Rather than relying on public opinion or conventional lore, systematic research may help address questions regarding the benefits vs. the risks of Catholic beliefs and practices. Although research on religion and mental health in Christians of all persuasions has been systematically reviewed elsewhere (Koenig, 2017), a few selected studies will be examined here to illustrate what has been reported when Catholics are compared to non-Catholics. Since there is a wide range of devoutness among Catholics (i.e., only one-third of Catholics in the U.S. are religiously active based on the figures reported earlier), the findings reported here should be interpreted in that light. Where available, then, research on level of religious devoutness and mental health in Catholics will also be examined. Presented now are studies on depression, suicide, general anxiety, guilt, obsessive/compulsive symptoms, and overall well-being.

Depression

 

Are Catholics more likely than non-Catholics to experience depression? The research findings are equivocal. In a 3-year longitudinal study of 2,812 older adults in New Haven, CT, Idler and Kasl (1992) reported that Catholics were more likely to develop depression than Jews. In contrast, a 2-year longitudinal study of 1,855 older adults in New York City found that Catholics were less likely than Jews to be depressed at baseline and were less likely to become depressed over time (Kennedy et al., 1996). Likewise, in a 10-year longitudinal study of 60 mothers and 151 offspring in New York City, Miller and colleagues (1997) found that Catholic mothers (compared to non-Catholic mothers) were at an 80% lower risk of major depressive disorder at baseline and an 85% lower risk at follow-up. Furthermore, their offspring were at lower risk for depressive disorder as well.

In another report from Miller and colleagues (2012), participants in the above study were followed up 10-years after the initial longitudinal study. They examined 114 offspring (mean age 29 years) of depressed and non-depressed parents, finding no significant difference in depression risk between Catholics and Protestants. However, offspring who indicated that religion/spirituality was very important to them were 76% less likely to develop major depressive disorder during the 10-year follow-up (OR=0.24, 95% CI=0.06-0.95).

Finally, in a 12-year longitudinal study of 48,984 women, weekly attendance predicted less depression in both Catholics and Protestant, with few differences (Li et al, 2016). Thus, based on these selected studies, there is little evidence that Catholics experience more depression than other groups. The conclusion from an earlier systematic review of this topic, then, seems as true today as well as when first reported (McCullough & Larson, 1999): “if there is any relationship between Catholicism and depression, this association is probably too trivial and elusive to merit any serious expenditure of money, time, and effort” (p 128). What is more important than just being Catholic is the extent to which Catholics are actively involved in their religious faith.

Suicide

 

Durkheim (1897) reported that regions of Europe where Catholics predominated had much lower suicide rates than Protestant areas. He attributed this finding to greater social control, integration and cohesion among Catholics, compared to Protestant who were more independent and free thinking. However, this claim of lower suicide rates in Catholics was challenged because the differences in suicide rate were based on ecological data (Van Poppel & Day, 1996; Stack, 2000). Other researchers have reported a decrease in denominational differences in suicide rate between Catholics and Protestants since World War II due to increases in education (Pyle, 2006).

Nevertheless, recent studies in Europe and the U.S. suggest that differences in suicide between Catholics and Protestants remain significant (Torgler & Schaltegger, 2014; VanderWeele et al., 2016). In Europe, Torgler & Schaltegger (2014) explained that the lower suicide rate in Catholics was larger due to greater belief that suicide is never acceptable. They also found that frequency of religious attendance and time spent with other church members, however, predicted negative attitudes toward suicide among Protestants. Since, church attendance is higher in Catholics than Protestants, this may at least partly explained the difference in suicide rate reported by these investigators.

In the most recent report, a 14-year longitudinal study of 89,708 women in the U.S. Nurses’ Health Study conducted by the Harvard School of Public Health, investigators found that those who attended religious services at least once per week were 84% less likely to commit suicide compared to women who never attended services (HR=0.16, 95% CI=0.06-0.46) (VanderWeele et al., 2016). There was more than a five-fold reduction in incidence rate from 7 per 100,000 person-years to only 1 per 100,000 person-years. No significant difference overall in suicide rates was found between Catholics (1.5 per 100,000 person-years) and Protestants (2.6 per 100,000 person-years). Effects of religious attendance on suicide rate, however, were particularly strong among Catholics (HR=0.05, 95% CI=0.006-0.48), where the effect was 7 times stronger than in Protestants (HR=0.34, 95% CI, 0.10-1.10). Thus, the difference between Catholics and Protestants on suicide rate must be due to more than just frequency of religious attendance. Both the authors of this study and an editorial commentary (Koenig, 2016) suggested that this may be due to Catholic prohibitions against suicide as Torgler & Schaltegger (2014) had suggested earlier.

