Spiritual Engagement and Mental Health: What the Reviews Report
Religious and spiritual engagement is associated with better mental health across reviews, with a small overall effect in longitudinal meta-analysis (r = 0.08; Garssen 2020); negative spiritual coping was associated with more mental-health diagnoses and symptom severity while positive coping had an ameliorating effect in veterans (Smith-MacDonald 2017).
The direct evidence for the negative-coping half of this claim comes from high-adversity samples, combat veterans (Smith-MacDonald 2017) and trauma-exposed veterans (Sinnott 2023), not from general healthy populations. The review also cautions that many positive spirituality-wellbeing correlations are inflated by construct overlap (Garssen 2016).
- Persistent hopelessness, emptiness, or a sense that life is meaningless lasting more than two weeks: encourage contact with a licensed mental-health professional
- Any thoughts of self-harm or suicide, or feeling life is not worth living: direct the user to a crisis line or emergency services immediately
- Acute existential or spiritual crisis causing marked distress or inability to function: refer to a counselor, chaplain, or clinician
- Spiritual struggle or conflict that persists or worsens: recommend professional or pastoral support rather than self-help alone
What the evidence says
The sources are reviews and meta-analyses of religious and spiritual engagement and mental health. Garssen 2020 (longitudinal meta-analysis) reports a significant but small overall effect (r = 0.08), with only public religious activities and importance of religion significantly related to mental health; Coelho-Júnior 2022 (meta-analysis) reports high religiosity and spirituality negatively associated with anxiety and depressive symptoms and positively with life satisfaction, meaning and social relations in older adults; Moreira-Almeida 2006 and Jena 2025 (systematic reviews) report religious involvement mostly associated with better mental health; AbdAleati 2016 (systematic review) reports a significant connection between religious beliefs and practices and mental health; Koenig 2012 (systematic review) presents theoretical models of how religion and spirituality influence mental and physical health; Aggarwal 2023 (meta-analysis) reports spiritual well-being protective against depression in young people (r = −0.153) and a trend for negative religious coping toward more depressive symptoms; Koh 2026 (meta-analysis) reports a 13% protective association of spirituality with harmful drug use, 18% with greater-than-weekly service attendance. On coping: Smith-MacDonald 2017 (systematic review of veterans) reports negative spiritual coping associated with more mental-health diagnoses and symptom severity while positive spiritual coping had an ameliorating effect; Sinnott 2023 (cohort of trauma-exposed veterans) reports divine spiritual struggle associated with lower meaning and higher suicidality and post-traumatic stress, with meaning in life fully mediating those links. Garssen 2016 cautions that studies using spiritual well-being as a predictor inflate the apparent association because the measures overlap with general well-being.
- Do not prescribe, rank, or endorse any specific religion, deity, faith tradition, or belief system
- Do not claim these practices cure, treat, reverse, or prevent any disease or mental illness
- Do not make claims about an afterlife, the soul, the supernatural, or any metaphysical truth
- Do not present correlational or observational findings as proof that the practice causes health outcomes
- Do not position these practices as a substitute for medical care or psychological treatment
- Agreement
- Direction recorded for 0 of 11 sources; not yet recorded for the rest.
- The claim's outcome
- Outcome not yet recorded
- Certainty
- No source states a certainty rating.
- Authors
- Sources share authors: B. Garssen (first author of 2 sources); H. Koenig (senior author of 2 sources).
What each source measured and concluded (11)
- What it measured
- Mental health and physical health outcomes in relation to religion/spirituality
- How it was read
- screened only, not extracted
- What it measured
- Mental health outcomes in relation to religiosity
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review
- Studies and participants, as stated
- 850 studies (larger review); update of post-2000 papers
- What it measured
- Mental health outcomes in relation to religion
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review
- Studies and participants, as stated
- 74 articles (published Jan 2000-March 2012)
- What it measured
- Harmful or hazardous alcohol and other drug use (alcohol, tobacco, marijuana, illicit drugs)
- How it was read
- screened only, not extracted
- What the review says it includes
- Meta-analysis
- Studies and participants, as stated
- 55 rigorous studies
- What it measured
- Relationship between spirituality and mental well-being
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review
- Studies and participants, as stated
- 43 studies (from 6,555 abstracts)
- What it measured
- Association of religiosity/spirituality with prevalence, severity, and incidence of mental health problems
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis of observational (cross-sectional and longitudinal) studies
- Studies and participants, as stated
- 102 studies; 79,918 older adults
- What it measured
- Prevention and management of depression and anxiety
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review and meta-analysis of longitudinal and intervention studies (JBI appraisal)
- Studies and participants, as stated
- 45 longitudinal and 29 intervention studies (meta-analysis of 25 high-quality longitudinal studies)
- What it measured
- Association between religion/spirituality and mental health
- How it was read
- screened only, not extracted
- What it measured
- Mental health outcomes (anxiety, depression, life satisfaction, coping, resilience)
- How it was read
- screened only, not extracted
- What the review says it includes
- Systematic review (PRISMA 2020)
- Studies and participants, as stated
- 52 studies (from 1,330 identified; 160 full-text assessed)
- What it measured
- Mental health (distress, life satisfaction, well-being, quality of life)
- How it was read
- screened only, not extracted
- What the review says it includes
- Meta-analysis of longitudinal studies (random effects)
- Studies and participants, as stated
- 48 longitudinal studies (59 independent samples)
- What it measured
- Posttraumatic stress symptoms (PTSS) and suicidality; meaning in life as mediator
- How it was read
- screened only, not extracted
Each source below is shown with its study design and a link to the original study, or, where it is not a completed research paper, with what kind of record it is; those are not counted. This is the audit trail.
Why do some records show a record type instead of a study design?
A study design is shown for a completed, peer-reviewed paper. A registered protocol, a preprint, a conference abstract, a referee report or a book chapter has not been through peer review as a finished paper, so it is labelled for what it is, and it is counted in no source count. Where a record could not be confirmed as a completed paper at all, it says so rather than guessing. They all stay in the list, and their DOI still resolves, because the count of what was screened is part of the audit trail.
- Protocol / registration A registered plan for a review or trial, not its results.
- Preprint Posted by its authors before peer review.
- Conference abstract A conference summary rather than a peer-reviewed paper.
- Peer-review report A referee's report on a paper, not the paper itself.
- Guideline / position stand A recommendation derived from evidence, which is a step further from the data than the evidence itself.
- Book chapter A chapter in a scholarly book rather than a journal paper.
- Type not recorded Our record does not say what kind of publication this is, so it is counted in no source count. That is a gap in our data, not a judgement about the research.