificance can be due to:
1. Sample size,
The sample surveyed consisted of 99 individuals which is inadequate to have an accurate study. Although 200 surveys where sent out, only 99 were completed. A larger sample size increases the chance of finding a statistical significance between believers and non-believers and their chances of getting depression. The reason larger samples increases the chance of significance is because they more reliably reflect the population mean.
2. Lack of an adequate control group,
The control group in this study is the non-believers (22.4%). When the surveys where sent out it was anticipated that believers would be more than the non-believers however ideally the control group should make up a higher percentage of the study. It is very important to include atheists as a control group in a study which attempts to find the relationship between religion and mental health
After analysing other studies performed in this field, it was discovered that those who valued their religious beliefs and participated in a religious organisation were at a substantially reduced risk of depressive disorder. The risk of major depressive disorder in those who have no religious link is as much as 60%. When one is not involved in a religious organisation it can increase the chances of
21 experiencing a depressive episode by 20-60%. From this we can deduce that not only must one believe in God but they must actively belong to a religious group. Belonging to a religious group provides one with social support from a faith community and this can potentially provide one with hope and care which could aid in protecting against depression.
Through proportions my survey revealed 84.1% of the believers believe that religion gives them a more positive outlook on life and 96.8% of them (the believers) think religion affects the outcome of depression in a positive way i.e. religious coping. Almost 80% (78.7%) of the non-believers, however, believe that their disbelief makes them more optimistic and they believe their happiness is not attributed to belonging to a religion. Having said that 68.1% of them (the non-believers) think that religion affects the outcome of depression positively. And 66% of them believe religious coping should be used be psychiatrist in aiding recovery. Much research had been done in the field of religious coping. One study was conducted in Malaysia amongst religious Muslims. They found that those who received both psychotherapy and lessons derived from the Quran and Islamic prayer were shown to improve at a faster rate than those who received psychotherapy alone (control group). Therefore religion can also be used as a coping mechanism during depression and a form of treating patients. Similarly a study was conducted in the Centre for Psychiatric Rehabilitation at Boston University, where 157 patients with mental health disorders including major depression, were surveyed (10). They were asked about the alternative health care practices they used to help them cope with their illness. It was found that greater than 50% of those with major depression and schizophrenia used religious/ spiritual activity to help them cope. The latter studies focused more on those with depression, and they were able to analyse how R/S is used as a coping mechanism and aids in
recovery. From a superficial view I can say that 80 percent of religious people said that after praying they instantaneously felt happier and more accomplished and 92.1 percent of them turned to religion to help them cope with a tragedy/ bad situation in their life. That being said to show the effects of
religious coping interviews of depressed patients must be conducted and follow up of the patients is necessary.
I did however find there are statistical significant difference between mean scores for: 1. Males and Females (P values – 0.006) (Table 4)
Females are more likely to have depression than males (Mean 13.88 and 8.97 respectively, P value 0.006). This can be due to factors such as greater genetic predisposition, woman tend to think more than men and are more in touch with their emotions. Age was also a factor which contributed to the development of depression.
2. Younger and older students (P values – 0.013)(Table 4)
Younger individuals where at a greater risk from suffering from depression than older individuals (Mean 14.97 and 10.64 respectively, P value- 0.013). Other studies on the other hand found that older
22 individuals are at a greater risk of depression. This is because they have more responsibility and stress on them. My study had a very narrow age group with the oldest person in the study being 27 and the youngest being 17. This age gap is very narrow as compared to the other studies.
