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To give a sense of the volume of published studies since 2010, a literature search using the words Hinduism and mental health in Google Scholar (9/8/16) yielded almost 18,000 results. Only a small fraction of these, however, were quantitative studies comprising Hindus and non-Hindus or examining relationships between religiosity and mental health in Hindus. To conduct a systematic review of even this small literature (like we conducted in the last chapter for research published prior to 2010), however, is beyond the scope of this review. Instead, a sampling of more recent studies will now be presented that illustrates the types of studies that have been appearing in the literature since 2010.
Research in this area has been held back in part by the lack of reliable/valid measures of Hindu religiosity. Although at least three such measures have been published (Bhushan scale, Hindu RCOPE, and Santosh-Francis Attitude ward Hinduism Scale), these scales assess religiosity quite broadly and often do not assess specific Hindu beliefs and practices (Bhushan, 1970; Tarakeshwar et al., 2003; Francis el al., 2008). Perhaps lack of specificity is necessary given the wide range of beliefs and practices in the Hindu faith tradition.
Studies from the research reviewed above will be categorised into coping with stress, anxiety and depression, suicide, somatic/psychosomatic symptoms, chronic mental illness, and substance abuse. In addition, research on psychological well-being will be included given the dramatic increase in research in the area of positive psychology. Recent Hindu-based mental health interventions (excluding studies of western-based Transcendental Meditation) will also be examined.
Coping with Stress
In a study of Hindu family caregivers of patients with cancer in Pune, India, Thombre and colleagues (2010) found that positive religious coping was associated with increased post-traumatic growth (PTG) and PTG was associated with less use of negative coping strategies. The authors concluded that these findings underscored the importance of meaning-focused forms of religious coping.
In a qualitative study of 18 first-generation Asian Indian older adults ages 61 to 82 years who had emigrated from India to the US, Tummala-Narra and colleagues (2012) found that spirituality or belief in a higher power helped to explain reasons for situations and events, including integration to the U.S. Since all participants were Hindus, researchers speculated that karma (belief that actions in the past determine future events) may have contributed to their ability to make sense of life transitions at this time. In particular the Hindu belief in contemplating life and death during the last stages of life seemed to drive their reminiscing about past life events and putting them in perspective (which researchers indicated was healthy).
Benson and colleagues (2012) examined the relationship between religious coping and enculturation stress in 112 Hindu Bhutanese refugees from camps in Nepal, who were now settled in Phoenix, Arizona. Over half had little or no English proficiency and few had any formal schooling. Using the 20-item Hindu RCOPE and two standard scales of acculturation stress, researchers found that contrary to expectation, higher religious coping was associated with higher levels of acculturation stress, both environmental (r=0.47, p<0.01) and social (r=0.46, p<0.01). These associations remained significant after controlling for age, education, marital status, working status, English proficiency, and satisfaction with social support. The authors explained that participating in ethnic communities (reflected by high levels of Hindu religious coping) may have an “insulating or cocooning effect” that could hinder the acculturation process for these refugees. An alternative explanation, not mentioned by the authors, is that high acculturation stress could have caused these refugees to turn to their religious beliefs for comfort and meaning.
Shah and colleagues (2011a) examined the relationship between religious/spiritual (R/S) beliefs and coping among 103 outpatients with residual schizophrenia (mean age 34.4) in Chandigarh, India. Mood symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS), and coping behaviour were measured by the Ways of Coping Checklist (WCC). R/S was assessed using the WHO Quality of Life-Spirituality, Religiousness and Personal Beliefs scale (SRPB), which measures spirituality, spiritual connection, meaning and purpose, experiences of awe and wonder, wholeness and integration, spiritual strength, inner peace, hope, optimism, and faith (i.e., this scale is heavily contaminated by indicators of mental health). The “faith” subscale asks: “To what extent does faith contribute to your well-being?”; “To what extent does faith give you comfort in daily life?”; “To what extent does faith give you strength in daily life?”; and “To what extent does faith help you to enjoy life?” While the “faith” subscale is the least contaminated with mental health items and most distinctive of the eight subscales, it is still heavily loaded with items tapping good mental health. Furthermore, how this patients understood the word “faith” is also unclear. Nevertheless, higher SRPB scores overall were associated with greater distancing, self-control, problem-solving, and positive appraisal. The faith subscale of the SRPB was positively associated with confrontational (r=0.27, p<0.01) and positive appraisal (r=0.44, p<0.001), both healthy coping strategies. No correlation was found between SRPB and mood scores on the PANSS.
In a second report from this study, Kate el al (2013) examined 100 caregivers of patients with schizophrenia to identify factors associated with positive aspects of caregiving. The Scale for Positive Aspects of Caregiving Experience (SPACE) assessed the primary outcome. All subscales of the SRPB (except meaning/purpose) including the faith subscale were positively associated with positive aspects of caregiving (r=0.23, p=0.02). Given the contaminated measures of spirituality used here, not much can be said about either the coping of Hindus with schizophrenia or their caregivers.
