Knowledge and Opinions of Orthodox Clergy in Greece Regarding Religious Psychopathology

Abstract

This study focuses on the knowledge and attitudes of Orthodox clergy in Greece regarding religious psychopathology, which refers to the complex phenomena where religious experiences or beliefs intersect with mental disorders. The sample included 125 clergy members with varying levels of education and pastoral experience. The findings reveal significant gaps in the understanding of basic concepts of religious psychopathology, despite recognition of the need for collaboration with mental health professionals. Formal education proved to be a decisive factor in understanding religious psychopathology, as clergy with higher educational levels demonstrated significantly better knowledge. In contrast, clergy opinions towards mental health issues appeared to be shaped by multiple factors beyond education alone. Experience in collaboration with psychologists or psychiatrists was positively associated with higher knowledge levels and more realistic, positive attitudes toward managing religious psychopathology. Additionally, clergy who had direct experience with cases of religious psychopathology showed greater sensitivity and differentiated perspectives. The study highlights the urgent need to incorporate knowledge of religious psychopathology into theological education in Greece and to strengthen cooperation between the Church and mental health services. Such initiatives can improve pastoral care, reduce the stigma surrounding mental illness, and holistically support members of religious communities

1. Introduction

The relationship between religiosity and psychopathology has been a subject of significant scholarly interest in both the fields of psychology and theology. Within the Orthodox Christian tradition, religious experience plays a central role in shaping human identity, mental balance, and social integration. However, phenomena such as excessive religiosity, misinterpretation of religious experiences, or religious fanaticism are often conflated with manifestations of mental disorders, posing challenges for both mental health professionals and religious leaders.

The term “religious psychopathology” refers to mental disorders expressed through religious beliefs, behaviors, or experiences (Noort et al. 2012). Distinguishing these from authentic religious expressions requires delicate epistemological and pastoral discernment. Orthodox clergy, as spiritual guides and first-line recipients of believers’ experiences, are frequently called upon to address cases where the boundary between healthy religious life and psychopathological manifestations becomes blurred. Their attitudes toward this phenomenon, as well as their perceptions of mental health, directly influence both their pastoral practice and their collaboration with mental health professionals (Aυγουστίδης 2008).

Despite the importance of this issue, existing research in Greece remains limited, particularly in regard to documenting the knowledge and opinions of clergy themselves concerning religious psychopathology. This article aims to explore the knowledge, perceptions, and attitudes of Orthodox clergy in Greece on this phenomenon, to identify the challenges they face in their pastoral practice, and to highlight the need for theological and scientific education on matters of mental health.

The main research question of this paper is: What are the knowledge and opinions of Orthodox clergy in Greece regarding religious psychopathology and what factors influence these opinions and knowledge?

2. Theoretical Framework

2.1. Analysis of the Concept of Religious Psychopathology

Religious psychopathology refers to psychopathology with religious content (Noort et al. 2012). This content varies and may include themes such as magic, death, spirit possession, and the supernatural. A significant conceptual distinction is found in differentiating between a spiritual/religious problem and religious psychopathology. Most mental health professionals who study religious psychopathology adopt this distinction and often take these two conceptual constructs for granted as they proceed with their research (e.g., Noort et al. 2012).

James ([1902] 2003), as early as the beginning of the 20th century, proposed four key characteristics that distinguish religious psychopathology: Ιneffability, insights with a curious sense of authority, transiency in time, and passivity. Lόpez-Ibor and Lόpez-Ibor Alcocer (2010) argue that religious experience and religious psychopathology can be differentiated based on an individual’s ability to distinguish between “their own world” and reality: those with mental illness (in this case, the psychotic patient) are enclosed within “their own world.” This perspective represents a phenomenological and existential approach to religious psychopathology (Noort et al. 2012).

However, for clergy (and believers in general), as revealed particularly through vignette-based studies, the core question is not what constitutes psychopathology, but rather, what is not considered spiritual/religious. This dichotomy, which is relatively clear for mental health professionals, may be much more fluid and subjective for religious individuals. Consider, for example, the vignette presented by Noort et al. (2012, p. 208):

Mr. V, 81 years of age, reports a range of physical complaints. He has problems with his stomach and his eyes, and complains of breathlessness. Yes, he is afraid that there will be no way to recover. His sleep is often disturbed by nightmares, and he is obsessed with ill health and death. He also fears being punished by God because he gave up his job as a church warden. But more disastrous is that he can no longer think of heaven. He does not feel any pleasure: happiness, light, affection, love—all these words have lost their meaning. And when his fears subside somewhat, he feels an incurable and unbearable loneliness all day long, on the verge of despair. In fact, he thought that he had been rejected, lost, and condemned by God. He feels the torments of hell.

From a psychiatric perspective, this would be diagnosed as a melancholic (depressive) state. However, a religious individual would interpret this condition by adding a spiritual dimension, driven by the underlying question: what is not spiritual?1

The religious content of mental disorders is of particular importance for accurate diagnosis and subsequent management. It is well known that there is a tense relationship between religion and psychiatry. Even within clinical settings, the definitions and criteria for classifying mental disorders with religious content are not universally accepted. An example of this is Cook’s (2015) review of 55 studies concerning religious delusions and religious hallucinations.

2.1.1. Exploration of the Relationship Between Religion and Psychopathology Within the Orthodox Tradition

Traditionally, in the Christian religion, according to the sacred texts and church history, people suffering from illnesses are very likely to place their hope in the message of Christ. At least in the Eastern Orthodox Church, suffering individuals approach clergy and seek comfort, healing, and the drawing of strength and courage. In Greece, the vast majority identify their religion as the Eastern Orthodox Christian Church, while in a recent 2024 survey, 73% of respondents stated that they believe in God (showing a decline from 92% in 2005). At the same time, the Church remains one of the institutions most trusted by Greeks (Research by Kapa Research, To Proto Thema, 29 April 2024).

