Influence of spirituality and psychological resilience on depression outcomes in India: A prospective observational study

Background: Spirituality and psychological resilience are recognized as protective factors for mental health, but a few Indian studies have examined their joint impact on recovery from depression. Aim: To assess how spiritual wellbeing and resilience relate to symptomatic improvement in depression. Materials and Methods: This prospective observational study was conducted at a government psychiatry outpatient department in Central India between September and November 2024. A total of 166 adults (18–65 years) diagnosed with mild to moderate depression (DSM-5) were assessed at baseline and 3-month follow-up using the Spiritual Well-Being Scale (SWBS), Brief Resilience Scale (BRS), and Hamilton Depression Rating Scale (HAM-D). Correlation, subgroup, mediation (5000 bootstrap resamples), and multiple linear regression analyses were performed. Ethical approval was obtained from the Institutional Ethics Committee (EC/MGM/Aug-24/30, dated August 17, 2024). Results: Higher baseline spiritual wellbeing was associated with greater reduction in HAM-D scores at follow-up ( ρ = –0.73, P < 0.001). Resilience was positively correlated with spirituality ( ρ =0.59, P < 0.001) and inversely with follow-up depression severity ( ρ = –0.49, P < 0.001). Mediation analysis indicated resilience partially mediated the effect of spirituality on depression improvement (indirect effect = 0.022, 95% CI: 0.007–0.040). Regression showed both SWBS ( β =0.179, P < 0.001) and BRS ( β =0.137, P = 0.001) were independent predictors, together accounting for 77% of variance in depression outcome. Conclusion: Spiritual wellbeing and resilience independently and synergistically predict improvement in depression, highlighting the value of culturally tailored interventions in Indian mental health care.