Letter to the Editor Depression not related to lower religious involvement in bipolar disorders? To the Editor: In their recent article on religiosity in bipolar disorders, Cruz et al. (1) reported higher rates of prayer / meditation in subjects in a mixed state, lower rates of prayer / meditation in euthymic subjects, and no association between depression or mania and religious involvement. Religiosity has been recognized as a major coping strategy and thus to have a positive influence on outcomes in psychiatric and addictive disorders (2, 3). How religiosity and spirituality dimensions change with mood swings is, however, poorly understood. During mania, many patients experience states of enlightenment and increased religious motivation that are often recognized as early signs of a new manic episode by mental health professionals (4). In depression, however, most studies have shown an inverse relationship between religiousness and depression, and in a meta-analysis of 147 studies the inverse correlation between religious involve- ment and depression was shown to be significant (5). It is thus surprising to find neither of these expected associations between depression or mania and religious involvement in the Cruz et al. study (1). This negative finding could be related to the statistical analysis strategy used. As there was no control group in this study, each class of subjects (i.e., depression, mania, mixed states, euthymia) was compared to the three others in four separate multivariate analyses. In the absence of a proper control group, it could seem reasonable to have considered euthymic subjects as the controls to which the subjects with pathological mood states could be compared. In this view, lower rates of prayer / meditation in euthymic subjects could not in any case be understood as lower religiosity in depressed subjects. On the contrary, it leaves open the possibility that depressed subjects have a higher rate of prayer / meditation than euthymic subjects. In this event, that could be a signature of the coping resources used by depressed bipolar disor- der subjects, who could be accustomed to enlight- enment experiences during manic phases, and thus more prone to use this type of coping response than subjects suffering from unipolar depression, who frequently report religious discontent as negative feelings toward God or a sense of having been abandoned by God (4). Henri-Jean Aubin, Olfa Mandhouj and Michel Reynaud Department of Psychiatry, Ho ˆpital Paul Brousse, University Paris-Sud School of Medicine, Villejuif, France Corresponding author: Henri-Jean Aubin, M.D., Ph.D. Department of Psychiatry Hoˆpital Paul Brousse AP-HP, INSERM U 669 University Paris-Sud School of Medicine 12 Avenue Paul-Vaillant-Couturier 94800 Villejuif, France E-mail: henri-jean.aubin@pbr.aphp.fr doi: 10.1111/j.1399-5618.2010.00841.x References 1. Cruz M, Pincus HA, Welsh DE, Greenwald D, Lasky E, Kilbourne AM. The relationship between religious involvement and clinical status of patients with bipolar disorder. Bipolar Disord 2010; 12: 68–76. 2. Huguelet P, Koeing HG. Religion and Spirituality in Psy- chiatry. Cambridge: Cambridge University Press, 2009. 3. Koenig HG. Research on religion, spirituality, and mental health: a review. Can J Psychiatry 2009; 54: 283–291. 4. Braam AW. Religion / spirituality and mood disorders. In: Huguelet P, Koeing HG eds. Religion and Spirituality in Psychiatry. Cambridge: Cambridge University Press, 2009: 97–113. 5. Smith TB, McCullough ME, Poll J. Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 2003; 129: 614–636. Key words: bipolar disorders – prayer – religion Bipolar Disorders 2010: 12: 582 ª 2010 The Authors Journal compilation ª 2010 Blackwell Munksgaard BIPOLAR DISORDERS 582