The impact of spirituality
on mental health A review of the literature
Contents
Executive Summary 2
1. Background 6
1.1 Definitions of spirituality 6
1.2 Spirituality and mental health 7
1.3 Aims of report 8
2. Consequences of spiritual activity for mental health 9
2.1 Spirituality and depression 10
2.2 Spirituality and anxiety 12
2.3 Spirituality and PTSD 14
2.4 Spirituality and schizophrenia 15
2.5 Spirituality and suffering 16
3. Factors mediating the relationship between
spirituality and mental health 18
3.1 Coping styles 18
3.2 Locus of control / attributions 20
3.3 Social support 21
3.4 Physiological impact 22
3.5 Architecture and the built environment 23
4. Limitations of the research 25
4.1 Over-reliance on quantitative research 25
4.2 Lack of distinction between religion and spirituality 26
4.3 Population biases 26
4.4 Divine intervention? 27
5. Implications and Recommendations 28
5.1 For Practice 28
5.2 For Research 30
6. Conclusion 32
7. Further information and support 33
8. References 34
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Executive Summary
Background
In the past decade or so, researchers across a range of disciplines have started to explore and
acknowledge the positive contribution spirituality can make to mental health. Service users and
survivors have also identified the ways in which spiritual activity can contribute to mental health and
wellbeing, mental illness and recovery. This report reviews the evidence and explores the impact that
some expressions of spirituality can have as part of an integrative approach to understanding mental
health and wellbeing.
Mental health problems
Anecdotal, quantitative and qualitative evidence all point to a positive (although often modest)
relationship between spirituality and mental health in relation to a number of mental health problems.
Depression is the most common mental health problem in the UK and has been the focus of much of
the research exploring the relationship between spirituality and mental health. The evidence shows
a positive association between church attendance and lower levels of depression amongst adults,
children and young people. It also shows that belief in a transcendent being is associated with reduced
depressive symptoms.
Similar research has examined the relationship between spirituality and anxiety or stress. Quantitative
research demonstrates reduced levels of anxiety in a number of populations, including medical
patients in later life, women with breast cancer, middle aged people with cardiac problems and those
recovering from spinal surgery. Qualitative research also demonstrates that yoga and meditation are
also associated with improvements in mental health and reductions in anxiety.
There is an emerging literature examining the association between spirituality and post-traumatic stress
disorder (PTSD). One review found 11 studies that reported links between religion, spirituality, and
trauma-based mental health problems. A review of these 11 studies produced three main findings. First,
these studies show that religion and spirituality are usually, although not always, beneficial to people
in dealing with the aftermath of trauma. Second, they show that traumatic experiences can lead to a
deepening of religion or spirituality. Third, that positive religious coping, religious openness, readiness
to face existential questions, religious participation, and intrinsic religiousness are typically associated
with improved post-traumatic recovery.
Similarly, the evidence exploring spirituality with schizophrenia is also relatively scarce. However, one
review of the literature concluded that “religion plays a central role in the processes of reconstructing
a sense of self and recovery”. Another found that for individuals who share the same religious values as
their family, religiosity can be a cohesive and supporting factor. Others have found that people with a
diagnosis of schizophrenia find hope, meaning and comfort in spiritual beliefs and practices.
Not all research exploring the association of spiritual or religious activity and anxiety shows a beneficial
effect of the former on the latter. Rather, it seems to depend to some extent on the way in which
spirituality is expressed. For example, increased mental health problems are often found amongst those
with a strict religious upbringing.
Some also find that their religious or spiritual beliefs are not understood or explored within mental
health services. For many, clinicians either ignore an individual’s spiritual life completely or treat their
spiritual experiences as nothing more than manifestations of psychopathology.
Mechanisms
Some of the research exploring the association between spirituality and mental health attempts to
understand the mechanisms through which potential benefits may occur. Mechanisms most often
discussed are:
coping styles
locus of control
social support and social networks
physiological mechanisms, and
architecture and the built environment
Findings show that a collaborative approach to religious coping (i.e. the individual collaborates with
‘God’ in coping with stress) is associated with the greatest improvement in mental health.
