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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

LUHS – Lithuanian University of Health Sciences

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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

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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

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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).

Researchers such as Sloan, Bagiella and Powell 1999 criticised some of the above findings about

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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

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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.

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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 11.2

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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

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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.

23

PRACTICAL RECOMMENDATIONS

A greater number of participants is required to improve the statistics

24

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