Religiosity: Is It Mainly Linked to Mental Health or to Psychopathology?

Abstract

The impact of religiosity on human mental health has been much debated over the last few decades. A large number of empirical and theoretical studies have been conducted to understand the impact of religiosity and spirituality on people’s quality of mental health. Though the vast majority of research indicates that religiosity makes a positive contribution to a person’s mental health and can give meaning to life, both the positive and some negative effects of religiosity on mental health are discussed. The impact of religiosity on people’s mental health seems to correspond to the quality of their religiosity.

1. Introduction

The impact of religiosity on human health has been much debated over the last few decades. A large number of empirical and theoretical studies have been conducted to understand the impact of different religious and spiritual practices on both physical and mental health.

Since 1998, hundreds of empirical studies have been conducted on the relationship between health on the one hand and spirituality/religiosity on the other, with rich findings (Ellison and Levin 1998).

More recent studies continue to be conducted using new scientific methods, but we still need much more work to understand the exact relationships between religiosity and mental health and/or psychopathology.

This chapter seeks to provide a clear and comprehensive overview of the existing research with regard to the possible impact of religiosity on mental health, a topic which despite recently attracting many researchers and that has significant implications and potential contributions, among the cohort of secular clinicians, it is still undervalued in practice.

More specifically, this chapter aims to identify any positive and/or negative impacts religiosity might have on people’s mental health.

In addition, this review paper not only aims to identify research gaps that are worthy of further investigation but it also seeks to examine how religiosity affects human wellbeing on multiple levels, and how if utilized properly, it can become an effective tool in improving mental health (Sharma and Sharma 2019).

Before we move on to examining the possible impact of religiosity on mental health, we need to clarify some basic terms and definitions (below) and then try to find evidence from the literature supporting the impact of religiosity on either mental health and/or psychopathology.

2. Some Basic Definitions

Let us first distinguish ‘religion’ from ‘religiosity’:

‘Religion’ refers to a structured set of beliefs or practices and often includes history, traditions, scriptures, liturgy, music, sacraments, doctrines, rituals, moral codes, and institutions that are collectively shared by a community, as well as systems that relate humanity to spiritual or supernatural elements.

“Religiosity’ on the other hand, is a concept often difficult to define (Smith 1995, p. 893), although many attempts have been made to describe it. According to Tsitsigkos (2012), there is no single scientific definition of religiosity, either because of the incomprehensibility and complexity of religious phenomena, our linguistic inability to define them, and/or even the biases of researchers, each of whom tries to describe them based on their own views and perspectives (Lee and Early 2000; Tsitsigkos 2012).

Therefore, religiosity can be defined as a measure that reflects how deeply and actively people engage with and express their religion. It refers to the intensity, extent, and manner of an individual’s or a group’s religious experience, beliefs, and practices related to the divine. Religiosity is more personal, and it is often measured through surveys and studies, looking both for factors that make someone religious and the importance of religion in one’s life. It is focused on the level and expression of religious adherence by individuals or groups.

Some researchers define ‘religiosity’ as an individualized or collective perception of the transcendent (divine) (Gross and John 2003; Gross 2006) or as a systematized way of accepting and externalizing a religious belief (Beck 1986; Legere 1984; Shafranske and Malony 1990; Vayianos 1989) and relationship with a God/deity or the transcendent. It includes the set of psycho-spiritual actions by which a person seeks religious truth as well as the meaning of life through the ‘IEROS’ (Pargament and Maton 1991).

Spirituality, on the other hand, is a more personal and individualistic concept that involves the pursuit of the scared, a sense of meaning, purpose, and connection to something greater than oneself, which may or may not involve participation in organized religion. It often focuses on personal growth, inner peace, and the exploration of transcendent experiences.

Pargament et al. (2013, p. 14) define spirituality as the ‘search for the sacred’, while Barber (2019) describes it as a journey in search of truth. Spirituality is also defined as making meaning in life, having feelings of connection with others and with the self, and/or with a higher power, as well as opening up and seeking self-transcendence (Goldstein 2010).

While it is often difficult to completely separate the concepts of religiosity and spirituality, as there are areas of overlap between them (e.g., the search for the ‘sacred’), these terms have begun to become increasingly distinct, both in the literature and in popular usage (Koenig et al. 2001).

