Clinical implications of spirituality to mental health: review of evidence and practical guidelines
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OBJECTIVE: Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health and recommendations by professional associations that these research findings be integrated into clinical practice, application of this knowledge in the clinic remains a challenge. This paper reviews the current state of the evidence and provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. METHODS: PubMed searches of relevant terms yielded 1,109 papers. We selected empirical studies and reviews that addressed assessment of R/S in clinical practice. RESULTS: The most widely acknowledged and agreed-upon application of R/S to clinical practice is the need to take a spiritual history (SH), which may improve patient compliance, satisfaction with care, and health outcomes. We found 25 instruments for SH collection, several of which were validated and of good clinical utility. CONCLUSIONS: This paper provides practical guidelines for spiritual assessment and integration thereof into mental health treatment, as well as suggestions for future research on the topic.
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Most patients would like to talk about their R/S in health care settings but most have never been asked.
“Indeed, most patients would like to talk about their R/S in health care settings but, surprisingly, most have never been asked.18”
From Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis (2023) · cites this paper as [18]
The Introduction (page unavailable) says patients value R/S discussion more than it occurs in practice and that most patients have undetected spiritual needs. Assessing R/S in clinical practice (page unavailable) reports that 83% of one older-patient group valued discussing spiritual issues, but only 41% of surveyed inpatients wanted such a discussion during hospitalization. The review does not establish that most patients across health care settings want to talk about R/S or that most have never been asked. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTaking a SH is an aspect of person-centered, compassionate, and culturally sensitive care.
“it is an aspect of person-centered, compassionate, and culturally sensitive care18,26”
A large majority of physicians consider it important to integrate R/S into their practice, but most face difficulties in addressing such topics due to lack of time and lack of appropriate training.
“The evidence shows that a large majority of physicians consider it important to integrate R/S into their practice, but most of them face difficulties in addressing such topics with their patients, due to a lack of time and a lack of appropriate training.13,14”
From How psychiatrists think about religious and spiritual beliefs in clinical practice: findings from a university hospital in São Paulo, Brazil (2019) · cites this paper as [14]
Some authors have emphasised the importance of discussing religion/spirituality in the therapeutic context and distinguished between their positive and negative aspects.
“In addition, some authors have emphasised the importance of discussing religion/spirituality in the therapeutic context and distinguished between their positive and negative aspects.23,24”
From A preliminary survey on the religious profile of Brazilian psychiatrists and their approach to patients' religiosity in clinical practice (2016) · cites this paper as [24]
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Concepções de idosos sobre espiritualidaderelacionada ao envelhecimento e qualidade de vida
