Letters to the Editor
Reply: An Analysis of Religion and Mental Illness
We thank Dr Patel and Dr Cabrera-Abreu for their interest in our article, as well as for their critique, which we will attempt to address. They state that, owing to the cross-sectional nature of the study, we cannot make any statements about outcome. It should be noted, however, that length of stay was determined, allowing us to assess this aspect of outcome. We do note, in the introduction and in the section on limitations, that causality cannot be determined—a point that Dr Patel and Cabrera find important to restate.
The Religious Coping Index (RCI) is a simple, 3-item questionnaire developed for use with persons having severe medical illness, including mental illness. To deal with any potential bias, we did not conduct any of the interviews or administer the RCI; we relied instead on a trained research assistant.
The frequent quoting of research done by Dr Koenig and Dr Larson was cited as a potential drawback. It should be noted that these 2 psychiatrists have in many ways led the way in the research of spirituality and mental health in the US, and their inclusion in various studies indicates the value of collaboration in advancing this field. Some of the articles quoted comprise extensive reviews of the published research to date, not just their own work.
The idea that the title’s reference to mental health may be too inclusive was also critiqued. Although we did study depressive symptoms, the subjects had high comorbidity and presented with various other diagnoses. Along with depressive symptoms, we also examined broader aspects of mental health, such as alcohol use and satisfaction with life.
The reference to a single 1975 article about Jehovah’s Witness membership being a predisposing factor for schizophrenia in fact represents what Dr Patel and Dr Cabrera are critical of—forming a conclusion from cross-sectional data. It should be noted that the study referred to is more than 25 years old; given our current understanding of the considerable influence that genetic and other biological factors have on the etiology of schizophrenia, it is unlikely that religious factors contribute much to causing the illness. High expressivity may be more related to relapses. Recent studies do indicate, however, that religious activity may be associated with reduced symptoms in patients with chronic mental illness (1).
We are always open to ideas for future research that may help to determine the impact of spiritual involvement and invite more dialogue and collaboration to help further understand this area.
1. Tepper L, Rogers SA, Coleman EM, Newton Maloney H. The prevalence of religious coping among persons with persistent mental illness. Psychiatr Serv 2001;52:660–5.
Marilyn Baetz, MD
Rudy Bowen, MD
Gene Marcoux, MD
Ron Griffin, PhD
David B Larson MD (deceased, March 2002)