Religion, Mental Health, and the Latter-Day Saints: A Review of Literature 2005–2022

: The objective was to review all peer-reviewed, scholarly articles on the mental health of members of The Church of Jesus Christ of Latter-day Saints from 2005 to 2022. Forty-six studies were identiﬁed. Research ﬁndings were consistent with the general research on R/S and mental health, which typically ﬁnds R/S related to better mental health. When comparisons are made, Latter-day Saints are typically found to have better mental health than those of other religions or no religion. It was found that in the last 10 years, research on sexual minorities has dominated the research on Latter-day Saints’ mental health. Although ﬁndings are nuanced, sexual minorities tend to have less favorable mental health when they are only somewhat enacting either a Latter-day Saint and/or sexual minority identity. The research literature on Latter-day Saints’ mental health is in its infancy, with few studies utilizing a high degree of methodologic rigor. More longitudinal and representative research is needed to better understand Latter-day Saints’ mental health. Further, more theoretical work is needed to provide a framework for explaining ﬁndings and guiding future research.


Latter-Day Saints and Mental Health
Although the relationship between religion and spirituality (R/S) and mental health has long been controversial (Bergin 1983;Dawkins 2011;Ellis 1980;Freud 1928;James 1902), research has predominantly found R/S related to better mental health (see Rosmarin and Koenig 2020).Still, aspects of R/S may be risk factors such as when fellow religionists or religious leaders are critical or demanding (Schieman et al. 2013), when God is viewed as having little or no interest in individuals' problems (Ellison et al. 2014), when divine favor is viewed "legalistically" (Judd et al. 2020), or when a religion is rejected by society (Koenig 2018).
However, the relationship between R/S and mental health is likely moderated by denominational differences (e.g., Oh et al. 2022).More than a century ago, (Durkheim 1897) examined whether Catholics or Protestants had higher suicide rates, basing his rationale on theological differences possibly leading to differences in social integration and suicide rates.Despite some flaws in his work (Stark et al. 1983), it is significant that Durkheim posited that differences in theology and/or practices would lead to different outcomes.Understanding differences can lead to a better understanding of protective and risk factors within a religion and provide direction for denominations in enhancing protective and reducing risk factors.
Over the past two decades, one denomination receiving increased attention regarding the mental health of its members is The Church of Jesus Christ of Latter-day Saints.Debate over the mental health of Latter-day Saints has recently emerged, particularly relating to sexual and gender minorities (SGMs) (Prince 2019).Questions have arisen over whether this more "high-demand" (Busby and Dollahite 2020) and sexually conservative religion may, on average, create dissonance for its SGMs, leading to poorer mental health (McGraw et al. 2021a).

1.
Using EBSCO, databases PsychInfo and Academic Search Premier were searched for the period between January 2005 and November 2022 to identify peer-reviewed journal articles that included Latter-day Saints' affiliation, beliefs, practices, or other aspects of R/S.Samples or sub-samples had to be clearly identified as being the majority Latter-day Saints.Search terms were the following: Latter-day Saint, LDS, and Mormon.2.
Studies included one or more measures of mental health or well-being.Combined with search terms of affiliation, the mental health search terms included the following: mental health, mental illness, anxiety, alcohol abuse, body-image, coping, delinquency, depression, divorce, drugs, drug abuse, drug use, eating disorder, obsessive-compulsive disorder, perfectionism, psychopathology, self-esteem, scrupulosity, sexuality, shame, social support, substance abuse, suicide, and well-being.

3.
In addition to this search, we also employed the "ancestry method", which included examining the reference citations of articles identified for related studies that may not have been captured in the database search.

