Religion and health in the Netherlands: Disentangling underlying pathways

Previous research into the relationship between religion and physical and mental health discloses scientific puzzles concerning causality and linearity, demonstrating the need to clarify underlying pathways. Therefore, we analysed a representative sample of the general Dutch population ( n = 4659), simultaneously testing four underlying pathways: (1) health advantages due to social benefits of religious participation; (2) religious prohibitions encouraging temperance; (3) direct physiological benefits of religious practice; (4) health benefits of certainty on existential matters. Regarding the first pathway, we found no direct association between church attendance and health. Regarding the second pathway, we found that church attendance is indirectly associated with better physical health through less smoking. However, this positive indirect association is counterbalanced by a negative indirect association between church attendance and physical health through less alcohol consumption, which we found to be positively associated with physical health. Regarding the third pathway, we unexpectedly found a negative association between praying and physical and mental health. Although our cross-sectional design precludes determination of causality, this negative association may be attributable to praying induced by adversity. Regarding the fourth pathway, we found a curvilinear association between religious belief and mental health, with convinced believers and convinced non-believers both having better mental health than those uncertain about the existence of God and an afterlife. However, we found no such association for physical health. Considering the percentage of explained variance, we found no substantial association between religion and health in the Netherlands, a secularized society with excellent healthcare access.