Chaves, L. J., & Gil, C. A. (2015) · Ciência & Saúde Coletiva · doi:10.1590/1413-812320152012.19062014 · Cited by 48 · see citing works
de Diego‐Cordero, R., Badanta, B., de Matos, F. A. P. S., Costa, E., Espinha, D. C. M., Tomasso, C. D. S., Lucchetti, A. L. G., & Lucchetti, G. (2018) · Journal of Clinical Nursing · doi:10.1111/jocn.14340 · Cited by 46 · see citing works
Spirituality and Health: A Middle Eastern Perspective
Weathers, E. (2018) · Religions · doi:10.3390/rel9020033 · Cited by 47 · see citing works
Borges, M., Lucchetti, G., Leão, F. C., Vallada, H., & Peres, M. F. P. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062873 · Cited by 51 · see citing works
Elias, A., Ricci, M., Rodriguez, L. H. D., Pinto, S. D., Giglio, J. S., & Baracat, E. (2015) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2015.01.007 · Cited by 41 · see citing works
Siqueira, J., Fernandes, N., & Moreira-Almeida, A. (2018) · Jornal Brasileiro De Nefrologia · doi:10.1590/2175-8239-jbn-2018-0096 · Cited by 34 · see citing works
Damiano, R. F., Santi, T. D., Beach, S. R., Pan, P. M., Lucchetti, A. L. G., Smith, F. A., Forlenza, O. V., Fricchione, G. L., Miguel, E. C., & Lucchetti, G. (2021) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2020-1582 · Cited by 58 · see citing works
Doram, K. R., Chadwick, W. A., Bokovoy, J., Profit, J., Sexton, J. D., & Sexton, J. B. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2050-5 · Cited by 37 · see citing works
On the Science of Consciousness: Epistemological Reflections and Clinical Implications
Facco, E., Lucangeli, D., & Tressoldi, P. E. (2017) · EXPLORE · doi:10.1016/j.explore.2017.02.007 · Cited by 38 · see citing works
Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment
Rosmarin, D. H., Salcone, S. G., Harper, D. G., & Forester, B. P. (2019) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.20180046 · Cited by 34 · see citing works
Vasconcelos, A. P. S. L., Lucchetti, A. L. G., Cavalcanti, A. P. R., Conde, S. R. S. D. S., Gonçalves, L. M., do Nascimento, F. R., Chazan, A. C. S., Tavares, R. L. C., Ezequiel, O. D. S., & Lucchetti, G. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06145-x · Cited by 32 · see citing works
Esteban, R. F. C., Chaparro, J. E. T., Mamani-Benito, O. J., Torres, J. H., & Sarria-Arenaza, F. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e06939 · Cited by 38 · see citing works
Marques, A., Ihle, A., Souza, A., Peralta, M., & de Matos, M. G. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.126 · Cited by 35 · see citing works
da Cunha, V. F., & Scorsolini‐Comin, F. (2019) · Psicologia Teoria e Pesquisa · doi:10.1590/0102.3772e35419 · Cited by 30 · see citing works
Peres, M. F. P., Oliveira, A. B., Leão, F. C., Vallada, H., Moreira‐Almeida, A., & Lucchetti, G. (2018) · SSM - Population Health · doi:10.1016/j.ssmph.2018.08.007 · Cited by 30 · see citing works
Gonçalves, J. R. L., Jorge, A. P., Zanetti, G. C., Amaro, E. D. A., Tótoli, R. T., & Lucchetti, G. (2018) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.64.06.537 · Cited by 28 · see citing works
Menegatti-Chequini, M. C., Maraldi, E. D. O., Peres, M. F. P., Leão, F. C., & Vallada, H. (2019) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2017-2447 · Cited by 28 · see citing works
Moral, Religious, or Spiritual Problem
Mattson, S. A., VanderWeele, T. J., Lu, F. G., Carey, L. B., Cowden, R. G., Fung, E. N., Koenig, H. G., Peteet, J. R., & Wortham, J. S. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001856 · Cited by 28 · see citing works
Associations between Prayer and Mental Health among Christian Youth in the Philippines
