Religiosity and mental health as aspects of comprehensiveness in care

Martins, Dalila de Alcântara; Coêlho, Prisca Dara Lunieres Pêgas; Becker, Sandra Greice; Ferreira, Alaidistania Aparecida; Oliveira, Maria Luiza Carvalho de; Monteiro, Leslie Bezerra

doi:10.1590/0034-7167-2020-1011

Brasil

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REVIEW • Rev. Bras. Enferm. 75 (01) • 2022 • https://doi.org/10.1590/0034-7167-2020-1011 linkcopy

Religiosity and mental health as aspects of comprehensiveness in care

Religiosidad y salud mental como aspectos de la atención integral

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to understand how religiosity can influence the health of individuals diagnosed with mental disorders, based on comprehensive care.

Methods: this is an integrative literature review, with the inclusion of articles in Portuguese, English and Spanish, between 2010 and 2018.

Results: the critical analysis and qualitative synthesis of the 24 selected studies were categorized into two subtopics: The influence of religiosity in promoting comprehensive mental health care; Mental health versus religiosity: influencing conditions for effective access to comprehensive care.

Final considerations: a positive influence of religiosity was identified in the lives of individuals diagnosed with mental disorders; however, evidence shows that health teams do not feel comfortable and prepared to work with religiosity as an expression of spirituality. This being one of the dimensional aspects of health, it can be inferred, on the results, the existence of this gap in the comprehensive care approach.

Descriptors: Religion; Mental Health; Mental Disorders; Comprehensive Health Care; Holistic Health

Search strategy	Selected descriptors		Pre-selection of databases
Search strategy	Controlled descriptors	Uncontrolled descriptors	LILACS	BDENF
1	"Religião" OR Religião	(Crenças Religiosas) OR Oração OR (Ética Religiosa)	187	153
2	("Saúde Mental") OR (Saúde Mental)	(Áreas de Saúde Mental) OR (Higiene Mental)	5,001	1,099
3	("Transtornos Mentais") OR (Transtornos Mentais)	(Diagnóstico Psiquiátrico) OR (Transtorno do Comportamento) OR (Transtornos Mentais Graves) OR (Doença Mental) OR Insanidade	290	126
4	1 AND 2 AND 3		7	4

Search strategy	Selected descriptors		Pre-selection of databases
Search strategy	Controlled descriptors	Uncontrolled descriptors	MEDLINE	CINAHL
1	"Religion" OR Religion	Religions OR (Beliefs, Religious) OR (Religious Beliefs) OR (Religious Ethics) OR (Ethic, Religious) OR Prayer OR Prayers	67,816	19,419
2	("Mental Health") OR (Mental Health)	(Health, Mental) OR (Mental Hygiene) OR (Hygiene, Mental)	413,264	116,323
3	("Mental Disorders") OR (Mental Disorders)	(Disorder, Mental) OR (Disorders, Mental) OR (Mental Disorder) OR (Diagnosis, Psychiatric) OR (Psychiatric Diagnosis) OR (Behavior Disorders) OR (Disorders, Behavior) OR (Mental Disorders, Severe) OR (Disorder, Severe Mental) OR (Disorders, Severe Mental) OR (Mental Disorder, Severe) OR (Severe Mental Disorder) OR (Severe Mental Disorders)	515,497	75,218
4	1 AND 2 AND 3		11	23

