Spirituality and depression: a look at the evidence.

Depression is one of the strongest predictors of suicide, especially when accompanied by hopelessness. (1) People often commit suicide when they perceive that there is no way out of an intolerably painful situation, or when they see no purpose or meaning to a life of seemingly unending suffering. Depressive illness can itself make people feel this way, and depression is very common among patients for whom medical clinicians care. Studies of medical inpatients have reported rates of depression approximating 50%. (2)

When patients are asked how they are able to manage with the stress of medical illness, disability, and pain, they frequently report that religious beliefs and practices are a source of comfort and strength. (3) Religious beliefs can be a source of hope for those facing difficult life problems, especially medical illness, and it is not surprising that religious activity is positively related to hope and optimism (4) and negatively related to depression. (5)

I review here some of the research that has demonstrated a relationship between religion/spirituality and depression in patients with physical illness. When medical patients are asked what they are doing that enables them to cope, in some areas of the country nearly 90% of hospitalized patients report that religion is a helpful resource, and 40% indicate that religion is the most important factor that keeps them going. (6) In a study of unconventional therapies for pain among a random sample of 382 persons with musculoskeletal complaints in San Diego, California, the most commonly mentioned therapy was prayer, which was also rated the second most helpful of 19 therapies examined. (7) Likewise, in a study of 100 patients on the day before cardiac surgery at the University of Alabama Medical Center in Birmingham, 95% reported using prayer and 70% rated prayer as "extremely helpful" for coping with surgery (ie, gave prayer a score of 15 on a 0-15 helpfulness scale). (8) Thus, according to patients themselves, religious practices facilitate adaptation to illness.

However, just because patients report that religion is helpful does not mean that such is actually the case. Many persons in the United States may report that they use religion to cope because this is the more socially acceptable way of responding to such questions, regardless of whether it is actually true for them. Nevertheless, when the religiousness of patients is measured, studies usually indicate that those who are more religious experience less depression (ie, are coping better). For example, in a study of 30 women over age 65 with hip fracture in the Chicago area, degree of religious involvement was associated with less depression (Geriatric Depression Scale) and longer walking distances at discharge. (9) These relationships persisted after controlling for severity of medical illness. Likewise, a study of 850 hospitalized men found that the degree to which patients used religion to cope was significantly and inversely related to depressive symptoms (whether measured by the self-rated Geriatric Depression Scale or by the clinician-rated observer-rated Hamilton Depression Rating Scale). (10) In that study, religious coping...