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Effects of Religion and Faith on Mental Health

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DOI: 10.1016/j.newideapsych.2020.100833

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 New Ideas in Psychology 60 (2021) 100833

Contents lists available at ScienceDirect

New Ideas in Psychology

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Discussion

Effects of Religion and Faith on Mental Health

Eleonora Papaleontiou - Louca
European University Cyprus, 13A, Patriarchi Grigoriou, 2414, Engomi, Nicosia, Cyprus

A R T I C L E I N F O A B S T R A C T

Keywords Religion and Mental Health have been found to be linked to several studies which seem to suggest that religion is
Religion an important way to have a meaning and purpose in life as well as a sense of well-being. Moreover, religious
Spirituality experiences have often coexisted with positive mental health. This article tries to summarize some of the most
Faith
important factors that were found to correlate with Religion/Spirituality (R/S/) and which are basic components
Mental health
in the notion of ‘Mental Health’.

1. Purpose of this article
Purpose of this article is to investigate the relationship of Religion/
Spirituality/Faith with Mental Health and more specifically it aims to
identify the effects of Religion on Mental Health and outline some of the
most important factors that were found in Literature to correlate Reli­
gion and Mental Health and which are basic components in the notion of
‘Mental Health’.
Basic Assumption is that Religion will be positively correlate to
Mental Health, though we need to identify, more specifically, how
Religion facilitates and promotes Mental Health.
The method of investigation followed in this article is the sys­
tematic Literature Review using the keywords Religion, Spirituality, Faith,
Mental Health and is based on previous Meta-analyses of the relationship
and possible effects among these concepts. Some of the basic resources
used include Electronic databases, such as OpenAthens, EBSCO EDS,
Scopus Journals, ResearchBib, ISI, WorldCat, Publons, Scilit, ICMJE,
EuroPub, Academic Resource Index, Advance Science Index and Google
Scholar).
2. Defining our basic terminology
Before examining the relationship between Religion/Spirituality/
Faith and Mental Health, let us first examine these basic terms under
consideration:
Religion: Oxford Dictionaries define religion as the belief in and
worship of a superhuman controlling power, especially a personal God
or gods (David Émile Durkheim French sociologist). Moreover, Religion
has been defined as ‘the close and living relationship, the dependence
and communication of humans to God. It is deep respect, sacred fear
before the Most High and Almighty, a sense of kinship and a strong
attitude towards him. Also, Kenneth Pargament (an emeritus professor
of psychology and an expert on religion and health at Bowling Green
State University in Ohio, in 1997, 32) defines religion as ‘a search for
significance in ways related to the sacred’.
Spirituality: In spite its subjective, vague, personal, and difficult to
articulate nature, spirituality has been defined as meaning making,
feelings of connectedness to others, self, and/or a higher power, as well
as a processes of searching for meaning and purpose, and the openness to
and search for self-transcendence, in which the self is embedded in
something greater than the self, including the sacred or the God
(Goldestein, 2010; Hart, 2005, pp. 163–178).
Faith: Belief and complete trust in and loyalty to God or something
that is believed especially with strong conviction especially a system of
religious beliefs (Merriam Webster Dictionary).
Mental Health: Mental health is defined as a state of well-being in
which every individual realizes his or her own potential, can cope with
the normal stresses of life, can work productively and fruitfully, and is
able to make a contribution to her or his community (WHO).
After defining the basic terms, let us move to a brief history of the
relationship between Religion/Spirituality/Faith and Mental Health to
see how the first effects the second.
3. A brief history of relations between religion/spirituality and
mental health
The relationship between religion and mental health has been
debated for centuries and in fact the two of them have been found to be
linked in a plethora of studies. Research findings indicate that religious
organizations are often the first to offer compassionate care to the

E-mail address: E.Papaleontiou@euc.ac.cy.

https://doi.org/10.1016/j.newideapsych.2020.100833
Received 20 August 2020; Received in revised form 10 October 2020; Accepted 11 October 2020
Available online 1 November 2020
0732-118X/© 2020 Elsevier Ltd. All rights reserved.
E. Papaleontiou - Louca
mentally ill and religion played a significant role in the first form of
psychiatric care in Western Europe and the US, known as ‘moral treat­
ment’. Actually, research identifies both negative and positive links
between religion and mental health, and consequent implications for the
clinical practice (Koenig & Larson, 2001).
The relationship between religion and mental health has passed
though different phases over the past few centuries. For hundreds of
years there was a strong prejudice against the ‘mentally ill’ (partially
due to the teachings of Freud about religion) and during a long period of
the 20th century most mental health professionals were negative to­
wards religion and often believed that this aspect of human life, is either
old-fashion or pathological, expecting that it would disappear as humans
would become more ‘civilized’. However, in a huge number of studies
performed recently, religion seems to remain an important dimension in
people’s life and is usually positively linked to mental health. This,
though, does not mean that any spirituality is associated with mental
well-being and health. There are cases where spiritual development can
worsen an illness or a post-traumatic stress; and, conversely, there are
cases where spiritual decline can be positively related to depression and
negatively related to mental well-being (Sandage & Moe, 2013).
