INT’L. J. PSYCHIATRY IN MEDICINE, Vol. 37(2) 213-227, 2007

RELIGIOSITY, ANXIETY, AND DEPRESSION AMONG

A SAMPLE OF IRANIAN MEDICAL STUDENTS*

SASAN VASEGH, MD

MOHAMMAD-REZA MOHAMMADI, MD

Tehran University of Medical Sciences, Iran

ABSTRACT

Objective: There are many studies of religion and mental health in a Christian

context, but studies in Islamic countries are few. Most previous studies used

only a single question for measuring religion, and several of them showed

negative associations between religion and indexes of anxiety or depression

among older people. This study preliminary assesses the associations between

religious variables, anxiety, and depression in a sample of Muslim students.

Method: This cross-sectional study examines a sample of medical students

(N = 285) for association(s) between religiosity, anxiety, and depression. The

subjects completed a Muslim religiosity questionnaire including religious

beliefs, emotions, and behaviors subscales and the Beck anxiety and depres-

sion inventories during their psychiatry rotation at Roozbeh psychiatric

hospital, Tehran, Iran. Results: all the three religious subscales were nega-

tively associated with and negatively predicted depression and anxiety; but

only prediction of anxiety by the religious beliefs score was statistically sig-

nificant. Conclusions: These findings provide further evidence for a protective

role of religion against anxiety and depression but more studies are required.

(Int’l. J. Psychiatry in Medicine 2007;37:213-227)

Key Words: medical students, anxiety, depression, religion, Iran

*This study was conducted by Dr. Vasegh as a residency thesis by his personal funding. Data

collection and preparation was done when Dr. Vasegh was at Tehran University of Medical Sciences

(T.U.M.S.). He now works as a psychiatrist at Ilam University of Medical Sciences west of Iran

and is a research collaborator of T.U.M.S.

213

� 2007, Baywood Publishing Co., Inc.

INTRODUCTION

Recently, there has been increasing interest in the relationships between various

aspects of religion and mental or physical health. There are many studies asso-

ciating religious variables with positive health outcomes [1-3]. For example,

studies have shown that religious beliefs and practices relate to decreased suicide,

decreased anxiety, decreased substance abuse, decreased depression and faster

recovery from it, increased hope and optimism, more sense of meaning in life,

and more satisfaction in marital life [4], though some religious beliefs or behaviors

can result in mental strain or negative health consequences [1, 4-6]. Yet, the

percentage of published studies in which a religious variable has been measured

is surprisingly low, and most of these studies have relied on only one variable to

measure religion [7], and has been done in a Christian context [8]. In addition,

many of the studies on religion and mental or physical health have been done in

older or sick people [1, 9], and there are very few published studies about religion

and health in Islamic countries among young persons.

Although not even one similar study could be found in a Muslim context, some

interesting randomized trials have shown faster recovery of religious anxious

or depressed Muslim patients using additional Islamic religious psychotherapy

compared with the usual treatment [10, 11] and some other studies have shown

less suicide rates among Muslims [12, p. 138].

Depression and anxiety are among the most common and debilitating mental

health conditions. Although there are many studies linking religion to depression

[13], anxiety has been largely ignored [14]. University and college students

usually experience many educational, cultural, social, and financial stresses,

which can lead to anxiety and depression [15, 16], and these in turn have

significant correlations with physical illness [17] and academic impairment [18].

Medical students are reported to bear more stress compared with other students,

and depression rates in this group increase more from the first to second year of

medical school, compared to a sample of control students [15]. Rosal’s findings

suggest that this increase continued through the 4th year of medical school [19].

In the present study we examined the associations between multiple religious

variables with depression and anxiety among a sample of 4th-year medical

students in Tehran, Iran. Effects of several covariates are controlled for, and

results are compared with previous studies conducted in Western cultures.

