Study: Doctors' Religious Beliefs Guide Depression Treatment

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Study: Doctors' Religious Beliefs Guide Depression Treatment

(September 3, 2007) - The Dallas Morning News - If you go to your family doctor complaining you're depressed, your treatment could be influenced by the religious beliefs of your doctor.

That's the thrust of a paper published today in the journal Psychiatric Services. The paper reports the results of a national survey of physicians taken in 2003.

The doctors were given this question:

"A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first? A psychiatrist or psychologist, a clergy member or religious counselor, a health care chaplain, or other."

A bit more than half the doctors chose the first option and about a third chose one of the two faith-linked counseling options. But the choices varied significantly depending on the faith and degree of religiosity of the doctor.

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Protestants were more likely to choose one of the religious options than any other religious group. The more religiously observant the doctor said he or she was, the more likely that doctor's first inclination would be to choose one of the religious options. And the less religious the doctor, the more likely the choice would be a psychiatrist or psychologist.

The question about grief is intentionally ambiguous -- lacking details a doctor would want -- the better to get the doctors to react based on their own biases, the paper said.

In the real world, of course, a doctor would be able to get a lot more information than was presented in that scenario, including details about religion. But the survey also indicated that two-thirds of American doctors rarely or never broach religious topics with their patients, said Dr. Farr Curlin, the University of Chicago doctor who was the lead researcher on the study.

And that could set up an important disconnect, because there are psychological issues like grief where the most successful treatments are tailored in part to the religious beliefs of the patient, Dr. Curlin said. And many people turn to their family doctors first when faced with problems like depression.

The national survey included a random sample of 1,114 doctors. The question analyzed in the new paper was one of a series of queries linking health care to faith and ethics.

Old-style training

Patients should take a lesson from the results, said Dr. Gary Barnes, associate professor of biblical counseling at Dallas Theological Seminary. They need to make sure their doctors know what's important to them -- including religion. And they need to consider for themselves whether to seek out clergy or other faith-based counseling.

"You are going to have to do your homework a little better," said Dr. Barnes, a licensed psychologist.

The doctors' answers also reflect old-style training, he said. As recently as the 1990s, for instance, not even psychologists were focused on issues such as forgiveness, a topic often tied to religious beliefs. These days, forgiveness is one of the hottest areas of psychological research, Dr. Barnes said.

The results are evidence of what people should already realize, said Dr. John Sadler, who teaches about medical ethics and about psychiatry at UT Southwestern Medical School.

"Some members of the public have the naive notion that scientific medical practice is completely objective. This is not true, and moreover, if you think about it, you don't want it to be true," he said.

But doctors should routinely ask patients about their religious and cultural background, the better to decide treatment, he said.

"What we often see with med students and beginning physicians is a sense of anxiety about how to handle religious matters," he said. "American medical education is still working on the best ways to address spiritual issues with patients. We need to develop our skills in taking religious and spiritual histories and making good use of the information."

Particularly when treating psychological issues, knowing about religion can be important, he said.

Sometimes the distinction between mental disorder and a spiritual crisis is not obvious, he said. "We have much to learn from clergy."

Patients' input

At Presbyterian Hospital of Dallas, every patient is asked about religious and cultural needs when they check in, said Dr. Don Hafer, a neuropsychologist and the clinical therapist coordinator for the hospital.

Most people answer, but say their religion is not particularly relevant to their health problem, he said. And that means the results of the new paper should not create too many new worries for patients, he said.

But he agreed that doctors should make inquiries about faith and culture a more standard part of their practice.

Dr. Curlin said he hoped his work would prompt doctors to consider their own biases a bit more when considering treatment options for the kind of situation in the question.

"Maybe it will cause the religious doctor to ask himself, 'Am I not sending this patient to a psychiatrist because I have a bias against that?' " he said. "And maybe it will cause the secular physician to ask, 'Should I ask about the patient's religious background, because this may be a place they have resources I might not otherwise know about?' "

Doctors and Religion

The following question posed to doctors in a national survey was the basis of a paper in the journal Psychiatric Services. Here's a look at the results.

A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first?

56% Psychiatrist or psychologist

25% Clergy member or religious counselor

7% Health care chaplain

12% Other

Source: Psychiatric Services, September 2007; the margin of error is plus or minus 3.5 percentage points

Last updated: 09/07

Study: Doctors' Religious Beliefs Guide Depression Treatment

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