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In this chapter, I summarise the research findings (early research, recent research, and overall), examine methodological challenges when conducting research on religiosity and mental health in Hindus, and discuss directions for future research necessary to move the field forward.
Early Research (from Chapter 6)
Thirteen studies compared Hindus and non-Hindus (usually Muslims and Christians), with 3 studies (23%) reporting better mental health or less substance use/abuse (MH/SU) in Hindus, 5 (42%) reporting worse MH/SI in Hindus, 3 finding no difference, and 2 reporting mixed results (Hindus with better MH/SU than some and worse MH/SU than others). Thus, in this early research, Hindu religious affiliation was inconsistently related to MH/SU, depending on the particular location and study. With regard to the relationship between religiosity and MH/SU in Hindus, 17 quantitative studies examined this association (including four clinical trials). Of those, 11 (65%) reported a positive correlation between religious involvement and better MH/SU (or greater improvement in response to a Hindu-based intervention), 2 (12%) reported worse MH/SU, 3 found no association, and 1 reported mixed findings (public religious activities related to better mental health, private religious activities related to worse). The majority of these quantitative studies, then, found that religiosity in Hindus is related to better mental health and less substance use/abuse. All four clinical trials reported that Hindu yoga-type interventions had beneficial effects on mental health.
Latest Research (from Chapter 7)
Of the 22 studies that compared Hindus and non-Hindus (including three national/cross-national studies), 9 (41%) reported better MH/SU in Hindus, 8 (36%) found worse MH/SU, and 5 reported mixed findings (better MH/SU than some, worse than others). With regard to religiosity and MH/SU in Hindus, 12 of 16 studies (75%) conducted since 2010 reported better MH/SU in those who were more religious, 2 reported worse MH/SU (13%), and 2 reported no association. These results are comparable to earlier studies, with the majority reporting less depression and anxiety, negative attitudes toward suicide and lower rates of suicide, greater self-esteem and mastery (especially in older adults), and less substance use (in Hindus vs. other religions, except Muslims). Several large studies, though, reported worse mental health and greater substance use in Hindus, more severe OCD symptoms in religious Hindus, and one study reported more mental disorder and less treatment seeking in Hindus compared to those with no religious affiliation (in Singapore). Recent intervention studies found that integrated yoga treatments for depression and other mental disorders have at least some benefit, although the evidence is largely of low quality. Finally, qualitative studies confirm (a) the importance of religion in the lives of Hindu immigrants, (b) the frequent perception of religious and supernatural beliefs as a cause for symptoms in somatoform disorder and bipolar disorder, and (c) the frequent use of faith healers to treat these conditions. When older Hindus are compared to older non-Hindus in terms of treatment seeking, Hindus are more likely than Christians or Muslims to seek treatment for mental health problems but are less likely than Buddhists or those with no religious affiliation to do so, again based on a single study conducted in Singapore.
Overall Summary
Over the past 50 years, at least 35 quantitative studies have compared Hindus and non-Hindus on MH/SU. Of those, 12 (34%) reported better MH/SU, 13 (37%) worse MH/SU, 3 found no difference between Hindus and non-Hindus, and 7 reported that Hindus had better MH/SU than some religious groups, but worse than others. With regard to religiosity, at least 33 studies have examined the relationship between religiosity and MH/SU or the effects of Hindu-based religious interventions. Of those, 23 (70%) found better MH/SU among Hindus who were more religious or receiving religious interventions, 4 (12%) reported worse MH/SU, and 6 (18%) reported no association or mixed results.
Therefore, one-third (34%) of studies report better mental health or less substance use in Hindus (vs. non-Hindus), about one-third (37%) found worse mental health or greater substance use in Hindus, and one-third (29%) reported no difference or mixed results. More importantly, over two-thirds (70%) of studies in Hindus found that greater religiosity was associated with significantly better mental health, greater well-being, or less substance use/abuse (or mental health was improved in response to Hindu-based interventions). Furthermore, the increasing suicide rate in India in recent years is concerning, and is possibly due to increased secularisation in India as it becomes more westernised and technologically advanced.