Similarly, perceiving negative events as externally caused and positive events as internally caused is
widely regarded as an ‘optimistic’ attributional style and is generally associated with better mental
health. One review of the literature has suggested that religious beliefs may allow a person to reframe
or reinterpret events that are seen as uncontrollable, in such a way as to make them less stressful or
more meaningful.
The support individuals derive from the members, leaders and clergy of religious congregations
is widely considered one of the key mediators between spirituality and mental health. As with
other forms of social support, spiritual or religious support can be a valuable source of self-esteem,
information, companionship and practical help that enables people to cope with stress and negative
life events or exerts its own main effects.
Some researchers have argued that certain expressions or elements of spirituality may positively affect
various physiological mechanisms involved in health. Emotions encouraged in many spiritual traditions,
including hope, contentment, love and forgiveness, may serve the individual by affecting the neural
pathways that connect to the endocrine and immune systems.
A final mechanism that may mediate the relationship between spirituality and mental health is the
environment. As well as specific ‘spiritual’ buildings and architecture – such as churches, temples or
mosques – nature, art and music may all have an impact upon mental health.
In short, the proposed benefits of the association are probably the result of a collection of inter-related
and interacting factors, some of which have been addressed in the literature and some of which may
yet need to be discovered. These may well interact with a number of individual factors, including a
person’s pre-existing mental health status, their age, their gender or their cultural background.
Limitations
Although the evidence generally supports the notion that spirituality is beneficial for mental health, the research does have limitations.
One of the key shortcomings in the field is that it relies almost exclusively on quantitative measures,
which may not fully access the meaning spiritual activity has for the individual. Quantitative research
tends to try and isolate the impact of one activity (e.g. church attendance) upon another (e.g. level of
depression), which may not always capture the rich and complex interactions of other factors on any
association found.
A further methodological limitation of the research is that it focuses on the effects of spirituality on
mental health problems. Few studies address the mechanisms through which spirituality may promote
good mental health and wellbeing in populations without those problems.
A conceptual limitation of the field relates to definitions used. Whilst there is recognition that there
are differences between religion and spirituality, the distinction between the two is often blurred, with
much of the research using measures of religious practice as a proxy.
In summary, research exploring the association of spirituality with mental health generally displays a
range of methodological and conceptual shortcomings. These need to be addressed before we can
deepen and extend the evidence base. Methods need to be combined and sample selection should
reflect the diversity of spiritual expression that exists in the UK, in order that the maximum potential
benefits of spirituality are available to as many individuals as possible.
Recommendations
Those working in mental health services should:
ask service users about their spiritual and religious needs upon entry to the service and throughout
their care and treatment
help service users to identify those aspects of life that provide them with meaning, hope, value
and purpose
ensure that all service users including those who do not regard themselves as spiritual or religious
are offered the opportunity to speak with a chaplain or other spiritual leader if desired
provide good access to relevant and appropriate religious and spiritual resources
offer or make available safe spaces where users can pray, meditate, worship or practice their faith
provide opportunities for service users to discuss their spirituality or religion with others
build strong and effective links with religious and spiritual groups in the local community
avoid pathologising, dismissing or ignoring the religious or spiritual experiences of service users.
Further research should:
acknowledge the socio-demographic, social and health factors that are known to be risk factors for
certain mental health problems
ensure that the methodologies employed are those most appropriate to answer the questions
being addressed
include service users, wherever possible, in the design, conduct and analysis of research projects
be sufficiently well designed to identify mediating factors that are exclusive to spiritual or religious
activity and how they relate to other dimensions of being human (emotional, psychological, social,
intellectual)
take into account the range of demographic variables that could moderate or mediate the
relationship between spirituality and mental health
develop measures of religion and spirituality that cut across a range of religious traditions without
robbing those traditions of their distinctive and substantive characteristics
consider using spiritual or religious activity as an outcome measure and to explore the impact of
mental health on different expressions of spirituality
explore the impact and effectiveness of the ‘healing’ dimensions of different spiritual activities
