Religion, spirituality and religious preoccupation in bipolar disorder: cross-cultural scoping review

BACKGROUND: Religious and spiritual preoccupation is clinically salient in bipolar affective disorder, especially during manic and mixed episodes. The boundary between culturally sanctioned religious experience and psychopathological religiosity is contested across cultures, creating diagnostic, therapeutic and ethical challenges. AIMS: To map evidence on religious preoccupation in bipolar disorder across cultural and religious settings, synthesise clinical and cultural determinants, and identify research gaps. METHOD: This scoping review followed Joanna Briggs Institute methodology and PRISMA Extension for Scoping Reviews guidance, and was pre-registered on the Open Science Framework (10.17605/OSF.IO/V3WA6). PubMed/Medline, Scopus, Google Scholar and four regional databases were searched. Bipolar-specific empirical studies were analysed separately from contextual reviews, historical and conceptual publications, and mixed or non-clinical samples. Data were synthesised narratively and thematically. RESULTS: Eighty-three sources published between 1966 and 2026 were included, comprising 46 bipolar-specific empirical studies and 37 contextual sources. Religious preoccupation, including hyper-religiosity, religious delusions, grandiosity and spiritual experiences, was documented across all six World Health Organization regions. Cultural context shaped explanatory models, pathways to care, diagnostic interpretation, medication adherence and outcomes. Religiosity was associated with protective effects, including lower suicidality and better coping, and adverse effects, including treatment delay and negative religious coping. Evidence gaps remain for Islamic, East Asian, Indigenous and secular-pluralistic populations. CONCLUSIONS: Religious preoccupation in bipolar disorder is cross-cultural and remains understudied outside Western settings. Clinicians require cultural competence and cultural formulation approaches to distinguish psychopathology from normative religious expression. Future research should prioritise underrepresented regions, culturally validated tools and care models integrating religious leaders.