Edgar Allan Poe's psychic daguerreotype.

that those who were religious were less likely to have ever used drugs or to be a hazardous drinker. On the other hand, spiritual people were more likely than those who were neither religious nor spiritual to have ever used or to be dependent on drugs and to have abnormal eating attitudes, generalized anxiety disorder, any phobia, or any neurotic disorder. Furthermore, Laurent et al. found that those who indicated that they were spiritual but not religious in the UK were nearly three times more likely to develop an episode of major depressive disorder during a 12-month follow-up period compared to those who were neither religious nor spiritual (OR 2.73, 95%CI 1.59-4.68). In contrast, in a much smaller study, Farias et al. compared modern spiritual individuals (n=114) with traditional religious believers (n=86) in England. The authors found anxiety, depression, and insecure attachment were not significant predictors of spirituality. The results of this study also revealed that spiritual believers reported high satisfaction with social support, with this variable predicting involvement in modern spirituality. Furthermore, spiritual practices correlated negatively with death anxiety scores. These conflicting results are not easy to reconcile. First, since all these studies were conducted in the United Kingdom, cultural context would not seem to play a significant role. Second, as only one study actually followed participants over time, the other two cross-sectional studies provide no information about the time sequence. Third, important psychiatric outcomes such as depression and anxiety were addressed in both studies. Some major differences between these three studies also warrant mention. The instruments used to assess religiosity/spirituality and mental health were different, which could help to explain the varying results; the enrollment of patients was diverse (two nationwide studies vs. one convenience sample); and the same psychiatric outcomes were not assessed in all three studies. In view of these findings, more research needs to be done comparing those who are religious and spiritual with those who are spiritual but not religious in a variety of locations and cultural settings to elucidate the role that spiritual and religious beliefs play in mental health and substance use.