People suffering from mental disorders endure significant hardship. Not only spiritual leaders, but clergy in general, serve as points of contact for many individuals, many of whom exhibit mental health issues. Earlier studies showed that clergy are among the first people to whom a person with mental illness will turn. More recent research also indicates that turning to a clergyman is a strong choice for those suffering from mental illness (Pieper and Van Uden 2005). Moreover, the Christian faith prescribes showing sensitivity in caring for the sick (“I was sick and you visited me…” Matthew 25:31–46; see also Aυγουστίδης 2008).

Furthermore, psychopathology with religious elements is quite common (see reviews by Bhavsar and Bhugra 2008; Gearing et al. 2011; Cook 2015). Another reason that should motivate clergy to engage with this issue is that religiosity appears to be positively correlated with religious psychopathology—that is, among individuals exhibiting religious psychopathology, most have some relationship to religion (Cook 2015)2.

2.1.2. Presentation of Previous Research on the Views of Clergy

Noort et al. (2012) showed the need for further training of clergy in mental health Issues and especially in religious psychopathology. Studies on the need and desire of clergy for such training are relatively few and mainly come from the United States (e.g., Domino 1990; Farrell and Goebert 2008). In the specific study by Farrell and Goebert (2008), a significant percentage of clergy reported that their knowledge about psychiatric issues was insufficient.

Difficulty of clergy in recognizing general psychopathology showed also Domino (1990), Weaver et al. (1997). Difficulty of clergy in recognizing signs of suicidal ideation showed Domino (1990).

According to Wang et al. (2003), although 25% of those who sought help from clergy had mental health problems, very few were referred to mental health professionals. Most of these studies used self-report questionnaires.

Another research method was using vignettes. The advantage of this method is that the researcher can assess the clergy’s ability to distinguish psychopathology in a more practical way. For example, Farrell and Goebert (2008) studied two vignettes, one describing a person with mania and the other with complicated grief. A significant portion of clergy said they would treat these individuals with counseling. Moreover, more than half of the participants stated that they lacked adequate training to recognize mental illnesses such as major depression, bipolar disorder, and schizophrenia. The participants were also asked to express their opinions on the main cause of the mental illness. Medical causes were the most frequently mentioned.

Milstein et al. (2000) conducted a study with three vignettes (for rabbis). The study by Noort et al. (2012) in the Netherlands aimed to evaluate the ability of clergy from various Christian traditions (Protestant and Roman Catholic) to recognize religious psychopathology in others and the possible need for psychiatric treatment and care. The researchers compared the assessments of clergy and mental health professionals regarding vignettes (case studies). The vignettes concerned one case of psychosis and one of melancholia, both with religious elements, while two others presented non-psychopathological conditions: grief and religious experience. Questions such as “How likely is it that the situation might be caused by a religious or spiritual problem?” or “How helpful would psychiatric medication be?” were asked.

The results showed that clergy attributed the psychiatric conditions of the cases to religious or spiritual problems at the same rate as the non-psychiatric cases. Based on this, the sensitivity of clergy to the need for psychiatric care was investigated and found to be lower than that of mental health professionals. Similarly, the specificity of clergy compared to mental health professionals was also significantly lower. Clergy recognized religious psychopathology but to a lesser extent than mental health specialists.

Many studies have been conducted regarding the relationship between religious people and mental health services. In the study by Lefevor et al. (2022), results showed that clergy attitudes towards mental health issues, particularly their references to it, correlate with the help-seeking behavior of believers with mental difficulties.

Vermaas et al. (2017) argue that clergy lack appropriate training for the mental health issues of believers. According to Payne (2009), some clergy consider depression as a moral or spiritual issue rather than a biological one. In the study by Magliano et al. (2021) of 559 Italian Roman Catholic priests, it was shown that they held prejudices against believers with schizophrenia and depression.

The stigma of mental illness is a barrier to prevention, treatment, and well-being of sufferers. According to Hefti (2011), many sufferers turn to clergy rather than mental health professionals because of stigma. He also reports that a very large proportion of people with mental illness use religious practices to cope with daily difficulties.

In the study by Μόσχος (2010), a perception of 69.4% of clergy of the Holy Metropolis of Neapoli and Stavroupoli in Greece reported that would like to be trained in psychology, making this their top preference.

3. Methodology

3.1. Ethics

We created a questionnaire using Google docs. It was anonymous and it has been approved by local Holy Metropolises. The study was fully in line with rules of ethics of the American Psychological Association and with the European Union Regulation on sensitive personal data (GDPR; https://gdpr.eu/tag/gdpr/, accessed on 23 July 2025), as in force from 25 May 2018 and as applicable in the Greece according to law 4624/2019 (Issue A’ 137/29 August 2019). Participants were informed about the purpose of the study and confidentiality procedures. Participants were informed that they could leave the survey at any time they wished. Then they declared consent to take part in the study and filled in their sociodemographic and responses. The total amount of time it took to complete the survey was less than 10 min. The survey was conducted from May to August 2025.

3.2. Instruments

Questi onnaire on the knowledge and opinions of clergy on religious psychopathology (QRP): After the study of the extant literature about religious psychopathology according to psychology and Christian theology, it seemed that there are two important factors about the knowledge and opinions of clergy on religious psychopathology.

We developed a questionnaire. We gave it to 10 priests and theologians for evaluation of content validity, and to 10 priests for a first pilot test. Based on their responses we proceeded to additions and subtractions of items. We then examined the face validity of the new questionnaire as we gave it to 10 priests and theologians, and we asked them to tell us what they think that this questionnaire measures. Then we gave it again to 10 priests. Finally, we came up with the final form of the questionnaire.

A priori power analysis was conducted using G*Power 3.1 to determine the minimum sample size required to detect a medium effect size 0.4 with an alpha level of 0.05 and a statistical power of 0.80. The analysis indicated that a total sample size of 46 participants would be sufficient to detect statistically significant relationships between the variables.