Depression
Gupta and colleagues (2011) examined relationships between religiosity and psychopathology in 60 patients experiencing a depressive disorder for the first time. Participants were being seen at a psychiatry clinic in Chandigarh, North India. Depression was assessed by the Beck Depression Inventory (BDI) and by the Hamilton Depression Rating Scale (HDRS). Also assessed were hopelessness (Beck Hopelessness Scale) and suicidal intent (10-item scale). Religiosity was measured in the local language using a 44-item scale which measured level of religious faith and belief. Based on their score, participants were divided into low (n=30) and high (n=30) religious groups. Although trends were in the expected direction, no significant difference was found between high and low religious groups on depressive symptoms or level of hopelessness or suicidal ideation. However, religiosity overall was inversely related to hopelessness on the Beck scale (r=-0.31, p<0.05) and to suicidal ideation (r=-0.35, p<0.01). Researchers concluded that “In depressed patients, hopelessness and suicidal intent are inversely related to level of religiosity.”
Agrawal and colleagues (2011) examined religious affiliation, and psychological well-being in 1,099 adults in Bangalore, South India (89% Hindu). Well-being was assessed with the 26-item PANAS (assessing positive and negative affect) and with Diener’s 5-item Satisfaction with Life Scale. No difference was found in positive affect or life satisfaction between Hindus and non-Hindus (mostly Christians and Muslims); however, negative affect was significantly lower among Hindus (p<0.05). Step-wise regression analyses controlling for income, age, and work status confirmed this relationship (B=0.07, p=0.025), which was similar in both men and women (though somewhat stronger in women).
Chokkanathan (2013) examined the relationship between religiosity and depressive symptoms in a random sample of 312 Hindu adults age 65 or older living in Chennai (Madras), India. Religiosity was measured using the 5-item Duke University Religion Index (DUREL), consisting of three subscales (ORA=organisational religiosity, NORA=non-organisational religiosity, IR=intrinsic religiosity). Also assessed were social support, depressive symptoms (20-item CESD and 15-item GDS), and master (6-item Pearlin scale). Simple correlations revealed a significant and inverse relationship between all three religious subscales and both measures of depressive symptoms, and a positive relationship between IR and mastery. Structural equation modelling was used to examine all relationships simultaneously. Religiosity was inversely related to depression both directly (B=-0.30, p<0.05) and indirectly (B=-0.14), producing a significant total inverse correlation (B=-0.44, p<0.01). Researchers concluded that “These findings suggest the crucial role of religiosity in influencing the well-being of older adults. The need to integrate religiosity in interventions for older Indian adults is discussed” (p 880).
Those with depression often have poor self-esteem and score low on self-efficacy. Khan and colleagues (2014) examined the association between religious practices, social identification as Hindu, self-efficacy, and well-being in 792 Hindu participants living in a rural area in northern India (Allahabad). The average age of participants was 64.1 years, 47% were female; and 91% belong to the general case. Self-efficacy was assessed using a 5-item standard scale (e.g., able to manage life, capable of doing things that matter, in control of life), and well-being was measured by a 3-item scale that assessed how often participants felt anxious, restless, and irritable. A 6-item religious practices scale measured religious practices at home (how often participants performed morning prayers, evening prayers, chanted religious texts) and religious practices at the temple (attended temple, offered gifts at temple, read or chanted religious texts at temple). Social identification as Hindu was assessed by three questions: “Does being Hindu matter to you?”; “Is being Hindu a key part of your life?”; and “Is being Hindu central to your sense of who you are?” Results indicated that self-efficacy was associated with religious practices at home (r=0.20, p<0.001), religious practices at temple (r=0.14, p<0.001), and social identification as Hindu (r=0.27, p<0.001). Religious practices at home were associated with fewer negative psychological symptoms (r=-0.14, p<0.001), although no significant relationship was found with religious practices at temple or social identification as Hindu. Structural equation modelling, however, indicated that social identification as Hindu was the only religious factor that independently predicted self-efficacy (B=0.14, p<0.001). Because of its relationship to self-efficacy, identification as Hindu was also related indirectly to better psychological and physical health.
Kamble and colleagues (2014) examined the relationship between religiosity and psychological adjustment in 250 graduate students at Karnatak University in Dharwad, India. Religiosity was measured by the 19-item Santosh-Francis Attitude toward Hinduism Scale (ATHS) and by a version of the Gorsuch and McPherson religious orientation scale that assesses intrinsic (IR), extrinsic religiosity-personal (ER-P), and extrinsic religiosity-social (ER-S). In addition, the 12-item Quest Scale (QS) (Batson) and the 16-item Religious Collective Self-Esteem Scale (RCSES) were also administered. Mental health characteristics assessed were self-esteem (assessed by 10-item Rosenberg scale) and depression/anxiety (assessed by Costello & Comrey scales). Regression analysis revealed that ATHS was positively associated with self-esteem (B=0.14, p<0.01) and negatively associated with depression (B=-0.10, p<0.05), and there was a significant interaction between ATHS and IR such that participants who scored high on both scales had especially high self-esteem (B=0.11, p<0.001), low levels of depression (B=-0.10, p<0.001), and low anxiety (B=-0.08, p<0.01).
