Following five key Buddhist teachings may help protect against depression, new research shows.
A study from Thailand showed that among people who observed what are known as the Five Precepts of Buddhism ― not to kill, steal, engage in sexual misconduct, tell ill-intentioned lies, or use intoxicants ― rates of depressive symptoms were significantly lower than among their counterparts who did not observe these Five Precepts.
"Observing the Five Precepts buffers the effects of perceived stress on depression," study investigator Nahathai Wongpakaran, MD, professor, Geriatric Psychiatry Unit, Chiang Mai University, Thailand, told Medscape Medical News.
The study was published online November 30 in PLOS ONE.
Tackling the "Big Five"
Neuroticism is one of the "Big Five" personality dimensions inherent in depression. A "clinically significant depressive symptom is usually attributable to an interaction of the trait of neuroticism with a life stressor," the investigators note.
Perceived stress — "thoughts or the feelings that individuals experience after encountering stressful life events" — is "strongly associated" with depression and often precedes it. Perceived stress may mediate the effect of neuroticism on depression.
The effect of neuroticism and perceived stress on depression may be "buffered" by positive variables, such as self-efficacy, resilience, equanimity, and religious participation. In particular, equanimity is "a strength found in Buddhist discipline."
However, "observance of the Five Precepts is not well-known among international academic circles, compared with mindfulness meditation," the authors note.
The researchers "observed that people who practice the Five Precepts usually have better health than those who do not." In addition, previously in this population, a "favorable relationship" was found between the Five Precepts and resilience, which made the investigators think that following the precepts might be beneficial in other areas of mental health, such as depression.
To investigate, they conducted an online survey of a convenience sampling of individuals in Thailand. Participants ranged in age from 18 to 72 years (n = 644; mean [SD] age, 28.28 [10.6] years; 74.2% women). Participants were required to be free of current or past psychiatric disorders.
Over half the participants earned a "moderate level" of income, and almost all (93.3%) were Buddhist.
Participants completed the 10-item Perceived Stress Scale (PSS-10), the Neuroticism Inventory (NI), the Core Symptoms Index–Depression subscale (CSI-D), and the Precept Practice or Observance Five Precepts (SBI-PP).
"As expected," the NI score was positively correlated with CSI-D and PSS scores but were negatively correlated with SBI-PP score (all Ps < .01).
Hierarchical regression analysis identified potential confounders and showed age, sex, and marital status to be the "significant predictors" that reduced the effect size of neuroticism on depression. Those confounders were therefore controlled as covariates in the moderated mediation model.
After adjustment, NI, PSS, and marital status (living alone) predicted depressive symptoms (all Ps < .0001). The addition of PSS changed the model of variance of depressive symptoms, which increased from 36.3% to 45.5%. NI had a "significantly indirect effect" via PSS (β = .072; P < .001).
For those with low vs high practice levels of the Five Precepts, there was a greater impact of perceived stress as well as neuroticism on depressive symptoms (all Ps < .001), with significant differences between slope coefficients.
|Relationship between scales||Slope coefficient||Difference between slopes|
|PSS and CSI-D||Low practice level: 0.375
High practice level: 0.244
|t = -3.561 (P < .001)|
|NI and CSI-D||Low practice level: 0.225
High practice level: 0.164
|t = -2.644 (P = .008)|
The researchers carried out more expanded moderated mediation analysis of precept practice, neuroticism, and perceived stress in the prediction of depressive symptoms in which they controlled for age, sex, and marital status.
They found that SBI-PP showed a moderating effect on PSS but not on NI (t = 3.22; P = .001). Nevertheless, this moderated mediation model "increased the percent variance explaining depressive symptoms to 47.6%, compared with 32.5% from the mediation model alone." Moreover, the index of moderated mediation model was significant (b = -.021; 95% CI, -.032 to -.009).
"Based on our findings, it suggests that [observance of] the Five Precepts has a protective mechanism," Wongpakaran commented.
The Five Precepts "define controlling behaviors based on self-loving and kindness to other people," she continued. "It also requires self-efficacy and locus of control to succeed in that." These mechanisms appear beneficial in protecting against depression.
She cautioned that the study is observational. "The results would be more robust if tested in an experimental design or longitudinal study."
Commenting for Medscape Medical News, Alan Maddock, PhD, MSW, assistant professor in social work, University College, Dublin, Ireland, described the study as being "reasonably well designed and executed, with a large sample size which allows the statistical analysis to be conducted."
However, the authors are "using a single item to measure a very complex set of phenomena — five different behaviors of varying intensity — and how it might moderate relationships within a complex model, with depression as an outcome, which also includes neuroticism," cautioned Maddock, who was not involved with the study.
"A more multifaceted measure of the Five Precepts is needed to explore these relationships thoroughly," he continued. This is a "significant limitation, which undermines the subsequent discussion and the clinical relevance of this paper, which is overstated in the discussion in my view."
Moreover, the nature of the sample (ie, a convenience sample) means "it cannot be generalized to a wider population," Maddock added.
"Longitudinal studies (which the authors call for) would need to be conducted with a more well-developed and tested measure (validated in the local context) of the Five Precepts included before any changes to clinical practice should be advocated for," he said.
The research was supported by the Faculty of Medicine Research Fund of Chiang Mai University. The authors and Maddock have disclosed no relevant financial relationships.
PLoS One. Published online November 30, 2022. Full text
Batya Swift Yasgur MA, LSW, is a freelance writer with a counseling practice in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).
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