Besides, as expected, philosophers, psychologists and theologians
naturally hold different views on this issue. They seem to agree, though,
in the basic criterion of mental health: (the Socratic) concept of the
useful, which is not meant in a utilitarian or pragmatic way, but is
identified with the law of justice and by the will of God (Tsitsigkos,
2015).
Religion, in general, seems to act as multifaceted to many and varied
adversities of human life; Firstly, trust is considered as a sign of
emotional health, since the very early age of infancy. Then, moral
guidance seems helpful in everyday issues, socialization occurs through
participation in holy services and faith leads to the formation of personal
identity. Moreover, in many cases, faith seems protecting patients with
severe psychosomatic diseases: it increases the ability of patients to
recover from post-traumatic stress, it gives them meaning in life (e.g. to
paraplegic people), it contributes in overcoming the psychological
consequences (feelings of anger, grief, grief, despair, loss of control,
personification etc.) of a sudden death by increasing people’s self-
esteem, and offers stability and vigor to the physically ill. Especially in
caner-patients, faith has been found to reduce the fear of death, to in­
crease self-esteem and lower suicide rates in religious communities
(Tsitsigkos, 2012).
In general terms, according to multiple empirical studies, spiritual­
ity/religiosity can help fulfill human needs for meaning in life (Park,
2005), mental relief (Exline, Yali, & Sanderson, 2000) and emotional
bonding (Rowatt & Kirkpatrick, 2002).
Notably, the majority of psychologists (82%) who researched the
importance of religiosity/spirituality in mental health found it to be
beneficial rather than harmful (7%) [Post & Wade, 2009)].
More specifically, according to several studies, religion has been
found to improve mental health, it fights depression and aids in faster
recovery from physical illnesses (Bonelli, Dew, Koenig, Rosmarin, &
Vasegh, 2012; Katsaouni, 2017; Katsaouni, 2017, 2017; Raphael,
Rachel, Harold, David & Sasan, 2012). Deeper religiosity and the level of
internal faith have been found to contribute to improving health
directly.
Several studies have shown that an inner religious or spiritual
experience helps in mental and physical health: So, positive correlations
have been found between spirituality and positive psychological states
(Richards & Bergin, 2005) including self-esteem (e.g. Pedersen, Wil­
liams, & Kristensen, 2000) and subjective well-being (e.g. Fabricatore,
Handal, & Fenzel 2000; Pedersen, Williams, & Kristensen, 2000). Also,
religiosity has been found to be positively linked to the treatment and
prevention of depression, apart from the improvement of physical health
and a faster recovery from illness (e.g. research team from Duke Uni­
versity of North Carolina, George, Larson, Koenig, & McCullough, 2000;
Larson & Larson, 2003; Musgrave, Allen, & Allen, 2002; ). Moreover,
2
New Ideas in Psychology 60 (2021) 100833
faith has been found to help patients (Mofidi et al., 2006; Mofidi et al.,
2007; Mohr & Huguelet, 2004), with a sense of meaning/purpose in life
and with reduced chances of risky behaviors (Davis, Kerr, & Rob­
inson-Kurpius, 2003). Almost all recent research shows the positive ef­
fects of religiosity on the personality of children/young people,
including physical health (e.g. reduced consumption of tobacco, alcohol
and drugs), mental health, longevity, life satisfaction, problem solving,
support from friends, coping mechanisms, healthy family relationships
and reducing the rate of depressive episodes. In fact, considerable
amount of research has been done investigating the effect of religion on
depression, suicide, anxiety disorders, despair, issues of meaning,
loneliness, guilt, mortality, schizophrenia, and other psychotic expres­
sions. In these studies, it has been shown that religion acts protectively
for the individual, not only by including suggestions for dealing with
such issues, but also by inspiring people, giving them meaning in life,
which may prove to be extremely effective in providing relief and con­
solation, and develop people’s self-esteem and hope (Nανοπούλου,
2015). Also, religiosity has been found to often help in stress manage­
ment, it contributes to well-being and quality of life, accelerates the
resolution of emotional disorders and reduces substance use. For
example, some religions encourage the avoidance of abuse, such as
alcohol, gambling, and overeating. Not adopting such habits can also be
an important part of a healthier life (Koenig & Larson, 2011, 2015).
Lack of religiosity/spirituality in a person’s life, on the other hand,
has been linked to several negative effects on behavior and psychology,
including suicide and stress (e.g. Davis, Kerr, & Kurpius, 2003),
depression (Wright, Frost, & Wisecarver, 1993), stress (James & Sam­
uels, 1999), and substance abuse (Hodge, Cardenas, & Montoya, 2001).
The beneficial effects of religion/congregation, especially on
the development of interpersonal relations can be found in the value
of community life, which has been emphasized both by the Christian
Religion and by other religion traditions (e.g. Islam) as a means that can
bring people out of their individuality and the exclusive self-love dis­
tracting them from their own problems and focusing their interest
beyond themselves. This behavior not only facilitates the resolution of
people’s own emotional stress (Koenig & Larson, 2011) but also supports
well-being and leads to a balance of the communion with others
(Λάβδας, 2009).
