Religion, spirituality and mental health: Journal Club Presentation

Religion, spirituality and mental health: results from a national study of English households

Michael King, Louise Marston, Sally McManus, Terry Brugha, Howard Meltzer and Paul Bebbington

BJP 2013, 202:68-73

Journal Club Presentation

Dr Yasir Hameed (MRCPsych)

Specialist Registrar Psychiatry

17/12/2013

Outline

o Clinical scenario

o Background on study/author

o Interactive use of checklist to appraise the paper

o Media attention

o MCQs

Clinical scenarioA 70 year old lady was admitted to the psychiatric unit with features suggestive of severe depressive episode without psychotic symptoms of 3 months duration.

She is a member of Jehovah Witnesses and was very active in the her congregation.

She initially refused medication but was persuaded by her husband to take it. She prayed with him and her friends while on the ward and nurses reported improvement in her symptoms.

Clinical questions

o Did her religious background play a role in her improvement?

o Would her prognosis change if she was an atheist, or spiritual (but not religious) person.

o How her faith contributed to her recovery?

Spirituality does not make sense?

Background

o This was Cross Sectional Survey commissioned by the National Centre for Social Research, an independent research agency with an interest in social attitudes.

o Part of the third National Psychiatric Morbidity

Study in England 2006-2007.

o Who is Michael King?

The study

o Background

Mental health and religion. Most research is American. ?Measures of spirituality.

o Aims

Associations between a spiritual/religious beliefs & psychiatric symptoms.

o Method

Data analysis of interviewing 7403 people (third National Psychiatric Morbidity Study in England).

Abstract (cont’d)

o Results

35% had a religious understanding of life

19% were spiritual but not religious

46% were neither religious nor spiritual

o Religious people = neither religious nor spiritual people with regard to the prevalence of mental disorders, EXCEPT that:o Religious people less likely to have ever used drugs

(odds ratio (OR) = 0.73, 95% CI 0.60–0.88) or be a hazardous drinker (OR = 0.81, 95% CI 0.69–0.96).

Abstract (cont’d)

Spiritual people more likely to:

oHave ever used (OR = 1.24, 95% CI 1.02–1.49) or be dependent on drugs (OR = 1.77, 95% CI 1.20–2.61)oHave abnormal eating attitudes (OR = 1.46, 95% CI 1.10–1.94) Generalised anxiety disorder (OR = 1.50, 95% CI 1.09–2.06), any phobia (OR = 1.72,95% CI 1.07–2.77) or any neurotic disorder (OR = 1.37, 95% CI 1.12–1.68). oThey were also more likely to be taking psychotropic medication (OR = 1.40, 95% CI 1.05–1.86).

Abstract (cont’d)

Conclusions

People who have a spiritual understanding of life in the absence of a religious framework are vulnerable to mental disorder.

Get ready for the appraisal…

Screening Questions

1.Did the study address a clearly focused issue?

2.Did the authors use an appropriate method to answer their question?

Detailed questions

o 3.Were the subjects recruited in an acceptable way? (multi-stage sampling)

o 4.Were the measures accurately measured to reduce bias?

o 5. Were the data collected in a way that addressed the research issue?

Measures

o Royal Free interview for religious and spiritual beliefs

o The revised Clinical Interview Schedule (CIS-R)

o The Psychosis Screening Questionnaire (PSQ)

o Close Persons Questionnaireo The Trauma Screening Questionnaire

(TSQ)

Measures (cont’d)

o The SCOFF questionnaire ( make yourself Sick, lost Control, lost more than One stone in a 3 month period?, Fat when others say you are too thin? Food dominates your life?)

o Problem gambling (DSM IV)

Measures (cont’d)

o Questions on use of recreational drugs came from the Diagnostic Interview Schedule.

o One question explored how happy the participants felt ranging from very, to fairly and not too happy.

o Psychotropic medication/psychotherapy or counselling.

Sample size

o 6. Did the study have enough participants to minimize the play of chance?

Analysis

o 7. How are the results presented and what is the main result?

o 8. Was the data analysis sufficiently rigorous?

o 9. Is there a clear statement of findings?

