Friday April 26 2013
Most people in the study said they were Christian or without faith
“Believing in God can help treat depression,” the Mail Online website claims. But how much faith can we put in this story?
The story is based on US research examining the association between belief in ‘God or a Higher Power’ and the effectiveness of mental health treatment.
The study found that patients with a self-reported strong belief in God were more likely to respond to treatment, and that a higher level of belief was associated with greater reduction in mental health symptoms such as depression and the desire to self-harm.
There are several important points to bear in mind when considering the results of this study. These include that:
- the type of study can only show an association, it cannot prove that belief in God will help people respond to treatment for depression
- the study was conducted in a small, specific population so it may not hold true for other groups of people
- belief in God was only measured by a single question, and the reliability and validity of this method is unclear
- it only examined religious belief and did not include the effect of secular (eg political) beliefs
Go to the Moodzone for more tips on changes you can make to your life if you are feeling down.
Where did the story come from?
The study was carried out by researchers from Harvard Medical School and was funded by the Gertrude B. Nielsen Charitable Trust – a US-based charity with a stated interest in childcare.
The study was published in the peer-reviewed Journal of Affective Disorders.
The Mail Online covered this story relatively well, but did not discuss the inherent limitations of the study. It also mentioned two additional studies, one apparently related to prayer and treatment of cardiac patients, and the other related to the success of IVF treatments. However, it failed to provide enough detail of these studies to allow us to assess what quality of evidence was on offer.
What kind of research was this?
This was a prospective cohort study that examined the association between belief in ‘God or a Higher Power’ with outcomes for patients being treated for mental health disorders.
The researchers report that previous studies suggest that spiritual or religious beliefs may act as a buffer against several mental health conditions and behaviours, including depression and self-harming.
Some studies suggest, however, that spiritual struggles can worsen or bring on symptoms.
As a cohort study, this research cannot tell us about any potential causal link between belief and treatment, only whether the two factors are associated. Furthermore, it cannot tell us what it is about belief that leads to an association with treatment outcomes.
What did the research involve?
The researchers recruited 159 patients in a day-treatment programme at a psychiatric hospital in the US. The average age of the patients was 34 years, approximately 62% of whom were women. All patients were experiencing serious symptoms or impairment. Mental health disorder diagnosis varied across the participants, with 60% having major depression, 12% bipolar disorder, and the remaining 28% having various other diagnoses including anxiety.
Before treatment, the researchers measured the patients’ belief in God by asking a single question: “to what extent do you believe in God?”, measured on a five-point scale from “not at all (no belief at all)” to “very (a strong sense of belief)”.
The researchers followed up the patients over the course of a year, and assessed four main treatment outcomes:
- treatment response
- degree of reduction in depression symptoms over the course of treatment
- overall psychological wellbeing
- self-harm behaviours
During the analysis, the researchers controlled for both age and gender as potential confounders, as both were associated with religious belief. They also assessed a range of variables they thought may account for, or mediate, any relationship between belief and treatment outcomes.
These factors included:
- their beliefs about treatment, including credibility (how confident the patients would be recommending the treatment to a friend who was having the same problems), and treatment expectancy (how much improvement in symptoms the patients expected to experience by the end of treatment)
- emotion regulation, which included an assessment of both positive and negative strategies to control emotions
- degree of support provided by the patients’ congregations, based on two questions regarding the extent to which the patients obtained emotional support from the spiritual or religious communities
What were the basic results?
The researchers found that belief in God or a higher power was significantly higher among those patients who responded to treatment compared to those that did not. Also, a higher level of belief was linked with greater reduction in depression symptoms and self-harm behaviours, and greater gains in overall psychological wellbeing over the course of treatment.
The type of religious affiliation – such as Catholic, Jewish or Hindu – had no effect on treatment response or any other psychological or behavioural variables.
Belief in God remained significantly associated with changes in depression and self-harm even after controlling for the patients’ age and gender, two factors that could potentially confound the relationships. The patients’ perceptions regarding treatment credibility and expectations about treatment effects were associated with belief in God.
None of the other variables looked at by the researchers were found to significantly change the relationship between belief and self-harm or psychological wellbeing.
How did the researchers interpret the results?
The researchers concluded that, “belief in God, but not religious affiliation, was associated with better treatment outcomes. With respect to depression, this relationship was mediated by belief in the credibility of treatment and expectations for treatment gains”.
This research suggests that religious or spiritual belief may be associated with response to treatment for some mental health disorders. However, the study cannot tell us what aspects of belief may be important in terms of this link to depression symptoms, treatment response and overall psychological wellbeing.
The researchers say that their findings suggest that “belief in the credibility of psychiatric treatment and increased expectations to gain from treatment might be mechanisms by which belief in God can impact treatment outcomes”.
They say that it is “notable that faith in treatment was virtually not present in the absence of belief in God, and that few participants with high belief in God had low treatment credibility/expectancy”. They also say that “this may suggest that faith is a general cognitive attribute” that may represent an optimistic outlook in several areas, including the spiritual and medical.
There are some limitations to the study that should be considered, including the facts that:
- All of the participants in this study were in a day-treatment programme for mental health conditions, and all were experiencing symptoms that severely limited their functioning. These participant characteristics make generalisation to less severe forms of these disorders difficult. It is also important to note that the majority of people in the study being treated for mental health conditions (61.6%) reported having a belief in God or a higher power.
- The positive effects of secular or political beliefs were not studied by the researchers.
- The study was highly culturally specific: the majority of participants expressing a religious belief were Christian.
- Belief in God was assessed using a single question, with no mention of the reliability or validity of this question in measuring belief.
This study provides insight into the relationship between faith, or belief, and mental health, and suggests a potential path through which such an association may operate.
Further research could be carried out to measure the size of the effects that believing in a ‘higher power’ (whether a supreme being or a concept of ‘humanity’ and ‘goodness’) may have on mental health outcomes.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.