In general terms, most religions encourage helping and caring for
others, they promote such virtues as forgiveness, mercy, kindness,
compassion and generosity towards others, strengthening thus people’s
bond with each other. In this way, religious beliefs and practices
strengthen social support (including family and marital ties as well as
networks outside the family). The presence of such supportive re­
lationships in times of stress or painful losses, has the power to enhance
the proper handling of the emotional disorder and prevent non-func­
tional behaviors (Koenig & Larson, 2011).
More specifically, people who believe in a loving and forgiving God
experience lower levels of stress and anxiety and have more optimistic
thoughts, whereas, religions that believe in a punishing God are asso­
ciated with higher levels of anxiety, depression and other mental dis­
orders, as they cause intense guilt, remorse, shame, fear and negative
dysfunctional thoughts (Katsaouni, 2017).
If one believes in a forgiving, merciful and all-good God, who loves
and cares for people, engages them in His purposes and responds to their
calls for help and support, is usually expected to develop positive
emotions and is positively associated with Mental Health (Koenig &
Larson, 2011).
Besides, cultural factors, such as assisting individuals to explore their
own spirituality, spiritual identification, and learn about and affiliate
with a religious organization has been shown to reduce feelings of
anxiety associated with medical illness (Koenig, Larson, & Larson,
2001).
Moreover, religious participation was found to increase resilience by
fostering a sense of belonging and togetherness. Researchers, in fact,
have identified various components of resilience, including religious and
E. Papaleontiou - Louca
spiritual beliefs, shared values and participation in church activities
(Howard, 1996). According to Panter-Brick and Eggerman (2012), cul­
ture and religion improve resilience, mainly through their contribution
in social interactions.
Similarly, Boris Cylurnik (in Malka, 2018) proposes that religion can
indeed be a valuable resilience factor: “When a baby arrives in the
world, the fact of sharing the same world as Mum causes solidarity and
above all a socialization of souls. I love the God that Mum, Dad and my
culture love. I belong to this group, which for me is reassuring and
strengthening. I know that if I respect the religious rituals, I will be in­
tegrated into the group at large, which will be in solidarity with me if
something bad happens to me”.
Literature also considers religion as a potential contributor to the
quality of mental health; and religiosity (how important religion is to
someone) was found to be associated to violence and adolescents’
mental health and behaviors (Baier & Wright, 2001; Ball, Armistead, &
Austin, 2003; Benda & Toombs, 2000; Evans, Cullen, Dunaway, &
Burton, 1995 in Panter-Brick & Eggerman, 2012).
The above do not imply that religious or even spiritual living is only
joy and happiness; it also (quite often) includes pain and suffering
(“cross”), and paradox. Nevertheless, even within pain, the faithful
person seems to experience some kind of ‘joy’ and consolation, deriving
from his/her relationship with God and from the consequence ‘meaning
of life’ that faith offers.
3.1. What kind of religiosity or spirituality is beneficial?
There is both a healthy relationship with God and a sick relationship
with God. And it could not be otherwise, because the relationship with
God is a relationship with a person, it is an interpersonal relationship.
A healthy relationship with God and a healthy religiosity is what
makes man capable of rejoicing, which does not take away his joy in the
name of a supposed faith. She is also the one who makes him creative
and therefore accepts science. Another criterion is the ability for re­
lationships. The person who has a healthy relationship with God opens
up to human relationships. It shows that he needs the Other, he is not
afraid, and he does not wear a mask in the relationship. And, of course, it
has the capacity for self-offering and self-transcendence.
So, to describe the conditions under which a religion is healthy, we
really need psychology. In a way, theology helps us in the goal, what is
the purpose of life, and psychology, on the other hand, describes the
intrapsychic conditions under which man lives his adventure in this life.
That is why we firmly believe that there is a need for a continuous
dialogue between the psychological sciences and theology, so that there
are no misunderstandings as in the past (
3.2. When can religiosity be toxic and psychopathological?
As in biological health we tend to distinguish whether a condition is
healthy or not for our body, similarly there are certain diagnostic criteria
in order to decide, whether a religion facilitates human’s mental health
or not. According to Fr. Vassilios Thermos (2006; 2009), healthy Reli­
gion/Spirituality is characterized by the following six criteria: love, joy,
freedom, humility, respect to God, essence (vs. formalism).
Moreover, according to Tsitsigkos (2015) not every spirituality is
positive/healthy (good), or at least not everyone agrees on its quality.
For example, extreme forms of ‘spiritual’ asceticism can cause psycho­
logical damage (depression, nervousness, guiltiness, phobias), neuro­
logical and biological beliefs; excessive spiritual beliefs, lead to Jealousy
and fundamentalism; the feelings of uniqueness might lead to narcis­
sism, some ‘spiritual’ groups engage in self-destructive behaviours; some
ideas and values, e.g. about supremacy might end up in political con­
flicts (sacred) wars, genocides, etc.