Results
By employing the search methods using the key terms described above, the initial search resulted in 748 studies.After further examination, studies that examined "LDS" that were not studying Latter-day Saints (keywords including "latent different scores" or "learning disabilities") were then excluded from the search results, leaving 355 studies.Studies were excluded if they did not report original research or if they were qualitative (although important, for comparability, we selected only quantitative research), resulting in 44 studies.In the final stages of manuscript preparation, we became aware of 2 more recent studies that were also included, resulting in 46 studies (with 117 outcomes) to be included in this literature review.
Of the 46 studies, only 5 were longitudinal.This raises important questions about the direction of effects.When in distress, individuals may reach out to religion for support, and the association between religiousness and negative mental health may be positive.On the other hand, the ample documentation of religion's mental health benefits suggests that those practices may reduce mental health problems (Oman and Syme 2018).Only longitudinal work examining reciprocal influences can determine the degree to which mental health difficulties may increase religiousness and religiousness may decrease mental health difficulties.Unfortunately, none of the studies reviewed examine such reciprocal effects.
Since 2014 there has been substantial interest in SGM Latter-day Saints.In fact, of the 33 studies on Latter-day Saints since 2014, 21 (64%) focus on SGM issues.None of these studies on SGM have been longitudinal; 33% (7) used no controls, and only 19% (4) used representative samples.We are therefore left with few studies of high methodological rigor.At the same time, these studies have broken important ground in this area, providing a much-needed baseline from which to formulate the future of this research.
In our summary, we note when studies are particularly rigorous or when they are not.For example, we emphasize a study on Latter-day Saints' depression that controlled for background factors over a study that used no controls.Table 1 contains a list of the studies with some of their attributes.Urges to use substances, Body Image -Compared to LDS, non-LDS were more likely to experience increased urges to use substances in response to negative emotion -LDS reported more positive feelings toward their bodies and more satisfaction with their bodies and body shape.
-Non-LDS females endorsed greater preoccupation with being overweight and more negative feelings about the body than LDS females.-LDS females residing inside Utah report greater concern with body shape and greater preoccupation with becoming overweight than Latter-day females residing outside Utah.Self-esteem, Quality of life, Sexual identity distress, Depression -Differences were found in mental health (self-esteem, quality of life, internalized homophobia, sexual identity distress, depression) across categories of 1) church affiliation, 2) relationship status, and 3) sexual activity.In general, those who were active LDS, those who were single, and those who were celibate (particularly not by choice) had less favorable mental health.Identity confusion, Sexual identity distress, Depression, Self-esteem, Quality of life -Those who integrated their religious and LGBTQ identity had the best mental health across sexual identity distress, depression, self-esteem, and quality of life.They had greater sexual identity distress than those who rejected their religious identity.-Those who rejected an LGBTQ identity and those who compartmentalized their religious and LGBTQ identities had particularly low mental health.-Church affiliation and activity -Social Support from Family and Friends Scale -Gay or SSA identity -Gay identity acceptance -Agreement with church policy -Rosenberg Self-Esteem Scale Self-esteem -Both active and former LDS reported similar levels of self-esteem.-These similar levels appear to be related to active individuals having higher family support but lower Gay/SSA identity, whereas former members had less family support but higher acceptance of Gay/SSA identity.(Wang et  No controls -Almost Perfect Scale -Penn Inventory of Scrupulosity -Attachment to God -Intrinsic Spirituality Scale -Rosenberg Self-Esteem Scale Maladaptive perfectionism, Scrupulosity, Self-esteem, Anxiety about God The following were significant pair-wise correlations: Between maladaptive perfectionism and scrupulosity (+) a , intrinsic spirituality (−), self-esteem (−), and anxiety about God (+).Between scrupulosity and intrinsic spirituality (−), self-esteem (−), avoidance of God (+), and anxiety about God (+).Between self-esteem and avoidance of God (−) and anxiety about God (−).Between anxiety about God and avoidance of God.
( Depression, Life Satisfaction (LS) -Full sample: greater LS was related to being heterosexual, not being LDS, having higher religious commitment, and fewer interpersonal religious struggles.-Full sample: greater depression was related to greater interpersonal religious struggles.-For LGBT, greater LS was related to greater LGBT connectedness.For LDS, IH was unrelated to LS, whereas it was positively related to LS for non-LDS.-For LGBT, greater depression was related to greater concealment.For LDS, IH was related to greater depression, whereas it was unrelated for non-LDS.
-For LGBT, LS and depression were unrelated to being LDS. a + = positive relationship, − = negative relationship; NOTE: In some studies, their primary statistics were pair-wise correlations, t-tests, or one-way ANOVAs.When this was the case, we reported these findings.However, when studies followed up with more rigorous tests (e.g., regressions that included controls), we did not report the more basic statistics, such as pair-wise correlations.

