Religion and mental health seeking behaviors in war-torn zones of the Democratic Republic of the Congo

Background: Although religious leaders play an important role in providing informal mental health care to individuals struggling to seek religious and spiritual care, existing studies have not explored the role of psychiatric symptoms and motivating factors in seeking mental health services from religious leaders in religious listening centers and mental hospitals. This paper presents preliminary data from a survey aimed at assessing psychiatric symptoms and factors associated with access to spiritual services among 151 individuals at a religious listening center, as well as to determine the pathways of care among 150 patients attending a mental health clinic in conflict zones of the Eastern Democratic Republic of the Congo.

Objectives: (1) To evaluate psychiatric symptoms and socio-economic factors associated with seeking spiritual services, and to map the corresponding healthcare pathways among patients utilizing both religious and conventional mental health facilities in conflict zones.

Methodology: A cross-sectional survey screened a total of 301 participants across two target cohorts in the Eastern DRC. The sample consisted of 151 individuals surveyed directly at a religious listening center and 150 patients receiving care at psychiatric hospitals. Standardized assessments were collected using semi-structured questionnaires to evaluate psychiatric disorders, healthcare pathways, and behavioral motivators. Descriptive analyses were performed to determine information on psychiatric symptoms and factors affecting access to spiritual and mental health services.

Results: Analysis revealed that nearly 6 in 10 individuals seeking spiritual help met the criteria for a diagnosable mental disorder, frequently presenting with bipolar disorder, schizophrenia spectrum disorders, recurrent admissions, or poor medication adherence. Additionally, 7 in 10 psychiatric hospital patients sought help from religious centers before attending a mental hospital. Primary drivers of spiritual help-seeking behavior included strong personal religious components, poverty, and an absolute lack of trained mental health professionals in active conflict zones. Most participants presenting to psychiatric hospitals were self-referred. Determinants of self-referral to psychiatric hospitals included the accessibility of the hospitals, the availability of trained mental health specialists, and a well-established referral system linking the PHC and psychiatric hospitals. Initial care-seeking for mental health challenges heavily favors psychiatric hospitals and religious leaders over primary healthcare, primarily driven by self-referral and cultural-religious attributions like witchcraft or divine punishment. Furthermore, the odds of bypassing primary health care are significantly increased by multiple psychiatric episodes and supernatural beliefs, whereas a family history of mental disorders lowers these odds.

Conclusion: Religious institutions play an overwhelming role as primary gatekeepers for mental health services in conflict-affected regions. There is an urgent need to develop integrated healthcare models that bridge the gap between medical professionals and religious leaders, ensuring person-centered care that honors patients’ spiritual beliefs while improving access to conventional psychiatric interventions. We conclude with discussion of a collaborative model between religious leaders and medical professionals to improve care pathways in conflict zones.

References

1. Vivalya, B. M. N., Vagheni, M. M., Piripiri, A. L., & Mbeva, J. B. K. (2025). Religion and mental health seeking behaviors in war-torn zones of the Democratic Republic of the Congo. The International Journal of Psychiatry in Medicine, 60(5), 581-594.
2. Vagheni, M. M., Mbeva, J. B. K., Piripiri, A. L., Kavulivwa, J. Z., Ricciardelli, R., Andjafono, D. O. L. E., & Mutume Nzanzu Vivalya, B. (2026). Beliefs, referrals, and mental healthcare pathways in the Eastern Democratic Republic of Congo. PLOS Global Public Health, 6(7), e0006715.