On the other hand, a healthy spirituality, according to Tsitsigkos
(2015) seems to be able to provide people with the acquisition of
mental-spiritual health (Bergin, 1980); it is characterized by
3
New Ideas in Psychology 60 (2021) 100833
growth/maturation (stability, prostitution, wisdom, cheerfulness, seri­
ousness, depth, bliss, holiness, etc.) of the individual. It helps people
acquire their self-knowledge and the deepening of the Ego of the person,
in the creativity and in the unity of the self with God and the world
(Applebaum, 1996).
Of course, religiosity does not always have a positive impact on
mental health, nor are all its manifestations healthy. For example, re­
ligions that demand the complete expulsion of reason, that sanctify
hatred, bigotry, aggression and prejudice, that promote excessive
dependence, helplessness, heterodoxy, divisiveness, that justify criti­
cism and lack of discrimination, which underestimate the value of the
body with extreme asceticism or cultivate a forced way of thinking
focusing on sin and guilt, instead of the love of God (Nανοπούλου, 2015).
Sometimes, in fact, religion does not promote positive emotions. It
can create feelings of guilt, shame and fear, social isolation and low self-
esteem, limit and hinder personal growth or encourage rigid thinking
and narrow-mindedness WHEN religiosity is distorted or misused
(Koenig & Larson, 2011).
So if one believes in a God who is impersonal, hostile, punitive, and
threatening to humans, it is expected to have a negative effect on mental
health, which can be profound - especially during intense stress,
mourning or prolonged misery - where the finding meaning becomes
intense (Koenig & Larson, 2011).
In recent decades, therapists around the world have taken into ac­
count more seriously the factor of religion in order to help their patients
maximize their potential and overcome their problems. Especially in
very subtle issues, which raise highly existential questions, such as the
announcencement of a deadly illness to an individual or to a member of
his/her family, faith can have very beneficial effects, as it soothes pain
and acts as an example of hope against the approaching death (Dein,
2018).
It seems that religion is an important way to have a sense of well-
being. Religious encouragement and support, and religious experiences
have often coexisted with positive mental health (e.g. Levin & Chatters,
1998). More specifically, people with deeper Religiosity/Spirituality
(R/S) were found to have less cases of anxiety, depression, abuse, suicide
attempts, substance use, while, on the other hand, they appear to have a
better quality of life, better recovery of depression and improved psy­
chiatric outcomes (Moreira-Almeida, Neto, Koenig, 2006; Koenig, 2009;
Bonelli, Koenig, 2013). Notably, the World Health Organization con­
siders religion, and spirituality as very important indicators of the
‘quality of life’ (Culliford, 2002). Besides, studies have shown that
prayer is an important factor, which acts as a catalyst for the well-being
and the peace of the individual (Katsaouni, 2017). Also, a study con­
ducted by Taylor and his co-authors suggests that even after controlling
the impact of racial origins, the useful effects of religion on mental
health and quality of life continue to exist (Taylor, Chatters, & Levin,
2004).
Another study found also consistent inverse associations between
religiousness on one hand and depression, suicide and cognitive
dysfunction on the other, though the association with anxiety seemed to
be rather inconsistent. Religion’s effects on mental health (though
modest in strength) was positively associated and generally protective in
direction (Van Ness & Larson, 2002). In any case, the assumption that
religion is positively linked to happiness is strongly supported (Stark &
Maier, 2008). People who believe in an of loving and forgiving God,
seem to experience lower levels of stress and anxiety and have more
optimistic thoughts.
Conversely, religions that believe in a punisher God has been related
to increased anxiety, depression and other mental disorders (e.g.
obsessive-compulsive disorder), as they cause intense guilt emotions,
remorse, shame, fear and negative dysfunctional thoughts such as “I am
a bad man, This is my punishment-I deserve it” (Katsaouni, 2017). So, a
survey conducted in 2010, found that faith in a punisher God had a
positive relationship with symptoms such as obsession, social anxiety,
compulsion and paranoia. On the contrary, believing to a philanthropy
E. Papaleontiou - Louca
God has been linked with decreases in these symptoms, whereas faith to
an indifferent God was not found to be related to such symptoms (Silton,
Flannelly, Galek, & Ellison, 2013).
4. Coping with adversity
A post-analysis of 24 studies and a systematic review of other 200
showed a consistent and consistent positive relationship between mental
health and religion. Moreover, a total of 454 more recent studies (344 of
them published after 2000) describe how Religion/Spirituality (R/S)
have been found helpful for people coping with various stressful situa­
tions and symptoms, natural disasters and diseases, and various adverse
life situations, bereavement and end-of-life conditions (Koenig, 2012).
