The role of religious advisors in mental health care in the World Mental Health surveys.
To examine the role of religious advisors in mental health care (MHC) according to disorder severity, socio-demographics, religious involvement and country income groups.



Face to face household surveys in ten high income (HI), six upper-middle income (UMI) and five low/lower-middle (LLMI) income countries totalling 101,258 adults interviewed with the WMH CIDI plus questions on use of care for mental health problems and religiosity.



1.1% of participants turned to religious providers for MHC in the past year. Among those using services, 12.3% used religious services; as much as 30% in some LLMI countries, around 20% in some UMI; in the HI income countries USA, Germany, Italy and Japan are between 15 and 10% whenever the remaining countries are much lower. In LLMI 20.9% used religious advisors for the most severe mental disorders compared to 12.3 in UMI and 9.5% in HI. For severe cases most of religious providers use occurred together with formal care except in Nigeria, Iraq and Ukraine where, respectively, 41.6, 25.7 and 17.7% of such services are outside any formal care. Frequency of attendance at religious services was a strong predictor of religious provider usage OR 6.5 for those who attended over once a week (p < 0.0001); as seeking comfort "often" through religion in case of difficulties OR was 3.6 (p = 0.004) while gender and individual income did not predict use of religious advisors nor did the type of religious affiliation; in contrast young people use them more as well as divorced and widowed OR 1.4 (p = 0.02). Some country differences persisted after controlling for all these factors.



Religious advisors play an important role in mental health care and require appropriate training and collaboration with formal mental healthcare systems. Religious attitudes are strong predictors of religious advisors usage.
EA 4057 Paris Descartes University Paris, UFR Institut de Psychologie, 71, avenue Edouard Vaillant, 92774, Boulogne-Billancourt, France. vkovess@gmail.com.
Vivianne
V
Kovess-Masfety
Kings College London, Institute of Psychiatry, Psychology and Neuroscience Health Service and Population Research, London, UK.
Sara
S
Evans-Lacko
Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA.
David
D
Williams
Institute of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Laura Helena
LH
Andrade
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico, Mexico.
Corina
C
Benjet
Netherlands Institute of Mental Health and Addiction, Epidemiology, Utrecht, Netherlands.
Margreet
M
Ten Have
Department of Psychiatry, University of Groningen, University Medical Center Groningen (UMCG), Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, The Netherlands.
Klaas
K
Wardenaar
IDRAAC, Psychiatry and Clinical Psychology, Ashrafieh, Beirut, Lebanon.
Elie G
EG
Karam
Katholieke Universiteit Leuven (UPC-KUL), Universitair Psychiatrisch Centrum Leuven, Kortenberg, Belgium.
Ronny
R
Bruffaerts
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Jibril
J
Abdumalik
Departament de Recerca Sant Boi de Llobregat, Parc Sanitari Sant Joan de Déu-CIBERSAM, Barcelona, Spain.
Josep Maria
JM
Haro Abad
National School of Public Health and Professional Development, Research and Evaluation, Bucharest, Romania.
Silvia
S
Florescu
Department of Health Care Policy, Harvard Medical School, Boston, USA.
Benjamin
B
Wu
Department of Developmental Psychology, Faculty of Social and Behavioural Sciences, University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation, Groningen, The Netherlands.
Peter
P
De Jonge
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Yasmina
Y
Altwaijri
Department of Global Mental Health, National Center for Public Health Protection, Sofia, Bulgaria.
Hristo
H
Hinkov
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan.
Norito
N
Kawakami
Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas Lisbon, Universidade Nova de Lisboa, Lisbon, Portugal.
Jose Miguel
JM
Caldas-de-Almeida
Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
Evelyn
E
Bromet
IRCCS St. John of God Clinical Research Centre, Brescia, Italy.
Giovanni
G
de Girolamo
Saldarriaga Concha Foundation, Development Rehabilitation System FSC Bogotá, Bogota, Colombia.
José
J
Posada-Villa
College of Medicine Diwania Governate, Al-Qadisiyah University, Diwania, Iraq.
Ali
A
Al-Hamzawi
Institute of Mental Health, Peking University, Beijing, China.
Yueqin
Y
Huang
Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.
Chiyi
C
Hu
Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitoria, Brazil.
Maria Carmen
MC
Viana
Institute for Development, Research, Advocacy, and Applied Care (IDRAAC), Beyrut, Lebanon.
John
J
Fayyad
Instituto Nacional de Psiquiatria, Epidemiology and Psychosocial Research, Mexico, Mexico.
Maria Elena
ME
Medina-Mora
Department of Psychiatry Leuven, University Hospital Gasthuisberg, Louvain, Belgium.
Koen
K
Demyttenaere
Department of Psychiatry, Fernand Widal Hospital, Paris, France.
Jean-Pierre
JP
Lepine
Psychology Research Institute Londonderry, University of Ulster, Coleraine, UK.
Samuel
S
Murphy
Medical Sciences Lisboa, University Nova of Lisboa, Lisbon, Portugal.
Miguel
M
Xavier
Japan National Institute of Neurology and Psychiatry, Epidemiology, Tokyo, Japan.
Tadashi
T
Takeshima
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Oye
O
Gureje
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D014943:Global Health; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010327:Pastoral Care / Q000706:statistics & numerical data*; D055815:Young Adult
Mental health; Religion; Services use