Religious beliefs, practices and mental health outcomes: what is the research question?

Results from three studies exploring the association of religion (specifically religious beliefs and practices) with depression among older adults are presented in this issue of the American Journal of Geriatric Psychiatry. Two of the three state specific hypotheses, yet all three studies are driven by a generic and—for all practical purposes—overt research question that, though varying across studies, is basically the same. The generic research question driving these studies is roughly, “Are self-reported religious beliefs and practices associated with less depression?” The null hypothesis is stated roughly, “Self-reported religious beliefs and/or practices are not associated with less depression.” The results of these studies, described in more detail below, are mixed. Two studies suggest a positive association between religious beliefs/practices and less depression, whereas a third does not find a clear association. These findings should not be surprising. They do not necessarily contradict one another but rather reflect the complexity inherent in studying a construct such as religion as a predictor of health outcomes. Progress in science is usually iterative and apparently conflicting results usually signify a need to study the subject more thoroughly, building upon findings from as well as constructive critiques of previous studies (however trite the call for “more studies” may appear). Yet studies of religion and health often stimulate a strong visceral response and that response may be negative or positive. I propose that such responses derive from how the research question is framed. We may find ourselves responding to a question that is not being asked by the study. Frequently that response is linked to more emotionally charged questions lurking in the background of the overt questions posed, therefore blurring our ability to move the science forward. The overt question driving the studies in this issue begs a more general and emotionally charged question: Can the benefits of religious beliefs and practices for health (if there be benefits) be studied, much less proven, via empirical research? At one pole, proponents such as Larry Dossey boldly assert that religious practices, for example prayer, have been unquestionably proven to be as valid and vital a healing tool as drugs or surgery. In contrast, critics such as Richard Sloan have challenged the entire religion and health research enterprise, asserting that there are no proven curative powers in practices such as prayer and that the contamination of medical practice with unproven “spiritual” approaches seriously undermines the effective as well as the ethical practice of medicine. (To be fair, Sloan mainly challenges the scientific justification for the use of spiritual practices by medical practitioners.) The answer to the question “Can the association between religious beliefs/practices and health be studied empirically?” will continue to be debated for years to come. I propose that the answer is neither yes nor no. Rather, each investigative endeavor must be evaluated on its own merits starting with how the research question driving the study is framed. The findings of the investigations reported in this issue should be absorbed, critiqued, and finally accepted for how well they address the specific question asked of the data, no more and no less.