The role of religious advisors in mental health care in the World Mental Health surveys



To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups.


Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity.


1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort “often” through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors.


Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.

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  1. 1.

  2. 2.


  1. 1.

    Koenig HG (2009) Research on religion, spirituality, and mental health: a review. Can J Psychiatry 54(5):283–291

    PubMed  Google Scholar 

  2. 2.

    Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Taylor RJ, Ellison CG, Chatters LM, Levin JS, Lincoln KD (2000) Mental health services in faith communities: the role of clergy in black churches. Soc Work 45(1):73–87

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Moran M, Flannelly K, Weaver A, Overvold J, Hess W, Wilson J (2005) A study of pastoral care, referral, and consultation practices among clergy in four settings in the New York City area. Pastor Psychol 53(3):255–266

    Article  Google Scholar 

  5. 5.

    Wang PS, Berglund PA, Kessler RC (2003) Patterns and correlates of contacting clergy for mental disorders in the United States. Health Serv Res 38(2):647–673

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Farrell JL, Goebert DA (2008) Collaboration between psychiatrists and clergy in recognizing and treating serious mental illness. Psychiatr Serv 59(4):437–440

    Article  PubMed  Google Scholar 

  7. 7.

    Youssef J, Deane FP (2013) Arabic-speaking religious leaders’ perceptions of the causes of mental illness and the use of medication for treatment. Aust N Z J Psychiatry 47(11):1041–1050

    Article  PubMed  Google Scholar 

  8. 8.

    Leavey G (2008) U.K. clergy and people in mental distress: community and patterns of pastoral care. Transcult Psychiatry 45(1):79–104

    Article  PubMed  Google Scholar 

  9. 9.

    Montesano VL, Layton BJ, Johnson R, Kranke D (2011) Exploring the mental health information needs of clergy. Adv Study Inf Relig 1(1):1–25

    Google Scholar 

  10. 10.

    Kovess-Masfety V, Dezetter A, de Graaf R, Haro JM, Bruffaerts R, Briffault X et al (2010) Religious advisors’ role in mental health care in the European Study of the Epidemiology of Mental Disorders survey. Soc Psychiatry Psychiatr Epidemiol 45(10):989–998

    Article  PubMed  Google Scholar 

  11. 11.

    Kessler RC, Ustun TB (2004) The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121

    Article  PubMed  Google Scholar 

  12. 12.

    Heeringa S, Wells J, Hubbard F, Mneimneh ZN, Chiu WT, Sampson NA et al (2008) Sample designs and sampling procedures. In: Kessler RC, Üstün T (eds) The WHO World Mental Health Surveys. Global perspectives on the epidemiology of mental disorders. Cambridge University Press, Cambridge, pp 14–32

  13. 13.

    Leon AC, Olfson M, Portera L, Farber L, Sheehan DV (1997) Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 27(2):93–105

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33(6):766–771

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Demyttenaere K, Bruffaerts R, Posada-Villa J, Gasquet I, Kovess V, Lepine JP et al (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291(21):2581–2590

    Article  PubMed  Google Scholar 

  16. 16.

    Wang PS, Demler O, Olfson M, Pincus HA, Wells KB, Kessler RC (2006) Changing profiles of service sectors used for mental health care in the United States. Am J Psychiatry 163(7):1187–1198

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Kessler RC, Demler O, Frank RG, Olfson M, Pincus HA, Walters EE et al (2005) Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 352(24):2515–2523

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    John DA, Williams DR (2013) Mental health service use from a religious or spiritual advisor among Asian Americans. Asian J Psychiatry 6(6):599–605

    Article  Google Scholar 

  19. 19.

    Adewuya A, Makanjuola R (2009) Preferred treatment for mental illness among Southwestern Nigerians. Psychiatr Serv 60(1):121–124

    Article  PubMed  Google Scholar 

  20. 20.