Castillo, F. A. D., del Castillo, C. D., & Koenig, H. G. (2023) · Religions · doi:10.3390/rel14060806 · Cited by 28 · see citing works
Roxburgh, E. C., & Evenden, R. E. (2016) · European Journal of Psychotherapy & Counselling · doi:10.1080/13642537.2016.1170059 · Cited by 27 · see citing works
Spiritual well-being and hope in the preoperative period of cardiac surgery
Bezerra, S. M. M. D. S., Gomes, E. T., Galvão, P. C. D. C., & Souza, K. V. D. (2018) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2016-0642 · Cited by 27 · see citing works
de Diego-Cordero, R., Lucchetti, G., Fernández-Vázquez, A., & Badanta-Romero, B. (2019) · Journal of religion and health · doi:10.1007/s10943-019-00780-3 · Cited by 24 · see citing works
Fernandes-Nascimento, M. H., & Wang, Y. (2022) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2021.101531 · Cited by 25 · see citing works
Approaching Spirituality Using the Patient-Centered Clinical Method
de Oliveira, J. D., Anderson, M., Lucchetti, G., Pires, E. A., & Gonçalves, L. M. (2019) · Journal of religion and health · doi:10.1007/s10943-017-0534-6 · Cited by 20 · see citing works
Interconexão entre saúde, espiritualidade e religiosidade
Teixeira, M. Z. (2020) · Revista de Medicina · doi:10.11606/issn.1679-9836.v99i2p134-147 · Cited by 25 · see citing works
Elderly caring for the elderly: spirituality as tensions relief
da Silva, M. C. M., Moreira‐Almeida, A., & de Castro, E. A. B. (2018) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2017-0370 · Cited by 23 · see citing works
ABORDAGEM TEÓRICO-PRÁTICA DA ESPIRITUALIDADE EM PACIENTES INSTITUCIONALIZADOS
Jacintho, J. D. O., de Abreu, L. M., Becker, R., Gontijo, C. M. M., Santos, M. E., Romera, F. A., Silva, M., Barra, A. D. A., & Barreto, L. B. (2018) · Revista UFG · doi:10.5216/revufg.v17i20.51766 · Cited by 22 · see citing works
Braghetta, C. C., Gorenstein, C., Wang, Y., Martins, C. B., Leão, F. C., Peres, M. F. P., Lucchetti, G., & Vallada, H. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.764132 · Cited by 22 · see citing works
Sulphey, M. M. (2022) · Journal of Religion and Health · doi:10.1007/s10943-022-01629-y · Cited by 22 · see citing works
Lilja, A., DeMarinis, V., Lehti, A., & Forssén, A. S. K. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011647 · Cited by 22 · see citing works
Jones, S., Sutton, K., & Isaacs, A. N. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0673-4 · Cited by 20 · see citing works
Amerongen-Meeuse, J. C. V. N., Schaap‐Jonker, H., Westerbroek, G., Anbeek, C., & Braam, A. W. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001150 · Cited by 20 · see citing works
Psychiatry and religion: consensus reached!
Verhagen, P. J. (2017) · Mental Health Religion & Culture · doi:10.1080/13674676.2017.1334195 · Cited by 19 · see citing works
Gonçalves, L. M., Tsuge, M. L. T., Borghi, V. S., Miranda, F. P., Sales, A. P. D. A., Lucchetti, A. L. G., & Lucchetti, G. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0681-4 · Cited by 20 · see citing works
Salimena, A. M. D. O., Ferrugini, R. R. B., de Melo, M. C. S. C., & Amorim, T. V. (2016) · Revista gaúcha de enfermagem · doi:10.1590/1983-1447.2016.03.51934 · Cited by 19 · see citing works
Camargo, M. L. D. S., Torres, R. V., Cotta, K. C. G., Ezequiel, O. D. S., Lucchetti, G., & Lucchetti, A. L. G. (2023) · International Journal of Social Psychiatry · doi:10.1177/00207640231157258 · Cited by 18 · see citing works
Iranian Hospital Nurses' Lived Experiences of Emotional Intelligence: A Phenomenological Study
Imani, B., Kermanshahi, S. M. K., Vanaki, Z., Kazemnejad, A., & Paydar, M. R. Z. (2018) · Issues in Mental Health Nursing · doi:10.1080/01612840.2017.1395497 · Cited by 18 · see citing works
