WPA Position Statement on Spirituality and Religion in Psychiatry

The WPA and the World Health Organization (WHO) have worked hard to assure that comprehensive mental health promotion and care are scientifically based and, at the same time, compassionate and culturally sensitive1, 2. In recent decades, there has been increasing public and academic awareness of the relevance of spirituality and religion to health issues. Systematic reviews of the academic literature have identified more than 3,000 empirical studies investigating the relationship between religion/spirituality (R/S) and health3, 4. In the field of mental disorders, it has been shown that R/S has significant implications for prevalence (especially depressive and substance use disorders), diagnosis (e.g., differentiation between spiritual experiences and mental disorders), treatment (e.g., help seeking behavior, compliance, mindfulness, complementary therapies), outcomes (e.g., recovering and suicide) and prevention, as well as for quality of life and wellbeing3, 4. The WHO has now included R/S as a dimension of quality of life5. Although there is evidence to show that R/S is usually associated with better health outcomes, it may also cause harm (e.g., treatment refusal, intolerance, negative religious coping). Surveys have shown that R/S values, beliefs and practices remain relevant to most of the world population and that patients would like to have their R/S concerns addressed in health care6-8. Psychiatrists need to take into account all factors impacting on mental health. Evidence shows that R/S should be included among these, irrespective of psychiatrists’ spiritual, religious or philosophical orientation. However, few medical schools or specialist curricula provide any formal training for psychiatrists to learn about the evidence available, or how to properly address R/S in research and clinical practice7, 9. In order to fill this gap, the WPA and several national psychiatric associations (e.g., Brazil, India, South Africa, UK, and USA) have created sections on R/S. WPA has included “religion and spirituality” as a part of the “Core Training Curriculum for Psychiatry”10. Both terms, religion and spirituality, lack a universally agreed definition. Definitions of spirituality usually refer to a dimension of human experience related to the transcendent, the sacred, or to ultimate reality. Spirituality is closely related to values, meaning and purpose in life. Spirituality may develop individually or in communities and traditions. Religion is often seen as the institutional aspect of spirituality, usually defined more in terms of systems of beliefs and practices related to the sacred or divine, as held by a community or social group3, 8. Alexander Moreira-Almeida1,2, Avdesh Sharma1,3, Bernard Janse van Rensburg1,4, Peter J. Verhagen1,5, Christopher C.H. Cook1,6 1WPA Section on Religion, Spirituality and Psychiatry; 2Research Center in Spirituality and Health, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil; 3‘Parivartan’ Center for Mental Health, New Delhi, India; 4Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa; 5GGZ Centraal, Harderwijk, the Netherlands; 6Department of Theology and Religion, Durham University, Durham, UK This document was proposed by the WPA Section on Religion, Spirituality and Psychiatry and approved by the WPA Executive Committee in September 2015. The authors thank all who contributed during the process of developing this position statement, and especially D. Bhugra, R. Cloninger, J. Cox, V. DeMarinis, J.J. Lopez-Ibor (in memoriam), D. Moussaoui, N. Nagy, A. Powell, and H.M. van Praag. This position statement has drawn on some of the text of recommendations already published in the Royal College of Psychiatrists position statement11.