Substance Use/Abuse
Given the Church of Jesus Christ of Latter-day Saints' teachings on health (The Church of Jesus Christ of Latter-Day Saints n.d.b), it is unsurprising that studies find Latter-day Saints are less likely to use alcohol, tobacco, or illicit drugs and are the least likely to experience the urge to drink alcohol in response to negative emotion (see Dulin et al. 2006;Dyer et al. 2022;Dyer and Goodman 2022;Merrill et al. 2005;Michalak et al. 2007;Sandberg and Spangler 2007).Greater religious activity for Latter-day Saints also predicts less substance use (Dulin et al. 2006;Merrill et al. 2005).

Depression and Anxiety
In our review, the earliest studies on depression are from Norton and colleagues (Norton et al. 2006(Norton et al. , 2008) ) examining elderly (65 years+) in a rural Utah county.Their 2008 longitudinal study finds Latter-day Saints at greater risk for new onset of major depression, though they also found going to church more than once a week related to better mental health.Thus, while being a Latter-day Saint is a risk, if one is a Latter-day Saint, attending church is better than not (there was no significant interaction between the two).This seemingly odd finding may have to do with the imbalance in the sample.Of the 2804 participants, only 6.6% were non-Latter-day Saints.Further, given that none of the comparison groups had new-onset depression (which was rare), the study is likely not estimating the true proportion of non-Latter-day Saints experiencing new onset depression, perhaps contributing to some of the counterintuitive findings.
Three studies using representative data on Utah adolescents (Dyer et al. 2022(Dyer et al. , 2023;;Dyer and Goodman 2022) are the exception in that they have large numbers of non-Latterday Saints and make comparisons to those of other religions and no religion.At the bivariate level, Latter-day Saint adolescents had significantly lower rates of depression than those of other religions or no religion, though, in two of these studies, significant differences largely disappeared when controlling for family conflict and adolescent and family substance use (Dyer et al. 2022;Dyer and Goodman 2022).However, in both of these studies, after other variables were added to the model, Latter-day Saints had lower levels of depression than those of no religion.Additionally, in one of the studies (Dyer et al. 2022), Catholics and Protestants had lower levels of depression than Latter-day Saints.One of the studies (Dyer et al. 2023) found lower rates of depression for Latter-day Saints associated with lower rates of COVID-19 stressors.
Other studies examining depression and anxiety use primarily Latter-day Saint samples and do not compare Latter-day Saints to others.In these studies, positive religiousness (e.g., intrinsic religiosity, self-transcendence, religious commitment) and religious practices were either unrelated to depression/anxiety (Allen and Heppner 2011;Kane et al. 2021) or related to lower levels of depression (Allen et al. 2019;Judd et al. 2020;Sanders et al. 2015).In contrast, Ogletree and colleagues found male private religious practices related to greater depression (Ogletree et al. 2019).However, the lowest depression levels were for males with authoritative fathers and high family religious practices.Certain negative aspects of religiousness commonly found to relate to poorer mental health (e.g., scrupulosity, legalism, abandonment by God, maladaptive perfectionism) were positively related to depression for Latter-day Saints (Allen and Wang 2014;Judd et al. 2020;Ogletree et al. 2019;Sanders et al. 2015).

Suicidality
"Suicidality" includes suicidal thoughts, plans, and attempts; we also included nonsuicidal self-injury here (NSSI).The earliest study reviewed was by Thomas et al. (2011), whose sample was drawn from an inpatient treatment facility, comparing Latter-day Saints to non-Latter-day Saints.At intake, Latter-day Saints were more suicidal, though, by discharge, there were no differences.The next study of Latter-day Saints' suicidality was conducted nine years later (Dyer et al. 2020) using a sample of primarily Latter-day Saints (87%).Shame was related to an increase in suicidality over time, whereas church support and family flexibility were related to a decrease over time.More recently, five studies (Angoff et al. 2021;Dyer et al. 2022Dyer et al. , 2023;;Dyer and Goodman 2022;McGraw et al. 2021b) have used representative data on Utah adolescents to examine suicidality or NSSI in adolescents.In general, Latter-day Saints had lower levels of suicidality and NSSIs though some of these differences disappeared when controlling for family and substance use factors (see Dyer et al. 2022;Dyer and Goodman 2022).

