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Article

Religious affiliation and the intention to

choose psychiatry as a specialty among
physicians in training from 11 Latin
American countries
Carlo Calizaya-Gallegos
Universidad Peruana de Ciencias Aplicadas

Percy Mayta-Tristán
Universidad Peruana de Ciencias Aplicadas; Universidad Cientı́fica del Sur

Reneé Pereyra-Elı́as
Universidad Peruana de Ciencias Aplicadas

Juan José Montenegro-Idrogo

Universidad Nacional Mayor de San Marcos

Johana Avila-Figueroa
Universidad Nacional del Altiplano

Ingrid Benı́tez-Ortega
Universidad del Sinú

John Cabrera-Enriquez
Universidad Nacional Pedro Ruiz Gallo

Omar-Javier Calixto
Universidad Militar Nueva Granada

Juan Pablo Cardozo-López

Universidad San Francisco Xavier de Chuquisaca

José Antonio Grandez-Urbina

Universidad Ricardo Palma

Corresponding author:
Percy Mayta-Tristán, Dirección de Investigación, Desarrollo e Innovación, Universidad Cientı́fica del Sur,
Lima, Peru.
Email: p.mayta@gmail.com; pmayta@cientifica.edu.pe
2 Transcultural Psychiatry 0(0)

Oscar Moreno-Loaiza
Universidad Nacional de San Agustı́n

Manuel A. Rodriguez
Universidad de Los Andes

Roxana Sepúlveda-Morales
Universidad de la Frontera

Jairo A. Sierra-Avendaño
Universidad Industrial de Santander

Fabian Carreño
Universidad Industrial de Santander

Gelsing Richard Vásquez-Garcı́a

Universidad Nacional de Ucayali

Roy R. Vasquez-Sullca
Universidad Nacional San Antonio Abad del Cusco

Gilberto Yescas
Universidad de Montemorelos

Red-LIRHUS

Abstract
The worldwide scarcity of psychiatrists makes the identification of the factors asso-
ciated with the intention to choose this specialty an important issue. This study aims to
evaluate the association between religious affiliation and the intention to choose psych-
iatry as a specialty among medical students from 11 Latin American countries. We
conducted a cross-sectional, multi-country study that included first- and fifth-year stu-
dents of 63 medical schools in 11 Latin-American countries between 2011 and 2012.
The main outcome and measures were the intention to pursue psychiatry as a specialty
over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with:
any religion). A total of 8308 participants were included; 53.6% were women, and the
average age was 20.4 (SD ¼ 2.9) years. About 36% were fifth-year students, and 11.8%
were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry;
the highest proportion of students with the intention to choose psychiatry was among
students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjust-
ing for demographic, family, academic as well as personal and professional projection
variable, we found that those who had no religious affiliation were more likely to report
Calizaya-Gallegos et al. 3

the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong
positive association between not having a religious affiliation and the intention to
become a psychiatrist. The possible factors that influence this phenomenon must be
evaluated in greater depth, ideally through longitudinal research.

Keywords
religion and medicine, career choice, medical students, psychiatry, Latin America

Introduction
There is a lack of psychiatrists to meet global mental health needs (Lancet Global
Mental Health Group, 2007; World Health Organization, 2013). The World Health
Organization (WHO, 2015) asserted that for all of its member states, the number of
psychiatrists per 100,000 individuals ranged from one (in low-income countries)
to nearly 50 (in developed countries) on average for 2014. Intention to choose
psychiatry among medical students is also low. Farooq et al. (2014), in a study
on 20 countries, found that less than 5% of students definitely considered becoming
psychiatrists.
Factors known to be associated with specialty choice include: vocation; interest
in psychiatry prior to medical school; exposure to personal or family history of
psychiatric illness; greater interest in anthropology, humanities and social sciences;
less interest in prestige; and the taking of elective classes or participation in extra-
curricular activities related to psychiatry (Amini et al., 2013; Farooq, Lydall &
Bhugra, 2013; Gowans et al., 2011; Lampe et al., 2010). An important negative
factor to take into account is the stigma held by other physicians and students
towards psychiatry (Amini et al., 2013; Lyons & Janca, 2015). Stigma is usually
related to the nature of the disorders, salary, and colleagues’ perception, among
others (Amini et al., 2013; Brown et al., 2016; Lampe et al., 2010; Lyons & Janca,
2015). However, studies investigating the choice of psychiatry have not addressed
students’ spirituality and religiosity – or their perception about these topics – as
potential associated factors.
The relationship between psychiatry and religion has always been complex and,
for a long time, even conflictive (Anderson, 1954; Baetz, 2013; Hall, 1953; Pruyser,
1966; Smith, 1961). During several stages throughout the history of humankind,
psychiatry and religion held different explanations and treatments for mental dis-
eases (Loschen, 1974; Pruyser, 1966). Previous studies found psychiatrists to be
among the specialists who least identify with a particular tradition or faith (Cook,
2011; Curlin et al., 2007a; Yoon et al., 2015). Despite a proportion of adults
changing the faith in which they were raised (King & Roeser, 2009), it is reasonable
to think that those religious views, for most psychiatrists, were present long before
medical school. We have found no reports assessing whether religious affiliation
could be influential in a student’s choice of psychiatry as a career. We hypothesized
4 Transcultural Psychiatry 0(0)