The QRP in its final form consists of 11 items. The responses are given on a five-point Likert scale (1 = not at all to 5 = very much) and (1 = I completely disagree to 5 = I completely agree).

An example item of the subscale “Knowledge” is “Have you ever been trained or informed about the relationship between psychology/psychiatry and religious life?”. An example of the subscale “opinion” is “A priest should collaborate with a psychiatrist or psychologist when suspecting a disorder”.

3.3. Participants

The sample consisted of 125 Orthodox Christian clergy serving in different Holy Metropolises in Greece. All participants were priests who voluntarily agreed to participate in the study. The sampling method was based on convenience sampling, as the participants were approached through official invitations sent by the Metropolises’ administrative offices.

Demographic Characteristics of the Sample

The present study investigated a sample of 125 Orthodox Christian clergy members, focusing on their demographic characteristics, educational background, and pastoral experiences related to mental health and religious psychopathology. The demographic profile of the participants provides critical context for understanding the clergy’s readiness and perspectives on mental health issues within their pastoral duties.

Regarding educational attainment, a significant percentage of the clergy in the sample held higher education degrees. Specifically, 48.8% (n = 61) had completed university studies, whereas 46.4% (n = 58) reported that their highest level of education was high school. A minority of the participants, 4.8% (n = 6), reported middle school as their highest level of education (see

Table 1. Demographic and Key Characteristics of the Sample (N = 125).

		N	%
Educational Level
	Middle School	6	4.8
	High School	58	46.4
	University	61	48.8
Marital Status
	Single	47	37.6
	Married	78	62.4
Have you collaborated with a psychologist or psychiatrist within framework of pastoral care?
	Yes	33	26.4
	No	92	73.6
Have you encountered cases in your ministry of people with psychopathology exhibiting religious elements?
	Yes	98	78.4
	No	27	21.6
Age
		49.26 ± 12.54
Years in Ministry (work experience)
		18.41 ± 10.24

Note: n = 125. Percentages may not total exactly 100 due to rounding. Age and years in ministry are presented as mean ± standard deviation. Experience-related questions refer to collaboration with mental health professionals and recognition of psychopathology cases within pastoral care.

).

These findings suggest a relatively high level of academic education among the clergy, which is significant given the increasing expectations for clergy to address complex pastoral issues, including those related to mental health. The high percentage of university graduates may reflect broader trends within the Church towards promoting higher theological education among its clergy. However, it is important to note that formal theological or university education does not necessarily equate to specialized knowledge or training in mental health issues, a gap that has been highlighted in previous research (Noort et al. 2012).

In terms of marital status, 62.4% (n = 78) of the clergy were married, while 37.6% (n = 47) identified as single. This distribution aligns with the canonical provisions of the Orthodox Church, which allows for both married and celibate clergy, though it is noteworthy that the majority of the participants were married. Marital status among clergy may influence pastoral approaches, particularly in matters involving family dynamics, counseling, and community engagement.

A key variable in this study was the extent to which clergy have collaborated with mental health professionals in the context of pastoral care. Notably, only 26.4% (n = 33) of the respondents reported having collaborated with a psychologist or psychiatrist, whereas a significant majority, 73.6% (n = 92), indicated that they had not engaged in such collaborations.

This finding underscores a persistent gap in interdisciplinary cooperation between clergy and mental health professionals. Despite the recognized role of clergy as first responders in matters of mental distress, the relatively low percentage of collaborations suggests a need for structured programs that encourage such partnerships. Previous studies (Domino 1990) have emphasized that clergy often face challenges in accurately identifying psychiatric symptoms and may benefit from collaborative efforts to enhance pastoral care.

When asked whether they had encountered cases of individuals with psychopathology exhibiting religious elements within their ministry, 78.4% (n = 98) of the clergy affirmed such experiences. Conversely, 21.6% (n = 27) reported not having encountered such cases.

This high prevalence indicates that religious psychopathology is a recurring theme in the pastoral field. The data align with existing literature, which has documented the frequent interweaving of religious content within the symptomatology of various mental disorders, particularly in communities where religious beliefs are deeply ingrained (Lefevor et al. 2022). The clergy’s frequent exposure to such cases further emphasizes the necessity for specialized training in recognizing and managing religiously influenced psychopathology.

The mean age of the sample was 49.26 years with a standard deviation of 12.54 years, indicating a mature demographic with a broad age range. Similarly, the participants reported an average of 18.41 years of experience in ministry, with a standard deviation of 10.24 years.

These figures reveal a group of clergy with substantial pastoral experience, which is likely to have exposed them to a variety of complex pastoral situations, including those involving religious psychopathology. However, experience alone may not suffice in equipping clergy with the necessary diagnostic and referral skills, especially in cases of severe psychopathology. The findings of Farrell and Goebert (2008), who demonstrated that even experienced clergy often lack adequate mental health training, are pertinent in this context.

The demographic composition of the sample presents a clergy body that is relatively well-educated and experienced, yet not systematically engaged with mental health professionals. The fact that a significant majority have encountered cases of religious psychopathology, while simultaneously a majority report no collaboration with psychologists or psychiatrists, highlights a critical gap in pastoral care practices. This gap is not merely academic but has profound implications for the mental health outcomes of individuals seeking help from clergy.

The intersection of religious belief and psychopathology is a delicate domain requiring both theological sensitivity and psychological expertise. As the present data illustrate, clergy are frequently at the frontline of encountering individuals whose mental illnesses are expressed through religious themes. Without adequate training or collaborative support, clergy may inadvertently perpetuate stigma or misinterpret symptoms as purely spiritual phenomena, an issue highlighted by Payne (2009) and evidenced in the Italian study by Magliano et al. (2021), where clergy exhibited stigmatizing attitudes toward individuals with schizophrenia and depression.

Furthermore, the data reveal an openness among clergy for further training, a trend also observed in Μόσχος (2010) study, where nearly 70% of clergy expressed a desire for education in psychological matters. Such willingness is a positive indicator for the development of interdisciplinary programs that bridge the gap between theology and mental health care.

