A scoping review is a type of literature review that aims to map the relevant literature in a field of interest, summarizing the main results found and identifying possible gaps (Arksey & O’Malley, 2005). The procedures of our review used the instrument of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping reviews (PRISMA-ScR) (Tricco et al., 2018).

The guiding question of this review was based on the PCC model (Population/Participants, Concept, Context) (The Joanna Briggs Institute, 2015), considered the most suitable for scoping reviews (Munn et al., 2018). The acronym indicates: P – Population: the population of lesbians, gays and bisexuals; C – Concept: the relationship between religiosity/spirituality and mental health; C – Context: the religious/spiritual identification of the LGB assessed. In this connection, the following investigation question ensues: What are the main evidences in regard to the relationship between religiosity/spirituality and mental health in religious/spiritual lesbians, gays and bisexuals?

The search was conducted from April to May 2021 in PubMed, PsycINFO, Web of Science, Scientific Electronic Library Online (SciELO) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) databases. The publications interval was set at the last ten years (2012-2021), with a view to mapping the most recent papers, since this period was marked by important socio-legal changes in relation to the LBG audience in several countries where there were restrictions of rights for these individuals, including the criminalization of homophobia, the legalization of civil marriage/common law marriage, and children adoption by homoparental families.

The descriptors used were based on the Thesaurus of Psychological Terms issued by American Phychological Association (APA), as well as the Descritores em Ciências da Saúde (DeCS, Terminologies in Health Sciences). However, in order to expand the search, other descriptors were added that correspond to constructs frequently used to refer to the phenomenon, in addition to the denomination of the main religions, with a large number of followers worldwide. Thus, the following search combinations were used, with the relevant Boolean operators: (religiosity OR religion OR spirituality OR spiritual OR religious OR catholic OR evangelical OR catholicism OR protestantism OR judaism OR islam OR muslim) AND (homosexuality OR homosexual OR bisexuality OR bisexual OR lesbianism OR lesbian OR gay OR lgb OR “sexual orientation” OR “sexual minority”) AND (“mental health” OR “well-being” OR depression OR suicide OR anxiety). The same descriptors were also used in Portuguese and Spanish. In addition, in order to better filter the results, in the PubMed database, it was decided that the descriptors should be contained in the title or abstract; in the PsycINFO and SciELO databases, in the abstract; in the Web of Science database, in the title; and in Lilacs, in the subject; according to the existing fields in each base.

The following inclusion criteria were considered, (a) published scientific papers; (b) an indexed article, peer-reviewed; (c) empirical; (d) quantitative; and (e) having lesbians, gays or bisexuals as participants in the study. The following papers were excluded: (a) duplicates; (b) those which did not have some quantitative measure of religiosity/spirituality and mental health; and (c) those that did not perform any analysis to measure the relationship between LGB religiosity/spirituality and mental health.

Initially, a search was performed according to the databases and combinations of selected descriptors. Additionally, two independent investigators reviewed the abstracts; the studies that met the inclusion/exclusion criteria were selected. The final sample of articles was blind-reviewed by two judges, who read the full articles. When there was disagreement on inclusion/exclusion, a third independent judge was consulted. Finally, an Excel spreadsheet was created containing the following information about the studies included: (a) authors; (b) year of publication; (c) country of research; (d) sample population; (e) religiosity/spirituality measurement(s); (f) mental health measurement(s); and (g) main results.

The synthesis and interpretation of the findings took place from the content analysis of Bardin (2016), taking into account the following steps: (a) exhaustive reading of the selected articles; (b) assessing in detail the characteristics of the studies; and (c) analysis by the judges.

As can be seen in Table 1, the articles reviewed were published during the period between 2012 and 2021; articles were published in each of the years of that period. The great majority of articles were sourced in the United States (n = 30; 83.3%), and there were also, to a lesser extent, articles from Israel (n = 2; 5.5%), Austria (n = 2; 5.5 %), Poland (n = 1; 2.7%) and Australia (n = 1; 2.7%).

As for the outcome variables related to mental health, 44.4% (n = 16) of the articles reviewed addressed the depression construct, 30.5% (n = 11) anxiety and 25% (n = 9) suffering. To a lesser extent, other similar variables were addressed, such as life satisfaction (n = 6; 16.6%), suicide attempts or suicide ideation (n = 5; 13.8%).

Out of the 36 studies reviewed, 16 used a variety of depression measurements the most commonly used being the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). Five studies did not find a significant association between R/S and depression (Drabble et al., 2018; Escher et al., 2019; Hamblin & Gross, 2013; Heiden-Rootes et al., 2020; Kralovec et al., 2014; Walker & Longmire-Avital, 2013). Among the significant effects, a more severe form of depression was associated with religious engagement (Barnes & Meyer, 2012), religious coping (Lasiter et al., 2019), affiliation with a non-affirming religion (Gattis et al., 2014), confused religious point of view (Lefevor et al., 2020), and activity within the church (Crowell et al., 2015). Less depression, in turn, was associated with greater spirituality (Lasiter et al., 2019) and an existing relationship with a higher power, compared to groups with a fractured or insecure relationship (Puckett et al., 2018), and better resolution of the conflict between religious and sexual identities (Lefevor et al., 2020).