that non-affiliated medical students would be more likely to consider the specialty.
We also recognize that faith is not a factor that may be removed to increase
recruitment in the field. However, the way students perceive the relationship
between religion and psychiatry might be a potential target for intervention –
given that medical school has been identified as a critical period where students
can engage with or reinforce the intention to choose the specialty (Amini et al.,
2013; Farooq et al., 2013; Farooq et al., 2014; Gowans et al., 2011; Lampe et al.,
2010). Therefore, our study aimed to test for a possible association between reli-
gious affiliation and the intention to choose psychiatry as a specialty among med-
ical students in 11 Latin-American countries.

Methods
Design and participants
This original study was conceived and executed by the Latin American
Collaborative Working Group for the Research of Human Resources for
Health (Grupo Colaborativo Latinoamericano para la Investigación de Recursos
Humanos en Salud, Red-LIRHUS). This observational, cross-sectional, multi-sited
study aimed to describe the academic, motivational and professional projec-
tion profiles of first- and fifth-year students from 63 medical schools in 11
Spanish-speaking Latin-American countries. The study was undertaken by
administering a paper-and-pencil self-report questionnaire to the subjects at
the participating universities between September 2011 and July 2012. Detailed
information of the primary study has been described elsewhere (Mayta-Tristán
et al., 2017).

Participants
We performed a secondary analysis of a subset of data obtained by the previously
described study. We included all surveyed students who named the specialty they
wanted to pursue and who mentioned their religious affiliation. Those subjects who
did respond to the covariates were excluded (Figure 1).

Measures
The outcome was the intention to choose psychiatry as a specialty. This intention
was first evaluated by asking if, 10 years after finishing medical school, the student
planned to have completed training in a specialty (residency). If the answer was
yes, the student was asked which specialty. This variable was dichotomized as
‘‘psychiatry’’ and ‘‘specialty other than psychiatry.’’ We excluded those who did
not answer this question or who wrote that they remained undecided regarding
pursuing a specialty.
Calizaya-Gallegos et al. 5

Total number surveyed by Red-LIRHUS

N = 11072

Excluded (n =1915)
1243 did not know if they
would pursue a specialty.
287 were not going to pursue a
specialty.
291 did not respond about
pursuing a specialty
94 did not respond whether or
not they practiced a religion

Included subjects
n =9157

Excluded (n = 849)
131 did not respond to one of the
demographic control variables.
115 did not respond to one of the
family control variables.
223 did not respond to one of the
academic control variables.
380 did not respond to one of the 10-
year projection control variables.

Final study subjects for analysis

n = 8308

Psychiatry Other speciality

n (%)= 217(2.6) n (%)= 8091(97.4)

Figure 1. Flowchart of Medical Students Included in the Study

6 Transcultural Psychiatry 0(0)

Religious affiliation was evaluated through self-reporting of the religion

practiced by the study subjects. Partially based on the frequency and distribution
of religions in Latin America, the participants had the following options:
‘‘Catholic,’’ ‘‘Jehovah’s Witness,’’ ‘‘no religion,’’ or ‘‘other.’’ We finally categorized
this variable as ‘‘affiliated’’ (i.e., all those who indicated or mentioned practicing a
religion) and ‘‘not affiliated’’ (i.e., those who marked ‘‘no religion’’ or who expli-
citly identified themselves as atheists or agnostics). According to the Pew Research
Center (2014), Protestantism is the second most practiced religion in Latin America
after Catholicism. However, we did not include this as an option in the question-
naire for two reasons: i) We specifically wanted to evaluate the group of Jehovah’s
Witnesses and included it as an option; and ii) we provided participants with the
alternative ‘‘other’’ and a blank space to collect their exact affiliation.
Four categories of covariates were considered:

(i) demographic: age, gender (male/female), marital status (single/not single), cur-
rent waged employment (yes/no);
(ii) family: having a first-degree relative who is a doctor (yes/no), relatives who are
economically dependent on the survey participant (yes/no), children (yes/no);
(iii) academic: year of medical school (first year/fifth year), type of university (pri-
vate/public), location (capital/province), level of English proficiency (advanced
and intermediate/basic), having failed a class during medical school (yes/no);
(iv) future projection: marrying (yes/no), having children (yes/no) and approxi-
mate expected income in ten years (the latter was measured through an open
question in which survey respondents stated their monthly expected salary in
U.S. dollars, whereby 5,000 (upper tertile) was adopted as a cut-off point).

Data analysis
We performed the data analyses using the statistical package Stata 12.0
(StataCorp, College Station, Texas, USA). First, for the descriptive analysis,
absolute and relative frequencies for the categorical variables were calculated.
The averages and standard deviations were used for numeric variables, which
were then categorized by tertiles for their subsequent analysis. The categorical
variables were then analyzed with the chi-square test. To evaluate the association
between the intention to become a psychiatrist and religious affiliation, odds
ratios (OR) and their 95% confidence intervals (95% CI) were calculated using
simple and multiple logistic regression models. We considered universities as
clusters for a more appropriate estimation of the standard errors due to the
intraclass correlation (Ip et al, 2011). We generated four adjusted models includ-
ing covariates with potential confounding effect. At each step, a group of vari-
ables was sequentially included: demographic, family, academic and ten-year
projections. For this study, a p-value <.01 was considered to be statistically
significant. Finally, we performed an additional ecological analysis. Using the
Calizaya-Gallegos et al. 7

data aggregated by country and by university, we calculated the frequencies of

intention to be a psychiatrist and of religious affiliation. The correlation between
the main variables was evaluated through scatter plots and simple linear regres-
sion models.

Ethical approval
The original study was approved by the Research Ethics Committee of the Instituto
Nacional de Salud del Perú (N 223-2011-CEI/INS) and by local ethics commit-
tees or the administration of the universities that required such approval.
After explanation of the study objectives and procedures, and according to
the study protocol, all participants verbally provided their informed consent and
completed the survey anonymously and confidentially. This secondary data
analysis was approved by the Ethics Committee of the Hospital Nacional
Docente Madre-Niño ‘‘San Bartolomé’’ (Lima).

Results
From approximately 16,000 first- and fifth-year students in the included schools
(Mayta-Tristán et al., 2017), 11,072 participated in the survey (response rate:
72%). Those who did not state whether they intended to pursue a specialty
(n ¼ 291); those who were unsure if they would pursue a specialty (n ¼ 1243);
those who did not intend to pursue a specialty (n ¼ 287); and those who did not
state whether they practiced a religion (n ¼ 94) were excluded. Of 9157 subjects
eligible for the study, 849 did not respond to one of the questions related to the
demographic, family, academic and future projection variables and were excluded.
Finally, 8308 students were included in the analysis (Figure 1). No differences in
age, sex or religion affiliation were found between the excluded and included par-
ticipants. Approximately 54% of respondents were female, with an average age of
approximately 20.4  2.9 years. About 64% of participants were in their first year
of medical school, and 63% attended public universities (Table 1).
We found that 11.8% (n ¼ 983) selected no religious affiliation or described
themselves as atheist/agnostic. Mexico had the highest percentage of religion-
affiliated students (93.4%), and Chile had the highest percentage of atheists/agnos-
tics (31.3%). In terms of universities, in two Peruvian schools, 100% of the student
body had a religious affiliation. A Chilean university had the highest proportion of
atheists/agnostics (37.7%).
We found that 2.6% (n ¼ 217) of the students had the intention to pursue psych-
iatry as a postgraduate specialty. In a hypothetical scenario, without excluding any
participant from the study, the proportion of students intending to choose psych-
iatry would decrease to 2.0%. The frequencies of selecting psychiatry as a specialty
for each of the 11 surveyed countries were as follows: Chile (8.1%), Paraguay
(5.0%), Colombia (3.4%), Honduras (2.9%), Costa Rica (2.4%), El Salvador
(2.4%), Peru (2.2%), Bolivia (1.9%), Ecuador (1.5%), Venezuela (1.2%) and
8 Transcultural Psychiatry 0(0)

Table 1. Comparison of Characteristics of Participants Affiliated with a Specific Religion

(Religious) and Others who were Not Affiliated (Atheists/Agnostics) Among Students in 63
Universities in Latin America.

Not affiliated Affiliated

(atheists/agnostic) (practice a religion) Total
Variables
n (%) n (%) n (%)

Demographic
Men 600 (61.0) 3256 (44.5) 3856 (46.4)
Age (years)* 20.9 (2.9) 20.3 (2.9) 20.4 (2.9)
Single 960 (97.7) 7132 (97.4) 8092 (97.4)
Paid employment 108 (11.0) 595 (8.1) 703 (8.5)
Family
Relative is a doctor 452 (46.0) 3820 (52.2) 4272 (51.4)
Dependents 59 (6.0) 489 (6.7) 548 (6.6)
Children 37 (3.8) 274 (3.7) 311 (3.7)
Academic
Fifth year 405 (41.2) 2589 (35.3) 2994 (36.0)
Intermediate/advanced 592 (60.2) 3524 (48.1) 4116 (49.5)
English Knowledge
Private university 330 (33.6) 2760 (37.7) 3090 (37.2)
University in the capital city 324 (33.0) 2427 (33.1) 2751 (33.1)
Failed a subject 323 (32.9) 2258 (30.8) 2581 (31.1)
Ten-year projection
Marriage 533 (54.2) 4833 (66.0) 5366 (64.6)
Having children 494 (50.3) 4430 (60.5) 4924 (59.3)
>5,000 U.S. dollars monthly income 232 (23.6) 1278 (17.5) 1510 (18.2)
*Mean (standard deviation)

Mexico (1.1%). A Chilean university presented the highest frequency of students

with the intention of becoming psychiatrists (12.5%).
In bivariate analysis, only two variables were found to be associated with the
intention to be a psychiatrist: intermediate/advanced level of English proficiency
and not having a religious affiliation. All other variables were not associated (for
details see Table 2). In the crude model, not having a religious affiliation was found
to be positively associated with the intention to become a psychiatrist [OR ¼ 2.97;
95%CI: 2.19-4.03]. After adjusting for all of the control variables, non-affiliated
students remained almost three times more likely than religion-affiliated students to
refer psychiatry as their specialty choice [OR ¼ 2.92; 95%CI: 2.14-4.00]. The dif-
ferent adjusted models are presented in Table 3. Both ecological analyses also
revealed a positive association between not having a religious affiliation and the
Calizaya-Gallegos et al. 9

Table 2. Characteristics of the Participants Comparing Those Who Do and Do Not Have
the Intention to Pursue Psychiatry as a Specialty (Includes Bivariate Analysis) Among Medical
Students from 63 Universities in 11 Latin American Countries.

Psychiatry

Yes No

n (%) n (%) OR (95%CI) p-value

Religious affiliation
No 60 (27.7) 923 (11.4) 2.97 (2.19-4.03) <.001
Yes 157 (72.3) 7168 (88.6) 1.00 Reference
Demographic
Men 97 (44.7) 3759 (46.5) 0.93 (0.71-1.22) .610
Age
<22 years 97 (44.7) 3758 (46.5) 1.00 Reference .846
22–24 years 69 (31.8) 2546 (31.5) 1.05 (0.77-1.44)
>24 years 51 (23.5) 1787 (22.1) 1.11 (0.78-1.56)
Single 208 (95.9) 7884 (97.4) 0.61 (0.31-1.20) .180
Paid employment 13 (6.0) 690 (8.5) 0.68 (0.39-1.20) .164
Family
Relative is a doctor 116 (53.5) 4156 (51.4) 1.09 (0.83-1.42) .543
Dependents 7 (3.2) 541 (6.7) 0.47 (0.22-0.99) .026
Children 5 (2.3) 306 (3.8) 0.60 (0.25-1.47) .225
Academic
Fifth year 74 (34.1) 2920 (36.1) 0.98 (0.91-1.05) .546
Intermediate/advanced English 140 (64.5) 3976 (49.1) 1.88 (1.42-2.49) <.001
Private university 93 (42.9) 2997 (37.0) 1.27 (0.97-1.67) .083
University in the capital city 74 (34.1) 2677 (33.1) 1.05 (0.79-1.39) .754
Failed a class 67 (30.9) 2514 (31.1) 0.99 (0.74-1.33) .951
Ten-year projection
Marriage 123 (56.7) 5243 (64.8) 0.79 (0.62-1.00) .045
Having children 111 (51.2) 4813 (59.5) 0.85 (0.68-1.05) .137
Monthly income >5,000 U.S. dollars 39 (18.0) 1471 (18.2) 0.98 (0.65-1.48) .907

intention to become a psychiatrist, both at the country level (R2 ¼ 0.750; p < .001)
and the university level (R2 ¼ 0.464; p ¼ .002) (Figure 2).