Mendes, N. S., Malaguti, C., Sena, L. D. A., Lucchetti, G., de Jesus, L. A. D. S., Vitorino, L. M., Mesquita, R., Lee, A. L., & Oliveira, C. C. (2021) · Journal of Clinical Nursing · doi:10.1111/jocn.15926 · Cited by 17 · see citing works
Mthembu, T. G., Wegner, L., & Roman, N. V. (2016) · Journal of Spirituality in Mental Health · doi:10.1080/19349637.2016.1206843 · Cited by 17 · see citing works
Reinaldo, A. M. D. S., & dos Santos, R. L. F. (2016) · Saúde em Debate · doi:10.1590/0103-1104201611012 · Cited by 17 · see citing works
Arani, Z. A., Biderafsh, A., & Salmani, S. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0643-x · Cited by 18 · see citing works
Adomako, B. (2023) · Health Psychology Open · doi:10.1177/20551029231202316 · Cited by 16 · see citing works
Salmani, S., Biderafsh, A., & Arani, Z. A. (2019) · Journal of Religion and Health · doi:10.1007/s10943-018-00749-8 · Cited by 16 · see citing works
Mthembu, T. G., Wegner, L., & Roman, N. V. (2017) · Occupational Therapy in Mental Health · doi:10.1080/0164212x.2017.1362367 · Cited by 16 · see citing works
Valdivia, L. J., Alves, L. P. D. C., & da Rocha, N. S. (2018) · Journal of Health Psychology · doi:10.1177/1359105317751619 · Cited by 16 · see citing works
Spirituality in geriatric psychiatry
Lucchetti, A., Barcelos‐Ferreira, R., Blazer, D., & Moreira-Almeida, A. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000424 · Cited by 10 · see citing works
Gonçalves, J. P. D. B., Lucchetti, G., Maraldi, E. D. O., Fernandez, P. E. L., Menezes, P., & Vallada, H. (2022) · Revista Brasileira de Psiquiatria · doi:10.47626/1516-4446-2022-2832 · Cited by 22 · see citing works
Religião e espiritualidade no curso de psicologia: revisão sistemática de estudos empíricos
Pereira, K. C. L., & Holanda, A. F. (2019) · Interação em Psicologia · doi:10.5380/psi.v23i02.65373 · Cited by 14 · see citing works
Gad, I., Tan, X.-W. C., Williams, S. J., Itawi, S., Dahbour, L., Rotter, Z., Mitro, G., Rusch, C., Perkins, S., & Ali, I. (2020) · Journal of Religion and Health · doi:10.1007/s10943-020-01103-7 · Cited by 14 · see citing works
Akanni, O. O., Olashore, A. A., & Oderinde, K. O. (2021) · Mental Health Religion & Culture · doi:10.1080/13674676.2020.1870218 · Cited by 14 · see citing works
Spiritual Care Guide in HospiceㆍPalliative Care
Kang, K., Kim, D.-B., Koh, S., Park, M., Park, H. Y., Yoon, D. H., Yoon, S.-J., Lee, S.-J., Choi, J., Han, H. S., et al. (2023) · The Journal of Hospice and Palliative Care · doi:10.14475/jhpc.2023.26.4.149 · Cited by 13 · see citing works
de Campos, R. J. D. S., Lucchetti, G., Lucchetti, A. L. G., Ribeiro, T. C. D. R., Chebli, L. A., Malaguti, C., Gaburri, P. D., Pereira, L. M. N., de Almeida, J. G., & Chebli, J. M. F. (2019) · Journal of Religion and Health · doi:10.1007/s10943-019-00801-1 · Cited by 13 · see citing works
Hathaway, D. B., Oliveira, F. H. A. D. O. E., Mirhom, M., Moreira‐Almeida, A., Fung, W. L. A., & Peteet, J. R. (2021) · Academic Medicine · doi:10.1097/acm.0000000000004167 · Cited by 14 · see citing works
Mosqueiro, B. P., Costa, M. D. A., Caribé, A. C., Oliveira e Oliveira, F. H. A., Pizutti, L., Zimpel, R. R., Baldaçara, L., da Silva, A. G., & Moreira-Almeida, A. (2023) · Brazilian Journal of Psychiatry · doi:10.47626/1516-4446-2023-3056 · Cited by 12 · see citing works
“…SHs should be taken in a patient-centered way that involves ethical commitment without proselytizing or prescribing religious or anti-religious perspectives 18 ; the approach must be respectful to the patient’s faith and culture, and the process should be focused on the patient’s beliefs and needs.”