Finally, in a study of 104 patients with HIV/AIDs being seen in a specialty clinic in Uttar Pradesh, India, Rai and Verma (2015) examined the relationship between religious affiliation (88.5% Hindu, 11.5% Muslim) and depression using the GHQ-28 and Montgomery-Asberg Depression Rating Scale (MADRS). The prevalence of depression (67.3%) and anxiety (76.9%) were high in this sample, with nearly two-thirds having CD4 counts of less than 300 (getting close to the threshold for having AIDS, which is <200). Hindus were significantly more likely than Muslims to experience depression (70.7% vs. 41.7%, p<0.05).
Suicide
Recall from the last chapter that earlier research had indicated low rates of suicide in India, considerably lower than in the U.S. and rest of the world (Pandey, 1968). More recent research, however, suggests that the suicide rate has been increasing in India. Between 1987 and 2007, the suicide rate increased from 7.9 to 10.3 per 100,000 (Vijaykumar, 2007), and remained stable at 10.5 per 100,000 in 2009 (Varnik, 2012). However, in 2012, the World Health Organisation reported that India had the highest number of suicides in the world with a suicide rate of 21.1 per 100,000. This was not the highest suicide rate in the world, but given the large population of India, no other country had more suicides (WHO, 2014). The rate appears especially high among women, where in 2012 the suicide rate was the 6th highest of any country (vs. 22nd highest for males). This is despite the fact that up until 2014, suicide was considered a criminal act under the Indian penal code. Because of that, rates prior to 2014 were often underestimated due to poor civil registration, variable standards in certifying deaths, legal problems, and stigma (Gupta et al., 2015). A number of recent studies have examined the relationship between Hindu religious affiliation or religiosity in Hindus and suicidal thoughts, attempts, or completed suicide.
Sisask and colleagues (2010) examined whether religiosity was a protective factor against attempted suicide. Analysing data from the World Health Organisation’s Suicide Prevention-Multisite Intervention Study on Suicidal Behaviours, suicide attempters were identified in seven countries: Brazil, Estonia, India, Islamic Republic of Iran, South Africa, Sri Lanka, and Vietnam. Suicide attempters were compared with controls from the general population. Religious characteristics were assessed, including religious affiliation, frequency of religious attendance, and self-identification as a religious person. In India, 571 suicide attempters were identified and compared to 460 controls from the general population. Suicide attempters were less likely to be Hindu-affiliated compared to those in the general population (84.0% vs. 92.0%); this trend was also true for the country of Sri Lanka (10.3% vs. 17.5%). In India, compared to those who never attended religious services, those who attended religious services yearly were at lower risk for suicide attempt (OR=0.45, 95% CI 0.26-0.77), controlling for gender, age, marriage, employment, and education. Self-identification as a religious person, though, was not related to suicide attempt.
Manoranjtham and colleagues (2010) examined risk factors for suicide in rural south India (Vellore district). A total of 100 consecutive suicides were compared with 100 living controls matched for age, gender, and neighbourhood. First-degree relatives of the 100 suicide cases were interviewed for this study. Bivariate analyses indicated that lack of religious faith was more likely in suicide cases than controls (27% vs. 14%, OR=2.3, 95 CI 1.1-4.7, p<0.05). In multivariate analyses, the only significant predictors of suicide were “ongoing stress” and chronic pain. The authors concluded that in India, many suicides were impulsive and related to stress. They also indicated that earlier qualitative analyses had revealed attitudes in the general population toward suicide. Many considered suicide a viable option when faced with insoluble personal difficulties and misfortune (Manoranjitham et al, 2007). Researchers also indicated that suicide in India is more likely due to stress and conflict (social, economic and cultural factors) than to mental illness, and underscored the belief that suicides are likely under-reported due to social stigma and legal consequences (as noted earlier; although I suspect that the decriminalisation of suicide in 2014 may have reduced under-reporting to some extent).
Stack & Kposowa (2011) examined the relationship between suicide acceptability and religious affiliation/religiosity using data from the 1999-2001 World Values Survey that assessed 50,547 participants in 56 countries. Religious commitment was measured by religious orthodoxy and attendance at religious services; religious networks by time spent with co-religionists; and religious coping by dependence on religion to cope. Results indicated an inverse relationship between Hindu religious affiliation and acceptability of suicide (B=-0.119), p<0.01), although this was the weakest inverse correlation when compared to inverse correlations with Muslim, Buddhist, Protestant, Catholic, Orthodox, and other affiliations. The inverse relationship with Hindu affiliation diminished to non-significance when religious commitment and religious networks were controlled for and remained nonsignificant when analyses were further controlled for moral community theory, national religious attendance, GDP per capita, and sociodemographic characteristics.