Also, according to several studies, an internal religious and spiritual
experience (e.g. prayer) helps mental health and helps in faster recovery
from illnesses (Katsouni, 2009; Raphael, Rachel, Harold, David & Sasan,
2012). So, deeper religiosity and the level of internal faith have been
found to contribute to improving health more directly. For example,
studies have shown that religious faith does not only help to deal with
depression but also to prevent it (Koenig, 2009). Also, Harrison and his
colleagues (Koenig, Hays, Eme-Akwari & Pargament, 2001) conclude
that the majority of the published empirical data show that religious
involvement has a beneficial influence on coping with mental and
physical illness. In sum, most of the studies, seem to suggest that R/S was
helpful for the participants (Koenig, 2012).
4.1. Positive emotions and happiness
The term ‘positive emotions’ refers to such states and feelings as well-
being, happiness, self-esteem, hope, optimism, altruism, being kind or
compassionate, grateful, forgiving, having meaning and purpose as well
as a sense of control over life.
Below we report the results of about 326 quantitative, peer-reviewed
studies (since mid-2010) examining the relationship between Mental
Health and Religion/Spirituality (R/S).
From these studies 79% report significant positive link between R/S
and well-being and only 3 studies found a significant negative associa­
tion between R/S and well-being (Dalgalarrondo, Marín-León, Botega,
De Azevedo & Bosco 2008 in; Koenig, 2012).
4.1.1. Hope
From a group of about 40 studies examining the relationship be­
tween R/S and hope, 73% found a strong positive relationship and no
one of them reported a negative association (e.g. Ai, Park, Bu Huang,
Rodgers & Tice, 2007; Murphy et al., 2000).
4.1.2. Optimism
A total of 32 studies examining relationship of optimism with R/S,
and 81% of them found a strong positive association, while no one
found an inverse association (e.g. Ai, Peterson, Bolling, & Koenig,
2002; Krause, 2002; Krause, 2006).
4.1.3. Meaning and purpose
From about 45 studies examining a possible relationship between R/
S on one hand and meaning/purpose in life on another, 93% reported
strong positive association. Most of these studies were conducted in
populations where a meaning and purpose in life is a real challenge (e.g.
in people with chronic illnesses) (Francis, 2000; Krause, 2009, 2010;
Skrabski, Kopp, Rózsa, Réthelyi, & Rahe, 2005).
4.1.4. Self-esteem
Some researchers consider that R/S negatively affects self-esteem,
4
New Ideas in Psychology 60 (2021) 100833
since it places much emphasis on humility and not pride in self (Watters,
1992). Ohers claim that R/S could create feelings of guiltiness in people,
if they don’t follow the high requirements of some religions, decreasing
so, the self-esteem. Nevertheless, 69 studies examining the association
between self-esteem and R/S, resulted to 61% reporting positive asso­
ciations and only 3% found inverse relationship. These findings look
similar to the findings related to depression (though, in the opposite
direction) (e.g. Krause, 2003; Le, Taylor, 2007; Hill, Burdette, Regnerus,
& Angel, 2008; Trevino et al., 2010; Miller et al., 2007).
4.1.5. Positive character traits
As far as character traits are concerned, research shows the following
findings:
First of all, regarding altruism/voluntarism, from 47 studies exam­
ining their correlation with R/S, 70% found significant positive associ­
ation, vs. 11% which found inverse association. Regarding forgiveness,
from a total of 40 studies examining the relationship with R/S, 85%
found significant positive relationship, while not even one study found
an inverse relationship. With regard to gratefulness, 5 out of 5 studies
found positive relationship with R/S (Emmons & Kneezel, 2005; Krause,
2009a, 2009b; Toussaint, Marschall, & Williams, 2012) and regarding
kindness/compassion, 3 out of 3 studies found significant positive
relationship with R/Steffen and Masters (2005). All the above studies
were based on self-reports (Koenig, 2012).
4.2. Depression
Depression has been also widely studied: Overall, from at least 444
studies examining its relationship with R/S, 61% found significant
negative associations and only 6% found positive relationships (e.g.
Strawbridge, Shema, Cohen, Kaplan & 2001; Koenig, 2007; Van Voo­
rhees, Paunesku & Kuwabara et al., 2008; Payman, George, & Ryburn,
2008; Ellison & Flannelly, 2009;Krause, 2009a). Notably, an indepen­
dent literature review concluded that the average degree of correlation
between depression and R/S was − 0.10. This average found in the re­
view was 50% greater in stressed than in non-stressed populations
(Smith, McCullough, & Poll, 2003). Another large study at Columbia
University, also found a negative association between R/S and depres­
sion, especially in high-risk people (Kasen, Wickramaratne, & Gameroff,
2012; Koenig, 2012; Miller et al., 2014; Miller et al., 2012).
4.2.1. Suicide
Correlations between suicide attitudes (i.e. suicide attempt,
completed suicide, and thoughts about suicide) and R/S are similar with
results reported for depression, hope and self-esteem. That is, people
with depression, lack of hope, and with low self-esteem are at a higher
risk for ending their lives with suicide. From about 141 studies exam­
ining the association between R/S and the aforementioned suicide at­
titudes, 75% found negative associations and only 3% reported positive
associations (Koenig, 2012).