Finally, the relatively low rate of collaborations with mental health professionals may also be attributed to structural and cultural barriers, including a lack of formal channels for referrals, limited availability of faith-sensitive mental health services, and persistent stigma surrounding mental illness within religious communities (Hefti 2011).

4. Results-Descriptive Analysis of Clergy’s Knowledge and Opinions on Religious Psychopathology

Table 2. Frequencies and Percentages for Each Item of the Scale.

Item		N	%
How familiar are you with the term “religious psychopathology”?
	Not at all	46	36.8
	A little	21	16.8
	Moderately	31	24.8
	Very	21	16.8
	Fully	6	4.8
Can you discern when a profound religious experience is genuine and when it is a possible symptom of a mental disorder?
	Not at all	13	10.4
	A little	21	16.8
	Moderately	37	29.6
	Very	45	36.0
	Fully	9	7.2
Are you aware of the basic symptoms of psychosis that may be expressed with religious content (e.g., delusions, auditory hallucinations)?
	Not at all	25	20.0
	A little	18	14.4
	Moderately	39	31.2
	Very	24	19.2
	Fully	19	15.2
Have you ever been trained or informed about the relationship between psychology/psychiatry and religious life?
	Not at all	49	39.2
	A little	27	21.6
	Moderately	30	24.0
	Very	13	10.4
	Fully	6	4.8
Do you know examples of mental disorders with religious manifestations, such as “religious ideation or delusion”?
	Not at all	55	44.0
	A little	18	14.4
	Moderately	34	27.2
	Very	9	7.2
	Fully	9	7.2
Intense religious life can easily be confused with psychopathology
	Strongly disagree	12	9.6
	Disagree	19	15.2
	Neither agree nor disagree	51	40.8
	Agree	24	19.2
	Strongly agree	19	15.2
Exorcism is not a solution in cases of mental illness
	Strongly disagree	9	7.2
	Disagree	3	2.4
	Neither agree nor disagree	34	27.2
	Agree	43	34.4
	Strongly agree	36	28.8
A priest should collaborate with a psychiatrist or psychologist when suspecting a disorder
	Strongly disagree	6	4.8
	Disagree	0	0
	Neither agree nor disagree	33	26.4
	Agree	49	39.2
	Strongly agree	37	29.6
I believe priests need more training on mental health issues
	Strongly disagree	9	7.2
	Disagree	3	2.4
	Neither agree nor disagree	12	9.6
	Agree	45	36.0
	Strongly agree	56	44.8
Many believers confuse disorders with demon possession
	Strongly disagree	9	7.2
	Disagree	6	4.8
	Neither agree nor disagree	21	16.8
	Agree	58	46.4
	Strongly agree	31	24.8
“Religious obsessions” may be an indication of a mental disorder
	Strongly disagree	15	12.0
	Disagree	12	9.6
	Neither agree nor disagree	31	24.8
	Agree	30	24.0
	Strongly agree	37	29.6

Note: Response options range 1 to 5. Percentages are calculated based on the total number of participants (n = 125). The first five items correspond to the subscale “Knowledge” and the last six to the subscale “Opinions”.

presents the frequencies and percentages for each item of the scale assessing clergy’s knowledge and opinions regarding religious psychopathology (Μ = 3.17, SD = 0.75). The data reveal significant variability in participants’ familiarity with key concepts, their capacity for discernment in pastoral practice, and their attitudes toward the intersection of religion and mental health care.

4.1. Knowledge Subscale

The first five items of the scale pertain to the clergy’s level of knowledge concerning religious psychopathology (M = 2.56, SD = 1.05). A substantial proportion of respondents reported being “Not at all” familiar with the term “religious psychopathology,” while only few indicated they were “Fully” familiar. Approximately one in four participants selected “Moderately”, suggesting that while complete unfamiliarity is prevalent, there is a considerable portion of clergy with at least an intermediate understanding of the term.

In terms of discerning whether a profound religious experience is authentic or indicative of a mental disorder, responses were distributed across the spectrum. Notably, 36.0% reported feeling “Very” capable of making this distinction, while 29.6% indicated a “Moderate” capacity. However, 27.2% of participants selected “Not at all” or “A little”, reflecting a notable lack of confidence among certain clergy members in differentiating religious experience from psychopathology. This finding underscores a potential gap in pastoral education concerning the phenomenology of mental disorders.

Regarding awareness of basic psychotic symptoms (e.g., religious delusions or auditory hallucinations), some of clergy reported “Moderate” knowledge, while only few claimed to be “Fully” aware. Interestingly, 20.0% admitted to being “Not at all” aware of these symptoms, a figure that raises concerns considering the clergy’s pivotal role as first-line responders to congregants’ religious experiences.

Training or formal information about the relationship between psychiatry/psychology and religious life was notably lacking. Nearly four out of ten respondents indicated no exposure whatsoever, and only a minimal number reported being fully trained or informed. Similarly, when asked about familiarity with examples of mental disorders with religious manifestations, such as religious ideation or delusions, some responded “Not at all”, and minimal reported full knowledge. This pattern indicates a significant deficiency in specialized education within clerical formation programs concerning religious psychopathology and its clinical presentations.

Opinions Subscale

The last six items of the scale assessed clergy’s opinions regarding the interplay between intense religious life, mental illness, and appropriate pastoral responses (M = 3.69, SD = 0.84). When asked whether intense religious life could be easily confused with psychopathology, responses were largely neutral or ambivalent. Specifically, some selected “Neither agree nor disagree”, suggesting a prevalent uncertainty or lack of conviction about this complex issue. Nevertheless, a significant percentage agreed to some extent (“Agree” or “Strongly agree”) that such confusion is possible, while another significant percentage disagreed.

