Research on Religion, Spirituality, and Mental Health:
Harold G Koenig, MD
religion, spirituality, depression, anxiety, psychosis, substance abuse
espite spectacular advances in technology and science,
90% of the world’s population is involved today in some
form of religious or spiritual practice.
make up less than 0.1% of the populations in many Middle-
Eastern and African countries. Only 8 of 238 countries have
populations where more than 25% say they are not religious,
and those are countries where the state has placed limitations
on religious freedom. Atheism is actually rare around the
world. More than 30 countries report no atheists (0%) and in
only 12 of 238 countries do atheists make up 5% or more of
the population. In Canada, 12.5% of the population are non-
religious and 1.9% atheist.
Evidence for religion playing a role in human life dates back
500 000 years ago when ritual treatment of skulls took place
during China’s paleolithic period.
Why has religion endured
over this vast span of human history? What purpose has it
served and does it continue to serve? I will argue that religion
is a powerful coping behaviour that enables people to make
sense of suffering, provides control over the overwhelming
forces of nature (both internal and external), and promotes
social rules that facilitate communal living, cooperation, and
Until recent times, religion and mental health care were
Many of the first mental hospitals were
The Canadian Journal of Psychiatry, Vol 54, No 5, May 2009
Religious and spiritual factors are increasingly being examined in psychiatric research.
Religious beliefs and practices have long been linked to hysteria, neurosis, and psychotic
delusions. However, recent studies have identified another side of religion that may serve
as a psychological and social resource for coping with stress. After defining the terms
religion and spirituality, this paper reviews research on the relation between religion and
(or) spirituality, and mental health, focusing on depression, suicide, anxiety, psychosis, and
substance abuse. The results of an earlier systematic review are discussed, and more recent
studies in the United States, Canada, Europe, and other countries are described. While
religious beliefs and practices can represent powerful sources of comfort, hope, and
meaning, they are often intricately entangled with neurotic and psychotic disorders,
sometimes making it difficult to determine whether they are a resource or a liability.
Can J Psychiatry. 2009;54(5):283–291.
Religious beliefs and practices may be important resources for coping with illness.
Religious beliefs may contribute to mental pathology in some cases.