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Fighting Depression: Prevention and Recovery's Religious Link

A review of more than 80 studies appearing over the last 100 years found a factor steadily linked with lower rates of depression-religious participation. Persons involved in a religious group and who highly valued their religious faith were at a substantially reduced risk of depressive disorder while people with no religious link may raise their risk of major depression by as much as 60%, the review found.

"Lack of organizational religious involvement leads to a 20-60% increase in the odds of experiencing a major depressive episode," noted review authors Michael McCullough, PhD, of Southern Methodist University and David Larson, MD, MSPH, president of the International Center for the Integration of Health and Spirituality(ICIHS).

Why might a religious link help? "Valuing one's religious faith as centrally important and actively belonging to a religious group may give spiritual roots that provide meaning as well as support from others. This creates anchors of hope and caring which might help protect against depression," Dr. Larson commented.

Former president of the American Psychological Association Martin Seligman, Ph.D., stated that ways religion and spirituality might decrease depression involve fostering positive beliefs and behaviors while lessening the impact of negative circumstances.

Differing Risks for Depression--A Look at "Intrinsic" vs. "Extrinsic" Faith

Dr. Gordon Allport, Harvard psychologist, first distinguished between intrinsic and extrinsic forms of religious commitment. The intrinsically religious person internalizes beliefs and lives by them regardless of outside or extrinsic social pressure or other possible personal consequences.

Intrinsic motivation was linked with less depression and also appeared to protect people from depression who face high stress, such as dealing with serious illness, the research review showed. "Medically ill adults with high degrees of intrinsic religiousness are less likely to be diagnosed with major depression," noted Dr. Larson.

In contrast, people whose religious motivation centers on obtaining self-justification, social advantages or personal security-known as "extrinsic" religious faith--showed slightly higher levels of symptoms of depression in the 100-year review.

Significance of Religious Faith

"A comprehensive study with a one-year follow-up found that people who indicated that 'a strong religious faith' was among the three most important things in life had only 38% of the odds of becoming depressed in comparison with those who did not ascribe such importance to their religious faith, " Dr. Larson noted. Also, among those who were depressed at the beginning of the study, those who ranked their religious faith as highly important recovered faster.

Furthermore," People who indicated that having a strong religious faith was one of the most important things in life had only 17% of the odds of remaining depressed at the one-year follow up," he commented.

Depression Overview

The Bad News
ºVisits to physicians for depression nearly doubled within 10 years-from 11 million in 1985 to 20.4 million by 1994, according to an article in the Journal of the American Medical Association.
ºAntidepressant medication more than doubled from 5.3 million to 12.4 million in the same time.1
ºBetween 10 to 25% of women and 5 to 12% of men will meet the medical criteria for major depressive disorder within their lifetime.
ºPeople with major depression have a substantially increased risk for early death and suicide attempts.
ºSome 45% of older hospitalized seriously ill patients experience some form of depression, compared to only 1% of the elderly in the community.4
ºDepression among the seriously physical ill can lengthen hospital stays and increase use of medical services.4
ºAll 100% of widowed men who did not belong to a church or temple scored above the cut off point for depression after facing another family member's death, according to a study by the UCLA School of Public Health.

The Good News
ºPeople who often attend religious services and highly value their religious faith are at a substantially reduced risk for depression.3
ºIntrinsic faith may help speed recovery from depression. A yearlong study of 87 depressed older adults hospitalized with medical illness found that for every 20% increase in their intrinsic religiosity score, there was a 70% increase in speed of remission. This effect remained after controlling for multiple demographic, psychosocial, physical health, and treatment factors. In a Netherlands study, intrinsic faith showed a relatively strong link with recovery from depression, especially among those with poor physical health.
ºIn another study of 850 acutely ill hospitalized men, researchers found that those who used their religious faith to cope were significantly less depressed. In a subgroup of 201 patients, the extent of their religious coping predicted lower depression scores six months later. Furthermore, the clinical effects were strongest among those with severe disability.
ºA study of elderly women recovering from hip fractures found that those to whom God was a strong source of strength and comfort and who frequently attended religious services were less depressed and could walk down the hall farther at discharge than patients who lacked a strong religious/spiritual commitment. The more religious had less depressive symptoms, which enhanced their recovery.
ºEight studies of college students in the Southeastern US found that an intrinsic religious outlook, which included a belief in "grace"-God's forgiveness-was associated with fewer depression symptoms. However, self-guilt without the influence of grace was directly related to depressive symptoms.
ºRisk of depression particularly among elderly who either have a small social network or feel a lack of control over their circumstances is fewer among people with frequent religious attendance and strong religious affiliation, found a Netherlands study of more than 2,800 adults over age 55.
ºPublic religious participation such as attending religion services was related to lower physical disability among men and women and private religious involvement, like prayer, was related to lower depression among recently disabled men in a 3-year study of more than 2,800 adults aged 65 and older. The authors stated, "We see a powerful phenomenon at work here. In almost every way we examined the relationship, religious involvements�were linked with the preservation of life and health."

1 McCullough ME, Larson DB. "Religion and depression: a review of the literature." Twin Research 1999; 2:126-136.
2Allport GW. The Individual and His Religion. Macmillan: New York, 1950.
3 Braam AW, Beekman ATF, Deeg DHG, Smit JH, Tilburg, W. van. "Religiosity as a protective or prognostic factor of depression in later life; results from a community study in The Netherlands." Acta Psychiatrica Scandinavica 1997; 96: 199-205.
4 Pincus HA, Tanelian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, Magno Zito J. "Prescribing trends in psychotropic medications: Primary care, psychiatry, and other medical specialties." Journal of the American Medical Association 1998; 7: 526-531.
5American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC, 1994.
6Koenig HG, George LK. "Depression and physical health outcomes in depressed medically ill hospitalized older adults." American Journal of Geriatric Psychiatry 1998; 6: 230-247.
7Siegel JM, Kuykendall DH. "Loss, widowhood, and psychological distress among the elderly." Journal of Consulting and Clinical Psychology 1990; 58 (5): 519-524.
8Koenig HG, George LK, Peterson BL. "Religiosity and remission of depression in medically ill older patients." American Journal of Psychiatry 1998; 155 (4): 536-542.
9Braam AW, Beekman ATF, Deeg DJH, Smit JH, Tilburg, W van. "Religiosity as a protective or prognostic factor of depression in later life: results from a community survey in The Netherlands." Acta Psychiatrica Scandinavica 1997; 96: 199-205.
10Koenig HG, Cohen HJ, Blazer DG, Pieper C, Meador KG, Shelp F, Goli V, DiPasquale R. "Religious coping and depression in the elderly hospitalized medically ill men." American Journal of Psychiatry 1992; 149 (1): 693-1,700.
11Pressman P, Lyons JS, Larson DB, Strain JJ. "Religious belief, depression, and ambulation status in elderly women with broken hips." American Journal of Psychiatry 1990; 147(6): 758-760.
12Watson PJ, Morris RJ, Hood, RW. Sin and self-functioning, part 4: Depression, assertiveness, and religious Commitments. Journal of Psychology and Theology 1989; 17 (1): 44-58.
13Braam AW, Beekman ATF, Tilburg TG van, Deeg DJH, Tilburg W van. "Religious involvement in older Dutch citizens. Social Psychiatry and Psychiatric Epidemiology 1997; 32: 284-291.
14Idler EL, Kasl SV. "Religion, disability, depression, and the timing of death." American Journal of Sociology 1992; 97 (4): 1052-1079.

         
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