However, one cannot ignore the 37% of studies that found worse MH/SU among Hindus (vs. non-Hindus). Those studies did not examine individual religiosity, which as noted above, has been associated with better mental health in the vast majority of studies. One also cannot disregard the 12% of studies that reported worse MH/SU in Hindus who were more religious. Nevertheless, note that the negative reports on religious involvement and mental health often came from studies of psychiatric patients (with religious delusions or connected with more severe OCD symptoms), adolescents or college students (probably with less than a mature religious faith), Hindus in countries where they are “outsiders” (making up only about 5% of the population such as in Malaysia or Singapore), or displaced Hindu refugees or Hindus with HIV/AIDS (where emotional distress may have caused an increase in religious involvement, not vice-versa).
Finally, analysis of three large population-based studies examining random samples of adults throughout the world found that Hindus scored higher on well-being than members of other religious groups in all three surveys, and religiosity was related to greater happiness and life satisfaction among Hindus in one of these (and a trend in that direction was also found in one of the two remaining studies). Thus, the evidence that Hindus have worse mental health than non-Hindus is inconsistent, and greater religious involvement by Hindus is clearly related to better mental health in most cases (70% of studies). Hindu beliefs and practices, then, appear to have a positive impact on coping with stress and overall mental health. Of course, this judgement is made based on the limited research now available.
Methodological Issues
Numerous methodological limitations affect both earlier and more recent studies of religious involvement/affiliation and mental health in Hindus. First, most studies are cross-sectional, forgoing any definitive conclusions with regard to causal direction of the relationship found; only a couple were prospective and followed participants over time. Second, many reports did not control for all confounders that could have explained associations (such as socioeconomic status). Third, many studies involved small non-representative regional samples, limiting generalisability. Fourth, and particularly concerning, several studies studies used measures of religiosity that were contaminated by indicators of mental health making interpretation of the results impossible (other than concluding that good mental health is related to good mental health, i.e., which is circular and does not have any meaning). Even when measures of religiosity were not contaminated, they were often weak and poorly attuned to the religion that most Hindus practice. Finally, intervention studies (other than Yoga integrated therapies) were rare, providing little information on how Hindu religiosity itself affects mental health. Based on the systematic review of earlier studies and the selective review of more recent studies, one may conclude that research on religiosity in Hindus, while now growing, lags far behind that reported in Christian or Muslim populations.
Future Directions
Research on religion and mental health in Hindus is just beginning, and there is much work to be done to substantiate the generally positive results uncovered in this review. In particular, prospective studies are needed to assess whether religious involvement leads to better mental health outcomes over time, allowing for some speculation about the causal direction in these relationships. Of course, randomised clinical trials are needed to identify effective clinical interventions based on Hindu religious beliefs and practices that can be used in the treatment of emotional disorders or to support those with chronic mental illness (and family members caring for them). In addition, studies are needed that examine the effectiveness of co-therapy that involves mental health professionals working with traditional healers in providing care for Hindus with mental disorder. Finally, research is needed to better understand when, how, and why Hindus (and in some circumstances, even devoutly religious Hindus) experience worse mental health.
Conclusions
When Hindus are compared to non-Hindus, quantitative studies indicate that one-third have better mental health and less substance use/abuse, one-third have worse mental health, and one-third indicate similar mental health. When level of religiosity and mental health are examined within Hindu populations, 70% of studies report better mental health among the more religious. While systematic research on Hindu beliefs/practices and mental health is still in its infancy and numerous methodological problems are present in existing studies, this chapter has described the kind of future research that is needed. Hinduism is a faith tradition that for nearly 3,000 years has focused on the relief of suffering, and we need to know how Hindu beliefs and practices accomplish this (and need to identify situations in which it fails to do so and try to understand why).