Religiousness/Spirituality and Schizophrenia: Implications for Treatment and Community Support

  • Jennifer A. NolanEmail author
  • Rachel E. Dew
  • Harold G. Koenig


Previous research into psychosis as it relates to religion or spirituality has focused on the phenomenon of religious delusion. Due to the prevalence of religious material in delusional systems, some psychiatrists may fear that all exposure to religion/spirituality conveys the risk of exacerbating psychosis. However, recent investigation reveals that for many psychotic patients, religion/spirituality offers solace, social support, and enhanced coping. Private religiousness/spirituality (i.e. prayer, beliefs, or a relationship to the divine) appears to be a prevalent method for coping with schizophrenia. Evidence also suggests that public religiousness (i.e. service attendance, Bible study groups) is helpful to some psychotic patients. Different styles of religious coping have been found to correlate with important health outcomes in the major psychoses, such as quality of life, medication adherence, substance abuse and suicide. If confirmed, this research may have clinical and public health implications. Mental health care providers may need to be trained to support religious coping among psychotic patients, rather than assuming it to be an irrelevant or possibly destabilizing force. Educational interventions may help religious groups to better accept and integrate individuals living with schizophrenia into their communities, thus enhancing social support for the severely mentally ill. This chapter will review the following topics: (1) the disabling and stigmatizing effects of severe mental illness, and the lack of adequate community support worldwide, in the context of limited available inpatient care; (2) the dearth of research characterizing relationships between religiousness/spirituality and severe mental illness, which exists in spite of the plethora of research on its relationship to depression, anxiety, substance abuse, and overall psychological well-being; (3) religious delusions in psychotic illness and concerns that exposure to religion may worsen psychosis; (4) the role of the cultural and religious context in determining how psychotic illness is understood; (5) review of past and current research on the relationship between religiousness/spirituality and health outcomes in the severely mentally ill; (6) directions for future research; and (7) potential implications of research for treatment and community interventions.


Religion Spirituality Schizophrenia 



human immunodeficiency virus


human immunodeficiency virus/ acquired immune deficiency syndrome


cognitive-behavioral therapy


religious-based cognitive-behavioural therapy


pastoral counselling therapy


mindfulness-based stress reduction


functional magnetic resonance imaging


Diagnostic and Statistical Manual of Mental Disorders, 4th Edition


National Center on Addiction and Substance Abuse


Diagnostic and Statistical Manual


Comprehensive Assessment of Symptoms and History


Comprehensive Assessment of Symptoms and History an adapted culturally sensitive version


Epidemiologic Catchment Area


Quality of Life


World Health Organization Quality of Life-BREF


  1. 1.
    Ustun TB (1999) The global burden of mental disorders. Am J Public Health 89:1315–1318PubMedGoogle Scholar
  2. 2.
    Cohen A, Patel V, Thara R et al (2008) Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophr Bull 34:229–244PubMedGoogle Scholar
  3. 3.
    Schultze B, Angermeyer MC (2003) Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med 56:299–312Google Scholar
  4. 4.
    Castle DJ, Morgan V (2008) Epidemiology. In: Mueser KT, Jeste DV (eds) Clinical Handbook of Schizophrenia. The Guilford Press, New York, NY, pp 14–24Google Scholar
  5. 5.
    Eaton WW, Chen C-Y (2006) Epidemiology. In: Lieberman J, Stroup TS, Perkins DO (eds) Textbook of Schizophrenia. American Psychiatric Publishing, Arlington, VA, pp 17–39Google Scholar
  6. 6.
    World Health Organization (WHO) (2008) The Global Burden of Disease. 2004 Update. World Health Organization, Geneva, SwitzerlandGoogle Scholar
  7. 7.
    Torrey EF (2001) Surviving Schizophrenia: A Manual for Families, Consumers and Providers. Harper Collins, New York, NY, pp 1–29Google Scholar
  8. 8.
    Kleinman A (2009) Global mental health: A failure of humanity. Lancet 374:603–604PubMedGoogle Scholar
  9. 9.
    Demyttenaere K, Bruffaerts R, Posada-Villa J et al (2004) The WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. J Am Med Assoc 291:2581–2590Google Scholar
  10. 10.
    Kebede D, Alem A, Shibre T et al (2003) Onset and clinical course of schizophrenia in Butajira-Ethiopia. A community-based study. Soc Psychiatry Psychiatr Epidemiol 38:625–631PubMedGoogle Scholar
  11. 11.
    Patel V, Prince M (2010) Global mental health: A new global health field comes of age. J Am Med Assoc 303:1976–1977Google Scholar
  12. 12.
    Daly R (2006) Prison mental health crisis continues to grow. Psychiatr News 41:1Google Scholar
  13. 13.
    Morrissey JP, Cuddeback GS (2008) Jail diversion. In: Mueser KT, Jeste DV (eds) Clinical Handbook of Schizophrenia. Guilford Press, New York, NY, pp 524–532Google Scholar
  14. 14.
    Torrey EF, Stieber J, Ezekiel J et al (1992) Criminalizing the seriously mentally ill: The abuse of jails as mental hospitals. Public Citizen’s Health Research Group and National Alliance for the Mentally Ill, Washington, DCGoogle Scholar
  15. 15.
    Peters RH, Sherman PB, Osher FC (2008) Treatment in Jails and Prisions. In: Mueser KT, Jeste DV (eds) Clinical Handbook of Schizophrenia. Guilford Press, New York, NY, pp 354–364Google Scholar
  16. 16.
    Maniglio R (2009) Severe mental illness and criminal victimization: A systematic review. Acta Psychiatr Scand 119:180–191PubMedGoogle Scholar
  17. 17.
    Rice DP (1999) The economic impact of schizophrenia. J Clin Psychiatry 60(Suppl 1):4–6PubMedGoogle Scholar
  18. 18.
    Knapp M, Mangalore R, Simon J (2004) The global costs of schizophrenia. Schizophr Bull 30:279–293PubMedGoogle Scholar
  19. 19.
    Burns J (2009) Dispelling a myth: Developing world poverty, inequality, violence and social fragmentation are not good for outcome in schizophrenia. Afr J Psychiatry 12:200–205Google Scholar
  20. 20.
    Saxena S, Thornicroft G, Knapp M et al (2007) Resources for mental health: Scarcity, inequity, and inefficiency. Lancet 370:878–889PubMedGoogle Scholar
  21. 21.
    World Health Organization (WHO) (2005) Mental Health Atlas. World Health Organization, Geneva, SwitzerlandGoogle Scholar
  22. 22.
    Koenig HG (2009) Research on religion, spirituality, and mental health: A review. Can J Psychiatry 54:283–291PubMedGoogle Scholar
  23. 23.
    Lukoff D, Lu FG, Turner R (1995) Cultural considerations in the assessment and treatment of religious and spiritual problems. Psychiatr Clin North Am 18:467–485PubMedGoogle Scholar
  24. 24.
    Huguelet P, Mohr S (2009) Religion/spirituality and Psychosis. In: Huguelet P, Koenig HG (eds) Religion and Spirituality in Psychiatry. Cambridge University Press, New York, NY, pp 65–80Google Scholar
  25. 25.
    Neeleman J, King MB (1993) Psychiatrists’ religious attitudes in relation to their clinical practice: A survey of 231 psychiatrists. Acta Psychiatr Scand 88:420–424PubMedGoogle Scholar
  26. 26.
    Roberts D (1997) Transcending barriers between religion and psychiatry. Br J Psychiatry 171:188PubMedGoogle Scholar
  27. 27.
    Sims A (1999) The cure of souls: Psychiatric dilemmas. Int Rev Psychiatry 11:97–102Google Scholar
  28. 28.
    Hufford DJ (2005) An analysis of the field of spirituality, religion, and health. Area 1 Field Analysis. Accessed 20 Mar 2010 from the Metanexus Institute Web site:
  29. 29.
    Koenig HG (ed) (1998) Handbook of Religion and Mental Health. Academic, San Diego, CAGoogle Scholar
  30. 30.
    Koenig HG, McCullough ME, Larson DB (2001) Handbook of Religion and Health. Oxford University Press, New York, NYGoogle Scholar
  31. 31.
    Levin JS (1994) Religion and health: Is there an association, is it valid, and is it causal?. Soc Sci Med 38:1475–1482PubMedGoogle Scholar
  32. 32.
    Smith TB, McCullough ME, Poll J (2003) Religiousness and depression: Evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 129(4):614–636PubMedGoogle Scholar
  33. 33.
    Moreira-Almeida A, Neto LF, Koenig HG (2006) Religiousness and mental health. Rev Bras Psiquitra 28:242–250Google Scholar
  34. 34.
    Powell LH, Shahabi L, Thoresen CE (2003) Religion and spirituality – linkages to physical health. Am Psychol 58:36–52PubMedGoogle Scholar
  35. 35.
    Larson DB, Swyers JP, McCullough ME (eds) (1997) Scientific Research on Spirituality and Health: A Consensus Report. National Institute for Healthcare Research, Rockville, MDGoogle Scholar
  36. 36.
    Zinnbauer BJ, Pargament KI, Cole B et al (1997) Religion and spirituality: Unfuzzying the fuzzy. J Sci Study Relig 36:549–564Google Scholar
  37. 37.
    Pargament KI, Smith BW, Koenig HG et al (1998) Patterns of positive and negative religious coping with major life stressors. J Sci Study Relig 37:710–724Google Scholar
  38. 38.
    Pargament KI, Koenig HG, Perez LM (2000) The many methods of religious coping: Development and initial validation of the RCOPE. J Clin Psychol 56:519–543PubMedGoogle Scholar
  39. 39.
    Kendler KS, Liu X-Q, Gardner CO et al (2003) Dimensions of religiosity and their relationship to lifetime psychiatric and substance use disorders. Am J Psychiatry 160:496–503PubMedGoogle Scholar
  40. 40.
    Baetz M, Griffin R, Bowen R et al (2004) The association between spiritual and religious involvement and depressive symptoms in a Canadian population. J Nerv Ment Dis 192:818–822PubMedGoogle Scholar
  41. 41.
    Azhar MZ, Varma SL (1995) Religious psychotherapy in depressive patients. Psychother Psychosom 63:165–168PubMedGoogle Scholar
  42. 42.
    Propst LR, Ostrom R, Watkins P et al (1992) Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. J Consult Clin Psychol 60:94–103PubMedGoogle Scholar
  43. 43.
    Johnson WB, Ridley CR (1992) Brief Christian and non-Christian rational emotive therapy with depressed Christian clients: An exploratory study. Couns Values 36:220–229Google Scholar
  44. 44.
    Propst LR (1996) Cognitive-Behavioral Therapy and the Religious Person. In: Shafranske EP (ed) Religion in the Clinical Practice of Psychology. American Psychological Association, Washington, DC, pp 391–408Google Scholar
  45. 45.
    Boelens PA, Reeves RR, Replogle WH et al (2009) A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 39:377–392PubMedGoogle Scholar
  46. 46.
    Ellison CG, Burdette AM, Hill TD (2009) Blessed assurance: Religion, anxiety, and tranquility among US adults. Soc Sci Res 38:656–667PubMedGoogle Scholar
  47. 47.
    Ando M, Morita T, Akechi T et al (2009) The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med 12:1091–1094PubMedGoogle Scholar
  48. 48.
    Goldin PR, Gross JJ (2010) Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion 10:83–91PubMedGoogle Scholar
  49. 49.
    Koszycki D, Benger M, Shlik J et al (2007) Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder. Behav Res Ther 45:2518–2526PubMedGoogle Scholar
  50. 50.
    Toneatto T, Nguyen L (2007) Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research. Can J Psychiatry 52:260–266PubMedGoogle Scholar
  51. 51.
    Mann JJ, Apter A, Bertolote J et al (2005) Suicide prevention strategies. J Am Med Assoc 294:2064–2074Google Scholar
  52. 52.
    Rasic DT, Belik SL, Elias B et al (2009) Spirituality, religion and suicidal behavior in a nationally representative sample. J Affect Disord 114:32–40PubMedGoogle Scholar
  53. 53.
    Nisbet PA, Duberstein PR, Conwell Y et al (2000) The effect of participation in religious activities on suicide versus natural death in adults 50 and older. J Nerv Ment Dis 188:543–546PubMedGoogle Scholar
  54. 54.
    Durkheim E (1951) Suicide: A Study in Sociology (trans: Spaulding JA, Simpson G). Free Press, New York, NYGoogle Scholar
  55. 55.
    Gearing RE, Lizardi D (2009) Religion and Suicide. J Relig Health 48:332–341PubMedGoogle Scholar
  56. 56.
    Brent DA (1995) Risk factors for adolescent suicide and suicidal behavior: Mental and substance abuse disorders, family environmental factors, and life stress. Suicide Life Threat Behav 25:52–63PubMedGoogle Scholar
  57. 57.
    The National Center on Addiction and Substance Abuse at Columbia University (CASA) (2001) So help me God: Substance abuse, religion and spirituality. A CASA White Paper. National Center on Addiction and Substance Abuse at Columbia University, New York, NY, pp 1–59. [cited 17 Jul 2010]. Available from: Google Scholar
  58. 58.
    Miller WR, Forcehimes A, O’Leary M et al (2008) Spiritual direction in addiction treatment: Two clinical trials. J Subst Abuse Treat 35:434–442PubMedGoogle Scholar
  59. 59.
    Koenig HG (2010) Schizophrenia and Other Psychotic Disorders. In: Peteet J, Lu FG, Narrow WE (eds) Religious and Spiritual Issues in Psychiatric Diagnosis: A Research Agenda for DSM-V. American Psychiatric Publishing, Washington, DC, pp 31–60Google Scholar
  60. 60.
    Gaines AD (1995) Culture-specific delusions. Sense and nonsense in cultural context. Psychiatr Clin North Am 18:281–301PubMedGoogle Scholar
  61. 61.
    Bhavsar V, Bhugra D (2008) Religious delusions: Finding meanings in psychosis. Psychopathology 41:165–172PubMedGoogle Scholar
  62. 62.
    Atallah SF, El-Dosoky AR, Coker EM et al (2001) A 22-year retrospective analysis of the changing frequency and patterns of religious symptoms among inpatients with psychotic illness in Egypt. Soc Psychiatry Psychiatr Epidemiol 36:407–415PubMedGoogle Scholar
  63. 63.
    Tateyama M, Asai M, Hashimoto M et al (1998) Transcultural study of schizophrenic delusions: Tokyo versus Vienna versus Tubingen (Germany). Psychopathology 31:59–68PubMedGoogle Scholar
  64. 64.
    Kiev A (1963) Beliefs and delusions of West Indian immigrants to London. Br J Psychiatry 109:356–363PubMedGoogle Scholar
  65. 65.
    Drinnan A, Lavender T (2006) Deconstructing delusions: A qualitative study examining the relationship between religious beliefs and religious delusions. Ment Health Relig Cult 9:317–331Google Scholar
  66. 66.
    Kim KI, Li D, Jiang Z et al (1993) Schizophrenic delusions among Koreans, Korean-Chinese and Chinese: A transcultural study. Int J Soc Psychiatry 39:190–199PubMedGoogle Scholar
  67. 67.
    Klaf FS, Hamilton JG (1961) Schizophrenia: A hundred years ago and today. J Ment Sci 107:819–827PubMedGoogle Scholar
  68. 68.
    Rudaleviciene P, Adomaitiene V, Stompe T et al (2010) Delusions of persecution and poisoning in patients with schizophrenia: Sociocultural and religious background. Medicina 46(3):185–192PubMedGoogle Scholar
  69. 69.
    Rudaleviciene P, Stompe T, Narbekovas A et al (2008) Are religious delusions related to religiosity in schizophrenia? Medicina (Kaunas) 44(7):529–535Google Scholar
  70. 70.
    Mohr S, Borras L, Betrisey C et al (2010) Delusions with religious content in patients with psychosis: How they interact with spiritual coping. Psychiatry 73:158–172PubMedGoogle Scholar
  71. 71.
    Fallot RD (2008) Spirituality and Religion. In: Mueser KT, Jeste DV (eds) Clinical Handbook of Schizophrenia. The Guilford Press, New York, NY, pp 592–603Google Scholar
  72. 72.
    Yorston GA (2001) Mania precipitated by meditation: A case report and literature review. Ment Health Relig Cult 4:209–213Google Scholar
  73. 73.
    Bhugra D (2002) Self-concept: Psychosis and attraction of new religious movements. Ment Health Relig Cult 5:239–252Google Scholar
  74. 74.
    van Os J, Hanssen M, Bijl RV, Vollebergh W (2001) Prevalence of psychotic disorder and community level of psychotic symptoms: An urban-rural comparison. Arch Gen Psychiatry 58:663–668PubMedGoogle Scholar
  75. 75.
    Kendler KS, Gallagher TJ, Abelson JM et al (1996) Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Arch Gen Psychiatry 3:1022–1031Google Scholar
  76. 76.
    Siddle R, Haddock G, Tarrier N et al (2002) Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 37:130–138PubMedGoogle Scholar
  77. 77.
    Ng F (2007) The interface between religion and psychosis. Aust Psychiatry 15:62–66Google Scholar
  78. 78.
    Curlin F, Lawrence RE, Odell S et al (2007) Religion, spirituality, and medicine: Psychiatrists’ and other physicians’ differing observations, interpretations, and clinical approaches. Am J Psychiatry 164:1825–1831PubMedGoogle Scholar
  79. 79.
    Turner RP, Lukoff D, Barnhouse RT et al (1995) Religious or spiritual problem: A culturally sensitive diagnostic category in the DSM-IV. J Nerv Ment Dis 183:435–444PubMedGoogle Scholar
  80. 80.
    O’Connor S, Vandenberg B (2005) Psychosis or faith? Clinicians’ assessment of religious beliefs. J Consult Clin Psychol 73:610–616PubMedGoogle Scholar
  81. 81.
    Pierre J (2001) Faith or delusion? At the crossroads of religion and psychosis. J Psychiatr Pract 7:163–172PubMedGoogle Scholar
  82. 82.
    Lukoff D (1985) The diagnosis of mystical experiences with psychotic features. J Transpers Psychol 17:155–181Google Scholar
  83. 83.
    Sims ACP (1995) Symptoms in the Mind: An Introduction to Descriptive Psychopathology, 3rd edn. W. B. Saunders, LondonGoogle Scholar
  84. 84.
    Wilson WP (1998) Religion and Psychoses. In: Koenig HG (ed) Handbook of Religion and Mental Health. Academic, San Diego, CA, pp 161–173Google Scholar
  85. 85.
    Thara R, Eaton WW (1996) Outcome of schizophrenia: The Madras longitudinal study. Aust N Z J Psychiatry 30:516–522PubMedGoogle Scholar
  86. 86.
    Doering S, Muller E, Kopcke W et al (1998) Predictors of relapse and rehospitalisation in schizophrenia and schizoaffective disorder. Schizophr Bull 24:87–98PubMedGoogle Scholar
  87. 87.
    Siddle R, Haddock G, Tarrier N et al (2004) Religious beliefs and religious delusions: Response to treatment in schizophrenia. Ment Health Rel Cult 7:211–223Google Scholar
  88. 88.
    Koenig HG (2005) Faith and Mental Health. Templeton Foundation Press, Philadelphia, PA, pp 17–42Google Scholar
  89. 89.
    Zandi T, Havenaar JM, Limburg-Okken AG et al (2008) The need for culture sensitive diagnostic procedures: A study among psychotic patients in Morocco. Soc Psychiatry Psychiatr Epidemiol 43:244–250PubMedGoogle Scholar
  90. 90.
    Milstein G, Midlarsky E, Link BG et al (2000) Assessing problems with religious content: A comparison of rabbis and psychologists. J Nerv Ment Dis 188:608–615PubMedGoogle Scholar
  91. 91.
    Ensink K, Robertson B (1999) Patient and family experiences of psychiatric services and African indigenous healers. Transcult Psychiatry 36:23–43Google Scholar
  92. 92.
    Teuton J, Bentall R, Dowrick C (2007) Conceptualizing psychosis in Uganda: The perspective of indigenous and religious healers. Transcult Psychiatry 44:79–114PubMedGoogle Scholar
  93. 93.
    Bosworth HB, Park KS, McQuoid DR et al (2003) The impact of religious practice and religious coping on geriatric depression. Int J Geriatr Psychiatry 18:905–914PubMedGoogle Scholar
  94. 94.
    Tepper L, Rogers SA, Coleman EM et al (2001) The prevalence of religious coping among persons with persistent mental illness. Psychiatr Serv 52:660–665PubMedGoogle Scholar
  95. 95.
    Reger GM, Rogers SA (2002) Diagnostic differences in religious coping among individuals with persistent mental illness. J Psychol Christianity 21:341–348Google Scholar
  96. 96.
    Murray-Swank A, Goldberg R, Dickerson F et al (2007) Correlates of religious service attendance and contact with religious leaders among persons with co-occurring serious mental illness and type 2 diabetes. J Nerv Ment Dis 195:382–388PubMedGoogle Scholar
  97. 97.
    Wahass S, Kent G (1997) Coping with auditory hallucinations: A cross-cultural comparison between Western (British) and non-Western (Saudi Arabian) patients. J Nerv Ment Dis 185:664–668PubMedGoogle Scholar
  98. 98.
    Kirov G, Kemp R, Kirov K et al (1998) Religious faith after psychotic illness. Psychopathology 1998(31):234–245Google Scholar
  99. 99.
    Schofield W, Hathaway SR, Hastings DW et al (1954) Prognostic factors in schizophrenia. J Consult Psychol 18:155–166PubMedGoogle Scholar
  100. 100.
    Chu CC, Klein HE (1985) Psychosocial and environmental variables in outcome of black schizophrenics. J Natl Med Assn 77:793–796Google Scholar
  101. 101.
    Verghese A, John JK, Rajkumar S et al (1989) Factors associated with the course and outcome of schizophrenia in India: Results of a two-year multicentre follow-up study. Br J Psychiatry 154:499–503PubMedGoogle Scholar
  102. 102.
    Mohr S, Borras L, Rieben I et al (2009) Evolution of spirituality and religiousness in chronic schizophrenia or schizoaffective disorders: A 3-years follow-up study. Soc Psychiatr Epidemiol 45:1095–1103Google Scholar
  103. 103.
    Yangarber-Hicks NI (2003) Religious coping styles and recovery from serious mental illness. Dissert Abstr Int Sect B Sci & Eng 63(7-B):3487Google Scholar
  104. 104.
    Phillips RE, Stein CH (2007) God’s will, God’s punishment, or God’s limitations? Religious coping strategies reported by young adults living with serious mental illness. J Clin Psychol 63:529–540PubMedGoogle Scholar
  105. 105.
    Heilman SC, Witztum E (2000) All in faith: Religion as the idiom and means of coping with distress. Ment Health Rel Cult 3:115–124Google Scholar
  106. 106.
    Rammohan A, Rao K, Subbakrishna DK (2002) Religious coping and psychological wellbeing in carers of relatives with schizophrenia. Acta Psychiatr Scand 105:356–362PubMedGoogle Scholar
  107. 107.
    Bussema KE, Bussema EF (2000) Is there a balm in Gilead? The implications of faith in coping with a psychiatric disability. Psychiatr Rehabil J 24:117–124Google Scholar
  108. 108.
    Bussema KE, Bussema EF (2007) Gilead revisited: Faith and recovery. Psychiatr Rehabil J 30:301–305PubMedGoogle Scholar
  109. 109.
    Mohr S, Gillieron C, Borras L et al (2007) The assessment of spirituality and religiousness in schizophrenia. J Nerv Ment Dis 195:247–253PubMedGoogle Scholar
  110. 110.
    Huguelet P, Mohr S, Borras L et al (2006) Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatr Serv 57:366–372PubMedGoogle Scholar
  111. 111.
    Mohr S, Brandt PY, Borras L, Gillieron C, Huguelet P (2006) Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia. Am J Psychiatry 163:1952–1959PubMedGoogle Scholar
  112. 112.
    Keks N, D’Souza R (2003) Spirituality and psychosis. Australas Psychiatry 11:170–171Google Scholar
  113. 113.
    Borras L, Mohr S, Brandt PY et al (2007) Religious beliefs in schizophrenia: Their relevance for adherence to treatment. Schizophr Bull 33:1238–1246PubMedGoogle Scholar
  114. 114.
    Mitchell L, Romans S (2003) Spiritual beliefs in bipolar affective disorder: Their relevance for illness management. J Affect Disord 75:247–257PubMedGoogle Scholar
  115. 115.
    Huguelet P, Mohr S, Borras L et al (2007) Effect of religion on suicide attempts in outpatients with schizophrenia or schizoaffective disorders compared with inpatients with non-psychotic disorders. Eur Psychiatry 22:188–194PubMedGoogle Scholar
  116. 116.
    Palmer BA, Pankratz VS, Bostwick JM (2005) The lifetime risk of suicide in schizophrenia: A reexamination. Arch Gen Psychiatry 62:247–253PubMedGoogle Scholar
  117. 117.
    Murphy M (2000) Coping with the spiritual meaning of psychosis. Psychiatr Rehabil J 24:179–183Google Scholar
  118. 118.
    Jarbin H, von Knorring AL (2004) Suicide and suicide attempts in adolescent-onset psychotic disorders. Nord J Psychiatry 58:115–123PubMedGoogle Scholar
  119. 119.
    Regier DA, Farmer ME, Rae DS et al (1990) Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. J Am Med Assoc 264:2511–2518Google Scholar
  120. 120.
    Huguelet P, Borras L, Gillieron C et al (2009) Influence of spirituality and religiousness on substance misuse in patients with schizophrenia or schizo-affective disorder. Subst Use Misuse 44:502–513PubMedGoogle Scholar
  121. 121.
    Borras L, Mohr S, Brandt PY et al (2008) Influence of spirituality and religiousness on smoking among patients with schizophrenia or schizo-affective disorder in Switzerland. Int J Soc Psychiatry 54:539–549PubMedGoogle Scholar
  122. 122.
    McCreadie RG, Scottish Comorbidity Study Group (2002) Use of drugs, alcohol and tobacco by people with schizophrenia: Case-control study. Br J Psychiatry 181:321–325PubMedGoogle Scholar
  123. 123.
    Brown S, Inskip H, Barraclough B (2000) Causes of the excess mortality of schizophrenia. Br J Psychiatry 177:212–217PubMedGoogle Scholar
  124. 124.
    Ziedonis DM, Kosten TR, Glazer WM et al (1994) Nicotine dependence and schizophrenia. Hosp Commun Psychiatry 45:204–206Google Scholar
  125. 125.
    Carosella AM, Ossip-Klein DJ, Owens CA (1999) Smoking attitudes, beliefs, and readiness to change among acute and long term care inpatients with psychiatric diagnoses. Addict Behav 24:331–344PubMedGoogle Scholar
  126. 126.
    Gaite L, Vázquez-Barquero JL, Borra C et al (2002) Quality of life in patients with schizophrenia in five European countries: The EPSILON study. Acta Psychiatr Scand 105:283–292PubMedGoogle Scholar
  127. 127.
    Nolan J, McEvoy JP, Koenig HG et al (under review) Religious coping and quality of life among individuals living with schizophrenia. Psychiatr ServGoogle Scholar
  128. 128.
    Sowell R, Moneyham L, Hennessy M et al (2001) Spiritual activities as a resistance resource for women with human immunodeficiency virus. Nurs Res 49:73–82Google Scholar
  129. 129.
    Dalmida SG (2006) Spirituality, mental health, physical health, and health-related quality of life among women with HIV/AIDS: Integrating spirituality into mental health care. Issues Ment Health Nurs 27:185–198PubMedGoogle Scholar
  130. 130.
    Simoni JM, Martone MG, Kerwin JF (2002) Spirituality and psychosocial adaptation among women with HIV/AIDS: Implications for counseling. J Couns Psychol 49:139–147Google Scholar
  131. 131.
    Rosenberg SD, Goodman LA, Osher FC et al (2001) Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness. Am J Public Health 91:31–37PubMedGoogle Scholar
  132. 132.
    McQuillan GM, Khare M, Karon JM et al (1997) Update on the seroepidemiology of human immunodeficiency virus in the United States household population: NHANES 111, 1988–1994. J Acquir Immune Defic Syndr Hum Retrovirol 14:355–360PubMedGoogle Scholar
  133. 133.
    Cournos F, McKinnon K (1997) HIV seroprevalence among people with severe mental illness in the United States: A critical review. Clin Psychol Rev 17:259–269PubMedGoogle Scholar
  134. 134.
    Loue S, Sajatovic M (2006) Spirituality, coping and HIV risk and prevention in a sample of severely mentally ill Puerto Rican women. J Urban Health 83:1168–1182PubMedGoogle Scholar
  135. 135.
    Mohr S, Pfeifer S (2009) Delusions and Hallucinations. In: Huguelet P, Koenig HG (eds) Religion and Spirituality in Psychiatry. Cambridge University Press, New York, NY, pp 81–96Google Scholar
  136. 136.
    Mohr S, Huguelet P (2009) Religious and Spiritual Assessment in Clinical Practice. In: Huguelet P, Koenig HG (eds) Religion and Spirituality in Psychiatry. Cambridge University Press, New York, NY, pp 232–243Google Scholar
  137. 137.
    Lukoff D (2007) Spirituality in the recovery from persistent mental disorders. South Med J 100:642–646PubMedGoogle Scholar
  138. 138.
    Surgeon General (1999) Mental Health: A Report of the Surgeon General. Surgeon General, Bethesda, MDGoogle Scholar
  139. 139.
    Fallot RD (2007) Spirituality and religion in recovery. Psychiatr Rehabil J 30:261–270PubMedGoogle Scholar
  140. 140.
    Phillips RE, Lakin R, Pargament KI (2002) Development and implementation of a spiritual issues psychoeducation group for those with serious mental illness. Community Ment Health J 38:487–495PubMedGoogle Scholar
  141. 141.
    Kehoe NC (2007) Spirituality groups in serious mental illness. South Med J 100:647–648PubMedGoogle Scholar
  142. 142.
    Kehoe NC (1999) A therapy group on spiritual issues for patients with chronic mental illness. Psychiatr Serv 50:1081–1083PubMedGoogle Scholar
  143. 143.
    Revheim N, Greenberg WM (2007) Spirituality matters: Creating a time and place for hope. Psychiatr Rehabil J 30:307–310PubMedGoogle Scholar
  144. 144.
    Johnson DP, Ringo EJ, Lyimo A et al (2009) Implementation of group psychoeducation for severe mental illness in East Africa: Lessons learned in Moshi, Tanzania. Int Psychol Bull 13:17–19Google Scholar
  145. 145.
    Raguram R, Venkateswaran A, Ramakrishna J et al (2002) Traditional community resources for mental health: A report of temple healing from India. Br Med J 325:38–40Google Scholar
  146. 146.
    Salib E, Youakim S (2001) Spiritual healing in elderly psychiatric patients: A case control study in an Egyptian psychiatric hospital. Aging Ment Health 5:366–370PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Jennifer A. Nolan
    • 1
    Email author
  • Rachel E. Dew
    • 2
  • Harold G. Koenig
    • 3
  1. 1.Center for Child and Family Policy, Social Science Research InstituteDuke UniversityDurhamUSA
  2. 2.Division of Child & Adolescent Psychiatry, Department of Psychiatry & Behavioral SciencesDuke Child & Family Study Center, Duke University Medical CenterDurhamUSA
  3. 3.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA

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