Similar findings were reported by Boyd and Chung (2012) who examined the same suicide variable using data from the 2005 World Values Survey (n=42,299 persons from 43 countries), where suicide acceptability was rated on a scale from 1-10 (1=never justifiable; 10=always justifiable). Religious measures were attendance at religious services (never to once a week) and importance of religion in life (not at all important to very important), along with religious affiliation. Multilevel modelling was used to analyse the data, examining associations at the individual level and at the country level. Compared to those with no religious affiliation, Muslim affiliation was most strongly inversely related to suicide acceptability (B=-0.43, p<0.001), followed by Protestant (B=0.40, p<0.001), other religious affiliation (B=-0.35, p<0.001), Catholic (B=-0.34, p<0.001), and Hindu (B=-0.26, p<0.05); Orthodox, Buddhist, and Jewish affiliations had been weaker correlations with suicide acceptability. At the country level, however, percent Hindu in the population was the strongest predictor of negative attitudes toward suicide acceptability (B=-1.52, p<0.001) followed by percent Muslim and percent Catholic (no other affiliations were associated with suicide acceptability at the country level).
With regard to actual suicides completed, Ali and colleagues (2014) examined patterns of suicide in Malaysia using national suicide registry data for 2009 (61% Muslim, 6% Hindu). Ethnicity was examined as a possible causal factor for the 328 suicides identified. The overall suicide rate was low (1.18 per 100,000). However, Indians had the highest suicide rate of 3.67 per 100,000. This was also reflected in religious affiliation with 4.94 per 100,000 among Hindus, compared to 3.58 in Buddhists, 1.19 in Christians, 0.53 in Muslims, and 0.99 in other affiliations. Authors did not explain this finding other than say that it reflected a trend that has been observed worldwide, especially the low rate in Muslims.
In a retrospective chart review of 626 attempted suicide cases in Singapore, Mak and colleagues (2015) compared cases and protective factors against suicide across various ethnic groups (64.9% Chinese, 13.9% Malay, 15.0% Indian, 6.2% others). Indians were more likely to regard faith in religion as a protective factor compared to Chinese (44.7% vs. 24.4%, p<0.001). Indians were also more likely to have two or more protective factors compared to Chinese (OR=7.74, 95% CI 1.04-8.72). Indeed, the researchers attributed this difference to the fact that Indians place more emphasis on religion than Chinese.
Finally, Thimmaiah and colleagues (2016) compared attitudes toward suicide and suicidal behaviour in a random sample of 172 Hindus and Muslims living in Bangalore, India. Attitudes toward suicide were assessed using a standard 37-item measure that explored exposure to suicidal problems and suicide. Results indicated that suicide attempt among family members (33.8% vs. 25.9%), knowing someone with suicidal thoughts (22.0% vs. 18.3%), and knowing someone who had committed suicide (30.8% vs. 5.8%) were all significantly higher among Hindus compared to Muslims. Muslims were also more likely to disagree with a statement saying that suicide was acceptable to terminate an incurable illness, but just barely so (65.4% versus 42.7%, p<0.058).
Anxiety
Joshi and colleagues (2012) examined the relationship between religiosity, depression, and anxiety in 150 women ages 20-30 recruited from Banaras Hindu University in Varanasi, India. Religiosity was assessed with the 36-item Bhushan scale; anxiety by a standard measure assessing state, trait, and total anxiety; and depression by the 20-item CES-D. Participants were divided into high (n=83) and low (n=67) religiosity groups. State anxiety, trait anxiety, and depression were all significantly lower among those with high compared to low religiosity (all p<0.01). Likewise, when religiosity was assessed using a continuous measure, it was inversely related to state anxiety (r=-0.66), trait anxiety (r=-0.55), and depressive symptoms (r=-0.59) (all p<0.01). In a second study by this group, researchers examined the relationship between religiosity, anxiety, and pregnancy outcomes in 200 pregnant women ages 20-30 years in their third trimester of pregnancy (Kumari et al., 2013). Religiosity was again assessed by the Bhushan scale and anxiety by the state-trait anxiety scale used earlier. Results indicated that religiosity was significantly negatively correlated with anxiety and was positively correlated with healthy pregnancy outcomes.
Fuad and colleagues (2015) examined religious affiliation and mental health in 762 medical students at the International Medical School/Management and Science University in the predominantly Muslim country of Malaysia. Participants were 69.2% Muslim, 22% Hindu, 5.6% Christian, and 2.6% Buddhist. The DASS-21 was used to assess anxiety, depression, and stress. Results indicated that Hindu medical students (compared to Muslim) were at increased risk of anxiety (OR=1.56, 95% CI 1.004-2.43), but not of stress (OR=0.96, 95% CI 0.68-1.37) or depression (OR=1.09, 95% CI 0.75-155) (all analysis uncontrolled). Adjusting for other risk factors including life stressors, race, and year of study, Indian students (89% Hindu) remained at increased risk for anxiety (OR=2.25, 95% 1.40-3.60, p=0.001). No mention of this finding was made in the discussion.