4.2.2. Anxiety
From a total of about 299 clinical trials studying the results of R/S
interventions on anxiety, 49% found negative relationships with R/S
and 11% reported positive associations. Regarding the latter, however,
it was not clear whether anxiety enhanced the levels of R/S as a coping
mechanism or R/S caused - or already co-existed with-anxiety (e.g.
Pargament, Koenig, Tarakeshwar & Hahn, 2004; Büssing, Michalsen,
Balzat HJ et al., 2009; Fitchett et al., 2004; Sodergren, Hyland, Craw­
ford, & Partridge, 2004). From the 19 longitudinal studies, 47% found
that R/S could predict lower levels of anxiety over time; some of results,
though, were not so clear, or mixed. Of the 9 experimental studies, 78%
reported less anxiety after the R/S intervention. From 32 randomized
clinical trials, 69% reported that a R/S intervention reduced anxiety
levels, whereas only 3% reported more anxiety (in people addicted to
alcohol) (Koenig, 2012; Miller, Forcehimes, O’Leary, & LaNoue, 2008).
E. Papaleontiou - Louca
Moreover, according to Koenig “people who are more involved in
religious practices and who are more religiously committed seem to
cope better with stress. One of the reasons is because (religion) gives
people a sense of purpose and meaning in life, and that helps them to
make sense of negative things that happen to them. A person’s religious
community can also provide support and encouragement through hard
times” he said (Rettner, 2015).
4.2.3. Psychotic disorder/schizophrenia and bipolar disorder
From a group of 43 studies examining the relationship between R/S
and chronic psychotic disorders, 33% found negative relationships, 23%
reported a positive relationship, 8 studies found mixed results and 1 had
complex results.
4.2.4. Bipolar disorder
Only 4 studies were identified to examine the association of R/S and
bipolar (BP) disorder. Two of them reported a positive relationship be­
tween R/S and bipolar disorder, and the other two found mixed findings.
One Canadian study with a random sample of 37,000 people found a
positive association between higher spiritual values and likelihood of
having BP disorder, while more often religious attendance was linked to
less possibilities of having the disorder (Baetz, Bowen, Jones, & Kor­
u-Sengul, 2006; Koenig, 2012).
4.2.5. Personality traits
Personality traits, such as the Big Five (extraversion, neuroticism,
conscientiousness, agreeableness, and openness to experience) were
assessed by the NEO Personality Inventory and by the Eysenck Person­
ality Questionnaire (in United Kingdom). Similar studies (Koenig, King,
& Carson, 2012, chap. 14) been also examining personality traits and
R/S by using the same measures. Regarding psychoticism, 84% of the
studies found significant negative associations (no study found a posi­
tive one). As far as extraversion is concerned, 50 studies conducted, 38%
of which reported a positive relationship with R/S and 6% found a
negative relationship. Regarding conscientiousness, 30 studies con­
ducted, the majority (63%) of which reported significant positive asso­
ciation with R/S and only 3% reported significant negative associations.
From 30 studies conducted on agreeableness, 87% found positive asso­
ciations (no study found negative relationships). Finally, as far as
openness to experience is concerned, from a total of 26 studies con­
ducted, 42% reported positive associations with R/S and 12% reported
inverse associations (Koenig, 2012).
In sum, R/S was found to have negative associations with neuroti­
cism and psychoticism and positive association with extraversion,
agreeableness, conscientiousness and openness to experience. These
studies scored especially high on agreeableness and conscientiousness
and especially low on psychoticism. These findings have health conse­
quences that we are just starting recognizing (Jensen-Campbell et al.,
2002; O’Cleirigh, Ironson, Schneider, Arnold, Bienias & Bennett, 2007;
Weiss & Costa, 2007; Wilson, Koenig, 2012).
4.2.6. Substance abuse
Religion/Spirituality seems to influence particularly the domain of
mental health, related to substance abuse. A total of about 278 studies
examined the relationship of R/S and use/abuse/dependence on
alcohol. Of those, 86% found inverse relationship and only 1% showed a
positive association. The results are similar regarding drug use/abuse.
About 185 studies were identified, 84% of which found inverse rela­
tionship with R/S and only 1% found positive relationships. It seems that
the protective effects of R/S on substance abuse may have positive ef­
fects on health through life (Koenig, 2012).
4.2.7. Social problems and delinquency/crime
4.2.7.1. Social problems. Since, most major world religions put much
5
New Ideas in Psychology 60 (2021) 100833
emphasis on love, compassion and human relationships, we could as­
sume that some of these qualities would have a significant positive as­
sociation with R/S, and this is the case, indeed.
4.2.7.2. Delinquency/crime. From about 104 studies, which examined
the relationship between delinquency/crime and R/S, 79% found a
strong negative association with delinquency/crime, whereas only 3%
reported a positive association. From those, researchers selected 60
studies with high ratings, 82% of which reported inverse relationships
(e.g. Barber, 2001; Benda, Toombs, & Peacock, 2003; Glanville, Sikkink,
& Hernández, 2008; Johnson, 2004; Pearce & Haynie, 2004; Regnerus,
2003; Stack & Kposowa, 2006; Torgler, 2006) and just one study re­
ported a positive association (Ozbay, 2008).
