Religiosity as a Protective Factor in Depressive Disorder

To the Editor: The detailed study by Harold G. Koenig, M.D., and colleagues on whether religiousness influences the outcome of depression within a 1-year follow-up period was of great interest to us. Because we are working on similar data that we reported on recently (1), we would like to compare the two studies.

Both studies focus on the intrinsic motivational (salient) aspect of religiousness (2), as opposed to behavioral, cognitive, or perceptual aspects. The operationalization of depression differs for the U.S. study (diagnostic criteria supplemented with four additional symptoms) and the Dutch study (Center for Epidemiologic Studies Depression Scale scores higher than 16). Nevertheless, the outcomes are fairly similar: time to first remission in the American study (reached by 54% of the subjects) and percentage permanent remission in the course of 1 year in the Dutch study (35%). Both studies show a strong association between religiousness and remission. The most striking similarity between the two studies, however, concerns the modifying effect of poor physical health. Depressed elderly people with chronic diseases, functional limitations, or symptoms of pain (Dutch study) or those with worsening physical functioning (American study) benefit more from intrinsic religiousness than healthy elderly people.

Western Europe and Northern America strongly differ with respect to religion. The percentage of non-church members in the Netherlands (50%) is more than twice as high as that in the United States (3). Because of considerable adherence to traditional beliefs, Americans are, as far as religion is concerned, categorized as belonging to a group of the most orthodox countries, whereas most Western European countries fall within the least orthodox group. These cultural differences, however, may be less pronounced in the older generation, in which religious traditions have been largely preserved. Moreover, questions of ultimate concern force themselves on elderly people in equal ways.

The essential mechanism of why intrinsic religiousness promotes the resolution of depression in older adults remains to be elucidated. Both articles underline the plausible capacities of religion to sustain self-esteem and to restore hope. Nevertheless, most models of depression regard the origins but not the course or the relevance of coping resources in the resolution of depression. A discussion between American and European scholars on similarities and differences between their findings might be fruitful to produce hypotheses on the psychological and cultural determinants of the course of depression on both continents.