Somatic/Psychosomatic Symptoms
Grover et al (2013) examined the association between religious affiliation (77% Hindu) and explanations for somatoform disorders in 99 consecutive adult patients with the disorder (ICD-10 criteria) seen in the department of psychiatry outpatient department of a tertiary care hospital in Chandigarh, northern India. Somatoform disorders involve physical symptoms that have underlying psychological causes, where physical causes have been ruled out. Results indicated that Hindus were less likely than other religious groups to report explanations for illness that involved prior illness, prior treatment, family problems, marital problems, work problems, other interpersonal problems, bereavement, financial stress, bad deeds, and neglect of vows or rituals, although numbers were small providing little power for comparison. More than half of the sample attributed their symptoms to a “karma-deed-heredity” category, with 30% reporting this explanation spontaneously (third most common cause behind psychological and social causes in a list of 11 possible categories). Authors explained that this category included fate/chance, bad deeds, heredity, will of God, evil eye, sorcery, possession, neglect of vows or rituals, astrology and other supernatural causes. Furthermore, more than half (54.5%) of the sample had sought help from faith healers for current symptoms at some point in the illness. Researchers concluded that culture/religion had a significant impact on explanatory models, with more than half of patients attributing symptoms to karma and deeds. Researchers suggested that clinicians should use Hindu patients’ beliefs about karma in the treatment of somatoform disorders.
Similarly, Kumar and Phookun (2015) examined the relationship between religious affiliation and somatoform disorder in 100 consecutive patients seen in the outpatient department of the department of psychiatry of Gauhati Medical College and Hospital in Assam, North-East India. Approximately half of participants were Hindu (51%) and the others were Muslim. Hindu and Muslim participants were compared on 19 symptoms and symptom clusters. No significant difference was reported on any symptoms except weakness, fatigue and anxiety. Muslims were more likely than Hindus to report weakness and fatigue (46 vs. 40, p=0.03) whereas Hindus were more likely to report somatic anxiety (39 vs. 27, p=0.02).
Several recent studies in Hindu populations have examined relationships between religious affiliation or religiosity and chronic mental disorders such as schizophrenia, obsessive-compulsive disorder, and bipolar disorder.
Schizophrenia
Recall the Shah et al (2011a) study on coping described earlier that involved 103 outpatients with schizophrenia in Chandigarh, India (73% Hindu). In a third report from that study (Shah et al., 2011b), “spirituality” (Part of the WHO-QOL-100 scale) was associated with greater functional independence, better social relationships, and overall psychological health. This finding is not surprisingly since this section of the WHO-QOL-100 focused specifically on having meaning/purpose. The “faith” subscale of the WHO-QOL-SRPB measure (likewise heavily contaminated with indicators of mental health, as discussed earlier) was also associated with every dimensions of quality of life: physical, psychological, functional independence, social relationships, environment, and overall (with p<0.001 for each). Other than the earlier report by Shah et al (2011a) on coping and the Kate et al (2013) study on schizophrenia caregivers (all results coming from the same sample and research team), no other recent studies could be found that examined religious involvement and mental health among Hindu patients with schizophrenia. Thus, there is a significant research gap here tha needs to be filled by future studies.
Obsessive Compulsive Disorder (OCD)
Jaisoorya and colleagues (2015) examined relationships between religious affiliation and OCD among 7,560 students enrolled at 73 schools in Ernakulam, India. OCD was assessed using a section from the Clinical Interview Schedule-Revised. Results indicated that 0.80% of students met ICD-10 criteria for OCD. Distribution of OCD by religious affiliation indicated that 23 of 3706 (0.62%) were Hindus, 20 out of 2335 were Christians (0.88%), 17 out of 1325 (1.28%) were Muslims, and 1 out of 14 were affiliated with other faith traditions (7.14%) (p=0.01). Thus, Hindu students had the lowest prevalence of OCD among all religious groups.
In a study of 201 outpatients with OCD in Calcutta, India, Das and Raychaudhuri (2016) found that those with more severe OCD (based on YBOCS scores) were more religious and more likely to be involved in religious rituals (as assessed by patients and informants during qualitative interviews). Of 43 patients from rural areas with extreme/severe OCD based on YBOCS scores, 31 (72%) were religious and practicing religious rituals, compared to only 4 (27%) of 15 patients suffering from moderate/mild OCD. Of 38 patient from semi-rural areas with extreme/severe OCD, 25 (66%) were religious, compared to only 3 (33%) of 9 patients with moderate/mild OCD.
Bipolar Disorder
In a study of 185 Indian patients with bipolar disorder (all in remission), Grover and colleagues (2016) examined level of religiosity, religious or supernatural beliefs, and religious psychopathology, along with the perceived causes of symptoms, and treatment seeking practices. Depressive and manic symptoms were assessed using standard scales (HDRS, YMRS, and GAF). More than one-third of participants (37.8%) indicated they had experienced psychopathology that included religious or supernatural content; nearly half (45.4%) believed that there was a religious or supernatural cause for their illness, the most common cause being God’s will (30.8%); and nearly half (44.3%) had initially sought treatment from a religious or faith healer. While almost of these patients believed in God (90%), only 30% reported their physician had addressed religious issues in their treatment.