Anxiety

 

In one of the first studies to compare Catholics and Protestants on levels of anxiety, Templer and Dotson (1970) found no difference in death anxiety scores between members of these faith groups in Kentucky college students. Likewise, Cohen and colleagues (2005) found no difference on death anxiety between Catholics and Protestants in a sample of 375 adolescents and young adults in New Jersey and Pennsylvania, although an inverse relationship between intrinsic religiosity and death anxiety was stronger in Protestants than in Catholics. Other studies have also found few differences between Catholics and Protestants in fear of death (Ellis et al., 2013).

In a study of 1,058 adults from North Carolina (108 Catholics, 188 Jews, 762 Protestants), Cohen and Hall (2009) found that Catholics and Protestants reported more fear of God (“I worry that God is upset with me”) than Jews. In that study, Jews were significantly less religious than Catholics and Protestants, which might have accounted for the difference in worrying that God was upset with them. Jews, however, reported that most death anxiety, Protestants the least, and Catholics were in the middle.

Finally, in a study of 167 German breast cancer patients, Catholics scored significantly lower than Protestants on anxiety assessed using the Hospital Depression & Anxiety Scale (uncontrolled analyses) (Zwingmann et al., 2008). Thus, as for depression, differences in anxiety between Catholics and other religious groups appear to be few or equivocal based on the studies above.

Guilt

Conventional thought (or lore) is that Catholics experience more guilt than others. In fact, a recent New York Times article, written near the time of Pope Frances visit to the U.S., was titled “The End of Catholic Guilt” (Egan, 2016). The guilt stereotype for Catholics is also a well-known phenomenon in the clinical literature (Tangney & Dearing, 2002). Given this view of Catholics and the undeniable fact that there are many opportunities for Catholics to feel guilty (as noted above), do Catholics really experience more guilt than members of other religious groups? What do objective comparisons show?

In one of the first studies to quantitatively measure guilt in Catholics and compare it to guilt in members of other faith traditions, London and colleagues (1964) surveyed a small sample of 63 college students in Illinois (15 Catholics, 26 Protestants, 22 Jews). Catholics had the most intensive religious education and Protestants had the least. Jews scored significantly higher on guilt feelings compared to Protestants (3.8 vs. 3.5, p<0.05), although Catholics (3.7) did not significantly differ from Protestants or Jews.

In a larger sample of 281 adults in New York state (average age 46 years), Demaria and Kassinove (1988) compared guilt levels across denomination using a standard 22-item multi-dimensional measure of guilt (interpersonal harm guilt, norm violation guilt, self-control failure guilt). There were 96 Catholics, 46 Protestants, 86 Jews, and 53 non-affiliates in the sample. While investigators found no significant difference in overall guilt between the four groups, Catholics scored significantly higher on “self-control failure” guilt than non-affiliates. The difference, however, was small (11.5 vs. 10.1, p<0.05). Overall religiosity (assessed by the Rohrbaugh & Jessor scale) was positively correlated with overall guilt (r=0.20, p=0.01), whereas “rationality” was inversely correlated with guilt (r=-0.51, p<0.001).

In a much larger sample of 1409 Catholic and 1261 Protestant undergraduate students at the University of Missouri, Sheldon (2006) also reported that Catholics scored higher on introjected motivation (a construct similar to guilt) compared to Protestants. The findings were replicated in a small sample of 40 Catholic, 30 Baptist, and 45 Unitarian adults from the community, helping to confirm the Catholic guilt stereotype. Nevertheless, because of scores on “identified motivation” and “external motivation”, Sheldon concluded that Catholics were not driven by guilt in their religious practices.

More recently, Vaisey and Smith (2008) analysed data on 3,290 U.S. teenagers ages 13-17 and their parents participating in the National Survey of Youth and Religion (NSYR). The NSYR is a nationally representative sample composed of 24.3% Catholics (similar to the percentage of Catholics in the U.S. population in 2002-2003 when the data were collected). Guilt was assessed with the question: “In the last year, how often, if ever, have you found yourself felling guilty about things in your life?” No evidence was found that Catholic teens were more guilty than other young people in this study (p=0.44), nor were Catholics more likely than non-Catholics to say that religion caused or relieved their guilt. Investigators also found no evidence that Catholic teens who went more often to confession did so because they felt guilty, or that Catholics who went to confession felt more religious guilt. However, they did find that Catholic teens who went to confession experienced higher levels of “religious relief” from guilt (which was mediated by importance of religious faith).