The Effect of Spirituality on the Subjective Recovery of Psychiatric Patients
ÖZ, Y. C., & Duran, S. (2021) · Journal of Religion and Health · doi:10.1007/s10943-021-01226-5 · Cited by 12 · see citing works
Weathers, E. (2019) · Springer eBooks · doi:10.1007/978-3-030-04420-6_1 · Cited by 12 · see citing works
The Use of Bibliotherapy in Revealing and Addressing the Spiritual Needs of Cancer Patients
Bálint, Á., & Magyari, J. (2020) · Religions · doi:10.3390/rel11030128 · Cited by 13 · see citing works
Spirituality, religion, and mood disorders
Mosqueiro, B. P., Pinto, A. D. R., & Moreira‐Almeida, A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-816766-3.00001-x · Cited by 12 · see citing works
Toward the Concept of ‘Spiritist Chaplaincy’
Saad, M., Lucchetti, G., Peres, M. F. P., & de Medeiros, R. (2015) · Journal of Religion and Health · doi:10.1007/s10943-015-0011-z · Cited by 11 · see citing works
Alsamara, K., Kakaje, A., Soqia, J., Ghareeb, A., Watson, L., Hadakie, R., Jawich, K., ALhomsi, A., & Forbes, D. (2024) · Journal of Religion and Health · doi:10.1007/s10943-024-02005-8 · Cited by 11 · see citing works
A Model of Collaborative Spiritual and Psychiatric Care of Oncology Patients
Kao, L. E., Lokko, H. N., Gallivan, K., O’Brien, V., & Peteet, J. R. (2017) · Psychosomatics · doi:10.1016/j.psym.2017.06.004 · Cited by 12 · see citing works
Spiritual Themes and Challenges in Global Health
Addiss, D. G. (2015) · Journal of Medical Humanities · doi:10.1007/s10912-015-9378-9 · Cited by 11 · see citing works
Bioética no acolhimento a dependentes de drogas psicoativas em comunidades terapêuticas
Schlemper, B. R. (2018) · Revista Bioética · doi:10.1590/1983-80422018261225 · Cited by 11 · see citing works
Leung, C. H. (2022) · Asia Pacific Journal of Education · doi:10.1080/02188791.2022.2114425 · Cited by 11 · see citing works
Religion, Spirituality, and Ethics in Psychiatric Practice
Dike, C. C., Briz, L., Fadus, M., Martinez, R., May, C., Milone, R., Nesbit-Bartsch, A., Powell, T., Witmer, A. M., & Brendel, R. W. (2022) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001505 · Cited by 12 · see citing works
Religious syncretism as a sociocultural factor of social security in cross-border regions
Gavrilova, Y., Анатольевна, Щ. И., Борисовна, Л. М., & Gordeeva, N. (2018) · Mental Health Religion & Culture · doi:10.1080/13674676.2018.1460590 · Cited by 10 · see citing works
Impact of Religion and Spirituality in Older Persons
Lucchetti, G., Vitorino, L., Nasri, F., & Lucchetti, A. (2019) · Spirituality, Religiousness and Health · doi:10.1007/978-3-030-21221-6_8 · Cited by 11 · see citing works
Jiménez, M. S. R., & Desfilis, E. S. (2020) · Nursing Reports · doi:10.3390/nursrep10020022 · Cited by 10 · see citing works
Bhagwandas, K., Kumar, G., Satish, L., Behera, N., Mohanty, S., & Mahadevan, J. (2024) · Journal of Religion and Health · doi:10.1007/s10943-024-02220-3 · Cited by 9 · see citing works
- Authors
- Moreira-Almeida, A., Koenig, H. G., & Lucchetti, G.
- Affiliations
- Universidade Federal de Juiz de Fora (UFJF), Brazil
- King Abdulaziz University (SA)
- Universidade Federal de Juiz de Fora (BR)
- Venue
- Revista Brasileira de Psiquiatria
- Publisher
- EDITORA SCIENTIFIC
- Published
- 2014-04
- Volume
- 36
- Issue
- 2
- Pages
- 176-182
- ISSN
- 1516-4446 (ISSN-L)
- OpenAlex
- W2158904243
- Cited by
- 261
- References
- 64
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 14 · 2023: 25 · 2022: 32 · 2021: 38 · 2020: 29 · 2019: 23 · 2018: 34 · 2017: 12 · 2016: 15 · 2015: 9 · 2012: 1
- FWCI
- 1.72
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- Brazilian Journal of Psychiatry (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- Americanae (AECID Library) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Social Sciences › Demography › Workplace Spirituality and Leadership
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- spirituality, religiosity, mental health, spiritual assessment, spiritual history, medication adherence, patient satisfaction
- MeSH terms
- Mental Disorders, Humans, Mental Health, Treatment Outcome, Practice Guidelines as Topic, Needs Assessment, Spirituality
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