Body Esteem/Appearance/Image
Four studies examined what Latter-day Saints think about their bodies.Three were female-only samples (Fischer et al. 2013;Sandberg and Spangler 2007;Steffen 2011), with the fourth being 82.1% female (Coyne et al. 2022).Three were Latter-day Saint-only samples (Coyne et al. 2022;Fischer et al. 2013;Steffen 2011), and one was primarily Latter-day Saint (68.6%;Sandberg and Spangler 2007).Although it was a Latter-day Saint-only sample, Fischer et al. compared the eating disorders of their sample to national statistics.Thus, there has been little work on male Latter-day Saints and little work on how Latter-day Saints compare to others.The comparative research found that Latter-day Saint women had more positive views about their bodies and were less likely to have eating disorders than other women (Fischer et al. 2013;Sandberg and Spangler 2007).Spiritual strength was negatively related to concern about appearance (Steffen 2011), and body esteem was positively related to positive church culture (e.g., acceptance; diversity) and negatively related to negative church culture (e.g., comparison; pressure to conform (Coyne et al. 2022)).Overall, research finds Latter-day Saint women, on average, have more healthy attitudes and behaviors towards their bodies, and the more connected they are with religious belief and activity, the better their attitudes.Two studies examined whether living in Utah was predictive of body image, with (Sandberg and Spangler 2007) finding Utah females having greater concern with body shape, whereas (Coyne et al. 2022) found no association between body esteem and living in or outside Utah.

Perfectionism, Scrupulosity, and Shame
Several studies examined some combination of perfectionism, scrupulosity, and shame.We, therefore, summarized these together.Perfectionism can be divided into adaptive perfectionism (attitudes that lead individuals to excel in healthy ways) and maladaptive perfectionism (attitudes that create fear and anxiety about performance).Scrupulosity is a form of obsessive-compulsive disorder manifest in a religious context (e.g., intense fear of God or fear of sinning).Shame often includes making "internal, stable, global attributions about one's self, which lead to negative feelings about the global self" (Cohen et al. 2011, p. 948).Allen and Wang (2014) classified nearly half of their Latter-day Saint sample (47.2%) as adaptive perfectionists, with 30.3% being maladaptive perfectionists and 22.5% non-perfectionists.Adaptive perfectionism was related to greater intrinsic religiosity (Rasmussen et al. 2013), experiencing God's grace, and less legalism (Judd et al. 2020).Maladaptive perfectionism was unrelated to intrinsic or extrinsic religiosity (Rasmussen et al. 2013;with no controls, Allen et al. 2021 found intrinsic spirituality related to less maladaptive perfectionism) but was significantly related to experiencing God's grace less, higher legalism (Judd et al. 2020), higher scrupulosity, lower self-esteem, and higher anxiety about God (Allen et al. 2021).
Scrupulosity was related to less religious commitment (Allen et al. 2015) and greater guilt, personal discrepancy, and God discrepancy (Wang et al. 2018).For females, scrupulosity was negatively related to experiencing grace and positively related to legalism (Judd et al. 2020).At the bivariate level, scrupulosity was related to lower intrinsic spirituality, lower self-esteem, greater avoidance of God, and greater anxiety about God (Allen et al. 2021).Shame was related to less religious commitment, greater scrupulosity (Allen et al. 2015), experiencing less grace from God, and greater legalism (Judd et al. 2020).Allen et al. (2015) also found that the relationship between legalism and shame was mediated by scrupulosity and that family perfectionism intensified the link between scrupulosity and shame.In the one comparative study, Dyer et al. (2020) found at ages 12-14, Latter-day Saints had lower levels of shame.However, they were no different from others two years later.

