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      Religious and Spiritual Factors in Depression: Review and Integration of the Research

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          Abstract

          Depressive symptoms and religious/spiritual (R/S) practices are widespread around the world, but their intersection has received relatively little attention from mainstream mental health professionals. This paper reviews and synthesizes quantitative research examining relationships between R/S involvement and depressive symptoms or disorders during the last 50 years (1962 to 2011). At least 444 studies have now quantitatively examined these relationships. Of those, over 60% report less depression and faster remission from depression in those more R/S or a reduction in depression severity in response to an R/S intervention. In contrast, only 6% report greater depression. Of the 178 most methodologically rigorous studies, 119 (67%) find inverse relationships between R/S and depression. Religious beliefs and practices may help people to cope better with stressful life circumstances, give meaning and hope, and surround depressed persons with a supportive community. In some populations or individuals, however, religious beliefs may increase guilt and lead to discouragement as people fail to live up to the high standards of their religious tradition. Understanding the role that R/S factors play in preventing depression, facilitating its resolution, or leading to greater depression will help clinicians determine whether this is a resource or a liability for individual patients.

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          Most cited references69

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          Concerns about measuring "spirituality" in research.

          H Koenig (2008)
          Spirituality is increasingly being examined as a construct related to mental and physical health. The definition of spirituality, however, has been changing. Traditionally, spirituality was used to describe the deeply religious person, but it has now expanded to include the superficially religious person, the religious seeker, the seeker of well-being and happiness, and the completely secular person. Instruments used to measure spirituality reflect this trend. These measures are heavily contaminated with questions assessing positive character traits or mental health: optimism, forgiveness, gratitude, meaning and purpose in life, peacefulness, harmony, and general well-being. Spirituality, measured by indicators of good mental health, is found to be correlated with good mental health. This research has been reported in some of the world's top medical journals. Such associations are meaningless and tautological. Either spirituality should be defined and measured in traditional terms as a unique, uncontaminated construct, or it should be eliminated from use in academic research.
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            The epidemiologic evidence for a relationship between social support and health.

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              Religiosity and remission of depression in medically ill older patients.

              The effects of religious belief and activity on remission of depression were examined in medically ill hospitalized older patients. Consecutive patients aged 60 years or over who had been admitted to medical inpatient services at a university medical center were screened for depressive symptoms. Of 111 patients scoring 16 or higher on the Center for Epidemiologic Studies Depression Scale, 94 were diagnosed with depressive disorder (DSM-III major depression or subsyndromal depression) by a psychiatrist using a structured psychiatric interview. After hospital discharge, depressed patients were followed up by telephone at 12-week intervals four times. At each follow-up contact, criterion symptoms were reassessed, and changes in each symptom over the interval since last contact were determined. The median follow-up time for 87 depressed patients was 47 weeks. Religious variables were examined as predictors of time to remission by means of a multivariate Cox model, with controls for demographic, physical health, psychosocial, and treatment factors. During the follow-up period, 47 patients (54.0%) had remissions; the median time to remission was 30 weeks. Intrinsic religiosity was significantly and independently related to time to remission, but church attendance and private religious activities were not. Depressed patients with higher intrinsic religiosity scores had more rapid remissions than patients with lower scores. In this study, greater intrinsic religiosity independently predicted shorter time to remission. To the authors' knowledge, this is the first report in which religiosity has been examined as a predictor of outcome of depressive disorder.
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                Author and article information

                Journal
                Depress Res Treat
                Depress Res Treat
                DRT
                Depression Research and Treatment
                Hindawi Publishing Corporation
                2090-1321
                2090-133X
                2012
                15 August 2012
                : 2012
                : 962860
                Affiliations
                1Departments of Psychiatry and Neurology, Sigmund Freud University, 1030 Vienna, Austria
                2Division of Child Adolescent Psychiatry, Duke University Medical Center, Durham, NC 27710, USA
                3Center for Spirituality, Theology and Health, Duke University Medical Center, Box 3400, Durham, NC 27705, USA
                4Department of Medicine, King Abdulaziz University (KAU), Jeddah 21589, Saudi Arabia
                5Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
                6Department of Psychiatry, Ilam University of Medical Sciences, Tehran, Iran
                Author notes
                *Harold G. Koenig: koenig@ 123456geri.duke.edu

                Academic Editor: Charles B. Nemeroff

                Article
                10.1155/2012/962860
                3426191
                22928096
                91c4e0f8-5d21-45fd-9520-9491329874bb
                Copyright © 2012 Raphael Bonelli et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 May 2012
                : 29 June 2012
                : 4 July 2012
                Categories
                Review Article

                Neurology
                Neurology

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