Spirituality and Religion: Initiating a Discussion With Patients

TO THE EDITOR: We commend Psychiatric Services and its sister publication, the American Journal of Psychiatry, for recently including several fine articles shedding much-needed light on the clinical relevance of patients’ spirituality and religion to mental health. This topic has been largely ignored—even shunned—throughout the history of psychiatry, and we are grateful to you for advancing knowledge in this area.

However, if clinicians are to provide spiritually sensitive evidence-based care, not only must they be aware of this domain but they must also take action. In particular, we recommend that clinicians initiate discussions with all patients about spiritual and religious life as a matter of routine clinical practice. Even in this increasingly secular age, 87% of the world’s population is affiliated with a religious group (1). Furthermore, in the United States, 76% hold “certain” belief in God, 57% believe that religion can answer “all or most” of today’s problems, and 53% attend religious services once per month or more (2). More important to psychiatric practice, 80% of acute psychiatric patients report using religion to cope with distress (3).

It is also noteworthy that in a recent survey we conducted at McLean Hospital in eastern Massachusetts —a predominantly irreligious locale (4)—more than half of the sample of 253 patients (N=147, 58%) reported being fairly, moderately, or very interested in discussing spiritual and religious matters with their treatment team (5). This interest was not associated with older age, lower socioeconomic or education status, or clinical characteristics, such as symptom severity or the presence of psychosis, bipolar disorder, or obsessive-compulsive disorder. Even more surprising, although religious affiliation and belief were associated with greater interest in discussing spiritual matters overall, more than a third of patients with no religious affiliation (N=37, 37%) reported being fairly, moderately, or very interested in broaching the subject of spirituality with their mental health practitioners.

Given these trends, we recommend that clinicians ask all patients whether they would like to discuss spirituality and religion in the context of their treatment. When patients provide an affirmative response, we recommend that clinicians follow up by asking patients if they view spirituality and religion as relevant to their symptoms or treatment. We have successfully used this approach with more than 500 patients and have found that it validates the importance of this domain while keeping any ensuing discussion focused on clinical assessment and treatment.

We hope to see more coverage of this topic in the pages of your journal and elsewhere in the coming years. More important, we hope to see the development of practice guidelines for providing spiritually sensitive care and their dissemination to trainees and practitioners alike.