    Picco L, Subramaniam M, Abdin E, Vaingankar JA, Zhang Y, Chong SA (2013) Roles of religious and spiritual advisors among adults in Singapore with mental illnesses. Psychiatr Serv 64:1150–1156

    Article  PubMed  Google Scholar 

  21. 21.

    WHO (2011) Global status report on non-communicable diseases 2010. WHO, Geneva

    Google Scholar 

  22. 22.

    Petersen I, Lund C, Bhana A, Flisher AJ, Mental H, Poverty Research Programme C (2012) A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings. Health Policy Plan 27(1):42–51

    Article  PubMed  Google Scholar 

  23. 23.

    Chibanda D, Mesu P, Kajawu L, Cowan F, Araya R, Abas MA (2011) Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health 11:828

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Ayonrinde O, Gureje O, Lawal R (2004) Psychiatric research in Nigeria: bridging tradition and modernisation. Br J Psychiatry 184:536–538

    Article  PubMed  Google Scholar 

  25. 25.

    Williams DR, Griffith EE, Young JL, Collins C, Dodson J (1999) Structure and provision of services in Black churches in New Haven, Connecticut. Cultur Divers Ethnic Minor Psychol 5(2):118–133

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Young JL, Griffith EE, Williams DR (2003) The integral role of pastoral counseling by African-American clergy in community mental health. Psychiatr Serv 54(5):688–692

    Article  PubMed  Google Scholar 

  27. 27.

    Hankerson S, Watson K, Lukachko A, Fullilove M, Weissman M (2013) Ministers’ perceptions of church-based programs to provide depression care for African Americans. J Urban Health 90(4):685–698

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R et al (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15(4):167–180

    Article  PubMed  Google Scholar 

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The research reported here was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, R01-MH092526, and R01-DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire Pharmaceuticals. The Sao Paulo Megacity Mental Health Survey is supported by the State of Sao Paulo Research Foundation Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders is supported by the Ministry of Health and the National Center for Public Health Protection. The Beijing, Peoples Republic of China World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The European Study of the Epidemiology of Mental Disorders project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO2004123), the Piedmont Region (Italy), Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnologı´a, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III(CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from Glaxo-SmithKline. Implementation of the Iraq Mental Health Survey (IMHS) and data entry were carried out by the staff of the Iraqi MOH and MOP with direct support from the Iraqi IMHS team with funding from both the Japanese and European Funds through United Nations Development Group Iraq Trust Fund (UNDG ITF). The World Mental Health Japan Survey (WMHJ) is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labor and Welfare. The Lebanese National Mental Health Survey (Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation) is supported by the Lebanese Ministry of Public Health, the World Health Organization (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to the Institute for Development, Research, Advocacy and Applied Care, Lebanon, and unrestricted Grants from Astra Zeneca, Eli Lilly, GlaxoSmithKline, Hikma Pharm, Janssen Cilag, MSD, Novartis, Pfizer, Sanofi Aventis, and Servier. The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the Pan American Health Organization. The Northern Ireland Study of Mental Health was funded by the Health and Social Care Research and Development Division of the Public Health Agency. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology and Ministry of Health. The Romania WMH study projects “Policies in Mental Health Area’’ and “National Study regarding Mental Health and Services Use” were carried out by National School of Public Health and Health Services Management (former National Institute for Research and Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, Statistics Contract 70, Cheyenne Services Societate cu Responsabilitate Limitata, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania Societate cu Responsabilitate Limitata. The US National Comorbidity Survey Replication is supported by the National Institute of Mental Health (U01-MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant 044708), and the John W. Alden Trust. These surveys were carried out in conjunction with the World Health Organization WMH Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. A complete list of WMH publications can be found at The authors appreciate the helpful contributions to WMH of Herbert Matschinger, PhD.

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Correspondence to Vivianne Kovess-Masfety.

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Kovess-Masfety, V., Evans-Lacko, S., Williams, D. et al. The role of religious advisors in mental health care in the World Mental Health surveys. Soc Psychiatry Psychiatr Epidemiol 52, 353–367 (2017).

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  • Religion
  • Mental health
  • Services use