Sexual and Gender Minority Latter-Day Saints
The relationship between religion and the well-being of SGMs has received much attention over the past few decades.Much of the literature conceptualizes religions as often creating "homophobic environments" (Sherry et al. 2010, p. 113), which create conflict for SGMs.Like many conservative-leaning religions, The Church of Jesus Christ of Latter-day Saints considers sexual relations appropriate only between opposite-sex married couples (situations of biological ambiguity about sex are handled on a case-by-case basis; (The Church of Jesus Christ of Latter-Day Saints n.d.a)).Minority stress theory is often invoked with hypotheses suggesting that SGMs face additional stressors within The Church of Jesus Christ of Latter-day Saints (Crowell et al. 2015).Over the last few years, research on SGMs has come to dominate the research on Latter-day Saints and mental health.Of the 25 studies of Latter-day Saints' mental health published in the last 5 years, 16 of them (64%) have focused on SGMs.
In 2021, McGraw and colleagues (2021) identified 33 studies (19 quantitative or mixed method, 14 qualitative) on Latter-day Saints SGMs.There were three categories of studies: (1) those with Latter-day Saint-only samples exploring the experiences of SGMs, (2) those examining the differences between current and former Latter-day Saints SGMs, and (3) those comparing SGM Latter-day Saints to SGMs of other religions or no religion.Some studies may have contained elements of more than one of these categories.Studies examining the experiences of SGM Latter-day Saints often describe difficulties navigating their sexuality and religious identity (Bradshaw et al. 2015;Dehlin et al. 2014aDehlin et al. , 2014b;;Dehlin et al. 2015).Resolving identity conflict is likely important for better mental health (Dehlin et al. 2015;Grigoriou 2014).In the same vein, feeling resolved about conflicts between religion and sexuality and being more moderate in one's views was also positively related to well-being (Lefevor et al. 2020b).
Studies that examined differences between current and former SGM Latter-day Saints are few.Bridges and colleagues (Bridges et al. 2020) found current Latter-day Saints had better mental health than former Latter-day Saints.Joseph and Cranney (2017) found no difference between current and former SGM Latter-day Saints on self-esteem.Examining depression, Crowell and colleagues (2015) found significant interactions where being an active Latter-day Saint buffered against the effects of internalized homophobia and identity confusion.However, Lefevor et al. (2021b) found internalized homophobia related to depression for Latter-day Saints (unrelated for non-Latter-day Saints) though it was unrelated to life satisfaction for Latter-day Saints (it was related for non-Latter-day Saints).Lefevor et al. (2022b) categorized their sample as engaged Latter-day Saints, moderately engaged Latter-day Saints, and lapsed Latter-day Saints, finding no differences in depression or life satisfaction across these groups but greater meaning of life and fewer alcohol problems for engaged Latter-day Saints.
Another study found SGM Latter-day Saints who either attended church regularly or those who did not attend church had greater life satisfaction than those who attended only sporadically (Lefevor et al. 2020b).Skidmore et al. (2022b) found the influence of belongingness to either The Church of Jesus Christ of Latter-day Saints or to various SGM groups seemed to be moderated by religious activity and one's connection with religion and sexuality.Whereas belongingness to The Church of Jesus Christ of Latter-day Saints was related to better mental health when church attendance and internalized homophobia were high, belongingness to SGM groups was related to better mental health when church attendance was low and internalized homophobia low (see also Skidmore et al. 2022a).They also found when active concealment of sexual orientation was low, mental health tended to be better (see also Skidmore et al. 2022c).