Other relevant findings indicated a positive association between depression and internalized homonegativity (Barnes & Meyer, 2012; Heiden-Rootes et al., 2020; Puckett et al., 2018) and outness, that is, openness about sexual orientation (Heiden-Rootes et al., 2020; Puckett et al., 2018). Gattis et al. (2014), in a study with 393 young American sexual minorities found that religious affiliation moderated the discrimination-depression relationship; in fact, sexual minorities youth affiliated with non-affirmative and secular religions had more depressive symptoms compared to those affiliated with an affirmative denomination. From a similar perspective, Barnes and Meyer (2012), with a sample of 396 LGB Americans, found that, although exposure to non-affirmative religious environments was not a predictor of more depressive symptoms, when the internalized homonegativity was included in the model, the results tended to move more strongly towards that expected direction.

Five studies used some measurement of suicidal ideation or suicide attempt. Lower suicide rates were associated with greater religiosity (Klundt et al., 2021; Plöderl et al., 2020) and spirituality (Plöderl et al., 2020). Furthermore, the feeling of belonging to a religious community was significantly associated with less suicidal ideation in the previous 12 months (Kralovec et al., 2014).

Some studies, however, go in the opposite direction, identifying a positive association between religiosity and suicide attempts in young people belonging to sexual minorities (Lytle et al., 2018; Shearer et al., 2018). The studies by Shearer et al. (2018) indicated that, for heterosexual American adolescents, being more religious or having a more religious father was associated with fewer suicide attempts. However, for youths belonging to a sexual minority, being more religious or having a more religious father was associated with an increase in suicide attempts. These results can be explained by homophobic messages that permeate some religious institutions, which can lead to more experiences of rejection by family members, as well as the internalization of such messages by the adolescents themselves.

Furthermore, Lytle et al. (2018) found that a lesbian/gay part of a sample was associated with recent suicidal ideation and recent suicide attempts among those with high religiosity, while this relationship was not significant for those of low to moderate religiosity. Overall, these results suggest that, among people who considered religion very important, sexual minority status was more strongly associated with suicide ideation and attempted suicide than among those who considered religion unimportant.

The study by Kralovec et al. (2014) highlights the importance of internalized homonegativity in this relationship. In a sample of Austrian LGB, the authors found that religious affiliation and the feeling of belonging to a religious community were significantly associated with increased internalized homonegativity and this, in turn, was associated with higher levels of recent suicidal ideation and suicidal ideation in the last 12 months. It is noteworthy, however, that when this relationship was not mediated by IH, there was a beneficial association between the feeling of belonging and suicide.

Eleven studies used a measurement of anxiety. Among the significant relationships, Klundt et al. (2021) found that religiosity had a direct negative effect on social anxiety. Zarzycka et al. (2017) found positive correlations between anxiety and all types of religious struggle, that is, negative emotions towards God; feelings of fear and guilt and negative social interactions in regard to religion.

Furthermore, higher levels of anxiety were observed: in LGB who were not well accepted in their religious setting (Hamblin & Gross, 2013); in LGB with a confused religious point of view (Lefevor et al., 2020); in those who were constantly struggling with their own LGB identity (Rodriguez et al., 2019); and mainly in bisexual women compared to bisexual men, gays and lesbians (Walker & Longmire-Avital, 2013).

The increase or not of anxiety also varied according to the type of religiosity, whether extrinsic, that is, when the practice of religion is used as a means to other ends, such as comfort, status or social support; or intrinsic, that is, seeing religion as an end in itself. Thus, extrinsic religiosity was associated with greater phobic anxiety, whereas intrinsic religiosity was associated with less social anxiety (Harari et al., 2014). Other relevant findings show that greater anxiety was associated with more concern about self-acceptance by others (Klundt et al., 2021), less resolution of the conflict between sexual and religious identities (Lefevor et al., 2020) and less resilience (Walker & Longmire-Avital, 2013).

Four studies measured self-esteem and all used the Rosenberg Self-Esteem Scale (1965). Most results did not show a significant association between R/S and self-esteem. One study did not find a direct relationship between these variables (Huffman et al., 2020), one found no difference in self-esteem between the groups with and without R/S (Meanley et al., 2016) and one found no difference between Mormons categorized by level of activity within the church (Joseph & Cranney, 2017).

Among the significant findings, results are quite varied; self-esteem was negatively associated with religious commitment, but positively associated with religious coping (Meanley et al., 2016) and activity within the Mormon church was related to lower acceptance of the LGB identity, which was associated with lower self-esteem (Joseph & Cranney, 2017). In a comparative analysis by groups, it was observed that secular LGB had higher self-esteem, whereas those who were in constant struggle with their own LGB identity had lower indices (Rodriguez et al., 2019), and bisexuals had lower self-esteem compared to lesbians and gays (Huffman et al., 2020).

