January 11, 2012 — A strong belief in religion or spirituality may provide a protective effect against the recurrence of depression, according to new research.
In a long-term longitudinal study of more than 100 adults, the participants who reported that religion or spirituality was very important to them had one-fourth the risk of experiencing major depression in the following decade than did those who reported no or low beliefs.
When examining only the participants who had a depressed parent, those who reported a high importance of religiosity showed approximately one-tenth the risk of having major depression compared with those who said that the concepts were not as important to them.
"We're beginning to realize that all kinds of mentalization can have an effect on long-term health outcomes," principal investigator Myrna M. Weissman, PhD, professor of epidemiology at Columbia University and chief of the Division of Epidemiology at New York State Psychiatric Institute, told Medscape Medical News.
Dr. Weissman noted that "more and more studies," including those using electroencephalogram (EEG) or magnetic resonance imaging (MRI), are being done to look at the effects of meditation, yoga, beliefs, and even psychotherapy.
"There is an increasing interest in people's feelings and attitudes and how they affect the brain. So in this study, we wanted to examine how it affected clinical course," she said.
In an accompanying editorial, Dan Blazer, MD, PhD, writes that although there has been some debate about whether the association between religiosity and health should even be investigated scientifically, this study did show that reporting high importance of religion "turned out to be a significant predictor of protection against recurrence of depression."
Although he cautions against over-generalizing the results, he writes that they do suggest that clinicians should consider religiosity as part of a normal psychiatric evaluation "so we can provide help to the best of our ability."
The study is published in the January issue of the American Journal of Psychiatry.
Long-Term Follow-Up
According to the investigators, a meta-analysis of 147 studies and nearly 100,000 participants published in 2003 found that greater religiousness was "mildly associated" with fewer symptoms of depression.
In 1997, Dr. Weissman and her team conducted a retrospective study (J Am Acad Child Adolesc Psychiatry. 1997;36:1416-1425) that looked at these issues. They found that adult women with a lifetime history of depression and a belief that spirituality was very important to them had less than one-tenth the risk for major depression recurrence during the previous 10 years than those who said that it was unimportant.
"Treatment utilization patterns suggest that many individuals seek spiritual meaning or resolution of depression, as nearly a quarter of people in the United States who seek help for a mental disorder do so from a clergy member," write the investigators.
For the current study, the researchers prospectively examined biological offspring of their original patient population. The offspring were assessed 10 and 20 years after the baseline visit by their parents.
A total of 114 adult offspring (100% white; 61.4% women; mean age at first visit, 29.3 years) who reported being Protestant (n = 17) or Catholic (n = 97) were included in this analysis. Other denominations were excluded "because there were too few to allow meaningful analyses."
Religiosity measurements included self-report questions, such as how important religion/spirituality was to the participants and how often they attended services.
The Schedule for Affective Disorders and Schizophrenia–Lifetime Version for adults or for children aged 6 to 17 years was used to assess for depression. A diagnosis at both examination periods was defined as an episode of major depression having occurred in the previous 10 years.
The investigators also conducted subgroup analyses on the basis of whether the offspring had a parent with a history of depression (high risk, n = 72) or not (low risk, n = 42).
Common Pathway?
Results showed that at the 10-year follow-up, 51.8% of the participants reported moderate importance of personal religion/spirituality, 25.4% reported high importance, 19.3% reported slight importance, and 3.5% reported no importance.
The group that reported high importance of religiosity at this first follow-up had a significantly lower risk for major depression between years 10 and 20 compared with the other groups (odds ratio [OR], 0.24; 95% confidence interval [CI], 0.06 - 0.95).
In the high-risk subgroup, the participants who reported that religion/spirituality was highly important also showed a significantly lower risk of having an episode of major depression between years 10 and 20 than did those who reported lower religiosity (OR, 0.09; 95% CI, 0.01 - 0.82).
However, "the protective effect was found primarily against recurrence rather than onset of depression," report the investigators.
Of the participants in the high-risk/highly religious group who also had experienced a previous episode of depression (n = 11), only 1 (9%) offspring had a recurrence of depression between the two follow-up periods compared with 12 of the 24 offspring (50%) in the high risk/lower religiosity groups (P = .02).
Neither denomination nor frequency of religious attendance was a significant predictor of major depression.
The researchers note that the findings do not explain the basis for the associations found but suggest the possibility that depression and religious importance share a common pathway.
"High personal importance of religion/spirituality might form an aggregate pattern of 'kindling' that protects against recurrence of depression," they write.
Another Piece of the Puzzle
The investigators plan to explore this topic further through the use of EEG or MRI to better understand possible biological correlates.
"There are many different ways that someone can put themselves into a positive framework, such as exercise and yoga. And we can now add having strong beliefs to that list," she said.
"We're not saying that everybody can do that, and it's probably a highly selective group who is able to put themselves into that sort of a state. But we shouldn't knock it either," said Dr. Weissman.
"The take-home message is that if somebody already has these thoughts, I wouldn't discourage them or even try to analyze it too much."
Dr. Blazer writes that although this is the first long-term outcome study on religiosity's impact on depression, "it confirms a growing literature…that generally supports the benefits" of spirituality in decreasing depressive disorders.
Nevertheless, he notes that the results should not be over-generalized.
"Given the strong and passionate views of American society regarding religion, such studies raise at least 3 questions," writes Dr. Blazer.
These include whether or not they should be published in scientific journals, what the strengths of the methodologies are, and "how is one to interpret these empirical findings given the strong and often nonempirical rationale for (or against) religious beliefs (or their dangers)?" he asks.
Dr. Blazer also noted that this was an observational study, and therefore not designed to provide "proof of concept" for interventions.
"The study under review is an empirical study and should be taken for what it is, no more and no less. Let the data speak for themselves," he writes.
"Nevertheless, the findings do suggest that clinicians should consider the religion or spirituality of their patients as part of the psychiatric evaluation, one more piece of the puzzle that makes up the person."
The study was supported by a grant from the National Institute of Mental Health and by the John Templeton Foundation. The study authors have reported several financial relationships, which are listed in the original article. Dr. Blazer has disclosed no relevant financial relationships.
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Cite this: Can Strong Religious Beliefs Reduce Recurrent Depression Risk? - Medscape - Jan 13, 2012.
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