Other studies found former SGM Latter-day Saints have better mental health than current Latter-day Saint SGMs (Bradshaw et al. 2022;Dehlin et al. 2014a;Ison et al. 2010) or that those in same-sex relationships had better mental health (Bradshaw et al. 2022); though these studies employed no statistical controls (see also Crowell et al. 2015).One study that did use controls found former SGM Latter-day Saints had less depression and more life satisfaction and flourishing than current SGM Latter-day Saints (Lefevor et al. 2020b).Lefevor and colleagues (2022) conducted more nuanced analyses finding (among other things) "religious struggles" had a stronger negative relationship with suicide ideation for active Latter-day Saints than for nonactive/former Latter-day Saints and that sexual identity affirmation was negatively related to suicide ideation for nonactive/former Latter-day Saints but unrelated to suicide ideation for active Latter-day Saints.
Of the studies comparing SGM Latter-day Saints to SGMs of other religions or no religion, some find SGM Latter-day Saints report better mental health (Cranney 2017;Dyer et al. 2022;Dyer and Goodman 2022;McGraw et al. 2021b).One study found SGM Latterday Saints to have greater negative sexual identities and more religious incongruence than those of other religions, though there were no differences in their mental health (Wolff et al. 2016).Finally, Angoff et al.'s (2021) findings are somewhat unclear, though it appears SGM Latter-day Saints may have fewer non-suicidal injuries (NSSI) (or are not any different) than SGMs of other religions or no religion.Some research finds family support predictive of better mental health for SGM Latter-day Saints (Grigoriou 2014;Mattingly et al. 2016).Two studies found no difference in depression or life satisfaction across Latter-day Saint and non-Latter-day Saint SGMs (Lefevor et al. 2021b;Skidmore et al. 2022a).
Sex differences regarding feelings towards The Church of Jesus Christ were also examined for same-sex attracted (SSA) men and women.Bradshaw et al. (2021) found that SSA women experienced greater alienation from the Church, were more likely than SSA men to express negative sentiments about their church experiences, and were less likely to subscribe to Church beliefs.Even though more women than men identified as bisexual, bisexuality facilitated continued activity in the Church for both sexes, but less so for women.
Some studies have examined how identity may play a role in sexual minority Latterday Saint's mental health.Grigoriou (2014) found that individuals who said their Latter-day Saint or SSA identity was more important than those who could not decide which was more important had lower levels of depression and anxiety.Dehlin et al. (2015) found integrating religious identity with sexual identity was related to the most optimal outcomes.It is likely that those who have identity conflicts are at increased risk of mental health difficulties.(Lefevor et al. 2020a) compared Latter-day Saints who indicated they were SSA to those who adopted an LGBQ label.SSA Latter-day Saints had higher religiousness, placed greater value on child-centered families, and were more likely to be celibate or in a mixed-orientation marriage than those who identified as LGBQ.Results indicate that SSA Latter-day Saints who were either consistently engaged or more disengaged from their religious identity experienced better well-being and better mental health than participants who were not resolved in their religious and sexual identities.LGBQ Latter-day Saints reported feeling more contentedness with their sexual feelings and less homonegativity.However, there were no mental health differences between these groups.
Although a different construct from sexual orientation, gender identity is an important area to include in research.Only one study examined the mental health of transgender individuals as a unique group, finding Latter-day Saint transgender individuals had the same level of mental health as those of other religions or no religion (Dyer and Goodman 2022).