Discussion
This study evaluated the relationship between not being affiliated with a specific
religion and the intention to pursue psychiatry as a specialty. The positive
10 Transcultural Psychiatry 0(0)

Table 3. Association Between Not Having a Religious Affiliation and the Intention to Choose
Psychiatry as a Specialty Among Medical Students from 63 Universities in 11 Latin American
Countries (n ¼ 8308).

OR (CI 95%) p

Crude model 2.97 (2.19-4.03) <.001

Adjusted model 1a 3.08 (2.26-4.19) <.001
Adjusted model 2b 3.05 (2.24-4.17) <.001
Adjusted model 3c 2.90 (2.12-3.97) <.001
Adjusted model 4d 2.92 (2.14-4.00) <.001
a
Adjusted for demographic variables.
b
Adjusted for demographic and family variables.
c
Adjusted for demographic, family and academic variables.
d
Adjusted for demographic, family, academic and ten-year projection variables.

association found between these variables remained after controlling for the dif-
ferent covariates considered for adjustment. Notably, in the adjusted models, reli-
gious affiliation was the only associated variable. This association was also evident
at an ecological level.
Our findings are in keeping with previous research, which suggests that psych-
iatrists have lower rates of religious affiliation than their colleagues in other
specialties (Cook, 2011; Curlin 2007a; Yoon, 2015). Menegatti-Chequini et al.
(2016) found that more than 30% of Brazilian psychiatrists in their sample
declared that they had no religious affiliation. Psychiatrists have also been
described as highly sensitized and involved with social problems (Amini et al.,
2013; Durà-Vilà et al., 2011; Gowans et al., 2011; Lampe et al., 2010; Lyons &
Janca, 2015; Shafranske, 1996; Shafranske, 2009). Curlin et al. (2007a) reported
that psychiatrists were more prone to take spiritual/religious aspects of the
patient’s experience into account than primary care physicians. Explicitly, in
the same sample of US doctors, psychiatrists were found more likely to consider
themselves spiritual, but not religious (Curlin, 2007b). Apparently, the strong
component of spirituality intrinsically related to the specialty is less likely to be
modulated by religiosity.
Hall (1953) found that medical students perceived psychiatry to be ‘‘irreligious.’’
However, his article did not include quantification of this statement. We have not
found more research on medical students evaluating their religious beliefs and the
intention to choose psychiatry. Among many possible explanations, this associ-
ation could exist because psychiatry has historical frictions with religion
(Anderson, 1974; Baetz, 2013; Cotti, 2014; Harris, 2014; Loschen, 1974). Mental
illnesses have been historically conceived and addressed in a way that excludes
other, non-medical explanatory models (Loschen, 1974; Pruyser, 1966; Smith,
1961). Even today, there are still controversies due to the ‘‘competing interpret-
ations’’ of the universe provided by psychiatry and religion (Cook, 2015; Dein,
Calizaya-Gallegos et al. 11

(a)
9
y = 0.252x – 0.282
8 R² = 0.750
Psychiatry intention (%)

7 (p<.001)

6
5
4
3
2
1
0
0 5 10 15 20 25 30 35
No religious affiliation (%)
(b)
14
y = 0.201x + 0.186
12 R² = 0.464
(p=.002)
Psychiatry intention (%)

10

0
0 10 20 30 40
No religious affiliation (%)

Figure 2. Correlation Between the Proportion of Atheists/Agnostics and the Intention to

Pursue Psychiatry Among Medical Students by Country (a) and University (b)

