Views of US Religious Leaders on the Etiology and Treatment of Depression

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CASE VIGNETTE

Ms Nixon is a 65-year-old African Americanfemale with no formal past psychiatric history who presents to the outpatient clinic for an initial evaluation. She has no significant past medical history besides hypertension that is adequately treated. Routine laboratory studies were unremarkable except for mildly low vitamin D levels.

For the past 3 months, she has experienced mood symptoms that satisfy DSM-5 criteria for a major depressive episode. Ms Nixon is active in apredominantly Black protestant church. She says she spoke about her depression with her pastor, who advised her that this was a spiritual problem due to lack of faith and recommended prayer and scripture study. As Ms Nixon’s psychiatrist, what treatment would you recommend, and how would you address her pastor’s response?

Up to 1 in 4 individuals seeking mental health treatment also seek help from a religious leader.¹ Therefore, knowledge and attitudes of clergy toward mental health and its treatment have important implications. As previous research in this area is limited, there are no established conclusions about the views of clergy regarding the causes and treatment of mental illness.

The Current Study

Holleman and Chaves² used the National Survey of Religious Leaders (NSRL) to provide information about the extent to which clergy view the etiology and treatment of depression as medical, religious, or a combination of both. They performed a cross-sectional study of the NSRL, a national representative sample of 1600 leaders of religious congregations (890 primary and 710 secondary) in the United States, conducted from February 2019 to June 2010.

Eighty-two percent of respondents completed the survey as an online, self-administered questionnaire. The cooperation rate among primary leaders was 70%.

The authors used data from the 890 primary leaders. Respondents read a vignette describing a hypothetical congregant who met DSM-IV criteria for major depressive disorder. They were asked questions on a Likert scale about the likely causes of the problem and recommendations for seeking help.

Respondents were categorized into 1 of 5 religious traditions: predominantly Black Protestant (21.6%); predominantly white conservative or evangelical protestant (43.2%); predominantly white mainline protestant (20.6%); Roman Catholic (6.1%); or other, which included Jewish, Muslim, Hindu, and Buddhist leaders (8.5%).

The authors reported the percentage of responses that were moderately or very likely for a given cause or recommendation. For each reported percentage, the authors calculated 95% confidence intervals (CIs).

The mean respondent age was 59 years, 83% of respondents were male, and 59% of respondents had a master’s degree. Religious leaders most commonly endorsed situational etiologies for the depression, including stressful circumstances (93%), traumatic experiences (82%), and lack of social support (66%). Biological explanations were endorsed by 79% (chemical imbalance) and 59% (genetics), respectively. A minority of clergy endorsed religious causes, including lack of faith (29%) and demonic possession.

Most clergy endorsed a medical approach, with 90% encouraging seeking help from a mental health professional and 87% encouraging taking prescribed medication. Most leaders also encouraged religious treatment, including addressing the situation through prayer, scripture study, or other religious activity (84%).

Leaders of predominantly Black protestant churches (15%) and predominantly white conservative or evangelical protestant churches (13%) were more likely to encourage only a religious response to symptoms than pastors of both predominantly white mainline protestant churches (3%) and catholic churches (1%).

Study Conclusions

The authors concluded that clergy were more likely to endorse situational or biological causes of depression than religious causes. Religious leaders were more likely to encourage religious treatment for depression than endorse a religious cause, but not isolated religious treatment. However, a nontrivial minority of religious leaders endorsed only religious causes and treatment of depression.

Study limitations include the cross-sectional design and most sample sizes of specific religious clergy, and the fact that the findings are limited to views about depression.

The Bottom Line

Most religious leaders adopted a wholly medical or combined medical and religious view of depression. Religious views of depression mainly supplement rather than replace medical views. Religious leaders are important allies in the recognition and treatment of depression.

Dr Miller is a professor in the Department of Psychiatry and Health Behavior at Augusta University in Augusta, Georgia. He is on the Editorial Board and serves as the schizophrenia section chief for Psychiatric Times^TM. The author reports that he receives research support from Augusta University, the National Institute of Mental Health, and the Stanley Medical Research Institute.

References

1. Wang PS, Berglund PA, Kessler RC. Patterns and correlates of contacting clergy for mental disorders in the United States. Health Serv Res. 2003;38(2):647-673.

2. Holleman A, Chaves M. US religious leaders' views on the etiology and treatment of depression [published online ahead of print, 2023 Jan 11]. JAMA Psychiatry. 2023;e224525.