Impacto de intervenções religiosas na melhora clínica de pacientes com sintomas depressivos: uma revisão sistemática e metanálise

Abstract

Abstract: Abstract: Introduction: Religious interventions have been proposed as culturally adapted strategies for managing depression in adults. However, the available evidence remains heterogeneous, making it difficult to draw consistent conclusions about their clinical effectiveness. Objectives: To evaluate the impact of religious interventions on reducing depressive symptoms in adults.. Methods: Randomized controlled trials investigating religious interventions in adults with depressive symptoms were included. Observational studies, case reports, reviews, trials with spirituality interventions without explicit religious reference, studies conducted in populations with serious and/or chronic illnesses, as well as samples predominantly composed of other mental disorders (psychoses, substance use disorders, post-traumatic stress disorder, obsessive- compulsive disorder, and eating disorders) were excluded. The searches were conducted in the PubMed/MEDLINE, Embase, and Cochrane Library databases, updated until May 13, 2025. The risk of bias was assessed using the RoB 2 considering the domains of randomization, deviations from intended interventions, missing outcome data, outcome measurement, and selective reporting. Data synthesis combined descriptive analysis and meta-analysis, using a random-effects model (DerSimonian–Laird) and the standardized mean difference (SMD) as a measure of effect. Results:Ten randomized controlled trials were included, totaling 531 participants. Religious interventions consisted predominantly of psychotherapies with explicit incorporation of religious elements, including liturgical practices such as prayer and recitation. Meta-analysis demonstrated a statistically significant overall effect in favor of religious interventions (SMD = -1.20; 95% CI - 1.84 to -0.56; p < 0.05), with high heterogeneity among studies (I² = 90%). The risk of bias was classified as some concern to high in multiple domains, especially in the domains of outcome measurement and missing outcome data. Despite methodological limitations, the body of evidence suggests that religious interventions can reduce depressive symptoms in adults, particularly when culturally congruent and compared to usual care or passive controls. The degree of certainty of the evidence was classified as moderate, according to the GRADE system. Conclusions: Religious interventions show a beneficial effect in reducing depressive symptoms in adults. However, the heterogeneity of the studies and methodological limitations indicate the need for larger, standardized trials to expand on the results found in this review and meta-analysis. Registration in PROSPERO: CRD420251168272