Apparently, “there is no agreement in the academic community on the psychological definition of religiosity, probably because of the complex nature of the religious phenomenon, and/or because of our linguistic inability to explain it, and even because of each researcher’s attitude towards the phenomenon called ‘religiosity’ (Lee and Early 2000).

Faith is a complex and multifaceted concept that generally refers to a strong belief or trust in someone or something. It can take the form of religious faith, personal trust (in a person, group, or organization), conviction, and even a philosophical perspective (disposition towards a particular belief). In this chapter, the term ‘faith’ is used with its religious form.

Overall, faith encompasses a range of beliefs and trust, often involving elements of hope, conviction, and commitment, whether in a religious, personal, or broader philosophical context.

Moving on, and before analyzing the notions of health and illness, it is important to define various aspects of the concept of ’health’ itself. Therefore,

‘Mental health’ refers to a person’s psychological and emotional wellbeing. It refers to how people think, feel, and behave. Mental health is influenced by various factors, such as genetics, brain chemistry, life experiences, and environmental factors.

‘Physical health’ refers to the state of the body and its ability to function optimally. It involves various aspects such as proper nutrition, regular exercise, adequate sleep, and avoidance of harmful substances.

‘Emotional health’ relates to an individual’s ability to understand, express, and manage their emotions effectively. It involves being aware of one’s feelings, handling stress, building resilience, and forming healthy relationships.

‘Spiritual health’ refers to a sense of purpose and meaning in life and a connection to something greater than oneself. It involves exploring personal values and beliefs and nurturing a sense of inner peace and fulfillment.

‘Psychological health’ refers to the state of an individual’s mind and cognitive processes. It involves factors such as cognitive functioning, mental processes and behaviors that influence how individuals perceive, interpret, and respond to the world around them.

3. Religiosity and Mental Health

The relationship between religiosity and mental health seems to have gone through several phases in the last few decades.

Additionally, this relationship has been examined from various perspectives, depending on the lens and background of different scholars, for example, philosophers, psychologists, theologians, social scientists, health professionals, etc.

In fact, a large number of studies have attempted to measure, in various ways, psychological and behavioral elements associated with religious beliefs and their influence on people’s psychological state (Powell et al. 2003; Koenig and Cohen 2002; Smith 2003; Simpson 1998; Ellison et al. 1989; Regnerus 2003; Papaleontiou-Louca 2021).

It is reported (Papaleontiou-Louca 2021) that for hundreds of years, there was a strong prejudice against ‘mentally ill’ people (partly due to Freud’s views on religiosity), and for much of the 20th century, most mental health professionals held negative opinions of religiosity. They often considered this aspect of human life to be either old-fashioned or pathological and expected it to disappear as people became more ‘civilized’. However, in a large number of recent studies, religiosity appears to remain an important dimension of people’s lives, and, as we will see below, it is usually positively associated with mental health.

The achievement of mental health comes from mentally resilient individuals (Masten and Coatsworth 1998), as mental resilience helps people to adapt to difficult circumstances and overcome traumatic events (Rutter 2006). This very capacity significantly reduces rates of mental illnesses, such as depression and anxiety disorders. Individuals with mental resilience have a sense of self-esteem, possess the patience to deal with difficulties with humor, and have a belief that all problems can be solved (Connor and Davidson 2003). These characteristics can bring about mental health in an individual. Therefore, it can be said that individuals with mental resilience are less likely to develop psychopathology, and, conversely, individuals with reduced levels of mental resilience are more likely to develop psychopathology (Campbell-Sills et al. 2006).

It is now known that these two concepts, religiosity and spirituality, are not only closely related to each other, as mentioned above, but in most cases, they are also positively related to mental health and wellbeing (Chamberlain and Zika 1992; Hill and Pargament 2003).

It is worth noting here that even the wellknown psychologist Erik Erikson paid much attention to the beneficial effect of religion on human development. For example, he argues that a successful resolution of the first stage of development in infants brings about and promotes the virtues of hope and trust (Erikson 1964, p. 118).

Erikson recognized that religion could serve a person for a lifetime, serving as a source of hope, which gradually over time becomes a mature faith.

