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Spirituality 'link' to mental illness

“Spiritual people are more likely to be mentally ill”, the Daily Mail reports.

Its headline is based on results from a survey of over 7,000 people in England. The research identified a group of people described as having a “spiritual understanding of life” but not practicing organised religion (for example, attending church regularly).

Researchers found this group were more likely to have a variety of mental health disorders and substance misuse problems than those describing themselves as religious and those reporting neither a religious nor a spiritual understanding of life (which for ease of reference, we will describe as atheists).

It is tempting to conclude that having a spiritual understanding of life (without a religious framework of regular worship) somehow causes more mental health problems, potentially through lack of social support increasing a person’s vulnerability.

However, it is equally valid to conclude that mental health problems cause people to develop a spiritual understanding of life, potentially through searching for alternative answers and explanations for their problems (as the American blues singer Bonnie Raitt put it, ‘Religion is for people who are scared to go to hell. Spirituality is for people who have already been there’).

This highlights the main limitation of this cross-sectional research – that it cannot prove cause and effect. It cannot prove which came first: spirituality or mental ill health.

Further research is needed to explore this potential link and how it may differ from person to person or culture to culture.

Where did the story come from?

The study was carried out by researchers from University College London.

The funding source was not stated in the online publication, but no conflicts of interest were declared.
 
The study was published in The British Journal of Psychiatry, a peer-reviewed medical journal.

The media reporting was generally accurate, although the significant limitations of the study were not highlighted.

What kind of research was this?

This was a cross-sectional study aiming to examine the association between a “spiritual or religious understanding of life” and symptoms or diagnoses of mental health problems and substance abuse. Cross-sectional studies are useful, but their main limitation is that they cannot prove cause and effect, only that two things are in some way related. This study was not designed to be able to tell us whether spirituality actually causes differences in mental health, only whether they are related.

What did the research involve?

The researchers analysed information collected from 7,403 randomly selected people who participated in the third National Psychiatric Morbidity Survey in England between October 2006 and December 2007. This was a survey commissioned by the National Centre for Social Research, an independent research agency with an interest in social attitudes.

The survey used standardised interview questions to ask about demographic characteristics, religious and spiritual belief, and aspects of common mental health disorders and substance abuse.

The interview surveys were wide ranging and covered questions on subjects such as:

Participants were provided with the following statement to help clarify the spirituality questions, “by religion, we mean the actual practice of a faith, e.g. going to a temple, mosque, church or synagogue. Some people do not follow a religion but do have spiritual beliefs or experiences. Some people make sense of their lives without any religious or spiritual belief”. The main question asked participants “would you say that you have a religious or spiritual understanding of your life?” with the available answers of religious, spiritual, or neither.

The survey results were appropriately “weighted” to take account of non-response to the survey and to make the results more representative of the English population as a whole.

The statistical analyses were also adjusted to take into account differences due to gender, age, ethnicity, educational attainment, marital status and perceived social support. Social support, the authors stated, is known to be associated with religious belief and practice.

What were the basic results?

A total of 13,171 people were contacted to take part in the interview survey, of which 7,403 (56.2%) responded.
 
Those that took part were 46.3 years old on average, 51.4% were women and 85% were ‘white British’. Of these, 35% had a religious understanding of life (86% stating they were Christian), 19% were spiritual but not religious, and the largest group were neither religious nor spiritual (46%).

Prevalence of mental health disorders was similar between the group of religious people and those with neither religious nor spirituality tendencies, except that religious people were less likely to have used drugs or be a hazardous drinker.

Spiritual people were more likely than those with neither religious nor spiritual beliefs to:

  • have ever used drugs
  • be dependent on drugs
  • have abnormal eating attitudes
  • have generalised anxiety disorder
  • have a phobia
  • have a neurotic disorder
  • to take psychotropic medication (medication that affects brain function) such as antidepressants or antipsychotics

How did the researchers interpret the results?

The researchers concluded that, “people who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.”

Conclusion

This large national cross-sectional survey suggested English people self-identifying as spiritual (without religion) may be more likely to suffer a range of mental health disorders and substance abuse than those identifying as having neither a spiritual nor a religious understanding of life. Those with a religious understanding of life were broadly similar to the group without a religious or spiritual outlook for the majority of mental health conditions assessed.

This national survey highlights a potential link between having a spiritual understanding of life and worse mental health compared to other outlooks on life.

However, there are many limitations to this research that should be considered when interpreting the results:

  • First and foremost is that this, and all cross-sectional surveys, cannot prove cause and effect. Therefore, it is uncertain whether mental ill-heath in some way causes people to take a more spiritual view of life or whether a spiritual understanding of life is somehow detrimental to mental health. For example, people who have experienced long-term mental health problems may find more comfort in taking a spiritual worldview than a purely rationalist one.
  • Other factors may be at play, for example, people who describe themselves as spiritual may be more willing to use complementary and alternative medicines to treat conditions such as depression, which may be less effective than conventional medications.
  • Despite the researchers’ best efforts, the participants in the survey may not be generally representative of the English population. For example, the ‘religious group’ were mainly white British Christians of middle age and so the findings may be less applicable to other groups.
  • The absolute numbers in the different groups were not reported, only the differences in percentages. And without knowing the numbers of people suffering mental health or substance abuse problems in the sample, it is not possible to assess the importance of these results. For example, the researchers say that religious people were 27% less likely to have ever used drugs (odds ratio 0.73, 95% confidence interval 0.60 to 0.88 compared to those who were neither religious nor spiritual. Without knowing how many in this population were using drugs it is not possible to say what this means in terms of how many fewer people this represents – a 27% decrease could range from just one person to thousands.

Further research is needed to explore this potential link and establish any causality and its direction. Based on this research alone, we should not conclude that having a spiritual understanding of life is bad for your mental health.

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