CONCLUSION
In this quantitative cross sectional study a questionnaire was used to analyse the religious background of individuals and evaluate the existence of depressive symptoms and the statistical data was analysed using the SPSS system
1. Sociodemographic
Of the individuals surveyed I found that 66.3% are female and 33.7% male, 39.2% are 17-21 years of age, and 60.8% are over 22. With regards to relationship status 66% are single and 34% are married or in a relationship. Greater than 87.6% are medical students and the remainder are dental/pharmacy/ veterinary/ public health students
2. Depression analysis
According to the depression scale scores 67.3% have mild depression (0-14) , 27.6% moderate (15-28) and 5.1% have severe depression (29-43)
3. Religious beliefs
Believers (Christianity, Islam, Hinduism, and Buddhism) make up the majority of the respondents with Islam and Christianity comprising the greater number f
Non- believers (Atheist/Agnostic) are only 22.4% of the study group. 4. Correlation between R/S and depression
There are certainly an exceptional amount of factors that contribute to the risk of depression besides R/S, including genetic environmental and developmental factors. When trying to find the relationship between depression and religion, I found that believers were similar to non-believers with regard to the prevalence of depression (Table 4 – Mean values - 12.38 and 11.68 respectively, P value 0.735). These results reveal no correlation between the two factors and my hypothesis that those who are more religious are less likely to suffer from depression than those who do not belong to a religion was proven false. Through proportions, in my survey, there is a correlation between R/S and depression but the data from the statistics (P value) shows there is no significant correlation. R/S involvement seems to be related to depression in one way or another, whether positive or negative therefore researchers and clinicians need to have a greater understanding of how R/S impacts mental health and vice versa.
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PRACTICAL RECOMMENDATIONS
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REFRENCES
1. Smith TB e. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 4 January 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12848223
2. Lewis C, Cruise S. Religion and happiness: Consensus, contradictions, comments and concerns. Mental Health, Religion & Culture. 2006;9(3):213-225.
3. KI H. Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 4 January 2016]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/12674819
4. King M, Koenig H. Conceptualising spirituality for medical research and health service provision. BMC Health Services Research [Internet]. 2009 [cited 11 February
2016];9(1):116. Available from:
http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-9-116#Bib1_987
5. Koenig H. Concerns About Measuring ???Spirituality??? in Research. The Journal of Nervous and Mental Disease [Internet]. 2008 [cited 13 December 2015];196(5):349-355.
Available from:
http://journals.lww.com/jonmd/pages/articleviewer.aspx?year=2008&issue=05000&artic le=00001&type=abstract
6. Tsuang M, Simpson J. Commentary on Koenig (2008). The Journal of Nervous and Mental Disease [Internet]. 2008 [cited 13 December 2015];196(8):647-649. Available from:
http://journals.lww.com/jonmd/Citation/2008/08000/Commentary_on_Koenig__2008__ __Concerns_About.10.aspx
7. Miller L, Wickramaratne P, Gameroff M, Sage M, Tenke C, Weissman M. Religiosity and Major Depression in Adults at High Risk: A Ten-Year Prospective Study. American Journal of Psychiatry [Internet]. 2012 [cited 10 February 2016];169(1):89-94. Available from:
http://www.ncbi.nlm.nih.gov.ezproxy.dbazes.lsmuni.lt:2048/pubmed/?term=Religiosity+ and+major+depression+in+adults+at+high+risk%3A+a+ten-year+prospective+study
8. 5. Kasen S e. Religiosity and longitudinal change in psychosocial functioning in adult offspring of depressed parents at high risk for major depression. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 4 January 2016]. Available from:
25 9. SL A. Religious psychotherapy in depressive patients. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 15 May 2016]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/?term=9.+SL%2C+Azhar.+%22Religious+Psycho
therapy+In+Depressive+Patients.+-10. Zlatka Russinova D. Use of Alternative Health Care Practices by Persons With Serious Mental Illness: Perceived Benefits. American Journal of Public Health [Internet]. 2002 [cited 14 February 2015];92(10):1600. Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447289/