4. Positive Impacts of Religiosity on Mental Health

The relationship between religiosity and mental health has been debated for years now, and, in fact, the two variables have been found to be linked in a plethora of studies. In general, it has been found that the application of various religious practices usually helps in treating various diseases and leads to a better quality of life.

So, according to McFadden and Levin (1996), the results of studies have been surprisingly consistent, generally reporting a positive association between religiosity and health. This seems to be confirmed in a variety of populations, regardless of gender, race, ethnicity, age, national origin, education, and religious beliefs (Hodge 2000).

Religiosity, in general, seems to contribute in multiple ways when dealing with the various adversities of life. First, the manifestation of trust is seen as a sign of mental health from very early infancy. In this phase, spiritual experiences in daily life seem helpful, while participation in sacred services promotes the development of faith.

Especially, the studies conducted by Pargament and co-workers (e.g., Jenkins and Pargament 1988; Pargament 1997; Pargament et al. 2000, 2004, 2013) seem to be central in the investigation of religious coping methods in relation to a person’s mental health. More specifically, Pargament and co-workers found that religious coping accounted significantly in the measure of adjustment (stress-related growth, religious outcomes, physical health, mental health, and emotional distress) after controlling for demographics and the impact of global religious measures (prayer frequency, church attendance, and religious salience). Better adjustment was associated with many religious coping methods, such as benevolent religious reassessment, religious forgiveness/purification, and seeking religious support. On the contrary, poor adjustment was associated with revaluation of God’s power, spiritual dissatisfaction, and punishing God’s revaluation. These studies suggest that religious coping methods could be useful for researchers who investigate their impact on mental health, as well as for practitioners interested in a rounded type of Counseling, which will include the religious and spiritual dimensions as well.

Moreover, in many cases, religious faith protects against serious psychosomatic illnesses: it increases a patient’s ability to recover after some post-traumatic stress and gives meaning to their life; it helps to overcome psychological difficulties (such as feelings of anger, sadness, despair, and loss of control) and to cope with crises and sudden death; it increases people’s self-esteem and offers stability and strength to patients. Particularly in cancer patients, faith has been found to reduce the fear of death, increase self-esteem, and reduce suicide rates in people belonging to religious groups (Jenkins and Pargament 1988; Tsitsigkos 2012).

Specifically, Kioulos (2014) reports that a high degree of religiosity was found to be associated with less stress, less psychopathology, less morbidity, and better quality of life. Positive ways of religiously coping with difficult life situations were negatively associated with depression and anger, while negative ways of coping were positively associated with malaise and various forms of psychopathology. In particular, a functional and mystical life was associated with less neuroticism, anxiety and anger, as well as better mental and physical health. Perceiving God as a punisher (rather than a father) was found to have a negative impact on mental health, as this view is associated with feelings of guilt, anticipation of punishment or condemnation, and chronic stress (Kioulos 2014).

It is worth noting that the majority of psychologists (82%) who investigated the importance of religiosity in mental health found it to be beneficial rather than harmful (7%) (Post and Wade 2009). More specifically, according to several studies, deeper religiosity and a level of inner faith were found to improve mental health, combat depression and help speed recovery from physical illness (Bonelli et al. 2012; Katsaouni 2017; Koenig et al. 2012).

It has also been often reported that religiosity helps in stress management, contributes to the person’s wellbeing and quality of life, accelerates the resolution of emotional disorders, and reduces substance abuse. For example, some religions encourage avoidance of abuses, such as alcohol, gambling, and overeating. Avoiding such habits may also be an important element of a healthier approach to life (Koenig et al. 2001; Nanopoulou 2015).

Darvyri et al. (2018) support the idea that religious spirituality not only improves people’s quality of life but also creates positive emotions, leads to increased levels of self-control and self-care, contributes to the establishment of a healthier lifestyle, and equips people with better management of stressful situations in their daily lives. Finally, she concludes that religious spirituality contributes to improving the quality of life and is a key element of a person’s holistic approach and care.

Moreover, the lack of religiosity in one’s life has been found to be related to many negative behavioral and mental health issues, including stress and suicidality (Davis et al. 2003), depression (Wright et al. 1993), anxiety (James and Samuels 1999), and substance abuse (Hodge et al. 2001).

