Introduction

The pandemic of coronavirus disease- 2019 (COVID-19) has significantly increased psychological disturbances in terms of quarantines and lockdowns, economic crises, social isolation, and uncertainty. Research suggests that stringent policy would minimize transmission and death during a pandemic, however, higher policy stringency was associated with higher mean psychological distress scores and lower life evaluations. ^{Reference Aknin, Andretti and Goldszmidt1}

When facing a crisis, humans tend to turn to faith to seek comfort and explanations; for example, previous research claimed that 90% of Americans turned to religion to cope with the psychological impact of the 9/ 11 terrorist attack. ^{Reference Schuster and Stein2} People turn to religion to cope with adversity. They pray for relief, understanding, hope, and love, as well as strength, comfort, courage, and perseverance. ^{Reference Davis, Kimball and Aten3} Research has documented that struggles with cancer, loss of family members, or suffering from severe illness are correlated with heightened religiosity. ^{Reference Religiosity4,Reference Merath, Palmer Kelly and Hyer5} Recent research also shows that adversity in the form of disasters causes people to use their religion more intensively. ^{Reference Khan, Watson and Chen6,Reference Fardin7} Religious beliefs and practices are known to help individuals cope with psychological disturbances and are associated with less anxiety and greater hope.

Francesco and his colleagues emphasized the importance of spirituality in the midst of uncertainty and crisis during the coronavirus pandemic. ^{Reference Chirico and Nucera8} Religious practice can help individuals reduce stress and anxiety in times of hardship through prayer, meditation, reading, and reciting scriptures, as well as centering prayer, listening to inspirational programs, or reading uplifting literature that nourishes the spirit. ^{Reference Coruh, Ayele, Pugh and Mulligan9} Many religious believers treat personal religious activities as a way to strengthen their faith and relationship with God. ^{Reference Koenig10}

To provide integrated and holistic care for individuals under the threat of COVID-19, individuals, groups, and churches try to supply spiritual and religious resources to cope with the impact of COVID-19. A previous study found that the Spiritual Hotline Project, which was intended to provide spiritual and religious assistance to people with different cultural backgrounds, was able to provide spiritual comfort and care to different parts of the world with different religious affiliations. ^{Reference Ribeiro, Damiano, Marujo, Nasri and Lucchetti11} Another study found that spiritual care addressed the provision of compassion and empathy as a means of coping for families, patients, and healthcare workers during the COVID-19 pandemic. ^{Reference Roman, Mthembu and Hoosen12} These studies imply that religion provides not only comfort but also effective strategies for believers to cope with stresses and find peace during the COVID-19 pandemic. Previous researchers have claimed that positive religious coping implies a secure relationship with God, which can help believers find meaning in life and build a better sense of connection with others, whereas negative religious coping reflects an insecure relationship with God, a shadowed or barren view of the world and significant religious struggles in life. ^{Reference Pargament, Tarakeshwar, Ellison and Wulff13} Studies have consistently suggested that positive religious coping strategies (e.g., religious purification/ forgiveness, seeking support from clergy/ members, and spiritual connection) have been associated with psychological adjustment variables such as self-esteem, life satisfaction, and quality of life, while negative religious coping strategies (e.g., spiritual discontent, interpersonal religious discontent, and passive religious deferral) have consistently been related to more depressive symptoms. ^{Reference Ano and Vasconcelles14,Reference Pargament, Feuille and Burdzy15}

China is 1 of the world’s most populous counties, as well as the least religious country in the world. ^{Reference Yang and Hu16,17} However, in recent decades, religion is becoming a prominent force in many people’s lives in China. Official documents suggest that approximately 200 million people identify themselves as religious believers in China. ^{Reference Fu and Rong18} Among this number, 38 million were Christians by 2018, and the population is growing rapidly. ^{Reference Zhang, Cui and Sheng19} Previous studies suggest that Chinese Christians have some specific characteristics in contrast to Buddhism and Taoism believers; that is, Christians tend to more frequently participate in religious activities, are more organized, and take their religious belief more seriously. ^{Reference Lu and Zhang20} On the other hand, even though Christianity is usually regarded as a foreign religion, it is drawing some Chinese traditions as well, including those of self-cultivation in Daoist and Buddhist aspirations to transcendence and world salvation. ^{Reference Feuchtwang21}

Empirical studies of which most were sampled in Western countries suggest that religiousness or religiosity could have positive effects on health, as well as a protective factor against mental problems. ^{Reference Stack, Kposowa, O’Connor, Pirkis and Wiley22} However, few studies found that religion in China may have a negative association with the mental health of religious believers. For example, a study found 17 (23%) out of the 74 suicide attempts sampled from 6 hospitals, were people with religious beliefs. This rate was higher than that of the general population. ^{Reference Zhang and Xu23} Another study found that religious believers were at a higher risk of depression and suicidality than atheists during the COVID-19 pandemic, yet it is unclear whether they suffered from mental health problems because they faced stress caused by the pandemic, or they turned to religion to cope with their mental health problems caused by personal or environmental difficulties. ^{Reference Zhang, Lew, Liu, Chistopolskaya and Zhao24} Even though this is a complicated topic, we may be able to further understand this topic by exploring whether religious believers with and without a history of mental disorders differed significantly in their mental health status as well as religious coping mechanisms during the COVID-19 pandemic.

There is a dearth of studies examining the role of religious coping in terms of its relation to psychopathology in Asian countries. Giving the rising number of Christians in China, it is worthy to investigate the mental health status of Chinese Christians with and without mental disorder history during the pandemic, and to understand the relationship among religious practice, religious coping strategies, and mental health. It may also help us to build resilience and maintain public health under such global crises in the future.