METHOD

Participants

The participants were medical students who entered Roozbeh Psychiatric

Hospital of Tehran University of Medical Sciences to complete their one month

psychiatry rotation from March to December 2004. Of 286 students meeting these

214 / VASEGH AND MOHAMMADI

criteria, only one student refused to give informed consent and participate in the

study, and a total of 285 students completed the study questionnaires.

Procedures

On the first days of each month, a group of medical students enter Roozbeh

Psychiatric Hospital to complete their one-month psychiatry rotation and most

of them attend an introductory session by entrance. At the end of this session, one

of the authors (S. Vasegh) introduced the current study and those who gave

informed consent received the study questionnaires including Beck Anxiety and

Depression Inventories, questions about demographic variables and other covari-

ates, and a religious questionnaire. All of the questionnaires were anonymous

but the students were asked to write a private personal 5-character code on the first

page so that they could recognize their own Beck scores later. After about one

week, results of the Beck Depression and Anxiety Inventories were provided

to the students, and counseling was provided if needed.

Measurements

Depression was measured using a Persian version of the Beck Depression

Inventory-II, a 21-item self-report questionnaire which has good reliability and

validity in college student populations [20-22], even Persian and Arabic versions

of it in Arabic and Iranian students [23-25]. Each item was scored on a 0-3 scale

(total range: 0-63) with higher scores indicating more severe depression in the

“past week, including today.”

Anxiety was measured using a Persian translation of the Beck Anxiety

Inventory, a 21-item self-report questionnaire used to measure state anxiety in

undergraduate students, which has good internal consistency and significant

correlations with several other related anxiety measures [26]. The items are

rated for the “past week, including today” on a 4-point scale from 0 (“not at all”)

to 3 (severe and barely tolerable) with the total score (range: 0-63) reflecting

severity of anxiety.

Religiosity was measured using a Persian questionnaire consisting of three

parts: religious beliefs (5 questions), religious emotions (5 questions), and

religious behaviors (5 questions). An English translation of this questionnaire

is presented in Figure 1.

No similar study was found in a Muslim context, so most questions of this

questionnaire were found originally by a discussion group consisting of the

authors and some interested psychologists consulting with some Islamic clergies.

First, a pool of about 40 questions was prepared and most reliable questions were

separated through a pilot study. Then, after some literary and cultural revision, the

final questionnaire was prepared. Only a few items such as religious salience

(question A) and believing in God (question B) were used before in several

previous studies in various forms [12, pp. 128, 129].

RELIGIOSITY, ANXIETY, AND DEPRESSION IN IRANIAN STUDENTS / 215

216 / VASEGH AND MOHAMMADI

Figure 1. An English translation of the religious questionnaire

used in this study.

Because asking about religion was believed to be culturally sensitive, most

questions of religious beliefs or emotions was first started by a religious (or

anti-religious) statement; then the participant was asked to mark his or her

agreement with that belief or emotional state from “completely agreed” to “com-

pletely opposed.” If the question stated a religious belief or emotional state,

“completely agreed” scored 5 and “completely opposed” scored 0. If the question

stated an anti-religious belief or emotional state, “completely agreed” scored 0

and “completely opposed” scored 5. So each question ranged from 0 to 5 with

higher scores indicating more agreement with that religious belief or emotion.

Each religious behavior question asked about the frequency of doing a particular

religious behavior, with responses ranging from 0 to 4.

Religious Beliefs Score (range 0-25) was computed by summing up the scores

of five questions. Four of these questions (questions B, C, M, and N) were about

what most Iranian Muslim people call “the three fundamentals of the religion.”

These include tawheed (Arabic, monotheistic belief in God; question B), ma’aad

(Arabic, belief in the afterlife; questions C and N), and nobowwat (Arabic, belief

in the prophet; question M). The fifth question (H) was intended to measure

religious commitment, i.e., how much the participant believed religious com-

mands should be completely or absolutely obeyed. One of Islamic instructions

taught in Iran is that Muslim men should not use golden ornaments and Muslim

women should completely cover their hair against strange men; but probably only

very religious people believe in these instructions absolutely. So the question H

believed in these statements are used as evidence of religious commitment.