According to Papaleontiou-Louca (2021, p. 3), the positive effects of religiosity, especially those related to interpersonal relationships, seem to be largely derived from community life, which is encouraged in many religions as a way of shifting people’s attention from their individuality and exclusive self-love to their fellow human beings and their problems, thus diverting their attention from their own problems and focusing their attention beyond themselves. This behavior has been found to not only reduce stress (Koenig and Larson 2011) but also enhance mental wellbeing, balancing self-love and love for others (Lavdas 2009).

In particular, faith has been found to help patients (Mofidi et al. 2006; Mohr and Huguelet 2004) by providing them with a sense of meaning and purpose in life, which is associated with reduced chances of engaging in risky behavior (Davis et al. 2003).

Another positive effect of religiosity and faith seems to be increased mental resilience and a strengthened sense of belonging/companionship. More specifically, researchers list various components of resilience, including both religious and spiritual beliefs, shared values, and people’s participation in church activities (Howard 1996). According to Panter-Brick and Eggerman (2012), culture and religion improve resilience, mainly due to people’s participation in social religious groups. In fact, culture is the social medium in which religions exist and in which people practice religion or do not.

Similarly, Malka (2018, p. 1) and Cyrulnik (2009) agree that religiosity is a valuable factor in terms of resilience. He states, “When a baby comes into the world, it shares the same world as the mother, which evokes solidarity, but above all a unity of souls”. In a similar way, people’s participation in church groups helps them experience security, support and solidarity, especially in difficult situations or during crises.

Research, moreover, suggests that faith and support from religious communities offer key strategies for coping with difficult situations (Gall et al. 2005) as they help people by giving them meaning during life’s difficulties and by helping them to ‘take control of their lives in their own hands’. They are also empowered by community support (Koenig et al. 2001). It has also been highlighted that religious beliefs serve as a buffer/protective factor when coping with difficult situations, such as depression, burnout, post-traumatic stress disorder (PTSD), and fatigue (Flanigan 2010).

In particular, with regard to spirituality, McSherry and Ross (2002) and Rushton (2014) suggest that it can contribute to improving quality of life and health-related behaviors by promoting and nurturing it.

Therefore, it seems that people who believe in a merciful, loving, and forgiving God experience lower levels of anxiety and stress and have more optimistic thoughts, while religions that believe in a punishing God are associated with higher levels of anxiety, depression, and other mental disorders as they cause intense guilt, remorse, shame, fear, and negative/dysfunctional thoughts (Katsaouni 2017). In other words, if one believes in a God of forgiveness, merciful and benevolent, who loves and cares for people, engages them in His purposes and meets their needs, one is usually expected to develop positive emotions, which are positively related to mental health (Koenig and Larson 2011).

In summary, most studies have shown that inner religiosity and spiritual experiences help both mental and physical health. Thus, positive correlations seem to link both spirituality/religiosity and positive psychological states (Richards and Bergin 2005), including self-esteem (e.g., Pedersen et al. 2000) and subjective wellbeing (e.g., Fabricatore et al. 2000; Pedersen et al. 2000). Additionally, religiosity has been found to be positively associated with the treatment and prevention of depression, in addition to improved physical health and faster recovery from illness (Pargament et al. 2000; Larson 2000; Larson and Larson 2003; Musgrave et al. 2002).

5. Negative Effects of Religiosity on Mental Health

Despite the generally acknowledged contribution of religiosity to mental health and a basic consensus on the issue, there are indeed some studies (Prati 2023) that argue that the effect of religion on wellbeing does not seem to be of practical importance and question the usefulness of religiosity in predicting wellbeing.

According to this research, religiosity and spirituality may, at least sometimes for some people, be negatively or non-significantly associated with wellbeing.

For example, there are cases where spiritual/and religious growth may exacerbate an illness or anxiety disorder, as in cases where instances of spiritual decline may be positively related to depression and negatively related to mental wellbeing (Sandage and Moe 2013; Tsitsigkos 2015).