Substance Use/Abuse
Several studies have also examined the relationship between religious affiliation/religiosity and drinking alcoholic beverages or using other illegal/harmful substances. In a study of 509 undergraduate students at the University of the West Indies (51% Christian, 31% Hindu, 11% Muslim, 6% “other”), Dhanookdhary and colleagues (2010) found that alcohol, tobacco, and marijuana used differed significantly across religious affiliation. Alcohol was most commonly used by those with “other” religious affiliations (81%), Hindus (77%), Chrisitians (73%), and Muslims (31%) (p<0.001); there was no significant difference in tobacco use across religious groups (30% of other affiliations, 18% of Christians, 16% of Hindus, and 13% of Muslims) (p=0.28); and marijuana was most commonly used by those with “other” religious affiliations (33%), Hindus (12%), Muslims (7%), and Christians (5%) (p=0.02). Thus, a relatively higher percentage of Hindu undergraduates use alcohol (77%); less frequent is tobacco (16%) or marijuana (12%) use. Differences from other religious groups vary by the particular substance used and the particular religious group.
Uddin (2011) examined the association between religious affiliation and arrack drinking (a form of alcohol) in rural Bangladesh. Out of 760 male arrack drinkers, a random sample of 391 (30% Muslim, 26% Hindu, 23% Santal, 23% Oraon) was selected and assessed. Muslims make up 80% of the population in Bangladesh. While social stress was lower among Muslims and Hindus compared to the other religious/ethnic groups, social stress was a strong risk factor for continued arrack drinking in Hindus. Overall, Hindus were least likely to be involved in chronic drinking, were least likely to consume “hard” drinks, and were least likely (along with Muslims) to drink frequently.
Luczak and colleagues (2014) explored the connection between religion and alcohol use in 1,209 middle-age adults living on the island of Mauritius (an island off Madagascar in the Indian Ocean). Participants were 10% Tamil (a Hindu group), 40% Hindu, 24% Catholic, and 22% Muslim. Researchers noted that in Hinduism, moderate alcohol use is generally accepted, although heavy use is discouraged. According to Hindu beliefs, alcohol use (and other tamasic foods) may cause “ignorance” or “violent tendencies” and so should be avoided, especially in excess. After controlling for occupation, education, marital status, and agender, results indicated that compared to Hindus (the reference group), Muslims were least likely to “use alcohol at some point in their life” (lifetime OR=0.03, 95% CI 0.02-0.05), followed by Tamil (OR=1.56, 95% CI 0.87-2.81), and Catholic (OR=2.63, 95% CI 1.65-4.20). For current use, again Muslims were least likely compared to Hindus (OR=0.02, 95% CI 0.01-0.04), then Tamil (OR=1.45, 95% CI 0.87-2.43), and then Catholic (OR=2.01, 95% CI 1.35-2.98). Alcohol use disorder (lifetime) was also least common in Muslims compared to Hindus (OR=0.18, 95% CI 0.09-0.38), Tamil (OR=1.25, 95% CI 0.71-2.22), and Catholic (OR=1.99, 95% CI 1.31-3.00). Thus, Muslims and Hindus used the least alcohol and had less problems with alcohol (especially compared to Catholics), and also had higher levels of abstinence, resulting in lower likelihood of alcohol use disorders.
Psychological Well-being
Besides studies in Hindus on religion and mental disorders or emotional symptoms, a number of reports have examined the relationship between religious affiliation or religiosity and good mental health characterised by high psychological well-being, life satisfaction, happiness, and other positive emotions. Differences may exist in how Hindus in India conceptualise well-being and happiness compared to how Westerners view them. For example, Joshanloo (2014) examined differences between Eastern (Hinduism, Buddhism, Taoism, Confucianism, Suffism) and Western views on happiness. He identified six fundamental differences between East and West in what is considered to be the “good life.” He indicated that Eastern views of happiness emphasise eudaimonic well-being (meaning and self-realisation), whereas Western views focus primarily on hedonic well-being (pleasure attainment and pain avoidance). The six fundamental differences noted between Eastern and Western views (respectively) were self-transcendence vs. self-enhancement, eudaimonism vs. hedonism, harmony vs. mastery, contentment vs. satisfaction, valuing suffering vs. avoiding it, and relevance vs. “relative irrelevance” of spirituality/religion. Along these same lines, Nisbett and colleagues (2001) have described the differences between holistic systems of thinking in Eastern cultures compared to more analytic cognitive processes in the West. Thus, the findings below on Hinduism and well-being should be interpreted in light of these differences in perspective.