11. Harris S, Koenig H. An 81-year-old woman with chronic illnesses and a strong faith. Journal of Complementary and Integrative Medicine [Internet]. 2015 [cited 10 February
2016];0(0). Available from:
http://www.ncbi.nlm.nih.gov.ezproxy.dbazes.lsmuni.lt:2048/pubmed/?term=An+81-year-old+woman+with+chronic+illnesses+and+a+strong+faith
12. Pargament K. Religion and Coping: The Current State of Knowledge. Oxford Handbooks Online [Internet]. 2010 [cited 11 February 2016];. Available from:
http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780195375343.001.0001/ox fordhb-9780195375343-e-014
13. Loewenthal KM e. Faith conquers all? Beliefs about the role of religious factors in coping with depression among different cultural-religious groups in the UK. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 15 January 2016]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/11589323
14. Religious coping and depression among elderly, hospitalized medically ill men: American Journal of Psychiatry: Vol 149, No 12. American Journal of Psychiatry [Internet]. 2016
[cited 11 February 2016];. Available from:
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.149.12.1693?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
15. Religiosity and Remission of Depression in Medically Ill Older Patients: American Journal of Psychiatry: Vol 155, No 4. American Journal of Psychiatry [Internet]. 2016
[cited 11 February 2016];. Available from:
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.155.4.536?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed
16. HG K. Religion and remission of depression in medical inpatients with heart failure/pulmonary disease. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 11
February 2016]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/?term=%E2%80%9CReligion+and+remission+of +depression+in+medical+inpatients+with+heart+failure%2Fpulmonary+disease%2C%E 2%80%9D
17. The Multi-Religion Identity Measure: A new scale for use with diverse religions. 1st ed. Abu-Rayya, H. M., Abu-Rayya, M. H., & Khalil, M; 2009.
26 18. Rosmarin, D.H., Pirutinsky, S., Pargament, K. I., & Krumrei, E. J. (2009). Are religious beliefs relevant to mental health among Jews? Psychology of Religion and Spirituality, 1, 180-190.
19. Kennedy GJ e. The relation of religious preference and practice to depressive symptoms among 1,855 older adults. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 15 May 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8931617
20. KI P. Religion: An overlooked dimension in cross-cultural psychology [Internet]. 1st ed. 2003 [cited 2 January 2016]. Available from: 10. Religion: An Overlooked Dimension in Cross-Cultural Psychology [Internet]. 1st ed. 2016 [cited 1 January 2016]. Available from:
http://jcc.sagepub.com/content/34/4/377.abstract
21. . Tarakeshwar N, Pargament KI, Mahoney A: Measures of Hindu pathways: development and preliminary evidence of reliability and validity. Cultural Diversity and Ethnic Minority Psychol 9:316-332, 2003
22. 12. Sloan RP e. Religion, spirituality, and medicine. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 2 January 2016]. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/10030348
23. Hwang K, Hammer JH, Cragan RT (2009) Extending religion-health research to secular minorities: Issues and concerns. J Relig Health 50:608-622
24. Isacco A e. How Religious Beliefs and Practices Influence the Psychological Health of Catholic Priests. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2016 [cited 15 January 2016]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25617141
25. Hoge, R., Shields, J. J., & Soroka, S. (1993). Sources of Stress Experienced by Catholic Priests. Review of Religious Research, 35(1), 3.
26. Isacco, A., Sahker, E., Hamilton, D., Mannarino, M. B., Sim, W., & Jean, M. S. (2014). A qualitative study of mental health help-seeking among Catholic priests. Mental Health,
Religion & Culture, 17(7), 741-757.
27. Rossetti S. J. (2011). Why priests are happy: A study of the psychological and spiritual
health of priests. Notre Dame, IN: Ave Maria Press.
28. Knox, SVirginia, S. Depression and Contributors to Vocational Satisfaction in Roman Catholic Secular Clergy [Internet]. 1st ed. 2005 [cited 15 May 2016]. Available from:
http://link.springer.com/article/10.1007%2Fs11089-005-6199-1
29. Behere P, Das A, Yadav R, Behere A. Religion and mental health. Indian Journal of Psychiatry. 2013;55(6):187.
27 30. Wijngaards-de Meij L, Stroebe M, Schut H. Couples at Risk Following the Death of Their Child: Predictors of Grief Versus Depression [Internet]. 1st ed. Journal of Consulting and Clinical Psychology; 2005 [cited 3 February 2016]. Available from:
http://www.fss.uu.nl/pubs/pgmvanderheijden/78.Couplesatriskfollowingthedeathoftheirc hild.pdf