Religious Emotions Score (range 0-25) was computed summing up five

questions (the questions A, F, G, L, and O). Except question A that asks about

feeling of importance of religion as a whole, other questions were about positive

or negative emotions toward specific religious concepts or behaviors, including

religious holy leaders (L), God (O), reading religious scriptures (F), and doing

Islamic daily prayers (G).

Religious Behaviors Score (range 0-21) was computed summing up five

questions (the questions D, E, I, G, and K). According to Islamic teachings, doing

five daily prayers is a duty for every adult Moslem and these prayers are

sometimes referred to as “the pillar of the religion.” Each of the five daily prayers

must be done in a specific time (for example, the Morning Prayer must be done

between the dawn and sunrise and the Noon Prayer must be done between the

noon and sunset), and it is strongly recommended to do these prayers early in

their time. So two of the questions were about doing daily prayers (the question I)

and the time pattern of doing daily prayers (the question J). Also, there are many

optional religious scriptures and prayers that Iranian religious people read and

say according to their interest. Four of these prayers included in the question E

are among the most famous of these prayers and are often read socially and weekly

in the mosques while people weep and ask many wishes from God. The students

reading these prayers collectively four times or more per month scored 4. Those

RELIGIOSITY, ANXIETY, AND DEPRESSION IN IRANIAN STUDENTS / 217

who read these prayers collectively 0, 1, 2, or 3 times per month scored 0, 1,

2, or 3, respectively. The question K was about fasting during the Ramadhan

lunar month during which every adult Muslim must fast (i.e., not drink, not eat,

not have sexual activity, etc., from dawn to sundown) throughout the month.

Total Religious Score (range 0-71) was computed by adding up the religious

beliefs, emotions, and behaviors scores.

The religious questions were ordered in a mixed manner believing this would

lead to more precise answers and greater validity. All three subscales and the total

questionnaire showed good two-week test-retest reliability (N = 15). Cronbach’s

alpha was 0.926 for the total religious questionnaire, 0.800 for religious beliefs

score, 0.852 for religious emotions score, and 0.824 for religious behaviors

score in this study.

There were also questions asking about other variables including age, sex,

marital status, regular substance use, history of depression in the family, presence

of any important socioeconomic problems during the last month, the presence of

important physical or psychiatric illnesses (other than depression), and existence

of physical or psychiatric illness (other than depression) in the subject’s family.

Statistical Analysis

Because the distribution of the data in this study were found to differ

significantly from normal distribution, Spearman’s rho was used to obtain

correlations between religious variables, depression, and anxiety.

Multiple linear regression analysis was conducted to examine the effect of

religious variables on anxiety and depression, and to examine and control for the

effects of other sociodemographic variables.

RESULTS

Of the subjects, 151 (53%) were male and 134 (47%) were female; 214 (75.1%)

were unmarried; and age ranged from 20 to 31 years (mean = 23.8, SD = 1.6).

concerning religion, 279 (97%) indicated their religion as Islam, 1 (.4%) as

Christian, and 5 (1.8%) as “other religions.” Of the Muslim subjects, 276 (98.9%)

identified their religious affiliation as “Shia” and 3 (1%) as “Sunni.”

Results of the Beck Depression and Anxiety Inventories and the religious

questionnaire scores are presented in Table 1.

Correlations, Comparing Groups, and Regression Analyses

The One-Sample Kolmogorov-Smirnov Test revealed that none of these

variables had normal distribution, so Spearman’s rho was used to obtain

correlations between religious variables, depression, and anxiety (Table 2.).

All of the religious variables were found to have negative correlations

with anxiety and depression scores, but the correlations were small (r < 0.20).