In studying the effects of religious pilgrimage on psychological well-being, Tewari and colleagues (2012) compared 416 pilgrims (called Kalpwasis) travelling to a holy site with a control group of 127 non-pilgrims (no information on controls except that they did not go on pilgrimage, but were comparable to pilgrims – see below). The holy site visited is at the confluence of the Ganges and Yamuna rivers where a month-long festival (Magh Mela) is held. This festival, held every year is visited by millions of pilgrims. The 6-year festival is visited by an estimated 20 million pilgrims and the 12-year festival by more than 50 million. Pilgrims go through great hardships to get there (most often walking) and stay in squalid conditions for the month (without heat, minimal sanitary facilities, sleeping on ground, often with temperatures close to 0 centigrade). Clearly, these conditions are not physically conducive to mental or physical well-being.
The present study was not an RCT, but a longitudinal study that compared the psychological and physical well-being of pilgrims and controls. Psychological well-being and physical symptoms were assessed one month before the pilgrimage and one month afterwards (T1 and T2 separate on average by 90 days). Age (64 vs. 61), gender (57% female vs. 50%), and case level (92% general vs. 86%) were similar between pilgrims and controls, and these differences were adjusted for in analyses. Results indicated that psychological well-being increased (group by time interaction p=0.04) in pilgrims compared to controls between T1 and T2.
Ganga and Kutty (2013) compared frequency of positive emotions across different religious affiliations in a random sample of 453 young persons in the age range 18-24 in Kerala, India. Religious composition of the sample was 325 Hindus, 62 Christians, and 66 Muslims. The Achutha Menon Centre Positive Mental Health Scale was used to assess positive emotions. Results indicated that Hindus and Christians scored significantly higher on the scale compared to Muslims who scored the lowest (p<0.001), especially in the domains of belief in the dignity and worth of others, productivity, and community contribution. The difference remained significant after controlling for quality of home learning environment, status in school, single vs. both parents in home, gender, and marital status.
Harding and colleagues (2015) surveyed a total of 6,643 students 11-13 years old attending schools in London boroughs (United Kingdom), of whom 4,785 were followed up when ages 14-16, and 665 when ages 21-23. The sampling scheme was to recruit 100 students in each ethnic group: White British, Indian (n-419, 59% Hindu), Pakistani or Bangladeshi, Black African, Black Caribbean, and other. The 20-item Strengths and Difficulties Questionnaire was used to assess mental health, producing a Total Difficulties Score (TDS). While the best mental health scores were found among Indian girls, the worst scores were in Indian boys. For both girls and boys as a group (all ethnicities combined), attendance at religious services was associated with better mental health at each evaluation from ages 11 to 16. Researchers attributed this finding to (1) family support from a religious community with shared values, and (2) greater parental control that is more normative in such communities where lack of autonomy is viewed by these adolescents as the norm. By ages 21-23, however, the positive associations between religious involvement and TDS scores disappeared.
Abdel-Khalek and Singh (2014) examined the relationship between religiosity and self-esteem, mental health, anxiety, and optimism/pessimism in 400 Indian university students enrolled at schools in the Uttar Pradesh Province in India (200 women and 200 men). Religiosity was assessed using two questions that asked about level of self-rated religiosity in general and self-rated religiosity in comparison to others (each rated on a 0 to 10 scale). Single questions were used to assess estimation of physical health, mental health, happiness, and satisfaction with life (all on 0 to 10 scales). Multi-item measures were used to assess self-esteem (Rosenberg), mental health, anxiety, and optimism-pessimism (using scales developed by the lead author). Results indicated that religiosity was significantly higher in women than in men. Religiosity was significantly and positively associated with mental health, happiness, and life satisfaction among men, and with satisfaction with life, self-esteem, optimism and lower anxiety in women. Regression analyses revealed a significant positive association between religiosity and life satisfaction in men, and with self-esteem, mental health, and optimism in women.
Singh (2014) surveyed 150 University students attending Banaras Hindu University in Varanasi, India, examining the relationship between religiosity, well-being, and emotional regulation. Measures included the 18-item Cognitive Emotion Regulation Questionnaire (which assesses cognitive strategies used in response to threatening or stressful life events), the 20-item Age Universal Religious Orientation Scale (which assesses intrinsic and extrinsic religiosity, dividing the sample into low, medium, and high groups), Diener’s 5-item Life Satisfaction Scale, the 20-item Positive and Negative Affect Scale (PANAS), and the 29-item Oxford Happiness Questionnaire. Results (uncontrolled) indicated that high religiosity was positively associated with life satisfaction, positive affect, happiness, functional emotional regulation, overall well-being, and was negatively associated with negative affect and dysfunctional emotional regulation.
In another report by Singh (2015), the researcher examined relationships between spiritual practices and psychological well-being among 204 Hindus living in northern India recruited from temples in the region. The average age of participants was 34.4 years. Spiritual involvement was measured by the Spiritual Practices Scale-Hindus (developed by the author and a colleague) consisting of three subscales: positive transformation, self-purification, and expanding awareness. Psychological well-being was assessed using the 28-item Psychological Well-Being Questionnaire. Not surprisingly, given the measure of spiritual involvement that included indicators of positive mental health, all three dimensions were positively associated with psychological well-being (r’s ranging from 0.24-0.31, p<0.01).