A meta-analysis of 469 articles conducted by Weaver et al. (2003) showed that only 4.7% of studies included the terms ‘religiosity’ or ‘spirituality’. Similar findings were confirmed by Pargament (2013), who found little research highlighting spiritual dimensions in people’s healing process despite the fact that religiosity and spirituality have emerged as primary sources of hope. This research aimed to understand how religiosity and spirituality act as protective factors (Weaver et al. 2003), enhance hope, and potentially promote mental wellbeing.

The above does not imply that religious life is only associated with experiences of joy and happiness. They also (quite often) include pain and the ‘cross’ as well as the notion of paradox. However, even in the midst of pain, believers seem to experience some kind of ‘joy’ (or rather joyfulness) and consolation, which they derive from their relationship with God and from the ‘meaning of life’ offered by faith (Papaleontiou-Louca 2021).

There are also cases where high ‘religiosity’ has been found to exacerbate depressive or anxiety disorders, particularly when the person feels that they have done something contrary to their values or contrary to what spiritual/and religious teachings say, and thus feel fear, guilt, and remorse (Blazer 2012; Exline et al. 2000).

Therefore, there are research findings that confirm the effect of religiosity on conditions such as depression, suicidality, anxiety disorders, despair, issues concerning meaning in life, loneliness, guilt, mortality, schizophrenia, and various psychotic manifestations. These studies seem to suggest that religiosity acts protectively for the individual, not only through suggestions when dealing with such issues but also by inspiring people, giving them meaning in life, which can prove to be highly effective in providing relief and comfort and in developing self-esteem and hope (Nanopoulou 2015).

In a large meta-analysis focusing on religiosity and life satisfaction, a positive correlation was found to a small to moderate degree (depending on the specific dimension measured), and the results of this study suggest that spiritual experience may be a moderate factor in the relationship between religiosity and wellbeing (Yaden et al. 2022).

Therefore, it has been suggested that no form of spirituality/or religiosity is associated with mental wellbeing and health. There are instances where spiritual growth may coexist with a mental illness or disorder, and conversely, there are instances where spiritual decline may be positively associated with depression and negatively associated with wellbeing (Sandage and Moe 2013; Tsitsigkos 2015, p. 475).

It also happens that negative religious beliefs (e.g., when people see their faith or God as the cause of the bad things that happen to them) have been found to be associated with increased mental health problems, as mentioned above, and are directly or indirectly related to a decrease in life satisfaction with a parallel increase in psychological distress (Warren et al. 2015).

Apparently, religions that promote relationships of love, freedom, joy, and humility rather than bigotry, hatred, aggression, and guilt are more likely to lead to positive mental health outcomes (Koenig and Larson 2011).

One such example of the negative effects on human mental health is confirmed by research data (Gray et al. 2023), where negative religiosity appeared to be associated with the development of psychopathology following traumatic events. A specific study investigated the relationship between religious coping (positive and negative) and post-traumatic stress disorder (PTSD) symptomatology among survivors of a major industrial explosion in Beirut in August 2020. In the majority of the (18–25-years-old) participants, higher levels of negative religiosity were a significant predictor of increased PTSD symptomatology and were associated with twice the odds of meeting the criteria for a diagnosis of PTSD. In this case, negative religiosity was described as attributing the causality of the event—based on a specific religion—to ‘God’ and was a form of post-traumatic experience (Grey et al. 2023).

6. Conclusions

Based on the above findings and remarks, one might not falsely conclude that mental health largely depends on healthy religiosity, such as a positive relationship between an individual and God [and other people] (righteousness) (Tsitsigkos 2015).

Therefore, healthy religiosity seems to correspond to adaptive emotional coping, whereas non-healthy religiosity corresponds to maladaptive emotional coping (Pargament et al. 2000). Positive religious coping (PRC) includes considerations about the meaning of life and a secure relationship with a good and merciful God (Pargament 1997).

We can, therefore, safely conclude that individuals who view their faith positively as an important aspect of their lives and draw on it for support and strength (particularly in times of increased stress and distress) often rely on their faith to enable them to be more functional in their daily lives. This positive approach to faith, as a reinforcing factor in life’s difficulties, has been found to be positively associated with conditions due to improved psychosocial adjustment and reduced rates of depression, anxiety, and self-esteem problems.

