Psychological Medicine

Original Articles

Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study

B. Leurenta1a2, I. Nazaretha2, J. Bellón-Saameñoa3, M.-I. Geerlingsa4, H. Maaroosa5, S. Saldiviaa6, I. Švaba7, F. Torres-Gonzáleza8, M. Xaviera9 and M. Kinga1 c1

a1 Mental Health Sciences Unit, Faculty of Brain Sciences, University College London Medical School, UK

a2 Research Department of Primary Care and Population Health, University College London Medical School, UK

a3 Department of Preventive Medicine, El Palo Health Centre, Malaga, Spain

a4 University Medical Centre, Utrecht, The Netherlands

a5 Faculty of Medicine, University of Tartu, Estonia

a6 Departamento de Psiquiatrıa y Salud Mental, Universidad de Concepción, Chile

a7 Department of Family Medicine, University of Ljubljana, Slovenia

a8 CIBERSAM-Granada University, Granada, Spain

a9 Department of Mental Health, Faculdade Ciencias Medicas, CEDOC, Lisboa, Portugal


Background Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the USA, limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.

Method Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.

Results The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p < 0.001). However, the findings varied significantly across countries, with the difference being significant only in the UK, where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.

Conclusions These results do not support the notion that religious and spiritual life views enhance psychological well-being.

(Received July 13 2012)

(Revised November 19 2012)

(Accepted December 06 2012)

(Online publication January 29 2013)

Key words

  • General practice;
  • longitudinal;
  • major depression;
  • religion;
  • spirituality


c1 Address for correspondence: Professor M. King, Mental Health Sciences Unit, University College London, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. (Email: