A Scoping Review Of Religion, Spirituality And Youth Mental Health Outcomes

A Scoping Review Of Religion, Spirituality And Youth Mental Health Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A Scoping Review Of Religion, Spirituality And Youth Mental Health Outcomes Ereni Nour Tadrus This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8665148/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This scoping review explored how religion and spirituality (R/S) influences mental health outcomes in young people aged 10–24 years. Guided by the JBI Manual for Evidence Synthesis and PRISMA-ScR criteria, thirteen studies published between 2006 and 2025 were reviewed, including longitudinal, cross-sectional, qualitative, and intervention designs. Across diverse cultural contexts, intrinsic religiosity and spiritual wellbeing were consistently associated with improved resilience, greater life satisfaction, and reduced depression and anxiety. Three core mechanisms (meaning-making, adaptive coping, and social connectedness) emerged as mechanisms through which R/S support positive mental health. Conversely, extrinsic religiosity and negative religious coping (e.g., guilt, exclusion, or rigid belief systems) were occasionally linked to poorer outcomes. Contextual factors such as culture, gender, and inclusivity within faith communities moderated these relationships. While most evidence supports the protective influence of intrinsic spirituality, inconsistent operationalisation of R/S constructs and reliance on self-report measures limit causal interpretation. Overall, R/S appear to function as complex psychosocial resources that promote wellbeing when internalised authentically and practiced within supportive environments. These findings highlight the need for culturally sensitive, spiritually informed approaches in youth mental-health promotion and for longitudinal research to clarify causal mechanisms and developmental trajectories. Figures Figure 1 Introduction Globally, one in seven adolescents aged 10–19 years experiences a mental disorder, contributing to 15% of the total burden of all diseases in this age group (WHO, 2024). Depression, anxiety, and behavioural disorders are leading causes of illness among adolescents, whilst suicide remains the third leading cause of death amongst young people aged 15–29 years (Institute for Health Metrics and Evaluation [IHME], 2024). Despite the high prevalence, many adolescent mental health conditions remain undiagnosed and untreated, resulting in long-term consequences that extend into adulthood, including impaired social functioning, physical health difficulties, and limited life opportunities (Mullens, 2018). Adolescence represents a critical developmental period characterised by significant physical, emotional, and social change. Exposure to risk factors such as poverty, family conflict, violence, and social pressure can increase vulnerability to psychological distress. Conversely, protective factors — such as supportive relationships, coping skills, positive identity formation, and safe communal environments — can buffer against poor mental health outcomes and foster resilience (Tietbohl-Santos et al., 2024). Religion & Spirituality (R/S) have emerged as potential psychosocial protective factors (Garssen et al., 2020). Religion refers to an organised system of beliefs and practices that provide a shared framework for understanding the world and seeking meaning (Guthrie, 1996). It often involves communal worship, faith traditions, and moral guidance, but can also include individual practices such as prayer or meditation (Rosmarin et al., 2016). Spirituality, while closely related, is a broader and more personal construct defined by an individual’s search for connection, purpose, and transcendence (Wink & Dillon, 2008; Schnall et al., 2014). Although religion and spirituality overlap, not all religious individuals identify as spiritual, and not all spiritual individuals adhere to a formal religion. This scoping review aims to explore how R/S influence mental health outcomes in young people. The population of interest is adolescents aged 24 years and under from both clinical and general populations. The concept focuses on the role of R/S as psychosocial factors that may enhance positive mental health outcomes, such as life satisfaction, resilience, coping strategies, and reduced psychological distress. The context encompasses studies conducted in diverse cultural, social, and healthcare settings that examine R/S as potential protective or moderating factors in youth mental health. Specifically, the review seeks to (1) map existing research on the relationship between R/S and mental health outcomes in youth; (2) distinguish between the roles of religion and spirituality; and (3) identify conceptual, methodological, and population gaps to inform future research and youth mental health practice. Method Search Strategy A systematic search was conducted across electronic databases including PubMed, and CINAHL, covering literature from January 2015 to August 2025. The full search strategy, including complete search terms and Boolean combinations, is provided in Appendix 1 to enable replication. The eligibility criteria were structured using the Population, Intervention Comparison, and Outcome (PICO) framework. The review focused on young people aged 24 years and under from clinical/high risk or general populations. The intervention or exposure of interest included religion — defined as formal adherence to organised doctrines, practices, and institutions such as service attendance or religious affiliation — and spirituality — defined as personal or subjective experiences of connection, meaning, or transcendence, such as spiritual wellbeing, prayer, or a perceived closeness to a higher power. Eligible outcomes included positive mental health indicators such as increased life satisfaction, hope, resilience, effective coping strategies, or reductions in depression, anxiety, and psychological distress. Only peer-reviewed studies published in English between 2015 and 2025 were included, while studies focusing solely on adult populations or outcomes unrelated to mental health were excluded. Reference lists of selected articles were also screened to identify additional relevant literature. Grey literature was included to reduce publication bias and capture emerging evidence not yet represented in peer-reviewed journals. Selection of Evidence All search results were imported into Covidence software for management, duplication removal, and screening. Titles and abstracts were screened for eligibility before full-text review. As the review was completed by a single reviewer, all screening decisions were recorded within Covidence to maintain transparency and replicability. Data Extraction and Synthesis This scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis (Aromataris & Munn, 2020) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist (Tricco et al., 2018). The checklist guided all stages of screening, data extraction, synthesis, and reporting to ensure transparency and replicability (see Appendix 3 ). All screening and appraisal processes were completed independently by the reviewer. Each included study was assessed for methodological quality and relevance using structured tools appropriate to its design, such as the JBI Critical Appraisal Checklists for qualitative, cross-sectional, or cohort studies. Data accuracy was verified through repeated checking at extraction and synthesis stages to minimise bias. Extracted variables included author, year, country, study design, sample characteristics, measures of religion and spirituality, mental health outcomes, and key findings. Findings were summarised narratively, with consideration given to methodological diversity, strengths, and limitations of the included studies. Data was synthesised thematically to identify key patterns and gaps in the evidence. Please refer to Appendix 2 for a summary of the included studies. Results Selection of Sources of Evidence A total of 98 records were identified through database searching. After removal of 3 duplicates, 95 titles and abstracts were screened for relevance. Of these, 53 full-text articles were assessed for eligibility, resulting in 13 studies meeting the inclusion criteria for this scoping review. Reasons for exclusion at full-text stage included adult-only samples, absence of religious or spiritual variables, or lack of mental-health outcomes. The selection process is summarised in Fig. 1 . Characteristics of Sources of Evidence A total of 13 studies published between 2006 and 2025 were included, encompassing diverse methodological approaches. Samples represented youth aged 10–24 years across multiple cultural contexts, including the United States, United Kingdom, Canada, Iran, and multi-country cohorts. A detailed overview of each study including design, population, R/S constructs, outcomes, and principal findings is presented in Table 1 and further elaborated in the Table of Included Source of Evidence Characteristics in Appendix 2 The table was adapted from the JBI Manual for Evidence Synthesis (Appendix 10.1) to capture the diversity of study designs and contextual features (Peters et al.,2020). Religious and spiritual constructs examined included intrinsic (personal faith) and extrinsic (institutional participation) religiosity, spiritual wellbeing, faith importance, spiritual coping, and faith-based interventions. Mental-health outcomes predominantly involved depression, anxiety, subjective wellbeing, resilience, and treatment-seeking behaviour. Critical Appraisal Within Sources of Evidence All included studies were appraised using the relevant JBI Critical Appraisal Checklists to assess methodological quality and potential bias. The overall quality of evidence was moderate-high. Common strengths included clearly defined research objectives and validated outcome measures, while limitations frequently involved small sample sizes, self-report bias, and inconsistent operationalisation of spirituality versus religiosity. Appraisal results informed interpretation but were not used as exclusion criteria. Synthesis of Findings Thirteen studies met inclusion criteria, examining how R/S relate to positive mental health outcomes in young people aged ≤ 24 years. Collectively, longitudinal, cross-sectional, qualitative, and intervention research published between 2015 and 2025 across 12 countries demonstrated that R/S generally enhances resilience, reduce depression and anxiety, and promote wellbeing, though effects vary according to type of religiosity (intrinsic vs. extrinsic), cultural context, and nature of stressors (see Appendix 2). Aggarwal et al. ( 2023 ) found that spiritual wellbeing consistently protected against depressive symptoms, whereas negative religious coping (e.g., guilt or divine punishment) predicted poorer outcomes. Earlier work by Cotton et al. ( 2006 ) reinforced these findings, distinguishing between spirituality and external religiosity, and showing that intrinsic spiritual engagement correlated with greater emotional stability and lower risk-taking behaviour among adolescents. Empirical studies reinforced these associations. Tsomokos and Dunbar ( 2023 ) reported that religiosity moderated the link between interpersonal distrust and depression among UK adolescents, while Fruehwirth et al. ( 2019 ) found an 11% reduction in depression among highly religious U.S. youth, independent of social supports. VanderWeele and Ouyang ( 2025 ) demonstrated that service attendance and intrinsic spiritual meaning predicted greater flourishing and slower growth of depressive symptoms. Complementing these, Tietbohl-Santos et al. ( 2024 ) highlighted spirituality and faith engagement as moderators of resilience in high-risk youth, and Al-amer et al. (2024) confirmed that religious coping strategies reduced stress in collectivist adolescent samples. Qualitative and intervention studies provided contextual depth. Breland-Noble et al. ( 2015 ) found that prayer and faith nurtured hope among African American youth, though stigma sometimes hindered help-seeking. Naghmeh et al. ( 2023 ) described spirituality among Iranian adolescents as a source of self-control and optimism. In India, Pandya ( 2017 ) demonstrated through a randomised trial that structured spiritual-development programs significantly enhanced happiness and psychological wellbeing. Several studies introduced nuance. Ji et al. ( 2011 ) distinguished intrinsic religiosity, which predicted reduced depression and substance use, from extrinsic religiosity, which correlated with maladaptive outcomes. Lekwauwa et al. ( 2022 ) showed that inclusive spirituality improved wellbeing for transgender adolescents, whereas exclusionary religious environments heightened distress. Shaver et al. (2022) reported that while spiritual connectedness buffered bullying effects for boys, excessive introspection among girls occasionally intensified distress. Across studies, intrinsic spirituality consistently moderated the relationship between adversity and mental health outcomes, fostering meaning, belonging, and adaptive coping (Aggarwal et al., 2023 ; Fruehwirth et al., 2019 ; VanderWeele & Ouyang, 2025 ; Tsomokos & Dunbar, 2023 ). Qualitative and experimental findings (Breland-Noble et al., 2015 ; Naghmeh et al., 2023 ; Pandya, 2017 ) illustrated that spirituality promotes emotional regulation and pro-social orientation, complementing quantitative results linking faith practices to flourishing (VanderWeele & Ouyang, 2025 ; Al-amer et al., 2024). Cultural and contextual factors shaped these outcomes. In collectivist societies (Naghmeh et al., 2023 ; Al-amer et al., 2024), spirituality emphasised communal harmony, whereas Western contexts (Cotton et al., 2006 ; Shaver et al., 2022; Tsomokos & Dunbar, 2023 ) framed it around personal meaning and autonomy. Among marginalised youth (Lekwauwa et al., 2022 ), the protective value of faith depended on inclusion within faith communities. While largely beneficial, some studies (Breland-Noble et al., 2015 ; Shaver et al., 2022) cautioned that spirituality may amplify distress when intertwined with guilt or stigma. Overall, the synthesis indicates that religion and spirituality function as moderators of stress and predictors of positive coping in youth, with the strongest effects when faith is intrinsic, inclusive, and self-determined, and weakest when characterised by rigidity or exclusion. These findings underscore the need for culturally sensitive, spiritually informed approaches to youth mental-health promotion and intervention. Table 1 Summary of Included Studies on Religion and Spirituality (R/S) and Youth Mental Health Article Study Design Sample/Demographic Key Results Critical Appraisal Comments Aggarwal et al. ( 2023 ) Systematic review & meta-analysis 74 longitudinal + 29 intervention studies of youth < 24 yrs Spiritual wellbeing reduced depressive symptoms; negative religious coping predicted poorer mental health. High-quality systematic review with clear aims, comprehensive search, and rigorous dual-review process. Methods for synthesis and bias assessment were appropriate. Limited discussion of policy implications, but strong research recommendations. Included due to methodological rigor and relevance to review questions. VanderWeele & Ouyang ( 2025 ) Longitudinal cohort U.S. adolescents & young adults Religious attendance and intrinsic meaning predicted greater flourishing and lower depression. Limited cultural diversity: Strong causal modelling (adjusted for confounders); robust design; aligns with inclusion. Tsomokos & Dunbar ( 2023 ) Longitudinal quantitative 11,045 U.K. adolescents Religiousness buffered link between interpersonal distrust and depression. Self-report bias; cross-sectional analysis within broader cohort. Excellent control for confounders. Strong internal validity. Fruehwirth et al. ( 2019 ) Longitudinal quantitative U.S. secondary-school students Religiosity reduced depression probability by 11% after adjusting for confounds. Possible unmeasured peer-influence factors. Strong control for confounding; longitudinal robustness; significant protective association. Pandya ( 2017 ) Randomised controlled trial 5,339 Indian adolescents Spiritual-development program increased happiness and wellbeing. Short follow-up; cultural specificity limits generalisation. Data-driven and relevant; ethical rigor present. Tietbohl-Santos et al. ( 2024 ) Systematic review High-risk youth (≤ 24 yrs) Multiple protective factors against youth depression, highlighting intrinsic religiosity and spirituality as significant buffers promoting resilience and wellbeing. Strong methodological rigor with a clear research question – adherence to all the JBI standards. Variability in how spirituality was defined and assessed across included studies limited the consistency and comparability of findings. Al-amer et al. (2024) Cross-sectional quantitative 1344 participants, aged 14 to 18 years Religious coping correlated negatively with stress (r = − 0.097, p < .001). Correlational design; single cultural context. Naghmeh et al. ( 2023 ) Qualitative interviews Iranian adolescents aged 14–18 years Spirituality promoted self-control, purpose, and optimism. Small, homogeneous sample; limited transferability. High congruity between methodology and aims; reflexivity limited but rich participant voice. Breland-Noble et al. ( 2015 ) Qualitative thematic analysis African American adolescents with depression Prayer and faith fostered agency and hope, but stigma hindered help-seeking. Non-generalisable; potential researcher bias. Cotton et al. ( 2006 ) Systematic review Adolescents 10–18 years (multi-country) Intrinsic spirituality linked to emotional stability and lower risk-taking. Broad scope; includes physical and moral outcomes; partial alignment to inclusion criteria. Outdated evidence base; limited cultural scope. Ji et al. ( 2011 ) Quantitative survey US adolescents Intrinsic religiosity lowered depression and substance use; extrinsic linked to maladaptive outcomes. Restricted to one faith tradition. Non-generalisable; potential researcher bias. Lekwauwa et al. ( 2022 ) Systematic review Transgender adolescents (18 studies) Intrinsic spirituality improved wellbeing: external stigma increased distress. Few high-quality studies; Western bias. Shaver et al. (2022) Cross-sectional quantitative 12,593 Canadian adolescents 11–15 years Spiritual connectedness buffered bullying impact but intensified distress for highly self-focused girls. Self-report bias; gender-specific effects unclear. High-quality sample; strong analytic design. Discussion This scoping review synthesised studies examining the relationship between R/S and mental health outcomes in young people aged 24 years and under. The findings indicate that R/S are not peripheral influences but central psychosocial constructs shaping adolescents’ emotional development, coping capacity, and identity formation. Adolescence is a formative stage marked by increasing cognitive and moral sophistication and a growing search for meaning; making it a crucial period for understanding how faith, spirituality, and existential frameworks influence wellbeing. Within this developmental context, R/S can offer structure, belonging, and hope ; key factors that help young people navigate stress and adversity. These findings are particularly relevant given the rising global burden of adolescent mental health disorders and the increasing recognition that clinical frameworks often overlook spiritual dimensions of care. Understanding the role of R/S therefore extends the scope of mental health promotion, particularly in culturally and religiously diverse settings. Across diverse study designs, R/S consistently emerged as protective or moderating factors in youth mental health. Intrinsic religiosity and spiritual wellbeing were associated with reduced depression and anxiety, improved life satisfaction, and stronger resilience (Aggarwal et al., 2023 ; VanderWeele & Ouyang, 2025 ). Conversely, extrinsic religiosity, rooted in obligation or conformity, was sometimes linked with maladaptive outcomes such as guilt or avoidance (Ji et al., 2011 ; Cotton et al., 2006 ). Three interrelated mechanisms consistently explained these relationships: meaning-making, adaptive coping, and social connectedness. Meaning making allowed adolescents to frame stressful experiences within a broader narrative of purpose or moral coherence, while adaptive coping involved using prayer, meditation, or spiritual reflection to regulate emotions and maintain hope. Social connectedness, facilitated through faith communities or shared belief systems, reduced isolation and provided relational support, often serving as a buffer against psychosocial stressors such as bullying or family conflict (Fruehwirth et al., 2019 ; Tsomokos & Dunbar, 2023 ). Operationalisation and measurement of “religiosity” and “spirituality” varied considerably across studies, ranging from behavioural indicators such as institution attendance and prayer frequency to psychological dimensions like meaning, transcendence, or perceived connection to a higher power. This heterogeneity complicates direct comparisons and likely accounts for inconsistent findings, particularly when intrinsic (personal faith) and extrinsic (institutional participation) religiosity were conflated. Only a few studies employed validated multidimensional measures to capture the complexity of R/S constructs, reducing construct precision and cross-study reliability. Moreover, most included studies were conducted in Judeo-Christian or Muslim populations, reflecting the dominant religious orientations of the countries represented. This limits generalisability to non-religious, minority-faith, Indigenous, and Eastern spiritual traditions, which remain underrepresented in the literature. Cultural, gender, and contextual factors consistently shaped the direction and magnitude of R/S effects. In collectivist societies, spirituality was embedded in family and communal structures, emphasising interdependence, moral duty, and social harmony (Al-amer et al., 2024). In contrast, Western studies framed spirituality as an individualised pursuit of authenticity and personal growth (Cotton et al., 2006 ; Tsomokos & Dunbar, 2023 ). Gendered patterns were also evident: faith-based belonging appeared particularly protective for males, whereas females reported greater vulnerability to guilt or exclusion when exposed to rigid or punitive religious teachings (Shaver et al., 2022). Among marginalised groups, such as transgender adolescents, inclusive faith settings enhanced wellbeing, while exclusionary or discriminatory religious environments exacerbated distress (Lekwauwa et al., 2022 ). Collectively, these findings underscore that R/S are not universally protective but operate as context-dependent psychosocial systems that can either mitigate or intensify vulnerability depending on inclusivity, authenticity, and community climate. The quality of the available evidence was mixed. High-quality longitudinal and meta-analytic studies (e.g., Aggarwal et al., 2023 ; VanderWeele & Ouyang, 2025 ) provided the strongest support for temporal and causal links between R/S and improved wellbeing. These designs suggest that faith-based engagement can exert a sustained protective effect on depressive trajectories and general flourishing. However, most studies were cross-sectional and reliant on self-report measures, limiting causal inference and increasing susceptibility to social desirability bias. Sample diversity was also limited: participants were typically school-based, Western, or religiously affiliated, with few studies including secular or multi-faith cohorts. Small sample sizes, insufficient statistical power, and inconsistent control for confounding variables (e.g., family cohesion, socioeconomic status) further constrain interpretation. Methodological limitations also exist within this review. Conducted by a single reviewer, there is an inherent risk of selection and interpretation bias, despite the use of Covidence software to ensure procedural transparency and adherence to JBI appraisal frameworks. Restricting inclusion to English-language studies may have excluded relevant non-English research potentially skewing findings toward Western perspectives. Furthermore, heterogeneity in study design and outcome measurement precluded quantitative synthesis, necessitating a narrative approach that emphasises thematic patterns over statistical precision. Nevertheless, the use of structured JBI tools and PRISMA guidelines enhanced methodological rigour and consistency throughout the screening and extraction process. Despite these constraints, several key implications emerge for practice and policy. R/S should be recognised as legitimate dimensions of youth mental health assessment and intervention, particularly in multicultural clinical settings. When internalised authentically and practiced within inclusive, supportive contexts, R/S can strengthen emotional regulation, foster hope, and enhance identity coherence — core developmental goals during adolescence. Clinicians, educators, and youth workers should approach R/S as potential strengths, integrating spiritual dialogue or meaning-based frameworks into care where appropriate. However, practitioners must remain attentive to circumstances where R/S may contribute to guilt, stigma, or exclusion. Building partnerships with faith leaders, school chaplains, and culturally specific services may enhance accessibility and cultural safety, ensuring that spiritual support complements evidence-based care rather than competing with it. Future studies should adopt longitudinal and mixed method designs to clarify developmental pathways and causal mechanisms through which R/S influence mental health. Standardised, multidimensional measurement tools are essential to distinguish between intrinsic and extrinsic aspects of religiosity and to enhance comparability across cultural settings. Research should intentionally include underrepresented populations, such as Indigenous, Eastern, and secular youth, to expand the cultural scope of existing findings. Furthermore, integrating psychophysiological and behavioural indicators alongside self-report measures may yield a more comprehensive understanding of how R/S engagement manifests in daily functioning and resilience. In conclusion, this review demonstrates that religion and spirituality are powerful yet context-sensitive determinants of adolescent mental health. When expressed inclusively and self-determinedly, they enhance meaning, belonging, and coping, serving as vital protective factors in the face of adversity. Conversely, when imposed rigidly or accompanied by exclusion, they can contribute to psychological distress. Importantly, religion and spirituality, though related, play distinct roles: religion often operates as a social and institutional system providing structure, values, and community, while spirituality reflects an individual’s personal search for meaning, transcendence, and connection. The evidence reviewed suggests that spirituality tends to exert a more consistent protective effect on mental health, whereas the impact of religion varies depending on inclusivity, authenticity, and cultural context. The findings advocate for a balanced, culturally responsive approach to integrating R& S dimensions into youth mental health promotion and early intervention frameworks. Doing so not only aligns with holistic models of care but also acknowledges the diverse ways in which young people seek meaning, connection, and healing in an increasingly complex world. 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Front Psychol 10(1). https://doi.org/10.3389/fpsyg.2019.01525 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":114526,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Flow Diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8665148/v1/3fa3bb0e60cbeaae55cd8b9c.png"},{"id":100953402,"identity":"0ae12477-8c32-4e11-b9e7-26b0fd854d7e","added_by":"auto","created_at":"2026-01-23 07:21:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":664614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8665148/v1/8654baee-31f9-46eb-8994-6b8a49a31535.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eA Scoping Review Of Religion, Spirituality And Youth Mental Health Outcomes\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eGlobally, one in seven adolescents aged 10\u0026ndash;19 years experiences a mental disorder, contributing to 15% of the total burden of all diseases in this age group (WHO, 2024). Depression, anxiety, and behavioural disorders are leading causes of illness among adolescents, whilst suicide remains the third leading cause of death amongst young people aged 15\u0026ndash;29 years (Institute for Health Metrics and Evaluation [IHME], 2024). Despite the high prevalence, many adolescent mental health conditions remain undiagnosed and untreated, resulting in long-term consequences that extend into adulthood, including impaired social functioning, physical health difficulties, and limited life opportunities (Mullens, 2018).\u003c/p\u003e\n\u003cp\u003eAdolescence represents a critical developmental period characterised by significant physical, emotional, and social change. Exposure to risk factors such as poverty, family conflict, violence, and social pressure can increase vulnerability to psychological distress. Conversely, protective factors \u0026mdash; such as supportive relationships, coping skills, positive identity formation, and safe communal environments \u0026mdash; can buffer against poor mental health outcomes and foster resilience (Tietbohl-Santos et al., 2024). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReligion \u0026amp; Spirituality (R/S) have emerged as potential psychosocial protective factors (Garssen et al., 2020). Religion refers to an organised system of beliefs and practices that provide a shared framework for understanding the world and seeking meaning (Guthrie, 1996). It often involves communal worship, faith traditions, and moral guidance, but can also include individual practices such as prayer or meditation (Rosmarin et al., 2016). Spirituality, while closely related, is a broader and more personal construct defined by an individual\u0026rsquo;s search for connection, purpose, and transcendence (Wink \u0026amp; Dillon, 2008; Schnall et al., 2014). Although religion and spirituality overlap, not all religious individuals identify as spiritual, and not all spiritual individuals adhere to a formal religion.\u003c/p\u003e\n\u003cp\u003eThis scoping review aims to explore how R/S influence mental health outcomes in young people. The population of interest is adolescents aged 24 years and under from both clinical and general populations. The concept focuses on the role of R/S as psychosocial factors that may enhance positive mental health outcomes, such as life satisfaction, resilience, coping strategies, and reduced psychological distress. The context encompasses studies conducted in diverse cultural, social, and healthcare settings that examine R/S as potential protective or moderating factors in youth mental health. Specifically, the review seeks to (1) map existing research on the relationship between R/S and mental health outcomes in youth; (2) distinguish between the roles of religion and spirituality; and (3) identify conceptual, methodological, and population gaps to inform future research and youth mental health practice.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eA systematic search was conducted across electronic databases including PubMed, and CINAHL, covering literature from January 2015 to August 2025. The full search strategy, including complete search terms and Boolean combinations, is provided in Appendix 1 to enable replication. The eligibility criteria were structured using the Population, Intervention Comparison, and Outcome (PICO) framework. The review focused on young people aged 24 years and under from clinical/high risk or general populations. The intervention or exposure of interest included religion \u0026mdash; defined as formal adherence to organised doctrines, practices, and institutions such as service attendance or religious affiliation \u0026mdash; and spirituality \u0026mdash; defined as personal or subjective experiences of connection, meaning, or transcendence, such as spiritual wellbeing, prayer, or a perceived closeness to a higher power. Eligible outcomes included positive mental health indicators such as increased life satisfaction, hope, resilience, effective coping strategies, or reductions in depression, anxiety, and psychological distress.\u003c/p\u003e \u003cp\u003eOnly peer-reviewed studies published in English between 2015 and 2025 were included, while studies focusing solely on adult populations or outcomes unrelated to mental health were excluded. Reference lists of selected articles were also screened to identify additional relevant literature. Grey literature was included to reduce publication bias and capture emerging evidence not yet represented in peer-reviewed journals.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSelection of Evidence\u003c/h3\u003e\n\u003cp\u003eAll search results were imported into Covidence software for management, duplication removal, and screening. Titles and abstracts were screened for eligibility before full-text review. As the review was completed by a single reviewer, all screening decisions were recorded within Covidence to maintain transparency and replicability.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Synthesis\u003c/h3\u003e\n\u003cp\u003eThis scoping review was conducted in accordance with the JBI Manual for Evidence Synthesis (Aromataris \u0026amp; Munn, 2020) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist (Tricco et al., 2018). The checklist guided all stages of screening, data extraction, synthesis, and reporting to ensure transparency and replicability (see \u003cspan refid=\"Sec14\" class=\"InternalRef\"\u003eAppendix 3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll screening and appraisal processes were completed independently by the reviewer. Each included study was assessed for methodological quality and relevance using structured tools appropriate to its design, such as the JBI Critical Appraisal Checklists for qualitative, cross-sectional, or cohort studies. Data accuracy was verified through repeated checking at extraction and synthesis stages to minimise bias. Extracted variables included author, year, country, study design, sample characteristics, measures of religion and spirituality, mental health outcomes, and key findings.\u003c/p\u003e \u003cp\u003eFindings were summarised narratively, with consideration given to methodological diversity, strengths, and limitations of the included studies. Data was synthesised thematically to identify key patterns and gaps in the evidence. Please refer to Appendix 2 for a summary of the included studies.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Sources of Evidence\u003c/h2\u003e \u003cp\u003eA total of 98 records were identified through database searching. After removal of 3 duplicates, 95 titles and abstracts were screened for relevance. Of these, 53 full-text articles were assessed for eligibility, resulting in 13 studies meeting the inclusion criteria for this scoping review. Reasons for exclusion at full-text stage included adult-only samples, absence of religious or spiritual variables, or lack of mental-health outcomes. The selection process is summarised in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCharacteristics of Sources of Evidence\u003c/h3\u003e\n\u003cp\u003eA total of 13 studies published between 2006 and 2025 were included, encompassing diverse methodological approaches. Samples represented youth aged 10\u0026ndash;24 years across multiple cultural contexts, including the United States, United Kingdom, Canada, Iran, and multi-country cohorts. A detailed overview of each study including design, population, R/S constructs, outcomes, and principal findings is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and further elaborated in the Table of Included Source of Evidence Characteristics in Appendix 2 The table was adapted from the JBI Manual for Evidence Synthesis (Appendix 10.1) to capture the diversity of study designs and contextual features (Peters et al.,2020).\u003c/p\u003e \u003cp\u003eReligious and spiritual constructs examined included intrinsic (personal faith) and extrinsic (institutional participation) religiosity, spiritual wellbeing, faith importance, spiritual coping, and faith-based interventions. Mental-health outcomes predominantly involved depression, anxiety, subjective wellbeing, resilience, and treatment-seeking behaviour.\u003c/p\u003e\n\u003ch3\u003eCritical Appraisal Within Sources of Evidence\u003c/h3\u003e\n\u003cp\u003eAll included studies were appraised using the relevant JBI Critical Appraisal Checklists to assess methodological quality and potential bias. The overall quality of evidence was moderate-high. Common strengths included clearly defined research objectives and validated outcome measures, while limitations frequently involved small sample sizes, self-report bias, and inconsistent operationalisation of spirituality versus religiosity. Appraisal results informed interpretation but were not used as exclusion criteria.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSynthesis of Findings\u003c/h2\u003e \u003cp\u003eThirteen studies met inclusion criteria, examining how R/S relate to positive mental health outcomes in young people aged\u0026thinsp;\u0026le;\u0026thinsp;24 years. Collectively, longitudinal, cross-sectional, qualitative, and intervention research published between 2015 and 2025 across 12 countries demonstrated that R/S generally enhances resilience, reduce depression and anxiety, and promote wellbeing, though effects vary according to type of religiosity (intrinsic vs. extrinsic), cultural context, and nature of stressors (see Appendix 2).\u003c/p\u003e \u003cp\u003eAggarwal et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) found that spiritual wellbeing consistently protected against depressive symptoms, whereas negative religious coping (e.g., guilt or divine punishment) predicted poorer outcomes. Earlier work by Cotton et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) reinforced these findings, distinguishing between spirituality and external religiosity, and showing that intrinsic spiritual engagement correlated with greater emotional stability and lower risk-taking behaviour among adolescents.\u003c/p\u003e \u003cp\u003eEmpirical studies reinforced these associations. Tsomokos and Dunbar (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) reported that religiosity moderated the link between interpersonal distrust and depression among UK adolescents, while Fruehwirth et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found an 11% reduction in depression among highly religious U.S. youth, independent of social supports. VanderWeele and Ouyang (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) demonstrated that service attendance and intrinsic spiritual meaning predicted greater flourishing and slower growth of depressive symptoms. Complementing these, Tietbohl-Santos et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) highlighted spirituality and faith engagement as moderators of resilience in high-risk youth, and Al-amer et al. (2024) confirmed that religious coping strategies reduced stress in collectivist adolescent samples.\u003c/p\u003e \u003cp\u003eQualitative and intervention studies provided contextual depth. Breland-Noble et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) found that prayer and faith nurtured hope among African American youth, though stigma sometimes hindered help-seeking. Naghmeh et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) described spirituality among Iranian adolescents as a source of self-control and optimism. In India, Pandya (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) demonstrated through a randomised trial that structured spiritual-development programs significantly enhanced happiness and psychological wellbeing.\u003c/p\u003e \u003cp\u003eSeveral studies introduced nuance. Ji et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2011\u003c/span\u003e) distinguished intrinsic religiosity, which predicted reduced depression and substance use, from extrinsic religiosity, which correlated with maladaptive outcomes. Lekwauwa et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) showed that inclusive spirituality improved wellbeing for transgender adolescents, whereas exclusionary religious environments heightened distress. Shaver et al. (2022) reported that while spiritual connectedness buffered bullying effects for boys, excessive introspection among girls occasionally intensified distress.\u003c/p\u003e \u003cp\u003eAcross studies, intrinsic spirituality consistently moderated the relationship between adversity and mental health outcomes, fostering meaning, belonging, and adaptive coping (Aggarwal et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Fruehwirth et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; VanderWeele \u0026amp; Ouyang, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Tsomokos \u0026amp; Dunbar, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Qualitative and experimental findings (Breland-Noble et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Naghmeh et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Pandya, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) illustrated that spirituality promotes emotional regulation and pro-social orientation, complementing quantitative results linking faith practices to flourishing (VanderWeele \u0026amp; Ouyang, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Al-amer et al., 2024).\u003c/p\u003e \u003cp\u003eCultural and contextual factors shaped these outcomes. In collectivist societies (Naghmeh et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Al-amer et al., 2024), spirituality emphasised communal harmony, whereas Western contexts (Cotton et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Shaver et al., 2022; Tsomokos \u0026amp; Dunbar, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) framed it around personal meaning and autonomy. Among marginalised youth (Lekwauwa et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), the protective value of faith depended on inclusion within faith communities. While largely beneficial, some studies (Breland-Noble et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Shaver et al., 2022) cautioned that spirituality may amplify distress when intertwined with guilt or stigma.\u003c/p\u003e \u003cp\u003eOverall, the synthesis indicates that religion and spirituality function as moderators of stress and predictors of positive coping in youth, with the strongest effects when faith is intrinsic, inclusive, and self-determined, and weakest when characterised by rigidity or exclusion. These findings underscore the need for culturally sensitive, spiritually informed approaches to youth mental-health promotion and intervention.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eSummary of Included Studies on Religion and Spirituality (R/S) and Youth Mental Health\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArticle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample/Demographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKey Results\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCritical Appraisal Comments\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggarwal et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic review \u0026amp; meta-analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 longitudinal\u0026thinsp;+\u0026thinsp;29 intervention studies of youth\u0026thinsp;\u0026lt;\u0026thinsp;24 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpiritual wellbeing reduced depressive symptoms; negative religious coping predicted poorer mental health.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh-quality systematic review with clear aims, comprehensive search, and rigorous dual-review process. Methods for synthesis and bias assessment were appropriate. Limited discussion of policy implications, but strong research recommendations. Included due to methodological rigor and relevance to review questions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVanderWeele \u0026amp; Ouyang (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLongitudinal cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S. adolescents \u0026amp; young adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReligious attendance and intrinsic meaning predicted greater flourishing and lower depression.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLimited cultural diversity: Strong causal modelling (adjusted for confounders); robust design; aligns with inclusion.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTsomokos \u0026amp; Dunbar (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLongitudinal quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11,045 U.K. adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReligiousness buffered link between interpersonal distrust and depression.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-report bias; cross-sectional analysis within broader cohort. Excellent control for confounders. Strong internal validity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruehwirth et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLongitudinal quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eU.S. secondary-school students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReligiosity reduced depression probability by 11% after adjusting for confounds.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePossible unmeasured peer-influence factors. Strong control for confounding; longitudinal robustness; significant protective association.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePandya (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRandomised controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5,339 Indian adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpiritual-development program increased happiness and wellbeing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShort follow-up; cultural specificity limits generalisation. Data-driven and relevant; ethical rigor present.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTietbohl-Santos et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh-risk youth (\u0026le;\u0026thinsp;24 yrs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultiple protective factors against youth depression, highlighting intrinsic religiosity and spirituality as significant buffers promoting resilience and wellbeing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStrong methodological rigor with a clear research question \u0026ndash; adherence to all the JBI standards. Variability in how spirituality was defined and assessed across included studies limited the consistency and comparability of findings.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAl-amer et al. (2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-sectional quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1344 participants, aged 14 to 18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eReligious coping correlated negatively with stress (r = \u0026minus;\u0026thinsp;0.097, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCorrelational design; single cultural context.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNaghmeh et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative interviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIranian adolescents aged 14\u0026ndash;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpirituality promoted self-control, purpose, and optimism.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall, homogeneous sample; limited transferability. High congruity between methodology and aims; reflexivity limited but rich participant voice.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreland-Noble et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQualitative thematic analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAfrican American adolescents with depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrayer and faith fostered agency and hope, but stigma hindered help-seeking.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNon-generalisable; potential researcher bias.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCotton et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdolescents 10\u0026ndash;18 years (multi-country)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntrinsic spirituality linked to emotional stability and lower risk-taking.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBroad scope; includes physical and moral outcomes; partial alignment to inclusion criteria. Outdated evidence base; limited cultural scope.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJi et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuantitative survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUS adolescents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntrinsic religiosity lowered depression and substance use; extrinsic linked to maladaptive outcomes.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRestricted to one faith tradition. Non-generalisable; potential researcher bias.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLekwauwa et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTransgender adolescents (18 studies)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntrinsic spirituality improved wellbeing: external stigma increased distress.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFew high-quality studies; Western bias.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShaver et al. (2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCross-sectional quantitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12,593 Canadian adolescents 11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpiritual connectedness buffered bullying impact but intensified distress for highly self-focused girls.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSelf-report bias; gender-specific effects unclear. High-quality sample; strong analytic design.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis scoping review synthesised studies examining the relationship between R/S and mental health outcomes in young people aged 24 years and under. The findings indicate that R/S are not peripheral influences but central psychosocial constructs shaping adolescents\u0026rsquo; emotional development, coping capacity, and identity formation. Adolescence is a formative stage marked by increasing cognitive and moral sophistication and a growing search for meaning; making it a crucial period for understanding how faith, spirituality, and existential frameworks influence wellbeing. Within this developmental context, R/S can offer structure, belonging, and hope ; key factors that help young people navigate stress and adversity. These findings are particularly relevant given the rising global burden of adolescent mental health disorders and the increasing recognition that clinical frameworks often overlook spiritual dimensions of care. Understanding the role of R/S therefore extends the scope of mental health promotion, particularly in culturally and religiously diverse settings.\u003c/p\u003e \u003cp\u003eAcross diverse study designs, R/S consistently emerged as protective or moderating factors in youth mental health. Intrinsic religiosity and spiritual wellbeing were associated with reduced depression and anxiety, improved life satisfaction, and stronger resilience (Aggarwal et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; VanderWeele \u0026amp; Ouyang, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Conversely, extrinsic religiosity, rooted in obligation or conformity, was sometimes linked with maladaptive outcomes such as guilt or avoidance (Ji et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Cotton et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Three interrelated mechanisms consistently explained these relationships: meaning-making, adaptive coping, and social connectedness. Meaning making allowed adolescents to frame stressful experiences within a broader narrative of purpose or moral coherence, while adaptive coping involved using prayer, meditation, or spiritual reflection to regulate emotions and maintain hope. Social connectedness, facilitated through faith communities or shared belief systems, reduced isolation and provided relational support, often serving as a buffer against psychosocial stressors such as bullying or family conflict (Fruehwirth et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Tsomokos \u0026amp; Dunbar, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOperationalisation and measurement of \u0026ldquo;religiosity\u0026rdquo; and \u0026ldquo;spirituality\u0026rdquo; varied considerably across studies, ranging from behavioural indicators such as institution attendance and prayer frequency to psychological dimensions like meaning, transcendence, or perceived connection to a higher power. This heterogeneity complicates direct comparisons and likely accounts for inconsistent findings, particularly when intrinsic (personal faith) and extrinsic (institutional participation) religiosity were conflated. Only a few studies employed validated multidimensional measures to capture the complexity of R/S constructs, reducing construct precision and cross-study reliability. Moreover, most included studies were conducted in Judeo-Christian or Muslim populations, reflecting the dominant religious orientations of the countries represented. This limits generalisability to non-religious, minority-faith, Indigenous, and Eastern spiritual traditions, which remain underrepresented in the literature.\u003c/p\u003e \u003cp\u003eCultural, gender, and contextual factors consistently shaped the direction and magnitude of R/S effects. In collectivist societies, spirituality was embedded in family and communal structures, emphasising interdependence, moral duty, and social harmony (Al-amer et al., 2024). In contrast, Western studies framed spirituality as an individualised pursuit of authenticity and personal growth (Cotton et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Tsomokos \u0026amp; Dunbar, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Gendered patterns were also evident: faith-based belonging appeared particularly protective for males, whereas females reported greater vulnerability to guilt or exclusion when exposed to rigid or punitive religious teachings (Shaver et al., 2022). Among marginalised groups, such as transgender adolescents, inclusive faith settings enhanced wellbeing, while exclusionary or discriminatory religious environments exacerbated distress (Lekwauwa et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Collectively, these findings underscore that R/S are not universally protective but operate as context-dependent psychosocial systems that can either mitigate or intensify vulnerability depending on inclusivity, authenticity, and community climate.\u003c/p\u003e \u003cp\u003eThe quality of the available evidence was mixed. High-quality longitudinal and meta-analytic studies (e.g., Aggarwal et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; VanderWeele \u0026amp; Ouyang, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) provided the strongest support for temporal and causal links between R/S and improved wellbeing. These designs suggest that faith-based engagement can exert a sustained protective effect on depressive trajectories and general flourishing. However, most studies were cross-sectional and reliant on self-report measures, limiting causal inference and increasing susceptibility to social desirability bias. Sample diversity was also limited: participants were typically school-based, Western, or religiously affiliated, with few studies including secular or multi-faith cohorts. Small sample sizes, insufficient statistical power, and inconsistent control for confounding variables (e.g., family cohesion, socioeconomic status) further constrain interpretation.\u003c/p\u003e \u003cp\u003eMethodological limitations also exist within this review. Conducted by a single reviewer, there is an inherent risk of selection and interpretation bias, despite the use of Covidence software to ensure procedural transparency and adherence to JBI appraisal frameworks. Restricting inclusion to English-language studies may have excluded relevant non-English research potentially skewing findings toward Western perspectives. Furthermore, heterogeneity in study design and outcome measurement precluded quantitative synthesis, necessitating a narrative approach that emphasises thematic patterns over statistical precision. Nevertheless, the use of structured JBI tools and PRISMA guidelines enhanced methodological rigour and consistency throughout the screening and extraction process.\u003c/p\u003e \u003cp\u003eDespite these constraints, several key implications emerge for practice and policy. R/S should be recognised as legitimate dimensions of youth mental health assessment and intervention, particularly in multicultural clinical settings. When internalised authentically and practiced within inclusive, supportive contexts, R/S can strengthen emotional regulation, foster hope, and enhance identity coherence \u0026mdash; core developmental goals during adolescence. Clinicians, educators, and youth workers should approach R/S as potential strengths, integrating spiritual dialogue or meaning-based frameworks into care where appropriate. However, practitioners must remain attentive to circumstances where R/S may contribute to guilt, stigma, or exclusion. Building partnerships with faith leaders, school chaplains, and culturally specific services may enhance accessibility and cultural safety, ensuring that spiritual support complements evidence-based care rather than competing with it.\u003c/p\u003e \u003cp\u003eFuture studies should adopt longitudinal and mixed method designs to clarify developmental pathways and causal mechanisms through which R/S influence mental health. Standardised, multidimensional measurement tools are essential to distinguish between intrinsic and extrinsic aspects of religiosity and to enhance comparability across cultural settings. Research should intentionally include underrepresented populations, such as Indigenous, Eastern, and secular youth, to expand the cultural scope of existing findings. Furthermore, integrating psychophysiological and behavioural indicators alongside self-report measures may yield a more comprehensive understanding of how R/S engagement manifests in daily functioning and resilience.\u003c/p\u003e \u003cp\u003eIn conclusion, this review demonstrates that religion and spirituality are powerful yet context-sensitive determinants of adolescent mental health. When expressed inclusively and self-determinedly, they enhance meaning, belonging, and coping, serving as vital protective factors in the face of adversity. Conversely, when imposed rigidly or accompanied by exclusion, they can contribute to psychological distress. Importantly, religion and spirituality, though related, play distinct roles: religion often operates as a social and institutional system providing structure, values, and community, while spirituality reflects an individual\u0026rsquo;s personal search for meaning, transcendence, and connection. The evidence reviewed suggests that spirituality tends to exert a more consistent protective effect on mental health, whereas the impact of religion varies depending on inclusivity, authenticity, and cultural context. The findings advocate for a balanced, culturally responsive approach to integrating R\u0026amp; S dimensions into youth mental health promotion and early intervention frameworks. Doing so not only aligns with holistic models of care but also acknowledges the diverse ways in which young people seek meaning, connection, and healing in an increasingly complex world.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAggarwal SK, Wright JC, Morgan AJ, Patton GC, Reavley N (2023) Religiosity and spirituality in the prevention and management of depression and anxiety in young people: a systematic review and meta-analysis. 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Front Psychol 10(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2019.01525\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2019.01525\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Wollongong","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8665148/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8665148/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis scoping review explored how religion and spirituality (R/S) influences mental health outcomes in young people aged 10\u0026ndash;24 years. Guided by the JBI Manual for Evidence Synthesis and PRISMA-ScR criteria, thirteen studies published between 2006 and 2025 were reviewed, including longitudinal, cross-sectional, qualitative, and intervention designs. Across diverse cultural contexts, intrinsic religiosity and spiritual wellbeing were consistently associated with improved resilience, greater life satisfaction, and reduced depression and anxiety. Three core mechanisms (meaning-making, adaptive coping, and social connectedness) emerged as mechanisms through which R/S support positive mental health. Conversely, extrinsic religiosity and negative religious coping (e.g., guilt, exclusion, or rigid belief systems) were occasionally linked to poorer outcomes. Contextual factors such as culture, gender, and inclusivity within faith communities moderated these relationships. While most evidence supports the protective influence of intrinsic spirituality, inconsistent operationalisation of R/S constructs and reliance on self-report measures limit causal interpretation. Overall, R/S appear to function as complex psychosocial resources that promote wellbeing when internalised authentically and practiced within supportive environments. These findings highlight the need for culturally sensitive, spiritually informed approaches in youth mental-health promotion and for longitudinal research to clarify causal mechanisms and developmental trajectories.\u003c/p\u003e","manuscriptTitle":"A Scoping Review Of Religion, Spirituality And Youth Mental Health Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 06:27:14","doi":"10.21203/rs.3.rs-8665148/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6aca7f76-9687-4ea7-916a-5ae7beab35c0","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T06:27:15+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 06:27:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8665148","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8665148","identity":"rs-8665148","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}