4.2.7.3. School performance. An interesting group of 10 studies between
(2000–2009) examined the relationship between R/S and academic
performance in high-school and college students of which all − 100% -
found that R/S in youth was strongly and positively associated to aca­
demic performance (Koenig, 2012; Koenig et al., 2012, chap. 14).
4.2.8. Marital stability
An analysis of 79 studies that examined relationship of R/S with
marital stability, 86% found that Religion/Spirituality (R/S) was posi­
tively associated to increased marital stability, while none of them found
a relationship with greater marital instability. From these, 38 studies
were selected as methodologically most rigorous, 92% of which reported
stronger association with R/S and increased marital stability (e.g.
Brown, Orbuch, & Bauermeister, 2008; Burdette, Ellison, Sherkat, &
Gore, 2007; Laurenceau, Stanley, Olmos-Gallo, Baucom, & Markman,
2004; Strawbridge, Shema, Cohen, & Kaplan, 2001; Uecker, 2008;
Wilcox, Wolfinger, 2007). An independent meta-analysis similarly,
suggested that deeper religiousness was related to reduced number in
divorces and greater marital stability and parenting (Koenig, 2012;
Mahoney, Pargament, Tarakeshwar, & Swank, 2001).
4.2.9. Social support and social capital
4.2.9.1. Social support. Research also gives us a substantial evidence for
a positive association between R/S and social support. From a total of 74
quantitative peer-reviewed studies examining the relationship between
R/S and social support, 82% reported strong positive association, and
none of them found an inverse relationship (e.g. Trevino, Pargament &
Cotton S et al., 2010).
4.2.9.2. Social capital. A group of 14 studies examined the association
between R/S/and social capital (i.e. the degree in which an individual
participates in community issues, practices volunteerism and exhibits
trust and reciprocity among other individuals within the community, as
well as membership in community-based, social -justice, civic, or po­
litical organizations). Among those studies, 79% reported strong posi­
tive relationship between R/S and the levels of social capital, whereas no
study found a negative association (Kim & Kawachi, 2006; Koenig,
2012).
4.2.10. The beneficial role of rituals and symbols
Rituals (regulated and repeatable symbolic actions) which are
common practices in religions (e.g. baptism, wedding, funeral) can
contribute significantly to suffering people (Norton & Gino, 2014) as
they offer a way (place/shape) for expressing emotions. They also assist
us in getting a grip on adversities that happen in life (e.g. a disaster or a
death of a beloved one). They also have a condensing function, since
complicated situations are compressed into one action and this enables
us to distance ourselves from situations hard to experience. Moreover,
there is the social function of rituals. Participation in rituals creates
connectedness with a community or group (e.g., a funeral strengthens
E. Papaleontiou - Louca
the mutual bonds between those who stay behind). Finally, there is the
transforming function, as rituals mark the transition towards the next
stage of life by completing the current one (e.g. a funeral service can
help with the transition from the role of spouse to that of widower or
widow). These therapeutic qualities of rituals are evident from the
positive links between rituals and mental health (especially shown in
Koenig’s work, 1988, 1995). More specifically, it has been found that
people for whom rituals are part of their lives suffer less from depres­
sion, anxieties and have a lower suicide rate. On the contrary, partici­
pation in rituals was positively linked to well-being and with
problem-solving abilities.
Besides, rituals are also used in psychotherapy (e.g. in PTSD, Gersons
& Olff, 2005). For example, in a farewell ritual, the traumatizing event is
experienced again and again, but as it takes place within a safe setting, it
is experienced from a kind of distance and, therefore, is not as over­
powering as it was in the original event.
As with rituals, symbols and symbolic actions used in religious
practices are also important in mental health. By ‘acting as if’, one dis­
tances oneself from what is symbolized. Symbolic actions evoke new
experiences and give a person the opportunity to shape them in a new
way. Acting symbolically functions in two basic ways: through similarity
and through contiguity. A connection through similarity is based on a
resemblance between the symbol and the person represented by it (e.g. a
photo of someone who has died). Contiguity refers to the proximity
between the symbol and the person concerned (e.g. objects that used to
be close to the person concerned (e.g. clothes, glasses, or toys) symbolize
that person.
Pain and sorrow will always be an integral part of life and religion
can play a very important function, facilitating mental health, especially
through its unique possibility of providing high-level meaning-making.
In sum, there are three main ways in which religion can be beneficial
in people’s mental health:
(1) by providing social integration and support from the faith
community
(2) by offering a framework for meaning making
(3) by providing a personal bond with God or other divine beings,
and
(4) by offering the possibility of performing private and public
religious
activities, and (5) religion stimulates a healthy lifestyle (Uden &
Zondag, 2016).
5. Discussion
In recent decades, therapists around the world have taken into ac­
count more seriously the factor of religion in order to help their patients
maximize their potential and overcome their problems.