The question regarding exorcism as an inadequate solution for mental illness yielded a more decisive pattern. A majority of participants agreed with this statement, with selecting “Agree” and “Strongly agree”, cumulatively accounting for over 60% of the sample. A smaller segment remained neutral, while outright disagreement was minimal. These findings suggest that, despite traditional beliefs in spiritual interventions, a significant proportion of clergy acknowledge the limitations of exorcism in addressing mental health disorders.

When asked whether priests should collaborate with psychiatrists or psychologists upon suspecting a mental disorder, the responses were overwhelmingly affirmative. Nearly 70% of clergy endorsed collaboration, with only a negligible fraction expressing disagreement. However, a substantial minority remained neutral, potentially reflecting lingering reservations or lack of experience with interdisciplinary cooperation.

The item concerning the need for further training of priests in mental health issues yielded the most decisive response pattern. An overwhelming of respondents agreed that clergy require more education on mental health, while only few disagreed. This consensus highlights a recognized gap in current clerical training and a willingness among clergy to enhance their competencies in this area.

When asked whether believers often confuse mental disorders with demonic possession, a majority of respondents concurred, totaling 71.2% of participants. These findings suggest that misconceptions among the laity remain widespread, necessitating corrective catechetical efforts and informed pastoral guidance. A smaller proportion remained neutral, while only few rejected the statement.

Finally, opinions on whether “religious obsessions” might indicate a mental disorder were more divided. While 53.6% agreed, a significant proportion either disagreed or remained neutral. This ambivalence may stem from theological interpretations of religious zeal and the fine line between devout practice and pathological fixation.

5. Statistical Analysis

The internal consistency of the scale was high, as indicated by a Cronbach’s alpha (α = 0.81) for the 11 items.

An Exploratory Factor Analysis (EFA) was conducted in order to explore possible subscales on the questionnaire. Its purpose was to highlight the way in which the variables are “connected” or structured into factors. The index Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) was calculated 0.64 indicating a sufficient adequacy of the data and the Bartlett’s test of Sphericity was statistically significant χ²(5) = 921.25, p < 0.001, supporting the factorability of the correlation matrix.

A Principal Component Analysis (PCA) with Varimax rotation and Kaiser normalization was conducted to explore the underlying dimensions of participants’ knowledge and opinions regarding religious psychopathology. Two factors were clearly revealed also on the scree plot.

The analysis revealed two main components explaining a substantial portion of the variance (65.38%).

Table 3. Rotated Component Matrix for the Principal Component Analysis of the Knowledge and Opinions Subscales.

Item	Component 1 (Knowledge)	Component 2 (Opinions)
How familiar are you with the term “religious psychopathology”?	0.82
Can you discern when a profound religious experience is genuine and when it is a possible symptom of a mental disorder?	0.86
Are you aware of the basic symptoms of psychosis that may be expressed with religious content (e.g., delusions, auditory hallucinations)?	0.85
Have you ever been trained or informed about the relationship between psychology/psychiatry and religious life?	0.78	0.35
Do you know examples of mental disorders with religious manifestations, such as “religious ideation or delusion”?	0.89
Intense religious life can easily be confused with psychopathology		0.76
Exorcism is not a solution in cases of mental illness		0.67
A priest should collaborate with a psychiatrist or psychologist when suspecting a disorder	0.44	0.62
I believe priests need more training on mental health issues		0.78
Many believers confuse disorders with demon possession		0.73
“Religious obsessions” may be an indication of a mental disorder		0.80

Note: Bold values indicate primary loadings. Extraction method: Principal Component Analysis. Rotated method: Varimax with Kaiser Normalization.

displays the factor loadings of the variables on these two components.

Component 1 groups variables related to participants’ knowledge and familiarity with the concept of religious psychopathology, recognition of core symptoms of psychosis with religious content, and training in psychology/psychiatry and religion.

Component 2 reflects attitudes and beliefs concerning collaboration between clergy and mental health professionals, the differentiation between religious experiences and mental disorders, and the perceived need for further training of clergy in mental health issues.

The internal consistency of the first component, which includes five items related to knowledge and familiarity with religious psychopathology, was assessed using Cronbach’s alpha. The scale demonstrated good reliability, with a Cronbach’s alpha coefficient of 0.90, indicating high internal consistency.

The internal consistency of the second component, consisting of six items related to opinions toward collaboration with mental health professionals and the differentiation between religious experiences and mental disorders, was assessed using Cronbach’s alpha. The scale showed very good reliability, with a Cronbach’s alpha coefficient of 0.83, indicating that the items reliably measure the underlying construct.

Spearman’s rank-order correlation was conducted to examine the relationship between the Knowledge and Opinions subscale scores. The analysis revealed a positive and statistically significant correlation between the two subscales, rho = 0.213, p = 0.017 (see

Table 4. Spearman’s rho correlations and Kruskal–Wallis H test results for the Knowledge and Opinions subscales.

Analysis	Variables	Statistic	p
Spearman’s rho	Knowledge—Opinions	0.213	0.017 *
Spearman’s rho	Knowledge—Age	0.012	0.892
Spearman’s rho	Opinions—Age	0.000	0.997
Spearman’s rho	Knowledge—Years of Ministry	0.122	0.174
Spearman’s rho	Opinions—Years of Ministry	−0.005	0.960
Kruskal–Wallis H	Knowledge (Education)	12.580	0.002 *
Kruskal–Wallis H	Opinions (Education)	3.377	0.185

Note. p < 0.05 is considered statistically significant. Statistically significant values are marked with an asterisk (*).

). This suggests a moderate correlation between participants’ knowledge about religious psychopathology and their opinions regarding collaboration with mental health professionals and related attitudes.

The relationship between age (a continuous variable) and the factors of knowledge and opinions was examined using Spearman’s rank correlation. Results indicated no statistically significant correlation between age and knowledge, nor between age and opinions. This suggests that age does not correlate participants’ levels of knowledge or opinions.

Spearman’s rho correlation analysis was conducted to examine the relationship between years of ministry experience and participants’ knowledge and opinions. The results indicated no significant correlation with knowledge or opinions, suggesting that work experience does not correlate participants’ responses on these subscales.