218 / VASEGH AND MOHAMMADI

Correlations of anxiety with Religious Beliefs Score (p < 0.01) and Total

Religious Score (p < 0.05) were significant, and correlations of depression

with Religious Beliefs Score (p = 0.058) and Total Religious Score (p = 0.086)

approached significance.

Multiple linear regression analysis from the SPSS statistical package, version

13.0, was used to predict anxiety and depression by individual religious dimen-

sions and total religious score. As is shown in Table 3, all three religious

dimensions and total religious score negatively predicted depression and anxiety,

but only prediction of anxiety by the Religious Beliefs Score was significant.

RELIGIOSITY, ANXIETY, AND DEPRESSION IN IRANIAN STUDENTS / 219

Table 1. Results of the Beck Depression and Anxiety Inventories and

the Religious Questionnaire Scores

Minimum Maximum Mean SD

Beck Depression Inventory

Beck Anxiety Inventory

Religious Beliefs Score

Religious Emotions Score

Religious Behaviors Score

Total Religious Score

.00

.00

.00

.00

.00

.00

36.00

38.00

25.00

25.00

21.00

68.00

8.45

7.90

19.36

18.65

10.93

49.14

6.75

6.55

5.41

5.16

5.33

14.43

Table 2. Correlations between Religious Variables with

Depression and Anxietya

BDI BAI RBelS REmS RBehS TRS

BDI

BAI

RBelS

REmS

RBehS

TRS

— .633**

—

–.113

–.170**

—

–.063

–.106

.716**

—

–.071

–.107

.701**

.719**

—

–.104

–.148*

.883**

.888**

.911**

—

aBDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; RBelS, Religious Beliefs

Score; REmS, Religious Emotions Score; RBehS, Religious Behaviors Score; TRS, Total

Religious Score.

*p < .05. **p < .01.

Because only one or few variables were used as indicators of religiousness in

many previous studies of religion and mental health, we also examined each of

the religious questions individually as predictors of Beck anxiety and depression

scores. The results are shown in Table 4.

To determine which covariates to control for, the covariates including age, sex,

marital status, regular substance use, history of depression in the family, existence

of important socioeconomic problems during the last month, physical or psychi-

atric illnesses (other than depression) in the subject, and physical or psychiatric

illness (other than depression) in the subject’s family, were first examined for

correlations with anxiety and depression. Family disease (existence of any impor-

tant physical or psychiatric diseases other than depression in the student’s family),

history of depression in student’s family, and regular substance use were signifi-

cantly correlated with the Beck anxiety score; and history of family depression,

last month socioeconomic stress, student’s important physical disease, and regular

substance use were significantly correlated with the Beck depression score.

After controlling for family disease, history of family depression, and substance

use, religious beliefs score prediction of anxiety became non significant; but

regarding individual questions, asking God daily (question D) and religious

commitment (question H) still significantly predicted anxiety after controlling

for the above three covariates.

220 / VASEGH AND MOHAMMADI

Table 3. Multiple Regression Analysis: Prediction of Depression

and Anxiety by Religious Variablesa

Dependent

variable

Independent

variables B Std. error p Value

BDI

BAI

RBelS

REmS

RBehS

TRS

RBelS

REmS

RBehS

TRS

–0.144

–0.048

–0.110

–0.040

–0.164*

–0.085

–0.084

–0.043

0.074

0.075

0.072

0.027

0.072

0.073

0.069

0.026

0.062

0.518

0.124

0.143

0.024

0.244

0.226

0.103

aBDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; RBelS, Religious Beliefs

Score; RemS, Religious Emotions Score; RBehS, Religious Behaviors Score; TRS, Total

Religious Score.