Characteristics

Neither religious or spiritual Spiritual Religious P

Male, % 55 44 43 <0.001

Age, years: % <0.001

16–24 19 11 10

25–34 19 16 13

35–44 20 21 17

45–54 16 18 16

55–64 13 17 17

65–74 7 10 14

75+ 5 8 14

Characteristics Neither religious or spiritual

Spiritual Religious P

White British 93 86 74

White non-British 4 6 6

Black 1 3 6

South Asian 1 2 9

Mixed or Other 2 3 4



Education, % <0.001

No qualifications 25 21 30

School or foreign qualifications 51 46 39

Post-school qualifications 24 32 30

Characteristics

Neither religious or spiritual


Married 46 53 60

Cohabiting 13 12 6

Single 28 21 17

Widowed 5 6 10

Divorced 6 7 5

Separated 2 2 2



Social support, mean 20.0 20.2 20.3

Strength of religious understanding, meana 6.2 7.0

Importance of religious practice, meana 4.4 6.2 <0.001



Drug use

Ever used drugs 32 30 16 <0.001

Used any drug in the past year 12 11 5 <0.001

Drug dependent 4 5 2 <0.001

Dependent on cannabis 3 4 1 <0.001



Dependent on another drug (+/– cannabis) 1 1 1

Hazardous drinker 30 23 17 <0.001

Problem gambling 0.8 0.6 0.7 0.880

Post-traumatic stress disorder 3 3 3 0.527



Eating attitudes

SCOFF ≥2 7 9 5 0.001

SCOFF score ≥2 and food interferes with lifea 2 2 1 0.646

Psychosis Screening Questionnaire

Definitely psychotic 0.1 0.4 0.4 0.106

Probably psychotic 0.3 0.6 0.5 0.118



Panic disorder 1 1 1 0.618

Generalised anxiety disorder 4 5 4 0.079

Mixed anxiety/depressive disorder 8 10 8 0.154

Obsessive–compulsive disorder 1 1 0.8 0.127

Any phobia 2 3 2 0.055

Depression 3 3 2 0.057

Any neurotic disorder 16 19 15 0.011



Receiving pharmacological treatment 5 7 6 0.026

Receiving counselling/

therapy 3 3 2 0.360

Findings

o 10. Can the results be applied to the local population?

Conclusion

o People who profess spiritual beliefs in the absence of a religious framework are more vulnerable to mental disorder.

o Those who were religious were broadly similar, in terms of prevalence of mental disorder and use of mental health treatments, to those who were neither religious nor spiritual after adjustment for potential confounders, except they were significantly less likely to use, or be dependent on, drugs or alcohol.

Strengths

o Random selection of a nationally representative sample

o The sample sizeo In-depth assessment of mental healtho Use of standardised questions on religion

and spirituality

Limitations

o Cross-sectional surveys, cannot prove cause and effect.

o Other factors may be at play (e.g., lack of peer support).

o Religious belief was not examined in details.

11. How valuable is the research? Why this subject is important?

o There has been a significant increase in research on spirituality, religion and mental health in recent years.

o Understanding spirituality/religious background is essential to provide holistic care.

o Religion & spirituality provide meaning and purpose that allow for rational interpretations of life problems

Psychiatrists and Spirituality

o More likely to encounter religion/spirituality issues in clinical settingso (92% versus 74%)

o More open to addressing religious/spiritual issues with patientso (93% versus 53%)

o Psychiatrists are more comfortable, and have more experience, addressing religious/spiritual concerns in the clinical settingCurlin et al, Am J Psychiatry, 2007

Media attention to this study

Gordian article

MCQs

1. Religious delusions may occur in:

a. schizophrenia

b. depression

c. anxiety states

d. anorexia nervosa

e. organic states.

2. In terms of religious beliefs and practices:

a. Psychiatrists are generally more religious than their patients

b. Religious teaching plays little part in psychiatric training

c. There is some evidence that religious patients prefer religious therapists

d. A significantly greater number of mental health professionals undergo religious conversion compared with the general population

e. Hospital chaplains in the UK have no training in mental health problems.

3. In terms of psychotherapy:

a. Freud held a negative view of religion

b. Jung held a positive view of religion

c. Perceptions of God derive from early childhood relationships

d. Perceptions of God never change during psychotherapy

e. The addition of religious components to cognitive therapy may enhance efficacy for religious patients.

5. Religious patients’ reluctance to engage in psychiatric treatment may be overcome by:

a. Using a culture broker

b. Using religious symbols

c. Antipsychotic administration

d. Brief cognitive therapy

e. Using the Mental Health Act

MCQs taken from:

Dein S. Working with patients with religious beliefs. Advances in Psychiatric Treatment (2004). 10: 287-294

Thank you

Religion, spirituality and mental health: Journal Club Presentation

Health & Medicine

Transcript of Religion, spirituality and mental health: Journal Club Presentation