Letters to the Editor
An Analysis of Religion and Mental Illness
We read the article by Baetz and others (1) with interest, as we emphatically agree with the principle of acknowledging the spiritual aspect of patients’ lives to address the person as a whole. However, we were disappointed to find that the published results do not seem to support the clinical implications stated at the beginning of the article. Unfortunately, the cross-sectional nature of this study does not allow us to assess the potential benefits of “support[ing] this potentially significant coping resource” or of “involv[ing] spiritual advisors, such as clergy or chaplains, when needed.” Although the authors may have shown a correlation between religious involvement and mental health, they have not demonstrated that external support for religious involvement has any effect upon patient outcome.
The researchers surveyed 88 adult psychiatric inpatients regarding measures of mental health and satisfaction and measures of religious commitment. These factors were then correlated with outcome variables. The authors found that high levels of religious commitment correlated with lower depression scores, shorter length of stay, higher satisfaction with life, and lower levels of alcohol abuse. Insofar as correlation does not imply causation, any or none of these variables may be causally linked.
The authors state that “religious coping was the only factor found to have a significant impact on psychiatric length of stay.” However, the basis for this finding was the Religious Coping Index (RCI), a composite measure that includes observer ratings. There is significant potential here for bias, given that the study authors’ strong support for increased religious involvement in psychiatric illness has previously been quoted and published many times. Baetz and others’ paper has 39 references: Koenig and Larson have each been referenced 14 times. Larson is also an author of this paper, and he has jointly published many times with Koenig; we feel that this may represent an abuse of the “Matthew effect” described by Robert Merton (2). Specifically in this case, quoting one’s own articles repeatedly has the effect of presenting one’s opinions as scientific fact.
Further, we find the title phrase, “An Association With Mental Health,” to be misleading. Specifically, the researchers only examine symptoms of depression. They omit other symptoms, such as those studied by Spencer (3), in which being a member of the Jehovah’s Witness faith may be a risk factor for a schizophrenic illness—an explanation being that strongly religious patients may have high emotional expressivity, which is known to correlate with schizophrenia. Even if Baetz and others’ findings are valid for depression, they cannot necessarily be applied to other mental illness.
We suggest that future studies examining the actual impact of spiritual involvement and counselling upon psychiatric inpatients be randomized and that the presence (or lack of) spiritual involvement not be disclosed to treating psychiatrists prior to the patients’ discharge from acute care.
1. Baetz M, Larson DB, Marcoux G, Bowen R, Griffin R. Canadian psychiatric inpatient religious commitment: an association with mental health. Can J Psychiatry 2002;47:159–65.
2. Merton RW. The Matthew effect in science. Science 1968;159:59–63.
3. Spencer J. The mental health of Jehovah’s Witnesses. Br J Psychiatry 1975;126:556–9.
Satyam Patel, MD
Casimiro Cabrera-Abreu, LMS, MSc, MRCPsych