Discussion
The research on Latter-day Saints and mental health fits relatively well within the overall research on religion and mental health.In studies examining only Latter-day Saints, those who are more active in their faith and/or have positive religious attributes (e.g., intrinsic religiosity, religious commitment) tend to have better mental health.Those less active and those with negative religious attributes (e.g., legalism, scrupulosity, feeling abandoned by God) tend to have worse mental health.Further, when comparing those of other religions or no religion, Latter-day Saints appear to have better mental health, though few studies examined this and, as will be discussed, the picture is more nuanced for sexual minorities.
Studies that examined why Latter-day Saints may have better mental health suggest their lower likelihood of alcohol use and stronger family connection is likely important (Dyer et al. 2022;Dyer and Goodman 2022).However, few studies examined this, and more research is needed to explain why differences may exist.Although identifying denominational differences is important, when the risk/resilience factors which give rise to those differences are understood, we are better able to capitalize on the processes that undermine or promote mental health.

Sexual Minority Latter-Day Saints
Much of the research on SGM Latter-day Saints begins with the premise that Latter-day Saint SGMs will have less favorable mental health than disaffiliated Latter-day Saints or those of other faiths.Findings for this, however, were mixed.Some studies found current Latter-day Saints had better mental health (Bridges et al. 2020), some found no differences in mental health (Joseph and Cranney 2017), and others found former Latter-day Saints with better mental health (Bradshaw et al. 2022).Some studies find SGM Latter-day Saints have better mental health than non-Latter-day Saint SGMs (Dyer and Goodman 2022;McGraw et al. 2021b).It is relevant to note that studies with samples that are generalizable find better outcomes for SGM Latter-day Saints.This likely overlaps with the results of a meta-analysis that found that when samples of SGMs were drawn from sexual minority venues (such as gay bars), the relationship between mental health and religiousness tended to be nonsignificant or more negative (Lefevor et al. 2021a).However, when the sampling method was more general and representative, there tended to be a positive relationship between religiousness and mental health.Riess (2022) compared a more representative sample of disaffiliated Latter-day Saints (a Qualtrics panel was used) with a sample of disaffiliated Latter-day Saints drawn from a survey advertised online with snowball sampling.They found the snowball sample was less diverse (more white) and more likely to have left religion and belief in God altogether.Disaffiliated Latter-day Saints in the snowball sample were more educated, with 70% college educated compared to only 21% of the disaffiliated from the more representative sample.Given education is related to mental health (Araya et al. 2003;Assari et al. 2018), snowball studies comparing former and current Latter-day Saints that do not account for education may confound education and affiliation.
In reviewing the research on SGM Latter-day Saints, one consistent finding is that identity confusion relates to less favorable mental health.For mental health, it appears more optimal to be either connected or, conversely, disconnected from religiousness as a Latter-day Saint than to have mid-level involvement or experience identity conflict (e.g., Lefevor et al. 2020b;Skidmore et al. 2022b).Resolution of identity conflicts is likely central to maintaining healthy religious connections.Future research should examine the various processes of identity development to provide direction for those experiencing identity confusion.
Much of the SGM Latter-day Saints research, however, needs additional nuance and more theorizing.Theories such as minority stress theory have not been employed granularly enough to theorize how affiliation or disaffiliation may differentially relate to outcomes (e.g., how affiliation might affect depression or anxiety differently) or what specific processes may be involved.An example of more granular research is Skidmore et al. (2022b), who test moderators of the relationship between church belongingness and mental health.However, even this research could benefit from more initial theoretical model building and testing, helping to improve our mid-range theories about SGM Latter-day Saints and mental health.This need for additional theorizing also applies to research on Latter-day Saints' mental health in general.

Methodology
To a rather striking degree, a substantial proportion of the 46 studies reviewed have used methodologies that substantially limit what can be concluded.For instance, because few studies are longitudinal (only three studies controlled for prior levels), the direction of effects is unknown.No studies of Latter-day Saints of which we are aware examine religiosity as an outcome of mental health.Given research suggests mental health problems may reduce individuals' engagement with religion (see Koenig 2018), it is unknown if more religious Latter-day Saints score better mental health measures because those who have less favorable mental health are more likely to disengage.Although one study that adjusted for the effect of disaffiliation found affiliated Latter-day Saints still likely have better mental health (Dyer et al. 2022), more research regarding reciprocal effects is needed.Further, several studies controlled for no confounding factors.This substantially limits whether we can attribute affiliation or religiousness to better mental health or whether confounds may explain the relationship.
In addition, the majority of research relies on convenience samples.It is also important to note that all studies reviewed were conducted in the United States, with most being heavily drawn from Utah.We have no peer-reviewed research on Latter-day Saints and mental health internationally.Given religiousness may have differential impacts based on culture (e.g., Stack and Kposowa 2011), cross-country and cross-cultural studies are needed.In the end, much of what we know about Latter-day Saints and mental health is based on the most basic types of statistics with non-representative samples.Conclusions drawn should be made with this crucial caveat, and the more methodologically advanced studies should be given more weight.
The studies reviewed relied almost exclusively on self-reported mental health.Thomas et al. (2011) used the most independent measures with pathology assessed by staff psychologists and psychology interns.It is possible that comparisons of Latter-day Saints to those of other religions or no religion are influenced by differential social desirability.One study examined how social desirability was influenced by religious affiliation, finding Latter-day Saints the least likely to respond in a socially desirable way (Regnerus and Uecker 2007).Thus the direction of bias in results would be towards Latter-day Saints looking "not as good" as those of other religions or no religion.
We should also note that much of this research does not directly address the common question of whether the effect of religiousness on mental health is due to factors shared with other organizations (e.g., creating a sense of belonging, providing a coherent worldview) or whether religion is unique in its effects.This is a longstanding research question (cf.Acevedo et al. 2014;Galen 2015) requiring appropriate comparison groups, controls, and the identification of the specific mechanisms of effects.Research on Latter-day Saints may benefit from engaging this question as it can provide additional understanding of specific Latter-day Saint effects.