A Kruskal–Wallis H test was conducted to examine whether knowledge scores differed according to participants’ educational level (1 = Middle School, 2 = High School, 3 = University). The results indicated a statistically significant difference in knowledge scores across the three educational groups. This suggests that educational attainment is associated with differences in participants’ knowledge regarding the subject matter.

The test showed no statistically significant differences in opinion scores across the three educational groups. This indicates that educational attainment does not significantly influence the opinions expressed by the clergy in this sample.

To compare the two groups of clergy—those who reported collaborating with a mental health professional within the framework of their ministry (group 1) and those who have not (group 2)—the non-parametric Mann–Whitney U test was applied due to non-normality in most subscales. The collaboration variable referred to whether the clergy had worked with a psychologist or psychiatrist (see

Table 5. Results of the study to compare the two groups of clergy—those who reported collaborating with a mental health professional (group 1) and those who have not (group 2), and also those who reported experience with cases of religious psychopathology (group 1) and those who have not (group 2).

Subscale	Comparison Groups	N	Mean Rank	Mann–Whitney U	p
	Collaboration
Knowledge	1 (Yes)	33	88.98	670.5	<0.001
	2 (No)	92	53.79
Opinions	1 (Yes)	33	77.95	1024.5	0.006
	2 (No)	92	57.64
	Experience
Knowledge	1 (Yes)	98	69.86	651.0	<0.001
	2 (No)	27	38.11
Opinions	1 (Yes)	98	69.24	711.0	<0.001
	2 (No)	27	40.33

).

For the “Knowledge” subscale, the collaborating group showed significantly higher scores compared to the non-collaborating group. Specifically, the mean ranks indicated greater knowledge among those who collaborated.

A similar pattern was observed in the “Opinions” subscale, where the collaborating group also scored.

The analysis examined the relationship between clergy experience with cases of religious psychopathology in their ministry and their knowledge and opinions regarding the topic. The sample was divided into two groups based on their response to whether they had encountered cases of religious psychopathology (Group 1: Yes, n = 98; Group 2: No, n = 27). The non-parametric Mann–Whitney U test was used to compare the two groups on the knowledge and opinions subscales, as the variables did not meet normality assumptions.

The results showed statistically significant differences between the two groups on both subscales. Specifically, on the knowledge subscale, Group 1 had a higher mean rank, indicating greater knowledge about religious psychopathology compared to Group 2. Similarly, on the opinion’s subscale, Group 1 also had a higher mean rank, reflecting more differentiated or consolidated opinions about the phenomenon (see also Table 5).

6. Discussion

In summary, the demographic profile of the clergy in this study paints a picture of a well-educated, experienced, and pastorally active group that is frequently confronted with mental health issues, particularly of a religious nature. However, the limited collaboration with mental health professionals and the lack of specialized training present significant challenges. The findings underscore the urgent need for targeted educational initiatives and the establishment of structured networks for cooperation between clergy and mental health services. Such efforts would not only enhance the pastoral effectiveness of clergy but also contribute to reducing the stigma of mental illness and improving the overall mental well-being of individuals within religious communities (Noort et al. 2012).

The descriptive data reveal a critical duality in clergy responses. On one hand, there is an evident acknowledgment of the necessity for collaboration with mental health professionals and a self-identified need for further training. On the other hand, the substantial lack of familiarity with fundamental concepts of psychopathology, as well as the ambivalence expressed in certain opinion items, indicate that current clerical formation inadequately prepares clergy to navigate complex intersections of mental health and religious life.

Moreover, the divergence between clergy’s recognition of pastoral limitations (e.g., exorcism not being a solution) and their uncertainty about diagnosing or identifying psychopathological symptoms reflects a broader tension in the clergy’s role. The data suggest that while theoretical openness to mental health discourse exists, practical knowledge and diagnostic confidence remain insufficient. This gap underscores the imperative for structured educational interventions aimed at integrating psychological literacy within theological training (Pieper and Van Uden 2005).

Spearman’s correlation analysis revealed a positive but modest correlation between the Knowledge and Opinions subscale scores (rho = 0.213, p = 0.017), indicating that clergy who reported greater familiarity and understanding of religious psychopathology also tended to hold more favorable attitudes towards collaboration with mental health professionals and recognized the importance of further training in mental health issues (Cook 2015).

In the context of clergy dealing with mental health concerns, this suggests that enhancing education about psychopathology and its religious manifestations could positively influence their willingness to engage in cooperative efforts with psychologists and psychiatrists (Cook 2015).

Despite the statistically significant association, the relatively low correlation coefficient implies that knowledge alone does not fully account for opinions and attitudes. Other factors, such as personal beliefs, theological perspectives, pastoral experience, or cultural context, may also play crucial roles in shaping clergy members’ attitudes. The moderate familiarity with key psychological concepts observed in the descriptive statistics and the ambivalence on certain opinion items further emphasize the complexity of this relationship (Vermaas et al. 2017).

Moreover, the data reflect a notable tension within the clergy between acknowledging the limits of pastoral care in addressing mental illness (e.g., the view that exorcism is not an appropriate solution) and uncertainty or lack of confidence in identifying psychopathological symptoms. This duality underscores the importance of not only providing knowledge but also fostering practical skills and diagnostic confidence through targeted training programs (Vermaas et al. 2017).

Overall, these findings reinforce the urgent need for structured educational interventions in clerical formation that integrate psychological literacy with theological training. By improving both knowledge and attitudes, such initiatives could enhance the pastoral care clergy provide to individuals experiencing mental health challenges, reduce stigma within religious communities, and promote effective collaboration with mental health professionals (Noort et al. 2012).

Future research should explore additional variables influencing clergy attitudes, such as demographic factors, religious tradition, or prior experience with mental health cases. Qualitative studies could also provide deeper insights into the nuanced ways clergy interpret and respond to mental health issues in their pastoral roles.

