Hostname: page-component-5d59c44645-klj7v Total loading time: 0 Render date: 2024-02-25T02:09:02.430Z Has data issue: false hasContentIssue false

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study

Published online by Cambridge University Press:  29 January 2013

B. Leurent
Mental Health Sciences Unit, Faculty of Brain Sciences, University College London Medical School, UK Research Department of Primary Care and Population Health, University College London Medical School, UK
I. Nazareth
Research Department of Primary Care and Population Health, University College London Medical School, UK
J. Bellón-Saameño
Department of Preventive Medicine, El Palo Health Centre, Malaga, Spain
M.-I. Geerlings
University Medical Centre, Utrecht, The Netherlands
H. Maaroos
Faculty of Medicine, University of Tartu, Estonia
S. Saldivia
Departamento de Psiquiatrıa y Salud Mental, Universidad de Concepción, Chile
I. Švab
Department of Family Medicine, University of Ljubljana, Slovenia
F. Torres-González
CIBERSAM-Granada University, Granada, Spain
M. Xavier
Department of Mental Health, Faculdade Ciencias Medicas, CEDOC, Lisboa, Portugal
M. King*
Mental Health Sciences Unit, Faculty of Brain Sciences, University College London Medical School, UK
*Address for correspondence: Professor M. King, Mental Health Sciences Unit, University College London, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. (Email:



Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the USA, limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.


Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.


The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p < 0.001). However, the findings varied significantly across countries, with the difference being significant only in the UK, where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.