Іn general, it seems that religious beliefs are associated with
improved mental health, higher social functioning and minimization of
self-destructive tendencies, though the relationship between religion
and mental health is not one-way. In spite the large amount of studies
supporting the idea that faith to God leads to healthier life, there are also
exceptions in this phenomenon, such as the (religious) fundamentalist
faith, which has been also linked to healthy psychosomatic effects.
Though, further research is needed here to identify whether other
possible mediating factors lead to this finding, it seems, nevertheless,
that the relationship between religion and well-being is not directly
proportional.
Indeed, religion could be a double-edged sword: As Pargament ex­
plains, negative religious beliefs (e.g. God as punitive, punishing,
abandoning us, threatening or unreliable), are likely to lead people
experience harmful outcomes, including higher rates of depression and
lower quality of life. One the other hand, positive religious beliefs (e.g. a
loving, kind perception of God as a supportive person) seem to lead in
6
New Ideas in Psychology 60 (2021) 100833
experiencing positive outcomes (Rettner, 2015).
So, many are those who through religion have managed to find peace
and tranquility, while others have been found captive to prejudice and
ideology. Besides, it is worth emphasizing, it is not only the kind of
religion that can harm or benefit someone, but also the image of God
that one shapes and the interpretation that one gives to religion indi­
vidually (Nανοπούλου, 2015).
In sum, the relationship between Religion and Mental Health is not
one-directional. In fact, some theorists consider it as positive, and others
as negative. The first group emphasizes a) the assistance of Psychology
to Religion, either through the use of ‘psychological language and
thinking’, either through a deeper understanding of religion (without
Psychology replacing Religion), b) the contribution of Religion to
Mental health, and c) the completing role to each other (Tsitsigkos,
2012). The second group gives emphasis in either Religion damaging
Mental Health, or (the contrary), as Psychology ultimately damaging
religious Faith.
A final comment in the above assumptions is that whether this
‘double’ influence of religion on mental health corresponds to the nature
and quality of ‘Spirituality’/Religiosity.
In other words, it seems that a. the kind of religion (based on love or
on fear); b. the image of God we hold (i.e. as a loving person vs. a
punishing force) and c. Several kinds of myths, symbols, pseudoscien­
tific ideologies, pseudo-beliefs and magical rites and practices, interre­
lated and integrated to authentic religion beliefs (e.g. when ritualism
replaces real faith, or symbols take the place of truly sacraments) seem
to explain to a great extend the positive or negative influences of religion
on mental health.
Some exceptions mentioned above (e.g. fundamentalists’ faith, being
linked to healthy psychosomatic effects) need further investigation and
examine whether some other factors in the lives of these people (e.g. the
sense of meaning in life, or the feelings of belonging) are actually
responsible for these (positive) findings.
Limitations of the Study: It should be noted, though, that most of
the above studies have been conducted in the U.S. in Christian pop­
ulations, though in the last few years several of the main findings have
been replicated in studies from different countries and religions.
Nevertheless, we need to further investigate the cross-cultural studies
and application of these findings to clinical practice in different areas of
the world.
6. Concluding note
All the above evidence seem to lead to the conclusion that religion is
a significant factor in human’s Mental Health and overall well-being.
Given, therefore, that religiousness has such associations with mental
health, this seems to raise important clinical implications and it should
be considered not only in research, but also in clinical practice. The
clinician who truly wishes to consider the bio-psycho-social aspects of a
patient needs to assess, understand, and respect his/her religious beliefs,
like any other psychosocial dimension. Increasing our knowledge of
religiosity on human beings will also increase our capacity as mental
health professionals in relieving the suffering people (Moreira-Almeida,
Lotufo, Francisco & Koenig, Harold, 2006). These research finding
should, therefore, be taken seriously into account from those interested
into the therapeutic process and in people’s Mental Health in general,
utilizing wisely this human potential for the benefit of mankind (Dein,
2018; Freire, Moleiro, & Rosmarin, 2016).
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Eleonora Papaleontiou - Louca is an associate professor in
Psychology at the European University Cyprus and a Vice-
Chairperson at the department of Social and Behavioral Sci­
ences. She has a B.Ed. degree (Cyprus & Greece), an M.A. in
Education (University of Reading, U.K.) and a PhD in Devel­
opmental / Cognitive and Educational Psychology (Cardiff
University, U.K.). She has published many articles in Greek and
international journals and has also published 6 books: “Chil­
dren’s and Adolescents’ Mental Health” (A & B volumes -Armos
pl/hers), “Current Trends in Preschool Curriculum” Tipothito
pl/hers, Getting Out of the Woods: A Guide for the Creative
Path – Fostering Creativity in Universities (Group Project pub­
lishes by EUC Research Center), “Metacognition and Theory of
Mind”, Cambridge Scholars Publications and “Metacognition:
Theory and Practice” Thymari Publications, Greece. Dr E. Louca
has also given hundreds of lectures to parents and specialized
groups related to psychological topics and children’s upbring­
ing issues. Her research interests include: Mental Health,
Metacognition, Theory of Mind, Creative and Critical Thinking,
Language Development, Emotional Development, Emotional
Intelligence and the relationship between Religion and
Psychology.