Spirituality and religion in psychiatry — structured clinical viva

This station tests risk plus R/S competence. Immediate tasks: clarify passive vs active suicidal ideation, intent, plan, means, protective factors, substances, supports, and safety tonight. Do not debate the pastor; explore the patient's own meaning of illness and treatment.^[2]

Definitions. Spirituality = meaning/purpose/connection/transcendence (may be non-religious). Religion = organised community and shared practices. WPA: clinically relevant for many; assess respectfully; do not impose beliefs.^[1]

Assessment. HOPE or FICA with permission. Map positive religious coping (support, hope) versus negative coping/spiritual struggle (punishment appraisals, conflict with faith community, guilt blocking care).^[3][5]

Evidence tone. Religiousness shows a small protective association with depression in meta-analysis, not absolute protection — this patient is depressed despite faith context.^[4]

Boundaries. Acknowledge prayer request; explain clinical role; offer chaplaincy/spiritual care practitioners with consent rather than dual religious leadership. Avoid proselytising and secret specialness.^[6][7]

Plan. Collaborative formulation linking mood, spiritual struggle, and social supports; evidence-based depression treatment with explanatory-model negotiation; crisis plan; optional spiritual care; GP and psychology follow-up; supervision if countertransference is strong.^[2][5][7]