Limitations
The inclusion criteria for this review only included studies that used quantitative measures.Qualitative research may help generate new research questions and provide rich descriptions of Latter-day Saints' mental health.We also did not include studies that have a small percentage of Latter-day Saints and/or for whom Latter-day Saints are not a focus.For example, several studies using the National Study of Youth and Religion (Smith 2005(Smith , 2009) ) find Latter-day Saints to be more devoted and that those who are devoted are more likely to have better mental health.

Implications and Future Research
While keeping the methodologic limitations of the studies in mind, finding that religiousness is generally related to better mental health for Latter-day Saints is valuable.For clinicians, this knowledge could be used in therapy with Latter-day Saints by working to incorporate a client's faith and religiosity, which could potentially be helpful in improving the client's mental health.For example, clinicians may help their Latter-day Saint clients by leveraging certain beliefs that may promote healthy coping (e.g., the belief that working through trials/opposition is part of the purpose of life).Latter-day Saint parents may also leverage information about what aspects of their religion may be particularly helpful to mental health.For instance, knowing their religion may increase mental health by promoting strong family relationships and reducing drug use can help parents focus on these aspects of their faith.
Regarding SGM Latter-day Saints, resolving identity concerns may be an important priority for clinicians.Some studies suggest that those Latter-day Saints who are "caught in the middle" of identities and beliefs are at greatest risk for mental health difficulties (Lefevor et al. 2020b;Skidmore et al. 2022b).This research also suggests it should not be assumed that SGM Latter-day Saints will or will not struggle.Findings here fit well with what Sherry and colleagues concluded: "A therapist should not, as the authors initially did, make assumptions that a client who identifies as both spiritual or religious, as well as LGB is necessarily dealing with a conflict in negotiating their identities.As the current study has shown, many LGB people have successfully negotiated the integration of these two aspects of identity in a way that allows them to feel congruent and free from identity conflict" (Sherry et al. 2010, p. 117).However, as they also note, "for those individuals who are not able to reconcile their sexual and spiritual identities, the conflict is particularly strong" (p.117).Regarding the general research on R/S, some suggests that those who are "all in" or "all out" have better outcomes than those in the middle (Nadal et al. 2018).It is, therefore, crucial to continue work on how SGM Latter-day Saints can successfully navigate their religious identity.Finally, there are notable differences in sexuality and gender that make it important to consider outcomes for sexual and gender minorities together and separately.
In the end, current research provides a base from which to launch research agendas regarding Latter-day Saints' mental health that is more rigorous theoretically and methodically.The better Latter-day Saints' mental health is understood, the better able ecclesiastical leaders, clinicians, and the religious will be able to accentuate the protective factors that may be found (or developed) within the faith.

Table 1 .
List of studies in chronological order.

Table 1 .
Cont.Fundamentalism and orthodoxy unrelated to anxiety.-Globalself-esteem was positively related to Acceptance of God's grace and love, involvement in organized religion, awareness Of God, and being repentant.In the presence of these other religiousness variables, global self-esteem was negatively related to affirming openness in faith and experiencing fellowship.-Extrinsic religiosity was positively related to global psychological distress, depression, and anxiety, unrelated to obsessive-compulsive. -Self-transcendence was negatively related to global psychological distress, depression, anxiety, obsessive-compulsive, and disordered eating.
Depression, Anxiety, Social Anxiety, Quality of life -Family support of GLBTQ individuals was related to less depression for women and men.For men only, family support was related to less social anxiety and better quality of life.

Table 1 .
Cont.Church Belongingness was related to lower SI when: concealment was low, internalized homonegativity was high, and service attendance was high.-ChurchBelongingness was related to greater SI when: concealment was high, internalized homonegativity was low, and service attendance was low.-LGBTQBelongingness was related to less SI when concealment was low and service attendance was low.-LGBTQBelongingness was related to greater SI when service attendance was high.