International Studies on Well-being
Data on religion and well-being was collected during the three international surveys discussed in chapter 4. These surveys assessed happiness, life satisfaction, sense of purpose/meaning, and role of religion in coping. In the ISSP (2008), Hindus were significantly more likely to indicate that they were very happy compared to non-Hindus (35.6% vs. 26.4%, p<0.01) (Table 1). However, among Hindus, “importance of religion in life” was only weakly associated with happiness (r=0.07, p=0.31, n=199). Hindus in the WVS (2005-2006) were also more likely to say they were very happy compared to members of other religious groups (33.0% vs. 28.2%, p<0.0001), and among Hindus, religiosity was correlated with greater happiness (r=0.19, p<0.0001, n=1910) and greater life satisfaction (r=0.20, p<0.0001, n=1879). In the GAP (2009) study, as well, Hindus were significantly more likely than non-Hindus to say they were very satisfied with life (49.0% vs. 30.2%, p<0.0001) (Table 14.2), although among Hindus, importance of religion in life was not related to happiness (r=0.01, p=0.54, n=1856).
Hindus in the ISSP study were equally as likely as non-Hindus to reject the notion that “life does not serve any purpose” (71.6% vs. 68.1%); among Hindus, religiosity was only weakly correlated with agreeing that life serves a purpose (r=0.12, p=0.08, n=197). Hindus were more likely than non-Hindus to strongly agree that religion helps people “find inner peace and happiness” (51.8% vs. 35.3%, p<0.0001) and helps people “gain comfort in times of trouble or sorrow” (52.0% vs. 39.0%, p<0.001). Not surprisingly, religiosity was strongly correlated with feeling that religion helps people to find inner peace and happiness (r=0.29, p<0.0001, n=197).
Thus, in all three cross-national studies involving random samples of the adults, Hindus scored higher on well-being, although in only one of three studies was religiosity in Hindus related to significantly greater happiness and life satisfaction.
Table 1. Comparison of well-being between Hindus, members of other religious groups, and the non-affiliated
(Editor: Detailed contents of this table has been omitted. Please contact the Editor if you require the details.)
In summary, of these nine studies (5 in regional and 3 in national/international samples), five (56%) found a significant correlation between religious/spiritual involvement and greater psychological well-being or positive mental health in Hindus. This is true for the effects of going on a religious pilgrimage, and for studies in adolescents, university students, and younger adults. These findings are similar to recent studies conducted in Christians and Muslims when examining religiosity and positive emotions. Five studies compared Hindus and non-Hindus on well-being, with 4 or 5 reporting higher well-being in Hindus (3 of 3 national/international studies).
Religious Interventions
A systematic review of studies examining complementary and alternative therapies directed at mental health in China and India (published in the Lancet), identified nine studies that examined the benefits of yoga in treating depression, schizophrenia, anxiety disorders, and addiction (Thirthalli et al., 2016). Of those nine studies, six were judged to have found positive results based on “low quality evidence”; one study reported negative results based on low quality evidence; and two studies reported mixed results from low quality evidence; no studies were rated as providing positive results from “high quality evidence.” This is the only recent research I could find examining Hindu-based interventions.
Treatment Seeking
In a survey of 1,092 adults age 60 or over in Singapore (National Mental Survey of Elderly Singaporean), Ng and colleagues (2011) found that older persons with any religious affiliation had a higher prevalence of mental health problems than those with no religious affiliation, and also less often sought help from mental healthcare professionals. The sample was comprised of 57% Buddhists/Taoists, 17% Christians, 14% Muslims, 6% Hindus, and 7% with no religious affiliation (consistent with the prevalence of Hindus in the general population estimated at 5%). The prevalence of mental disorders was highest among Muslims (17.6%), next highest in Hindus (14.9%) and Christians (14.1%), and lowest in Buddhists/Taoists (9.4%). Those with no religious affiliation had the lowest prevalence of mental disorders (7.6%). Multivariate analyses (controlling for presence of mental disorder, mental health, disability, gender, age, ethnicity, education, health beliefs, caregiver support, and financial difficulty) revealed that treatment seeking was lowest for Christians (OR=0.12, 95% CI 0.02-0.57), similar for Muslims (OR=0.12, 95% CI 0.01-1.31), next lowest for Hindus (OR=0.21, 95% CI .02-2.56), and highest for Buddhists (OR=0.59, 95% CI 0.18-1.88), and all lower than the comparison group with no religious affiliation.
Conclusions
Recent research is generally consistent with research published prior to 2010. Mental disorders are not uncommon among Hindus, but are not more common in Hindus than in non-Hindus. As noted earlier, Hindus often ascribe mental illness to religious factors and often consult traditional healers before consulting mental health professionals. In the next chapter, I summarise the research findings on religiosity and well-being in Hindus, and the findings from studies that compared the mental health of Hindus and non-Hindus.