The question of whether religion has beneficial or detrimental effects on the mental well-being of the adult individual is debatable. Because most Korean citizens are free to select their own religion, there is a higher proportion of non-believers than believers among the Korean population. The aim of this research was to investigate the association between spiritual values and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders in Korea across all types of belief systems, including Koreans not affiliated with a particular religion.
The Korean version of the Composite International Diagnostic Interview 2.1 was used to interview 6,275 people across South Korea in 2001. While controlling for age and sex, we used logistic regression to analyze the relationship between mental disorders (both current and past) and the types of religion and spiritual values.
Strong spiritual values were positively associated with increased rates of current depressive disorder and decreased rates of current alcohol use disorder. Using "atheist" as the reference category, Catholics had higher lifetime odds of single episodes of depression whilst Protestants had higher lifetime odds of anxiety disorder and lower lifetime odds of alcohol use disorders.
The results of this study suggest that depressive episodes often lead to a search for spirituality and that religion may be helpful in overcoming depression or becoming less vulnerable to relapsing. The associations between religion, spiritual values, and mental health have not been fully elucidated and warrant further exploration.
The effect of religion on mental health has long been debated and remains controversial despite some positive findings in reviews of empirical research.
Although many studies have been conducted on mental illness among people with different religious affiliations, almost all have focused on Christian denominations. Therefore, few studies have explored the association between mental health and religiosity across a wide variety of types of religious believers.
Although the last Korean dynasty was based on Confucianism, which had been imported from ancient China approximately 700 years ago, most Koreans adopted Buddhist beliefs until the early 20th century. However, the Christian population, including Protestants and Catholics, has increased in the past several decades, and Christianity has now become the most popular religion in Korea. Nonetheless, the proportion of atheists remains substantial because religion is not obligatory in Korean society. Another factor affecting religious adherence is the negligible number of minor religious groups among Korean nationals, which reflects the ethnic homogeneity of the country.
Spirituality can be defined as a personal quest for understanding answers to ultimate questions about life, meaning, and the relationship with the sacred. Because religious practices and rituals differ, spirituality may be associated with mental health, regardless of the type of religion.
The aim of this study was to compare the rates of three psychiatric disorders (major depressive disorder, anxiety disorder, and alcohol use disorder) according to type of religion or spiritual values in a nationwide sample of Korea.
The Korean Epidemiologic Catchment Area study was conducted between June 1 and November 30, 2001 to collect mental health-related information about the Korean population aged 18-64 years living in private dwellings. This survey utilized the diagnostic definitions in the DSM-IV
A current mental disorder was defined as the occurrence of an episode that met the diagnostic criteria of any mental disorder during the preceding 12 months. In addition, the term "past mental disorder" was used to categorize cases with a lifetime history of any mental disorder that fulfilled the diagnostic criteria but with no episodes during the preceding 12 months.
We asked the respondents two questions: "What is your major religion in most of your life?" and "How much have spiritual values played an important role in your life?" Spiritual values were evaluated using quartiles of one (none) to four (high).
Minor religions were excluded in the analysis due to cell sizes below five.
Group differences in the sociodemographic variables and the stated importance of spiritual values were computed using the chi-squared and ANOVA tests We also applied logistic regression models to determine the lifetime, one-year, and past odds of mental disorders based on the type of religion, using "atheist" as the reference category. Each mental disorder was analyzed separately and adjusted for age and sex. In addition, a series of logistic regression analyses derived odds ratios and 95% confidence intervals using the past or current mental disorders as the main outcome variables and DSM-IV SP and spiritual values as the predictor, after adjusting for age, sex, and type of religion. All statistical analyses were conducted using SPSS version 14.0.
Universally, females reported more religious affiliation across three religious groups (64.0% for Buddhism, 63.9% for Christianity, and 67.4% for Catholicism) than males. Buddhism was more popular among older, less-educated, and lower-income individuals.
Spiritual values were higher among Christians than among Buddhists (
The lifetime prevalence of a single episode of major depressive disorder was higher in Catholics than in atheists. Moreover, the lifetime prevalence of anxiety disorder was higher in Protestants and Catholics than in atheists. In contrast, the lifetime prevalence of alcohol use disorder was lower in Protestants than in atheists. There were no significant differences between the types of religion in either the lifetime or the one-year prevalence of any mental disorder (
Protestants had higher ORs for lifetime anxiety disorder and lower ORs for lifetime alcohol use disorder. Catholics had higher ORs for lifetime and past prevalence of single episodes of major depressive disorder but not for one-year prevalence (
The results of the logistic regression analysis indicate that stronger spiritual values were associated with higher odds of suffering current depression (
Conversely, there was a significant negative correlation between the odds ratio of alcohol use disorder and the reported importance of spiritual values. There were no significant differences in the prevalence rates of past mental disorders according to spiritual values (
This study revealed two important associations between mental disorders and spirituality. We confirmed that attaching high importance to spiritual values was associated with a higher prevalence of current depression, irrespective of causality. In contrast, a higher importance placed on spiritual values was also associated with less current alcohol use disorder. These results are similar to those of a previous Canadian study that analyzed mental disorder prevalence data using the CIDI.