*p < .05

Tab

le4

.In

div

idu

alR

elig

iou

sQ

uestio

ns

as

Pre

dic

tors

ofA

nxie

tyan

dD

ep

ressio

na

Th

ere

ligio

us

qu

estio

ns

Pre

dic

tio

no

fth

eB

eck

Dep

ressio

nIn

ven

tory

Sco

re

(Bin

linear

reg

ressio

n)

Pre

dic

tio

no

fth

eB

eck

An

xie

tyIn

ven

tory

Sco

re

(Bin

linear

reg

ressio

n)

Belie

fin

Go

d(q

uestio

nB

)

Belie

fin

pro

ph

ets

(qu

estio

nM

)

Belie

fin

afterl

ife

(qu

estio

nC

)

Belie

fin

afterl

ife

jud

gm

en

t(q

uestio

nN

)

Relig

iou

sco

mm

itm

en

t(q

uestio

nH

)

Relig

iou

ssalie

nce

(qu

estio

nA

)

Feelin

gaffectio

nfo

rG

od

(qu

estio

nO

)

feelin

gaffectio

nfo

rp

rop

hets

(qu

estio

nL)

Feelin

gin

tere

ste

din

relig

iou

sre

ad

ing

(qu

estio

nF

)

Feelin

gin

tere

ste

din

daily

pra

yers

(qu

estio

nG

)

Do

ing

five

daily

pra

yers

(qu

estio

nI)

Tim

eo

fd

oin

gfive

daily

pra

yers

(qu

estio

nJ)

Fastin

gd

uri

ng

Ram

ad

han

mo

nth

(qu

estio

nK

)

Daily

askin

gfr

om

Go

d(q

uestio

nD

)

Mo

nth

lyre

ad

ing

sp

ecia

lp

rayers

(qu

estio

nE

)

–0

.48

3

–0

.56

7

–0

.17

6

–0

.47

7

–0

.36

4

–0

.18

8

–0

.36

7

–0

.23

8

0.0

19

–0

.20

7

–0

.77

9*

–0

.54

1*

–0

.38

5

0.1

74

–0

.18

1

–0

.00

9

–0

.56

6

–0

.17

9

–0

.52

4

–0

.63

4**

–0

.15

6

–0

.23

7

–0

.44

9

–0

.22

9

–0

.22

6

–0

.58

0

–0

.31

4

–0

.60

8

–0

.59

8*

–0

.36

6*

aS

ee

Fig

ure

1fo

rin

div

idu

alq

uestio

ns.

*p

<0

.05

.**p

<0

.01

.

RELIGIOSITY, ANXIETY, AND DEPRESSION IN IRANIAN STUDENTS / 221

DISCUSSION

Concerning depression, most of the previous research on religion has revealed

negative correlations between various measures of religion and depression

or depressive symptoms [13, 27]. The correlation between religiousness and

depressive symptoms across 147 independent investigations (N = 98,975)

meta-analyzed by Smith et al. (2003) was –.096 [27], which means greater

religiousness was mildly associated with fewer symptoms. The results of our study

are consistent with previous findings and support the hypothesis that religion plays

a protective role against depression. Most studies of religion and mental health

have been done in a Christian context and many included only elderly sick people

[9], so similar results among our Muslim healthy young sample are interesting.

None of the direct correlations between religious scores and depression were

significant in our study, but the negative correlation between religious beliefs

score and depression approached significance (p = .058). Because of the diversity

of measures of religiousness and depression in previous studies, direct comparison

of the results is not possible, but questions similar to our study (particularly our

religious beliefs subscale) has yielded similar results [28].

No previous studies were found concerning the five daily Islamic prayers and

depression, so this is probably the first published study showing negative and

significant correlations between depression and the five prayers or time of

doing them. These significant negative correlations (r = –0.141 for doing the

five prayers and r = –0.154 for their time) were stronger than the negative

correlation of our total religiousness score (r = –0.104) or religious beliefs score

(r = –0.113), both statistically non-significant.