Thus, while the Catholic guilt stereotype is reasonable and has some evidence supporting it from regional studies examining convenience samples, data from at least one large national sample did not provide solid support for this hypothesis. Furthermore, even among those studies confirming the Catholic guilt hypothesis, differences between Catholics and others while statistically significant are not large. Finally, guilt is not always bad. There is some evidence that Catholic guilt may actually have prosocial consequences (McKay et al., 2013). Indeed, the absence of guilt has long been known to have its own problems, problem that affect not only the individual but also the community (see McCord & McCord’s 1964 study of psychopathy).

Obsessive-Compulsive Disorder

Early studies reported higher OCD symptoms in Catholics who were more religious, but also found fewer religious obsessions and compulsions in highly religious Catholics compared to highly religious Protestants. Measures of OCD symptoms used in these studies, however, may have been contaminated by items assessing traditional religious beliefs and values (Koenig, 2004, pp 89-90).

In a study of 111 members of convents, nunneries, Catholic associations, and college students in Northern Italy, Sica and colleagues (2002) found that those with medium or high religiosity scored higher on anxiety symptoms, depressive symptoms, and obsessiveness (Obsessive Beliefs Questionnaire) (uncontrolled correlations).

Abrahamwitz and colleagues (2002) examined differences between 197 Catholic and Protestant college students on religious obsessions and compulsions using the 77-item Penn Inventory of Scrupulosity (made up of two subscales titled “fear of God” and “fear of sinful thoughts”). They found that religious Protestants scored higher on fear of sinful thoughts than religious Catholics, Jews overall, and less religious Protestants. However, in an online survey of 102 Catholic (average age 36 years) and 128 Protestant adults (average age 39), no differences on any aspects of scrupulosity, mental contamination, thought-action fusion, or OCD symptoms were found between the two groups (Fergus, 2014).

Thus, based on these few studies, there is little evidence that Catholics are more prone to OCD symptoms compared to Protestants, and when differences are found, these may be due to the use of measures contaminated by conservative religious beliefs or values.

Psychological Well-being

In an early study of 183 retired Catholic sisters, who were compared with 653 retired older adults from various medical and community settings in the Midwestern U.S., the Catholic sisters had the highest well-being of all groups studied (Koenig et al., 1988; Kvale et al., 1989). In the Cohen and Hall (2009) study described earlier, which took place in predominantly Protestant central North Carolina, Catholics and Jews were not significantly different in overall well-being, but Protestants showed significantly higher well-being (morale) than either Jews or Catholics. Concerning satisfaction with social relationships, Catholics did not differ from either Jews or Protestants, although Protestants reported greater social satisfaction than did Jews. Religiosity (measured by a single self-rated item) was positively correlated with well-being in Protestants but not in Jews or in Catholics (although the correlation in Catholics was similar to that in Protestants, i.e., r=0.07 vs. r=0.01).

Most recently, Dilmaghani (2017) analysed data from the Ethnic Diversity Survey of Statistics Canada, a random national sample of 41,695 adults (42% Catholic, 27% Protestant, 16% none, <2% Judaism and Islam). She found that average well-being on a 0 to 5 scale was similar among Catholics (4.3), Protestants (4.8), Jews (4.2), Muslims (4.2), and “none” (4.1). Likewise, the percentage of those who indicated they were “very satisfied” with life was similar in Catholics (48.9%), Protestants (49.2%), Jews (42.8%), Muslims (48.0%), and greater than that in those with no religious affiliation (36.9%). In multivariate models, the particular religious affiliation (Catholic, Protestant, etc.) did not predict life satisfaction once demographic characteristics and religious activity (importance of religion, private religious activities, and religious attendance) were controlled for. Greater religious involvement overall, however, was related to greater well-being, an effect that was equally strong in Catholics and Protestants. Thus, Catholics tend to have similar psychological well-being compared to members of other religious groups, particularly those who are highly religious.

Summary

With the possible exception of experiencing more guilt, Catholics as a group tend to be similar to members of other religious groups in terms of depressive symptoms, suicide, anxiety, obsessions and compulsions, and satisfaction with life, based largely on studies conducted in North America. More important than simply being Catholic, however, is level of Catholic belief, practice, and commitment, which tends to be related to better mental health and greater well-being.