Skip to main content Accessibility help

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

  • B. Leurent (a1) (a2), I. Nazareth (a2), J. Bellón-Saameño (a3), M.-I. Geerlings (a4), H. Maaroos (a5), S. Saldivia (a6), I. Švab (a7), F. Torres-González (a8), M. Xavier (a9) and M. King (a1)...

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.

Corresponding author
*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:
Hide All
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.
Blaxter, M (1990). Health and Lifestyles. Routledge: London.
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.
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.
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.
European Values Study (2012). Research theme: religion ( Accessed 6 July 2012.
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.
Hackney, CH, Sanders, GS (2003). Religiosity and mental health: a meta-analysis of recent studies. Journal for the Scientific Study of Religion 42, 4355.
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.
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.
Kasen, S, Wickramaratne, P, Gameroff, MJ, Weissman, MM (2012). Religiosity and resilience in persons at high risk for major depression. Psychological Medicine 42, 509519.
King, M, Speck, P, Thomas, A (1999). The effect of spiritual beliefs on outcome from illness. Social Science and Medicine 48, 12911299.
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.
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.
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.
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.
Koenig, HG (2008). Concerns about measuring ‘spirituality’ in research. Journal of Nervous and Mental Disease 196, 349355.
Koenig, HG, George, LK, Peterson, BL (1998). Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry 155, 536542.
Koenig, HK, McCullough, ME, Larson, DB (2001). Handbook of Religion and Health. Oxford University Press: Oxford.
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.
Lewis, CA, Maltby, J, Burkinshaw, S (2000). Religion and happiness: still no association. Journal of Beliefs and Values 21, 233236.
McCullough, ME, Larson, DB (1999). Religion and depression: a review of the literature. Twin Research 2, 126136.
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.
Park, JI, Hong, JP, Park, S, Cho, MJ (2012). The relationship between religion and mental disorders in a Korean population. Psychiatry Investigation 9, 2935.
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.
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.
Royston, P (2005). Multiple imputation of missing values: update of ice. Stata Journal 5, 527536.
Schaefer, WE (1997). Religiosity, spirituality, and personal distress among college students. Journal of College Student Development 38, 633644.
Schumann, JJ, Meador, KG (2003). Heal Thyself: Spirituality, Medicine, and the Distortion of Christianity. Oxford University Press: New York.
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.
StataCorp (2009). Stata Statistical Software: Release 11. Stata Corporation: College Station, TX.
WHO (1997). Composite International Diagnostic Interview (CIDI). Version 2.1. World Health Organization: Geneva.
World Values Survey (2012). Online Data Analysis, WVS 2005–2008 ( Accessed 6 July 2012.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Leurent Supplementary Material

 Word (69 KB)
69 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed