The Role of Religion in Depression: Implications for Mental Health Services in South Africa

Background and Purpose: Religiosity is an important aspect of the African cultural beliefs systems, and may play a significant role in mental health, particularly in sub-Saharan Africa, where support from formal sources is limited. Depression is one of the most common mental disorders in South Africa, according to a nationally representative psychiatric epidemiological survey (Williams et al., 2008). However, the literature (McCullough and Larson, 1999; Bonelli and Koening, 2013) points to the complex role of religion, and population-based studies in sub-Saharan Africa is limited.

Methods: Data from the South African National Income Dynamics Study (SA-NIDS) Waves 1-3 was used to examine the association between religion and depression. SA-NIDS is the first longitudinal panel survey of a nationally representative sample of households in South Africa. Depressive symptoms were assessed using the 10-item four-point Likert version of the Center for Epidemiologic Studies Depression Scale (CES-D). Two self-reported measures of religiosity, namely perceived importance of religious activity and affiliation, were available in SA-NIDS. Two adjusted mixed-effects logistic regressions were fitted to assess the relationship between the measures of religiosity and depression. All analyses were adjusted for post-stratification weight.

Results: One third (n = 5,275; 32.2%) of adult study participants had a positive screen for depressive symptoms at baseline based on total cut-off CES-D scores ≥10. A large majority (88.0%; n = 13,699) reported religious activities as being either important or very important. Few individuals (10.4%; n=1,666) reported not having any religious affiliation. The results of the adjusted mixed-effects logistic regressions over waves 1-3 indicated that individuals who reported religious activity to be important (aOR = 0.80, 95% CI: 0.68-0.95) or very important (aOR = 0.78, 95% CI: 0.65-0.92) had a significantly lower levels of depressive symptomatology [compared to very unimportant/unimportant]. Furthermore, religious affiliation (aOR = 0.85, 95% CI: 0.75-0.95) was associated with lower levels of depressive symptomatology [compared to no religious affiliation].

Conclusions and Implications: We found some evidence that religiosity may be associated with better mental health outcomes in the area of depression in South Africa. The study limitations included the lack of strong measures of religiosity, and the potential for adverse effects on health is probable, warranting further studies. Religion is personal, often eliciting deep seated feelings. Competent engagement by social workers who incorporate religion into their practice should approach their clients with sensitivity and care.