The present study examined the potential influence of age on participants’ knowledge and opinions, measured through 5-point Likert scale responses. Using Spearman’s rank correlation, no statistically significant relationships were found between age and either knowledge (rho = 0.012, p = 0.892) or opinions (rho = 0.000, p = 0.997). These findings suggest that age does not play a significant role in shaping the knowledge levels or opinions of the participants in this particular sample.

This lack of correlation aligns with prior research indicating that knowledge and attitudes are often influenced more by factors such as education, life experience, cultural background, and access to information rather than chronological age alone. For instance, an individual’s motivation to learn or engage with certain content can vary widely irrespective of their age. Similarly, opinions can be shaped by social environment, personal values, and exposure to diverse perspectives rather than simply by aging.

It is also important to consider the nature of the measurement tools used in this study. The 5-point Likert scale, while a widely accepted method for capturing attitudes and perceptions, may limit sensitivity to subtle gradations in knowledge or opinion differences across age groups. This limitation could contribute to the absence of statistically significant findings.

Another potential explanation for the null results could be the relative homogeneity of the sample in terms of socio-demographic characteristics. If the participants share similar educational or cultural backgrounds, this could minimize variability in knowledge and opinions, making it harder to detect age-related effects. Furthermore, the relationship between age and knowledge or opinions may not be linear. There might be age thresholds or curvilinear patterns that Spearman’s correlation does not capture.

Additionally, this study did not consider other moderating variables such as cognitive function, technological literacy, or socio-economic status, which may interact with age to influence knowledge and opinions. Future research could incorporate these variables and apply more complex statistical models, such as multiple regression or structural equation modeling, to better understand these relationships.

Lastly, while the sample size of 125 participants is reasonable, it might lack sufficient statistical power to detect very small effects. Larger and more diverse samples would provide greater confidence in generalizing these findings.

In conclusion, this study suggests that age alone does not significantly affect knowledge or opinions within this sample. To gain a more comprehensive understanding, further research should explore additional demographic and psychological factors, utilize more sensitive measures, and consider longitudinal approaches to observe changes over time.

The results of this study indicated that years of ministry experience were not significantly associated with participants’ knowledge or opinions. Spearman’s rho correlation between experience and knowledge was low (rho = 0.122, p = 0.174), while the correlation with opinions was essentially zero (rho = −0.005, p = 0.960). These findings suggest that professional experience does not influence participants’ knowledge levels or their expressed attitudes regarding the topics assessed.

The absence of a significant correlation may imply that knowledge and opinions are shaped more by other factors, such as formal education, recent training, or personal interests, rather than by years of service per se. Furthermore, the variability and qualitative differences in the professional experiences of participants may explain the lack of a statistical relationship. This suggests that length of experience alone is not a sufficient predictor of knowledge or attitudes in this context. These findings highlight the need for further investigation into other variables that may influence knowledge and opinions, such as ongoing professional development, access to specialized education, and individual commitment to lifelong learning (Farrell and Goebert 2008). Future research could benefit from a more detailed exploration of these factors to better understand what contributes to the development of professional competencies and perspectives.

The findings of this study demonstrated a statistically significant relationship between participants’ educational level and their knowledge scores. Specifically, the Kruskal–Wallis H test revealed that participants with higher educational attainment (university graduates) reported significantly higher knowledge levels compared to those with lower educational backgrounds (middle school and high school). This result suggests that formal education plays a crucial role in shaping individuals’ knowledge on the examined subject matter, possibly due to greater exposure to academic resources, critical thinking skills, and structured learning environments (Lefevor et al. 2022).

Individuals with university education are more likely to have received specialized training, engaged in academic discourse, and developed competencies that enable them to understand complex topics more thoroughly. Conversely, participants with only middle or high school education may have had fewer opportunities for formal instruction on the subject, which may limit their knowledge base.

It is also important to consider that knowledge is not solely influenced by years of experience, as earlier analyses in this study indicated no significant correlation between work experience and knowledge. This finding emphasizes the distinct and perhaps superior impact of formal education compared to experiential learning in this context. However, this does not necessarily diminish the value of professional experience but highlights that structured educational programs may provide foundational theoretical knowledge that informal learning environments cannot fully replace.

The significant association between education and knowledge has important implications for professional development and policy-making. It suggests a need for targeted educational interventions, continuous training programs, and the provision of accessible learning materials for priests with lower educational backgrounds. Ensuring that knowledge gaps are addressed through lifelong learning initiatives could enhance overall competency levels across diverse educational groups (Lefevor et al. 2022).

The findings indicate that the opinions of clergy members do not significantly vary according to their educational background. Unlike knowledge scores, which showed a clear association with education level, opinions appear to be more stable and less influenced by formal education. This suggests that personal beliefs and attitudes among clergy may be shaped more by factors other than academic training, such as individual experiences, religious traditions, cultural influences, or community contexts.

The absence of significant differences could also imply that the opinions measured reflect widely held views within the clergy community that transcend educational attainment. These shared perspectives may be grounded in common religious values, ecclesiastical teachings, or the social environment of the clergy, leading to a relative homogeneity in opinions regardless of formal education.

Moreover, opinions often have an emotional and value-laden dimension, which may not be easily altered or directly correlated with education. While education can enhance knowledge and understanding, changing opinions may require different approaches—such as experiential learning, dialog, and pastoral engagement—that address values and beliefs more directly.

Although the Spearman’s correlation analysis revealed a positive but modest correlation between the Knowledge and Opinions subscale scores (r = 0.213, p = 0.017), it is important to understand why educational level was significantly associated only with the Knowledge subscale and not with Opinions.

This pattern is common in social science research because knowledge and opinions, while related, represent different constructs. Education tends to have a more direct and stronger impact on knowledge, as formal education provides the information and cognitive skills that build one’s knowledge base. In contrast, opinions are shaped by a broader range of factors, including personal experiences, cultural background, religious beliefs, social influences, and values, which are not necessarily linked to formal education.