Positive associations between mental disorders and spiritual values have been interpreted in two ways.
Because we did not include worship frequency, which is associated with different types of belief in God across religions, our study provides no information on how religious activity is related to depression. However, we can posit that current depression can result in people placing a high importance on spiritual values regardless of the frequency of their attendance at religious services. It is natural that a serious illness could cause an individual to seek spiritual support.
Strong spirituality was associated with a significantly lower odds ratio of current alcohol use disorder. This pattern differs from those observed for current major mental disorders. These results are in accordance with prior studies indicating that a high level of religious involvement predicts a reduced risk for alcohol misuse.
The associations between religion/spirituality and anxiety disorders were insignificant and similar to those of prior studies.
There have been epidemiological observations that members of some religious groups appear to be at elevated risk for certain mental disorders.
The unadjusted prevalence data indicate that the highest lifetime prevalence for a single episode of depression was associated with Catholic religious affiliation. In contrast, the same group had the lowest lifetime prevalence of recurrent depression, though the difference was not significant in the logistic regression analysis. Because we have no information regarding the timing of the onset of depression and the entry into religious life, it is not clear whether depressed persons are eager to become Catholics. However, the significant association of Catholicism with past depression leads us to a particular interpretation. Catholic beliefs, for example, may have a healing effect on depression or may prevent a relapse. This hypothesis is supported by the absence of a significant current ethnic religion affiliation among Koreans, who are allowed to freely select their own religious beliefs. In other words, their religion might not be determined by their parents but rather by the individuals themselves; therefore, there is a tendency to become involved with religion with increasing age.
The lower odds ratio of lifetime alcohol use disorder in Protestants is relatively easy to explain
The lifetime prevalence of anxiety disorder was higher among this survey's Protestant respondents compared with the atheists. People with anxiety disorder may attend church to relieve anxiety. In contrast, some Christian doctrines, such as the belief that people are born with original sin, may evoke anxiety among believers. Inconsistent with our results, a previous study has reported a high rate of anxiety disorder among young adults with no religious affiliation.
Our study has several limitations. First, although we examined a large, nationally representative population using the K-CIDI 2.1, this was essentially a cross-sectional study. Therefore, our choice to divide lifetime prevalence into current and past prevalence was based on incomplete evidence used to infer temporal associations between mental health and religious beliefs/spirituality. More valid and rational explanations concerning directionality need to be explored in prospective studies of large, general populations. Second, we only evaluated spirituality in one survey question. Because of the different cultures and rituals across religions, we predicted that this method would provide a more tailored approach to elucidating the association between religion and mental health. Nonetheless, we question whether our study evaluated the correct "spirituality" because measures of spiritual values are not well established.
The results of our study may reflect the possibility that a depressive episode motivates people to search for spiritual meaning or the power of God. Spirituality might not have been as highly regarded when the individual first became depressed, but over time, spiritual values may help an individual overcome depression or become less vulnerable to relapse. However, this interpretation fails to provide firm evidence for why a longing for God appeared to occur only among the surveyed Catholics. Thus, further research is required.
This work was funded by the Korean Ministry of Health and Welfare in 2001. Technical support was provided by Dr. Harry Minas, Associate Professor, Center for International Mental Health, School of Population Health, the University of Melbourne, Victoria, Australia.
The relation between spirituality and past and current mental disorders (with adjusted sex, age, type of religion). *p<0.05, **p<0.01. MDD: major depressive disorder.
Sociodemographic profiles according to religion in the Korean Epidemiologic Catchment Area (KECA) Study (N=6,275)
*chi square test and ANOVA test. N: number, SD: standard deviation
The prevalence of mental disorder according to the type of religion
MDD: major depressive disorder, CI: confidence interval
Multiple logistic regression for relation between the type of religion and prevalence of mental disorders (with adjusted sex and age)
*p<0.05, **p<0.01, ***reference axis. MDD: major depressive disorder, CI: confidence interval
Multiple logistic regression for relation between spirituality and past and current mental disorders (with adjusted sex, age and type of religion)
*p<0.05, **p<0.01. MDD: major depressive disorder, CI: confidence interval