Although our results agree with some studies showing negative correlations

between religion and lifetime anxiety disorders particularly in younger adults

[29], it should be noted that the results of previous studies concerning religion

and anxiety look mixed and confusing. Some studies showed increased anxiety

in religious people, others showed decreased anxiety, yet others resulted in

nonsignificant relationships [14]. In their 2004 review, Shreve-Neiger and

Edelstein stated 10 studies showing decreased anxiety in religious people, six

studies showing increased anxiety, and four studies showing non-significant

relationships between various measures of anxiety and religion [14]. Four of the

six studies linking religion to increased anxiety were the same as the studies

linking religion to decreased anxiety. In three of these four studies, intrinsic

religiousness correlated with decreased anxiety, and extrinsic religiousness cor-

related with increased anxiety. In the fourth study, Catholic religious affiliation

was correlated with increased anxiety and frequent church attendance correlated

with decreased anxiety. In the fifth study linking religion to increased anxiety,

sudden “religious conversion,” which authors defined as “changing from one

religion to another or from a nonreligious state to a religious one,” was asso-

ciated with increased anxiety; and in the sixth study, religion was measured by a

222 / VASEGH AND MOHAMMADI

self-report questionnaire that included common dimensions of religious

participation and beliefs, but the authors didn’t mention the questions specifically.

Intrinsic-extrinsic religiosity concept was first developed by the Harvard

psychologist Gordon Alport in the 1950s [12, pp. 21, 22, 500, 501]. According to

Alport, intrinsically religious people have deep belief in religion and think of

religion as their master motive in their life, but extrinsically religious persons are

interested in religion only in order to achieve a different, nonreligious goal. An

example of the items measuring intrinsic religiosity in the Alport’s scale is, “I

try hard to carry my religion over into all my other dealings in life”; and an

example of the items measuring extrinsic religiosity is, “A primary reason for my

interest in religion is that my church is a congenial social activity.” Although we

have not used any intrinsic-extrinsic religiosity scale, it seems that our religious

beliefs questions primarily measure intrinsic religiosity. Therefore, results of our

study agree with almost all of the previous studies, showing decreased anxiety

in intrinsically religious people.

There are two main approaches concerning direct and indirect effects of religion

on health, the “value added” approach and the “web of causality” approach [1].

According to the “value added” approach, indirect effects of religion on health,

such as reducing adolescent tobacco use [30], are of little interest because only

religious variables adding “variance explained” to models that include

well-established predictors of morbidity or mortality are important. According to

the “web of causality” approach, indirect effects of religion on health can have

important intellectual and practical implications. They help us to better understand

and theorize relationships between various variables in webs of causalities and

can, for example, influence public health interventions [1]. Although beneficial

effects of religion on depression or anxiety cannot be concluded empirically

from our cross-sectional study, considering many previous studies in the field

including well designed prospective studies [e.g., 31], there is good evidence for

probable direct and indirect positive impact of some aspects of religiosity on

mental health. In our study, the cross-sectional correlations between religious

variables and anxiety or depression (r < 0.20) were relatively small but compared

with some other well known risk factors such as age, sex, and marital status,

religious variables were more significantly correlated with depression and anxiety.

This is in agreement with previous findings [9].

Theoretically, religion can have many complex interactions with the factors

influencing anxiety and depression. For example, when a religious person

anticipates a significant stress and feels anxiety, some religious activities such as

asking from God can increase (shown in our study), and this may later decrease

him or her anxiety; or when a religious person tolerates significant chronic stresses

and feels depression, some religious activities may decrease [32], and this can

in turn lead to increased depression.

Of the covariates having significant correlations with anxiety and depression in

our study, only regular substance use also had a statistically significant correlation

RELIGIOSITY, ANXIETY, AND DEPRESSION IN IRANIAN STUDENTS / 223

with religious variables (r = –0.377 for total religious score, p < 0.001). This

negative correlation, too, has been shown in previous studies [28, 30, 33]. So

it is probable that some of the association between religion and anxiety was

mediated by substance use.

