Canadian Psychiatric Inpatient Religious Commitment: An Association With Mental Health

Marilyn Baetz, MD1, David B Larson, MD2, Gene Marcoux, MD3, Rudy Bowen, MD4,
Ron Griffin, PhD5

Background: Research indicates that religion may have a positive effect on coping and possibly enhance clinical outcomes. This study aims to determine the level of religious interest of psychiatric inpatients and to assess whether religious commitment has an impact on selected outcome variables.

Methods: There were 88 consecutive adult patients (50% men) who were admitted to a Canadian tertiary care psychiatry inpatient unit and were interviewed about their religious beliefs and practices. Patients with a Beck Depression score of 12 or more were included for outcome analysis.

Results: A total of 59% believed in a God who rewards and punishes, 27% had a high frequency of worship attendance, and 35% prayed once or more daily. More frequent worship attenders had less severe depressive symptoms, shorter current length of stay, higher satisfaction with life, and lower rates of current and lifetime alcohol abuse (P < 0.05), when compared with those with less frequent or no worship attendance. In contrast, private spirituality was associated with lower depressive symptoms and current alcohol use only (P < 0.05), and prayer frequency had no significant associations.

Discussion: This study indicates that certain religious practices may protect against severity of symptoms, hospital use, and enhance life satisfaction among psychiatric inpatients. This is the first known Canadian study that examines religious commitment among psychiatric inpatients.

(Can J Psychiatry 2002;47:159–166)

Clinical Implications

Address the spiritual aspect of patients’ lives whether positive, negative, or neutral in order to address the person as a whole.
Support this potentially significant coping resource.
Involve spiritual advisors, such as the clergy or chaplains, when needed.

Limitations

The small sample size was limited to 1 geographic location.
Cross-sectional assessment of religiousness may not reflect past activity.
Only psychiatric inpatients were surveyed, so generalizability is limited.

Key Words: spirituality, religion, mental health, outcomes, length of stay, life satisfaction

Résumé : Engagement religieux des patients psychiatriques canadiens hospitalisés : une association avec la santé mentale

Over the last few decades, Gallup polls in the US and opinion polls in Canada have consistently shown that a high proportion of the adult population has moderate to high levels of religious beliefs. A 1996 US Gallup Poll (1) found that the 88% surveyed felt religion was fairly to very important in their lives. Moreover, a Canadian opinion poll in 1993 (2) found that 78% affirmed a belief in God, with 67% ascribing to the basic tenets of Christianity.

Many studies have focused on the impact of religious beliefs and practices on health outcomes. These studies have been conducted with increasingly stringent accounting for confounding variables, namely, age, sex, social support, socioeconomic status, and health (3). Literature reviews indicate that, in general, higher levels of religious involvement are moderately associated with better physical and mental health status (3–8). Many of these studies have been epidemiologic in nature, initially studying well populations and determining incidence of physical or mental diagnoses. In several large studies, regular worship attenders had longer life expectancy (9,10), decreased adverse consequences of stressful life events on psychological well-being (11,12), and enhanced psychosocial well-being (3).

Causality cannot be determined, due to the cross-sectional nature of many of the studies. There is, however, an increasing body of evidence to indicate that some forms of religious or spiritual practices do enhance mental health (13), including several recent prospective analyses (14). Strawbridge and others (15), for example, in a longitudinal study with a 29-year follow up in Alameda county, found weekly worship attendance associated with improving and maintaining good mental health, increasing social relationships, and enhancing marital stability.

Recent research has begun to look at clinical populations, both in a cross-sectional and prospective manner. This has been primarily among the medically ill elderly. Koenig and others (16) have shown that, for the elderly, having higher levels of intrinsic religiousness not only enhanced their ability to cope with the stress of physical illness but also showed faster recovery times from major depressive illness in those who were hospitalized with a comorbid medical illness. Among the elderly who use hospital services and in those who were more frequent church attenders, Koenig and Larson showed lower use of hospital services. For those who used them, lengths of stay were shorter, with understandable health-cost implications (17).

Studies of religious beliefs and practices on hospitalized psychiatric patients found similar rates of religious beliefs; in fact, in some cases, they were higher than those found in control groups. These rates were based on small numbers and diverse psychiatric diagnoses (18,19). How these beliefs specifically impact outcome has not yet been addressed. Finally, nearly all of these studies have been done on US samples. It is important to determine whether these findings generalize to psychiatric populations in other countries.

This study of hospitalized patients on a psychiatric ward focuses on 2 questions. First, what is the level of religious commitment? Second, does religious commitment have an impact on the level of mental health, satisfaction with life, hospital use, and alcohol use?