Recently a number of heavy-hitting psychiatry journals have published articles about a lower risk of depression in people who are religious or spiritual. The studies have not been without controversy, with an editorial asking: “How does one conceive of measuring such a nebulous topic as religion or spirituality?” And: “Should studies that explore the association of religion or spirituality with health even be fielded and reported in the empirical scientific literature?”
The second question is one only a true skeptical academic could ask. As a clinician practicing in the USA in 2014, religion and spirituality are an important part of many people’s lives, and in my experience, it can lend significant benefits in resiliency. I’ve seen non-spiritual folk struggle more, perhaps, with feelings they are unloved and unworthy when traumatized than those with a spiritual “back-up” who feel that, no matter what happens, they have a spiritual connection to something greater. In addition, the spiritual and religious don’t seem to wrestle as much with those existential question of “why am I here? What is my purpose?” that can plague the non-spiritual. On the other hand, being religious can sometimes lead to greater vulnerability to holding onto guilty feelings about perceived wrongdoings and feeling, more deeply, a personal failure as a spiritual matter. Also, those involved in a religious community can experience devastating losses precipitating depression if views change and the person is expunged from the community. The scientific question of whether religion, on a personal level, helps or harms human psyche is legitimate.
Spirituality is a significant part of our human history and evolution, and that ability to conceptualize religious ideas or a connection to others is part of what separates us from the other animals. Evidence of spiritual practices existed in close hominid relatives, including Homo heidelbergensis and Neanderthals, who buried their dead. Humans were burying their dead with “grave goods,” special objects to take to the afterlife, in Qafzeh cave 100,000 years ago. The three modern Abrahamic religions, Christianity, Judaism, and Islam, came from the Middle East along with agriculture, a rapid rise in world population, and pandemic infectious and sexually transmitted diseases, which may explain some of the cleanliness and sexual taboos found in these and other modern forms of religion, including the Indian and East Asian religious groups.
Once we’ve established that spirituality is a part of being human and the practicality of the religious question, what is the actual data? In January of 2012, the first long-term longitudinal prospective study of religiosity and risk of major depression was published in the Green Journal by authors from Columbia University. The study was undertaken as many previous studies covering thousands of people seemed to show that the more religious someone reported him or herself to be, the less likely that person was to be depressed. In these cross-sectional studies, there can be significant association bias. For example, a deep depression could affect the spirituality of the suffering individual, and perhaps someone in a religious community where mental illness is not accepted would be less likely to report being depressed. On the other hand, many people seek counseling from clergy members, and the ready availability in religious populations may act as a preventative measure. Longer term data would be important to sort out some of the details.
In the 2012 study, 114 adult offspring of depressed and non-depressed parents were followed for 10 years. All participants were Catholic or Protestant, and their religiosity was measured by self-report of importance of spiritual beliefs and church attendance. Those who reported that religion and spirituality were highly important had about 1/4 the chance of being diagnosed with major depressive disorder in the 10 year study period than those who didn’t. Frequent attendance at church service and denomination were not significantly protective or an increased risk factor. Further parsing of the data was hampered by the small sample size, but those with a previous episode of depression who self-reported as highly spiritual or religious had fewer repeat episodes of depression than those who were not religious.
In a second paper published at the end of 2013, these same authors added an interesting biological twist. They measured the thickness of the brain cortex in the study individuals via brain MRI at two points during five years. A thinner or damaged cortex in certain areas of the brain correlates with lack of empathy and more sociopathic behavior (1)(2) and a greater risk of depression. In healthy individuals, stimulating certain cortical areas with transcranial magnets evoked spiritual feelings (3). People who meditate regularly also have thicker areas of cortex in important regions and more metabolic activity there. In the 2013 paper, individuals who reported they were highly spiritual or religious were far more likely to have a thicker brain cortex in certain areas than those who reported themselves to be nonspiritual. Thickness of cortex was unrelated to whether or not the subjects attended church. As in previous studies, a thicker cortex seemed to be protective against depression risk, and the thinner cortex was more of a risk factor in those who had a family history of depression.
What to make of all these studies? There are two possible explanations. One is that a thicker cortex is more associated with being interested in spiritual questions, the connectedness of people, etc and is simultaneously protective against depression. The other is that a lifelong habit of meditating and/or contemplation of spirituality stimulates the metabolism and neurogeneration in areas of the brain that confer resilience to trauma and therefore reduce the risk of developing depression. With regards to the specific question of conferring resistance to depression, actually attending religious services seems unimportant.
Obviously, the studies are limited by small sample size, observational design, and, as the editorial notes, a lack of precise terminology when it comes to measuring spirituality. But clearly there is neurobiological basis of spirituality and depression risk. It is unlikely to be harmful, and may very well help to steer the religious depressed patient to more spiritual contemplation, and the non-religious one to more meditation and reflection.
Copyright Emily Deans, MD