How can we justify using a total religiosity score while some elements of

religion (like private prayer) can differ from other elements (such as church

attendance) regarding interactions with depression and anxiety? Actually among

Muslims, non-organizational religious activities such as prayer are very important

parts of life and are not just turned to during times of stress, and attendance at

Temple worship services are not as obligatory as in Christianity. We wanted

to measure a person’s whole religiosity and “overall integration of” faith into the

life of Muslim students, so we thought that total religiosity is a better reflection

of this. Besides, although some previous studies have shown non-significant or

positive cross-sectional relationships between some non-organizational religious

activities and depression or anxiety, there are several other studies showing

significant negative correlations between them, and it seems that these activities

too can buffer effects of stresses on religious persons [12, pp. 86, 87].

Cognitive Modeling and Future Directions

Religion is multidimensional in nature [1, 28], so perhaps each dimension of it

can differently affect different individuals. According to cognitive theory, the four

basic emotions of sadness, anxiety, anger, and happiness are, respectively, evoked

by thoughts of loss, danger, wrongdoing by others, and gain [34]. Therefore, the

depressed patient has intense feelings of loss, deprivation, and unfulfillment

referring to his or her self, experiences and future, and the anxious patient infers

danger from one or more of his or her experiences. So each religious belief or

practice can decrease depression or anxiety possibly by leading to thoughts of

personal gain or security, and can increase depression or anxiety by leading to

thoughts of deprivation or insecurity. Therefore, the power of a religious belief

to increase or decrease depression or anxiety in a given person, among other

variables, would depend first on the manner of use of this belief by the individual’s

cognitive system, whether resulting in thoughts of loss and danger or thoughts

of gain and security; and second, rate of behaviors that directly or indirectly lead

to change of frequency of these thoughts in the individual, such as reading

religious scriptures, attending religious services, saying prayers, meeting and

identifying with religious friends, etc.

This theory explains why some religious beliefs such as “having committed

an unforgivable sin” or “feelings of alienation from God” have been associated

with increased depression [5]. This theory also predicts that in a religious

depressed individual, if cognitive techniques can transform religious “loss

thoughts” to “gain thoughts,” there would be faster or better recovery from

depression. In the authors’ psychotherapy experience, drawing attention of some

224 / VASEGH AND MOHAMMADI

religious depressed patients to religious gain thoughts such as kindness and

forgiveness of the God could help them to better overcome their guilt feelings.

This is consistent with randomized controlled trials that have shown faster

recovery in religious anxious or depressed patients undergoing similar religiously

oriented psychotherapies [10, 11, 35].

According to this practical view, future directions would include focusing

more on loss-gain or security-insecurity thoughts in religious questionnaires,

conducting more studies on different sociocultural and ethnic groups to better

understand how religious concepts are used in their cognitive system, more use

of qualitative studies for theorizing the role of religious beliefs in these groups,

more precise formulizing of discussion about religious beliefs in psychotherapy,

doing more controlled prospective trials to test the efficacy and side effects of

these approaches, and better studying various religious behaviors, their fre-

quencies, and their cognitive consequences, especially the kinds of thoughts they

evoke in various groups and individuals. According to results of our study, doing

five daily Islamic prayers is an especially good candidate for future studies.

Our study had limitations so the findings should be considered preliminary.

For example, we used a convenience sample of young students, so caution should

be exerted in generalizing the findings. Many previous studies linked church

attendance to positive health outcomes, but no equivalent (e.g., mosque

attendance) was used in our study. Our study was cross-sectional; therefore,

clearly, causality cannot be determined.

On the other hand, our study is perhaps the first study with multiple religious

questions in a Muslim sample, and probably can provide valuable information for

future studies both in Muslim and Christian populations.

ACKNOWLEDGMENTS

The authors would like to thank professor Harold G. Koenig for his valuable

comments and suggestions and also thank all the medical students who par-

ticipated in our study.

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