Abstract
BackgroundDepression is a pervasive mental health issue that significantly impacts individuals' quality of life. Individuals with depression often feel disconnected from their purpose in life, others, and the environment. Seeking professional help is uncommon due to low awareness and stigma associated with mental illness. Early identification and intervention are crucial. Some individuals discontinue pharmacological treatment due to the adverse effects of antidepressants and seek alternative therapies. Recent literature highlights the benefits of spiritual care or intervention, but the evidence is inconsistent, and there is a lack of understanding of the healing mechanisms of spiritual interventions.
Aim
This study aimed to develop a community-oriented spiritual intervention programme focused on connectivity and evaluate the effectiveness of the Spiritual Connectivity Intervention (SCI) in reducing depressive symptoms and anxiety levels while enhancing hope, meaning in life, self-esteem, and perceived social support. Additionally, the study explored the healing mechanisms from participants' perspectives and examined the moderation effect of demographic variables on the intervention's impact.
Methods
A randomized controlled trial (RCT) with single blinding was conducted, involving fifty-seven participants with mild to moderate depressive symptoms. Participants were randomly allocated to the spiritual connectivity group (SCG, n = 28) or the waitlist control group (WLG, n = 29). The intervention protocol was developed based on a comprehensive literature review, expert consultations, and a pilot study. The programme consisted of eight weekly sessions focusing on divine connection, forgiveness and freedom, suffering and transcendence, hope, gratitude, and relapse prevention. The theoretical framework was strengthened by integrating existential psychology with cognitive behavioural therapy (CBT), positive psychology, and spirituality/ religiosity in a group therapy approach. Quantitative data were collected using standardized measures of depressive symptoms, anxiety levels, spiritual experience, hope, meaning in life, self-esteem, and perceived social support. Participants completed self-administered questionnaires at baseline (week 0), post-intervention (week 8), and 3-month follow-up (week 20). Repeated-measures ANOVA and one-way ANCOVA were used to examine within-group and between-group differences in outcome variables. Interactions between demographic variables and group assignments were incorporated into the model to investigate moderating effects. Qualitative data were gathered through focus group interviews to gain insights into participants' experiences and perceptions of the intervention. Data were analyzed primarily using intention-to-treat (ITT) and supplemented with per-protocol (PP) approaches to ensure robustness.
Results
Quantitative results indicated significant reductions in depressive symptoms and anxiety levels in the SCG compared to the WLG, with large effect sizes confirming the intervention's efficacy. Secondary outcomes also showed significant improvements, particularly in spiritual experience and hope, with small to large effect sizes. Effect size statistics indicated slight to substantial differences (Cohen’s d, 0.308 to −1.452). Additionally, 85.71% of participants in the intervention group experienced clinically essential reductions in depressive symptom scores from baseline to post-intervention. Significant interactions between age and group assignment were observed, with older adults experiencing notable impacts. Participants without prior treatment histories benefited more from the programme, highlighting the need for tailored approaches. Qualitative findings revealed participants’ transformative spiritual encounters with profound cognitive and emotional shifts attributed to spiritual components, mindset shifts, group dynamics, and programme-specific aspects. Shared experiences within the group setting facilitated emotional catharsis and positive cognitive reframing.
Conclusion
The SCI demonstrated significant therapeutic benefits in reducing depressive symptoms and enhancing overall well-being. The integration of spiritual and psychological dimensions in the intervention was particularly effective, highlighting the importance of a holistic approach to mental health care. The study’s findings underscore the need for tailored interventions that address both the psychological and spiritual needs of individuals, particularly in community settings.
Significance
This research adds to the growing evidence supporting the incorporation of spiritual interventions in mental health treatment. The results significantly affect clinical and nursing practice, training, and policy-making. Mental health professionals are encouraged to integrate spiritual aspects into therapy methods, creating a more inclusive and comprehensive approach to mental health care. Guided by a standardized protocol, this intervention is non-invasive, cost-effective, easily accessible, and generally perceived as less stigmatizing. Clergy leaders or programme staff from faith-based organizations can implement it for individuals with diverse beliefs within the community. Further research is needed to explore the long-term effects and sustainability of spiritual interventions and their applicability in diverse cultural contexts, enhancing the understanding and implementation of holistic mental health interventions and ultimately improving outcomes for broader populations.
| Date of Award | 25 Apr 2025 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Kin-Kit (Ben) LI (Supervisor) & Yu Lung Marcus CHIU (Co-supervisor) |