Therefore, although individuals with higher knowledge often hold certain opinions, the relationship is moderate, indicating that opinions are influenced by additional complex factors beyond education. This explains why educational level predicts knowledge levels but does not significantly influence opinions in the same way.

In summary, education equips individuals with knowledge, but opinions are formed through a multifaceted process involving both cognitive and affective components. This distinction highlights the need for different approaches when aiming to influence knowledge versus opinions among clergy.

The findings of this study highlight the significant impact that collaboration between Orthodox clergy and mental health professionals has on both knowledge levels and attitudes regarding religious psychopathology. Clergy members who had experience working with psychologists or psychiatrists showed significantly higher scores on the knowledge subscale, suggesting that interdisciplinary collaboration enhances the understanding of psychiatric issues with a religious dimension (Magliano et al. 2021).

Moreover, the elevated scores on the opinions subscale indicate that collaboration does not merely influence the cognitive domain but also contributes to the development of more positive and realistic attitudes towards phenomena of religious psychopathology. This finding is critical as it underscores the importance of experiential learning and direct engagement with mental health specialists as mechanisms for challenging prejudices or stereotypical perceptions that may exist within the clergy (Magliano et al. 2021).

The observation that clergy who have not collaborated with professionals exhibit lower scores reinforces the necessity of developing structured training and awareness programs that incorporate cooperative practices between the Church and mental health services (Magliano et al. 2021). The differences in scores do not appear to be due to random variation but rather reflect a substantive effect of collaborative experience on both knowledge and attitudes.

These results are consistent with international literature that emphasizes the value of interdisciplinary approaches in addressing psychosocial phenomena with religious connotations. Furthermore, they support the view that the Church can play a meaningful role in mental health care, provided that clergy receive appropriate education and engage in partnerships with scientific and clinical institutions (Lefevor et al. 2022).

Therefore, these findings offer practical directions for designing policies that foster collaboration between the Church and mental health services, aiming to strengthen the psychological support provided to believers through holistic and integrated approaches. Encouraging such collaborations could bridge existing gaps between spiritual care and mental health, promoting a more comprehensive understanding and management of religious-related psychopathological manifestations (Lefevor et al. 2022).

The findings of this study indicate that clergy members who have encountered cases of religious psychopathology in their ministry exhibit higher levels of knowledge and differentiated opinions compared to those without such experience. This aligns with the expectation that practical experience and direct exposure to complex phenomena enhance understanding and shape more mature and informed viewpoints.

The increased knowledge likely reflects clergy’s need to better comprehend the psychological and spiritual elements coexisting in cases of religious psychopathology, in order to provide more appropriate support and effectively manage such incidents. Moreover, the variation in opinions may signify the development of critical thinking and sensitivity towards complex issues combining religious and mental health aspects (Farrell and Goebert 2008).

Finally, future research could explore how exactly experience influences knowledge and opinions, as well as which educational interventions are most effective in enhancing clergy skills in this field.

An important limitation of the present study concerns the difference in sample sizes between the two comparison groups. The group of clergy who reported encountering cases of religious psychopathology was important larger than the group without such experience. The group also of clergy who reported that they have collaborated with a psychologist or psychiatrist within framework of pastoral care was important smaller (n = 33) than the group of clergy without collaboration (n = 92). This imbalance may affect the power and stability of the statistical results, making it more difficult to draw generalizable conclusions. Although the non-parametric Mann–Whitney U test used is suitable for samples of unequal size, the smaller group may not be representative and may increase the risk of Type II errors. Future research would benefit from ensuring more balanced sample sizes to improve the reliability and validity of the findings.

7. Conclusions

This study highlights critical aspects regarding the knowledge, attitudes, and perceptions of Orthodox clergy towards issues of religious psychopathology and their collaboration with mental health professionals. The findings reveal a clergy population that, although possessing significant education and extensive pastoral experience, faces challenges due to insufficient specialized training and limited cooperation with mental health experts.

The study confirms the existence of a dual trend among the clergy: on the one hand, there is a clear recognition of the necessity to collaborate with psychiatrists and psychologists, along with a desire for further education. On the other hand, there is a notable lack of familiarity with basic concepts of psychopathology and a pervasive uncertainty about diagnosing and recognizing symptoms of mental disorders. The discrepancy between the theoretical acceptance of the limits of pastoral care—such as the rejection of exorcism as a solution—and the practical uncertainty underscores the difficulties clergy face when addressing complex mental health issues.

A significant finding is the positive, though moderate, correlation between knowledge and attitudes: clergy members with greater understanding of psychopathology related to the religious domain tend to hold more positive and realistic views and recognize the value of collaboration with mental health specialists. This suggests that increasing psychological and psychiatric education within the theological context could enhance clergy openness to cooperation and improve the effectiveness of pastoral care.

The study also confirms that age and years of service do not significantly relate to levels of knowledge or attitudes, indicating that education and access to updated information weigh more than time or experience in shaping these factors. Conversely, educational level appears to be an important factor for knowledge, with clergy who have completed university studies demonstrating significantly higher knowledge levels. However, attitudes do not vary significantly by education level, suggesting that personal values, religious beliefs, and cultural context play a decisive role in shaping perspectives.

Another crucial finding is the positive impact of collaboration with mental health professionals. Clergy who have worked with psychologists or psychiatrists exhibit higher knowledge levels and more positive attitudes, highlighting the importance of interdisciplinary approaches and direct contact with the scientific community for understanding and managing complex psychoreligious phenomena. Such collaboration appears to help overcome stereotypes and prejudices, promoting a more holistic and effective pastoral care.

The clergy’s experience with cases of religious psychopathology is associated with higher knowledge levels and differentiated views, confirming the role of practical exposure in deepening understanding and developing critical thinking. However, the imbalance in subgroup sizes indicates that future research requires more balanced samples to strengthen the reliability of the results.