Title	Year Country	Outlining	Outcome
Bem-estar psicológico de jovens de 18 a 24 anos: fatores associados⁽¹⁷⁾	2012 Brazil	Quantitative study	- Those who reported some type of religious practice were 5% more likely to report psychological well-being; - People with mental disorders are less likely to indicate psychological well-being.
Religiosidade e os transtornos mentais comuns em adultos ⁽ ¹⁸ ⁾	2017 Brazil	Cross-sectional study	- Women showed greater religious involvement than men; - According to sex, women had a higher prevalence of common mental disorders, they were not significantly associated with religiosity.
The Spiritism as therapy in the health care in the epilepsy⁽¹⁹⁾	2016 Brazil	Qualitative study	- Spirituality practices are associated with lower rates of suicide, less anxiety and depression and greater well-being in people with epilepsy; - Patients with bipolar disorder, religiosity and positive religious coping strategies were associated with fewer symptoms of depression.
Contributions from ethics and research that guide integrating religion into psychotherapy⁽²⁰⁾	2011 USA	Qualitative study	- Psychologists' codes of ethics agree that respect for clients' self-determination and decision-making are obligations; - Belief in a loving God can be beneficial, while belief in a vengeful, harmful God.
Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status?⁽²¹⁾	2010 USA	Cross-sectional study	- Measures of religious participation and religious beliefs were significantly associated with a lower likelihood of abuse/dependence among those with alcohol use; - Religiosity was associated with greater social support and positively associated with any drink.
Understanding spirituality from the perspective of patients with mental disorders: contributions to nursing care⁽²²⁾	2016 Brazil	Qualitative study	- Religious elements have been associated with health strengthening; - For the interviewees, it was clear that the Psychosocial Care Center (CAPS - Centro de Atenção Psicossocial) is not a place that encourages spirituality; - Higher levels of religious and spiritual involvement are positively associated with indicators of psychological well-being.
The faith of the psychiatrist⁽²³⁾	2011 England	Qualitative study	- There is evidence that psychiatrists are less likely to identify with a particular tradition of faith and to believe in God than their patients; - Psychiatrists do not consider themselves less spiritual than their patients.
Ministers' perceptions of church based programs to provide depression care for African Americans⁽²⁴⁾	2013 USA	Cross-sectional study	- Women and young people were cited as a high-risk group for being depressed; - Depression can be more stigmatized in the religious community, hampering the prominent role of ministers in care.
Mental and Physical Health and Spiritual Healing: An Evaluation of Complementary Religious Therapies Provided by Spiritist Centers in the City of São Paulo, Brazil⁽²⁵⁾	2016 Brazil	Cross- Sectional Study	- Directors of spiritist centers interviewed are sought mainly for depression (11.8%), cancer (11.3%) and 8.7% for diseases in general; - In the question of when a person is advised to seek medical help, 87% said 'always', with several observations that spiritual treatment is not a substitute for medical treatment.
Conceptualizing mental health in the United Arab Emirates: the perspective of traditional healers⁽²⁶⁾.	2015 United Arab Emirates	Qualitative study	- All healers reported that women were more likely to seek their services; - Healers were positive about the idea of integrating mental health care services, suggesting that their interventions had no adverse effect and were generally helpful and comforting.
The role of religious advisors in mental health care in the World Mental Health surveys⁽²⁷⁾	2017 USA; Brazil; Bulgaria; China; Colombia; Italy; Spain; Iraq; Germany; Japan; Lebanon; Mexico; Northern Ireland; Portugal; Romania; Nigeria; Ukraine	Epidemiological study	- In low-income countries, the use of religious counselors was greater among respondents with more serious disorders; - Among those who used some service, women and young people were more likely to seek help from religious counselors.
Religious discrimination and common mental disorders in England: a nationally representative population-based study⁽²⁸⁾	2015 England	Quantitative study	- 11-fold increase in the prevalence of discrimination against people who did not follow Christianity in relation to Christians; - Increase in the prevalence of all mental disorders in people who have suffered some form of discrimination.
Caracterização clínica e sociodemográfica dos usuários de um centro de atenção psicossocial (CAPS) ⁽ ²⁹ ⁾	2011 Brazil	Quantitative study	- 64.8% of caregivers are defined by blood ties, with mothers being 29.7%; - 87.4% of users live in locations outside the neighborhood where the service is implemented.
Listening to disembodied voices: anthropological and psychiatric challenges⁽³⁰⁾	2014 India	Ethnographic study	- Most caregivers were women from the third group of pilgrims who cared for a son or daughter with schizophrenia; - Most pilgrims support the idea that staying in the Sanctuary has a calming effect on anyone affected by madness.
The diagnostic and statistical manual: sacred text for a secular community?⁽³¹⁾	2014 USA	Qualitative study	- Even if DSM is not considered a prophetic text (like the Bible), it works as a historical text written for a specific people (mental healthcare professionals) and their culture, at a specific point in history.
Ethnic density and risk of mental ill health - The case of religious Sectarianism in Northern Ireland: A population data linkage study⁽³²⁾	2017 United Kingdom	Ethnographic study	- Increased Catholic population density, especially in underserved areas, was associated with greater chances of reporting mental health problems; - In the Protestant population, there was a decrease in the likelihood of self-reported mental health difficulties as the Protestant population density increases.
Religion, spirituality, and mental health of US military veterans: Results from the National Health and Resilience in Veterans Study⁽³³⁾	2017 USA	Cross- Sectional Study.	- The chances of having post-traumatic stress disorder throughout life, major depression and alcohol use disorder were 54%, 50% and 34% lower, respectively, in the high R/E versus low R/E group; - Compared to the moderate R/E group, the high R/E group scored higher on measures of mental health (vitality, mental health, emotional functioning) and general health.
Parent Spirituality, Grief, and Mental Health at 1 and 3 Months After Their Infant's/Child's Death in an Intensive Care Unit⁽³⁴⁾	2016 USA	Longitudinal study	- Spiritual strategies and activities helped fathers cope with grief and helped bereaved mothers to maintain their mental health and personal growth.
Religion-Based Emotional Social Support Mediates the Relationship between Intrinsic Religiosity and Mental Health⁽³⁵⁾	2014 USA	Cross-sectional study	- Intrinsic religiosity was significantly negatively associated with hopelessness, depression and suicidal behaviors, while extrinsic religiosity was not; - Emotional support was significantly negatively associated with each of the mental health variables.
Psychiatric disease incidence among Danish Seventh-day Adventists and Baptists⁽³⁶⁾	2013 Denmark	Cohort study	Increased incidence rates: - General affective disorders in women and decreased in men; - Unipolar disorders for both Adventist and Baptist people; - Bipolar disorders only among Seventh-day Adventists.
Religion, health beliefs and the use of mental health services by the elderly⁽³⁷⁾	2011 Singapore	Cross-sectional study	- Elderly people with religious affiliations had higher rates of mental health problems; - Elderly people interviewed without religious affiliation reported the lowest rate of mental health problems and the highest rate of demand for treatment.
Religion, spirituality, and mental health: current controversies and future directions⁽³⁸⁾	2012 England	Qualitative study	- In adolescence, religious involvement has salutary effects on subjective well-being, and religious adolescents experience less symptoms of anxiety and depression.
The effects of mental illness on families within faith communities⁽³⁹⁾	2012 USA	Cross-sectional study	- Individuals in the DEP group (depression/emotional problems) were younger, more likely to be female and less likely to marry when compared to the CON (Control) group; - Help with depression and mental illness was the second priority for families in the DEP group, while it ranked 42^nd on the list of requests for families in the CON group.
African American Men and Women's Attitude Toward Mental Illness, Perceptions of Stigma, and Preferred Coping Behaviors⁽⁴⁰⁾	2013 USA	Cross-sectional study	- Younger and middle-aged men and women, compared to older men and women, significantly preferred the use of professional help, informal support and religious coping.

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