Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program

Background: Persons contending with serious mental health difficulties often experience struggles with religious faith and/or spirituality that may also demand clinical attention. However, research has not examined the relative importance of specific forms of spiritual struggles in mental health status or treatment outcomes of psychiatric patients. Methods: Focusing on 217 adults who completed a spiritually integrated inpatient program, this study examined (1) which struggles in Exline et al.'s (2014) framework (Divine, Morality, Ultimate Meaning, Interpersonal, Demonic, and Doubting) represented the most salient indicators of major depressive disorder (MDD) symptomatology and positive mental health (PMH) and (2) whether alleviation of these struggles predicted improvements in patients' mental health status over the treatment period. Results: Greater severity of spiritual struggles was generally associated with worse MDD symptomatology and less PMH at intake and discharge. However, when weighing the role of varying forms of struggles, issues with ultimate meaning emerged as a salient indicator of mental health status at the two assessments as well as longitudinal changes in both MDD symptomatology and PMH. Limitations: This sample was recruited from acute stabilization units in a single spiritually integrated behavioral health center with a general affiliation with Christianity. Hence, treatment periods were relatively brief in some cases and findings might not generalize to other psychiatric programs or settings. Conclusions: Findings highlight the utility of assessing prominent forms of spiritual distress for planning and delivering psychosocial interventions, particularly with respect to issues related to a perceived absence of ultimate meaning in life.