These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Original Articles
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Baetz, M, Bowen, R, Jones, G, Koru-Sengul, T (2006). How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Canadian Journal of Psychiatry 51, 654661.CrossRefGoogle ScholarPubMed
Blaxter, M (1990). Health and Lifestyles. Routledge: London.CrossRefGoogle Scholar
Braam, AW, Deeg, DJ, Poppelaars, JL, Beekman, AT, van Tilburg, W (2007). Prayer and depressive symptoms in a period of secularization: patterns among older adults in the Netherlands. American Journal of Geriatric Psychiatry 15, 273281.CrossRefGoogle Scholar
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189194.CrossRefGoogle ScholarPubMed
Dwan, K, Altman, DG, Arnaiz, JA, Bloom, J, Chan, AW, Cronin, E, Decullier, E, Easterbrook, PJ, Von Elm, E, Gamble, C, Ghersi, D, Ioannidis, JP, Simes, J, Williamson, PR (2008). Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS One 3, e3081.CrossRefGoogle ScholarPubMed
European Values Study (2012). Research theme: religion ( Accessed 6 July 2012.Google Scholar
Gartner, J, Larson, DB, Allen, DG (2012). Religious commitment and mental health: a review of the empirical literature. Journal of Psychology and Theology 19, 625.CrossRefGoogle Scholar
Hackney, CH, Sanders, GS (2003). Religiosity and mental health: a meta-analysis of recent studies. Journal for the Scientific Study of Religion 42, 4355.CrossRefGoogle Scholar
Huber, PJ (1967). The behavior of maximum likelihood estimates under non-standard conditions. Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability 1, 221233.Google Scholar
Johnstone, B, Franklin, KL, Yoon, DP, Burris, J, Shigaki, C (2008). Relationships among religiousness, spirituality, and health for individuals with stroke. Journal of Clinical Psychology in Medical Settings 15, 308313.CrossRefGoogle ScholarPubMed
Kasen, S, Wickramaratne, P, Gameroff, MJ, Weissman, MM (2012). Religiosity and resilience in persons at high risk for major depression. Psychological Medicine 42, 509519.CrossRefGoogle ScholarPubMed
King, M, Speck, P, Thomas, A (1999). The effect of spiritual beliefs on outcome from illness. Social Science and Medicine 48, 12911299.CrossRefGoogle ScholarPubMed
King, M, Speck, P, Thomas, A (2001). The Royal Free Interview for Spiritual and Religious Beliefs: development and validation of a self-report version. Psychological Medicine 31, 10151023.CrossRefGoogle Scholar
King, M, Walker, C, Levy, G, Bottomley, C, Royston, P, Weich, S, Bellón-Saameño, J, Moreno, B, Svab, I, Rotar, D, Rifel, J, Maaroos, H, Aluoja, A, Kalda, R, Neeleman, J, Geerlings, MI, Xavier, M, Carraça, I, Gonçalves-Pereira, M, Vicente, B, Saldivia, S, Melipillan, R, Torres-Gonzalez, F, Nazareth, I (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Archives of General Psychiatry 65, 13681376.CrossRefGoogle ScholarPubMed
King, M, Weich, S, Nazroo, J, Blizard, R (2006 a). Religion, mental health and ethnicity. EMPIRIC – a national survey of England. Journal of Mental Health 15, 153162.CrossRefGoogle Scholar
King, M, Weich, S, Torres-González, F, Svab, I, Maaroos, HI, Neeleman, J, Xavier, M, Morris, R, Walker, C, Bellón-Saameño, JA, Moreno-Küstner, B, Rotar, D, Rifel, J, Aluoja, A, Kalda, R, Geerlings, MI, Carraça, I, de Almeida, MC, Vicente, B, Saldivia, S, Rioseco, P, Nazareth, I (2006 b). Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 6, 6.CrossRefGoogle ScholarPubMed
Koenig, HG (2008). Concerns about measuring ‘spirituality’ in research. Journal of Nervous and Mental Disease 196, 349355.CrossRefGoogle ScholarPubMed
Koenig, HG, George, LK, Peterson, BL (1998). Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry 155, 536542.CrossRefGoogle ScholarPubMed
Koenig, HK, McCullough, ME, Larson, DB (2001). Handbook of Religion and Health. Oxford University Press: Oxford.CrossRefGoogle Scholar
Kruijshaar, ME, Barendregt, J, Vos, T, de Graaf, R, Spijker, J, Andrews, G (2005). Lifetime prevalence estimates of major depression: an indirect estimation method and a quantification of recall bias. European Journal of Epidemiology 20, 103111.CrossRefGoogle Scholar
Lewis, CA, Maltby, J, Burkinshaw, S (2000). Religion and happiness: still no association. Journal of Beliefs and Values 21, 233236.CrossRefGoogle Scholar
McCullough, ME, Larson, DB (1999). Religion and depression: a review of the literature. Twin Research 2, 126136.CrossRefGoogle ScholarPubMed
Miller, L, Wickramaratne, P, Gameroff, MJ, Sage, M, Tenke, CE, Weissman, MM (2012). Religiosity and major depression in adults at high risk: a ten-year prospective study. American Journal of Psychiatry 169, 8994.CrossRefGoogle Scholar
Park, JI, Hong, JP, Park, S, Cho, MJ (2012). The relationship between religion and mental disorders in a Korean population. Psychiatry Investigation 9, 2935.CrossRefGoogle Scholar
Payne, IR, Bergin, AE, Bielema, KA, Jenkins, PH (1991). Review of religion and mental health: prevention and the enhancement of psychosocial functioning. Prevention in Human Services 9, 1149.CrossRefGoogle Scholar
Robins, LN, Wing, J, Wittchen, HU, Helzer, JE, Babor, TF, Burke, J, Farmer, A, Jablenski, A, Pickens, R, Regier, DA, Sartorius, N, Towle, LH (1988). The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Archives of General Psychiatry 45, 10691077.CrossRefGoogle ScholarPubMed
Royston, P (2005). Multiple imputation of missing values: update of ice. Stata Journal 5, 527536.CrossRefGoogle Scholar
Schaefer, WE (1997). Religiosity, spirituality, and personal distress among college students. Journal of College Student Development 38, 633644.Google Scholar
Schumann, JJ, Meador, KG (2003). Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity. Oxford University Press: New York.CrossRefGoogle Scholar
Smith, TB, McCullough, ME, Poll, J (2003). Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychological Bulletin 129, 614636.CrossRefGoogle ScholarPubMed
StataCorp (2009). Stata Statistical Software: Release 11. Stata Corporation: College Station, TX.Google Scholar
WHO (1997). Composite International Diagnostic Interview (CIDI). Version 2.1. World Health Organization: Geneva.Google Scholar
World Values Survey (2012). Online Data Analysis, WVS 2005–2008 ( Accessed 6 July 2012.Google Scholar
Supplementary material: File

Leurent Supplementary Material


Download Leurent Supplementary Material(File)
File 69 KB