Thus, a positive view of faith, through the optimism it generates, influences an individual’s overall psychosocial adjustment, which is an essential predictor of positive psychological states and improved mental health. In addition, it was found to lead to greater life satisfaction, better psychological adjustment, and less distress in people with psychiatric disabilities.

On the other hand, negative religious interpretations, such as believing that life adversities are a form of God’s punishment and other negative appraisals of God’s power and intentions, as well as a less secure relationship with a divine being (Papaleontiou-Louca 2023, p. 11; Pargament et al. 2011), will presumably lead to negative effects on mental health.

As Pargament et al. (2000) commented, religiosity may become adaptive or maladaptive and indeed, research identifies correspondingly both positive and negative relationships between religiosity and mental health depending on how ‘healthy’ religiosity is. This has not just a research value but it also has consequential implications for clinical practice (Koenig and Larson 2001; Papaleontiou-Louca 2021).

However, it is worth noting that, in general, the vast majority of research indicates that religiosity appears to make a positive contribution to the quality of an individual’s mental health and can help fulfil human needs and give meaning to life (Park 2005), emotional relief (Exline et al. 2000), a sense of emotional connectedness (Rowatt and Kirkpatrick 2002), as well as fostering an environment of increased social support, a key component of mental health, and the ability to recover and heal from potential trauma (Ditzler et al. 2009).

Despite these positive associations between religiosity and mental health, it seems, nevertheless, that more empirical research and likely a meta-analysis of studies in the field are needed to draw firm conclusions about the impact of religiosity on mental health. In addition, the methodology for studying religiosity needs careful attention so that we can better understand the distinct impact of religiosity on people’s mental health (Sheharbano and Ahmad 2013).

7. Some Practical Implications

We cannot dismiss the fact that a large majority of people use spirituality and religiosity to deal with mental pain and wish to discuss spirituality in their treatment. Therefore, spirituality/religiosity could play a key role in the use of evidence-based treatments and also provide a new perspective for mental health workers to improve their understanding of the human condition. A state of distress occurs when a person suffers in a way that undermines their personal identity, raising existential questions about the reason for this particular suffering, highlighting the urgent need for spiritual care. Spiritual suffering (i.e., the pain associated with the inability to experience meaning in life) in people going through adversity should not be underestimated.

Particularly in the area of mental health, social support and connectivity found in religious communities provide a supportive network that plays an important role in the sense of belonging and psychological wellbeing of individuals. This can happen not only through connection with a spiritual father and spiritual brothers and sisters but also through participation in various religious communities, small groups, church meetings, etc. In all cases, the feeling of connection and support can be triggered by the awareness that other people are following the same spiritual journey (Ellison and Levin 1998).

In short, it seems that religious and spiritual care is not a luxury; rather, it is necessary for any system that claims to care for people holistically, and mental health services and clinicians might not undervalue these phenomena in practice and take them more seriously into account.

8. Suggestions for Future Research

Future empirical research could also contribute to a fuller understanding of the relationship between spirituality and religiosity. Although many theoretical articles have been written about the differences between spirituality and religiosity, in empirical research, the domains are often not clearly distinguished.

Although the concepts of ‘Spirituality’ and ‘Religiousness’ are inextricably linked (since one seems to be intertwined with and separate from the other), it would be interesting if the effects of each of these concepts separately on the mental health of the developing human being could also be investigated in research.

In this regard, future empirical studies could try to be more explicit in the questionnaires and psychometric instruments they use, better distinguishing the terms ‘religiosity’ and ‘spirituality’, so that the answers of those who will be interviewed also correspond with validity to the purpose of each specific study and are in line with the definition that researchers define for each of these two related concepts.

This, of course, while being of research interest, involves some practical difficulties, as the construction of relevant instruments would need to have a good validity, which becomes practically difficult due to the conceptual relevance of the two terms.

Researchers could, therefore, work toward reaching a consensus on the most appropriate definitions of “spirituality” and “religiosity” and the most effective scales for capturing both dispositional and operational spirituality and religiosity in adolescence. If a “gold standard” for definition and measurement could be achieved, communication among researchers would be improved, and scholars would be better able to communicate their findings with other psychologists, as well as with the media, practitioners, and the general public. Health researchers have begun to make progress toward such a goal with the Short Multidimensional Measure of Religiousness/Spirituality (Fetzer 1999).