Six studies measured satisfaction with life and all used the Satisfaction With Life Scale (SWLS; Diener et al., 1985). Specifically, Huffman et al. (2020) and Foster et al. (2017) did not find a significant relationship between R/S and satisfaction with life, whereas Harari et al. (2014) found a positive association with spirituality, but not with religiosity.

Among the significant findings, satisfaction with life was positively correlated with religious comfort and negatively correlated with negative social interactions in regard to religion (Zarzycka et al., 2017); less satisfaction was associated with a confused religious point of view and less conflict resolution between sexual and religious identities (Lefevor et al., 2020).

Szymanski and Carretta (2020) found that the greater lived experiences of sexual stigma based on religion were associated with greater internalized homonegativity and greater struggles with religion, which, in turn, were associated with less satisfaction with life. Furthermore, religiously-based sexual stigma was positively associated with lower satisfaction at high and medium levels of religiosity, but not at low levels. Moreover, Lefevor et al. (2020) found that Mormon LGB with high or rare frequency in religious activities reported more satisfaction with life.

One study used a measurement of subjective well-being, two used the Psychological Well-Being Scale (PWBS) and two used a measurement of general health, which contains a well-being sub-scale. One study found no significant association between variables (Shilo & Savaya, 2012). Among the significant findings, religious activity was associated with greater well-being (Scroggs et al., 2018), whereas negative religious coping, that is, marked by an insecure connection with God, religious struggle to find a meaning in life, and spiritual discontent were associated with worse well-being (Brewster et al., 2016; Shilo et al., 2016).

Other findings show a relationship between worse well-being and internalized homonegativity (Barnes & Meyer, 2012; Brewster et al., 2016; Shilo et al., 2016) and better well-being with a higher level of outness (Shilo et al., 2016). Furthermore, the interaction of positive religious coping (based on a secure connection with God and a belief that life has meaning) vs. acceptance of one’s sexual orientation by friends was associated with greater well-being; similarly the interaction of positive religious coping vs. connection with the LGB community was positive (Shilo et al., 2016). Furthermore, the integration of sexual and religious identities was associated with greater religious activity and this, in turn, with greater well-being (Scroggs et al., 2018).

Nine studies measured a type of suffering, whether general, psychological or psychiatric. Some studies did not find significant association with this variable (Brewster et al., 2016; Foster et al., 2017; Shilo & Savaya, 2012). Among the significant associations, there were some beneficial effects of religiosity (Klundt et al., 2021), but many religious variables were associated with greater suffering, such as negative religious coping (Brewster et al., 2016; Shilo et al., 2016), religious struggle (Szymanski & Carretta, 2020) and self-identification as a Christian or former Christian (Sowe et al., 2014).

Sowe et al. (2014) studied Christian, former Christian and non-religious LGB in Australia and found that Christians had greater religious introjection which was predictive of higher levels of suffering. Furthermore, greater homonegativity in one’s religious and family settings predicted higher levels of suffering. Also, former Christians reported greater suffering compared to non-religious individuals.

Shilo et al. (2016) found that the interaction of positive religious coping vs. connection with the LGB community was associated with less suffering. Szymanski and Carretta (2020) found that the greater experience of sexual stigma based on religion was associated with greater internalized homonegativity and greater struggles with religion, which, in turn, were associated with greater suffering. Furthermore, religiously based sexual stigma was positively associated with greater suffering at high and medium levels of religiosity, but not at low levels.

Other variables that have been addressed are quality of life (Klundt et al., 2021), meaning of life (Moscardini et al., 2018), loneliness (Escher et al., 2019; Rodriguez et al., 2019), subjective happiness (Barringer & Gay, 2017), dangerous alcohol consumption and drug use (Drabble et al., 2018; Watkins et al., 2016), purpose in life (Meanley et al., 2016), positive and/or negative affects (Barringer & Gay, 2017; Rodriguez et al., 2019), non-suicidal self-injury (Longo et al., 2013), Flourishing (Lefevor et al., 2020), hopelessness (Kralovec et al., 2014), general health (Cranney, 2017), benevolence (Rodriguez et al., 2019), sensitivity to rejection (Lasiter et al., 2019), identity (Page et al., 2013) and resilience (Lassiter et al., 2019; Walker & Longmire-Avital, 2013).

In connection with the above variables, the following findings are highlighted: higher levels of religiosity were associated with lower meaning of life in individuals who experienced discrimination, but among those with lower levels of religiosity, experiencing more discriminatory situations was associated with higher meaning of life (Moscardini et al., 2018); spirituality was associated with positive affects (Harari et al., 2014); young seculars presented higher risks of self-harm behavior in comparison to young Christians who had received little or no religious orientation; but Christians who received a significant religious orientation presented higher risk of self-harm (Longo et al., 2013); and resilience was positively associated with spirituality, but negatively with religiosity (Lassiter et al., 2019).