Psychological Therapy Outcomes and Engagement in People of Different Religions
Authors: Zainab Shafan-Azhar, Jae Won Suh, Henry Delamain, Laura-Louise Arundell, Syed Ali Naqvi, Tania Knight, Sarah Ellard, Stephen Pilling, Rob Saunders, Joshua E. J. Buckman
Journal: JAMA Network Open (2025)

Importance Identifying whether people of minoritized religious identities are less likely to benefit from psychological therapy is key to tackling inequalities in mental health treatment. Objective To assess inequalities in the effectiveness of routinely delivered psychological therapy across religious groups and by the intersections with ethnicity. Design, Setting, and Participants Retrospective cohort study including all patients who completed a course of treatment at 5 London-based National Health Service Talking Therapies for anxiety and depression (NHS TTad) services between 2011 and 2020. Individuals reported their religion using routine patient records collected by the services. Data were analyzed from September 2023 to October 2024. Exposures Self-identified religion was categorized into (1) no religion, (2) Christian, (3) Muslim, and (4) other (which was further categorized into Buddhist, Hindu, Jewish, Sikh, and any other in a sensitivity analysis). Ethnicity was conceptualized as a potential confounder and separately as an effect modifier. Self-reported ethnicity was categorized based on UK Census codes into Asian, Black, mixed race, White, and other ethnic groups. Main Outcomes and Measures Psychological treatment outcomes used to assess NHS TTad services nationally, including reliable recovery, recovery, and reliable deterioration. Dropout from treatment was also examined. These outcomes were defined based on pre-post treatment changes in depression and anxiety symptom measures according to national guidelines. Results A total of 70 098 patients with data on self-reported religion were included in the study (mean [SD] age at referral, 39.2 [14.1] years; 47 797 [68.2%] female). After adjusting for sociodemographic, treatment-related, and clinical characteristics, the odds of reliable recovery were higher in patients who did not have any religious belief (odds ratio [OR], 1.34; 95% CI, 1.26-1.42) or self-reported Christian (OR, 1.39; 95% CI, 1.31-1.48) and other religion (OR, 1.25; 95% CI, 1.17-1.34) compared with Muslim patients. While treatment outcomes improved each year in all groups, Muslim patients remained least likely to improve and more likely to deteriorate. There were interactions between religion and ethnicity; in particular, Muslim patients of White or other ethnic backgrounds had worse outcomes than Muslim patients of Asian, Black, or mixed race ethnic backgrounds and compared with non-Muslim patients of those ethnicities. Conclusions and Relevance In England, patients who identified as Muslim, and particularly those of White or other ethnicities, had poorer outcomes from psychological therapies for depression and anxiety disorders than patients who reported no religion or any other religion. This may be partly due to unmeasured characteristics that warrant further investigation (eg, nationality and asylum-seeking or refugee status). Best practice guidelines on working with people of minoritized ethnicities may inform some of the changes needed to reduce inequalities, but must address religious identity separate from ethnicity, as well as their intersections.