Cook, & Koenig, 2012; Harris, 2014). This could lead religious students to perceive
psychiatry as in opposition to their ideals/beliefs and consequently, the specialty
might fall outside their preferences. However, the discipline has seen a growing
interest in the subfield of cultural psychiatry, which takes religious views into
account when approaching a patient’s clinical evaluation and treatment
(Aggarwal et al., 2016; Baetz, 2013; Dein, 2011; Moreira-Almeida, 2016).
For obvious reasons, it would be unethical and impractical to enroll more non-
affiliated students in medical schools or to attempt to modify their faith in order to
increase the chance they might become psychiatrists. However, as previously men-
tioned, exposure to psychiatric activities during medical school has been recognized
as a strong associated factor with predilection for the specialty (Amini et al., 2013;
Farooq et al., 2013; Farooq et al., 2014; Gowans et al., 2011; Lampe et al., 2010).
Therefore, a strategy to increase interest in psychiatry could be to expose students
12 Transcultural Psychiatry 0(0)

to curricular or extra-curricular activities throughout medical school, showing

them that psychiatry and religion – whatever their faith is – are not opposed.
We found that only 2.6% of the medical students in our study had the intention
to become psychiatrists. This proportion is lower than the previous evidence
from around the world comprised in a systematic review by Lyons (2013).
The Latin-American studies report an intention of 4–5% (Lyons, 2013). Chile
showed the highest proportion of students with preference for the specialty, and
Mexico the lowest. This outcome is noteworthy given that since the 2000s both
countries have implemented solid policies for the prevention and promotion of
mental health (Alarcón, 2003).
This study has some limitations. First, we evaluated the ‘‘intention to choose’’
psychiatry as a medical specialty, not the actual selection of it (being admitted to a
residency program). Additionally, the exclusion of those participants who did not
know what specialty to choose could be considered as a limitation. However, no
differences were found between the characteristics of the excluded participants and
those whose responses were analyzed.
Other factors which, according to the literature, may contribute to an interest in
psychiatry, such as family or personal mental-health disorders and related extra-
curricular experiences (Amini et al., 2013; Gowans et al., 2011; Lampe et al., 2010),
were not considered for this analysis. Such factors could be evaluated in conjunc-
tion with religion in subsequent studies. In addition, given the cross-sectional
design, we were not able to evaluate causality, but only an association. We also
consider not having measured the intensity of religious beliefs or of the actual
practice of their faith to be a limitation. However, we can clearly differentiate
between self-reports of having and not having a religious affiliation. Students
who described themselves as atheist and agnostic were grouped together because
we could not be sure that they knew the difference between the two terms and for
practical purposes: the two groups are similar in not being affiliated with a par-
ticular religious belief. Finally, it is responsible to acknowledge the probability that
our main finding may reflect a type I error secondary to the large sample size
(Leppink et al., 2016b). Notwithstanding, we believe this is unlikely because of
the large magnitude of the effect (Leppink et al., 2016a).
The strength of our study lies in the size and diversity of the analyzed popula-
tion. To our knowledge, this study is the first and largest evaluation of this asso-
ciation among medical students. We should clarify that the frequencies found are
not representative of all Latin America or each country, except for Peru (Mayta-
Tristán et al., 2017). However, this limitation does not affect the findings regarding
the association, which have been extensively discussed.

Conclusion
In conclusion, we found that in our sample of Latin-American medical students,
those without a religious affiliation were three times more likely to declare that they
intended to pursue psychiatry as their future career. Additionally, the proportion
Calizaya-Gallegos et al. 13

of students considering the specialty was low. Our findings could be expanded by
evaluating in greater depth not only religious affiliation but also the different
dimensions of religion: spirituality, intensity of belief, types of religion, among
others. As we have argued in this article, religious affiliation is not something
one can take away from students to increase their likelihood of becoming psych-
iatrists. However, efforts can be made within the religion-affiliated group. Basically,
we recommend using recruitment strategies, such as considering the ‘‘psychiatry/
religion’’ relationship as a topic in the elective or curricula-included courses.
In addition, the group of those that practice a religion should be considered in a
more sharply focused, in-depth study to learn which characteristics can be
addressed to increase the probability that these individuals might become psych-
iatrists without affecting their beliefs. We also recommend conducting longitudinal
studies to explore this association.

Adherence to ethical standards

The original project was approved by the Ethics Committee of the Instituto Nacional de
Salud (Peru). This secondary data analysis was approved by the Institutional Review Board
of the Hospital Nacional Docente Madre-Niño ‘‘San Bartolomé’’.

Acknowledgements
We would like to thank the members of Red-LIRHUS: Adriana Sanchez-Pozo (Universidad
Nuestra Señora de la Paz, Bolivia); Juan Pablo Cardozo-López (Universidad Mayor Real y
Pontifcia San Francisco Xavier de Chuquisaca, Bolivia); Silvia Luizaga-Panozo
(Universidad Mayor de San Simón, Bolivia); Rhanniel Theodorus-Villar (Universidad
Catolica Boliviana San Pablo, Bolivia); Milisen Vidal (Universidad de Concepción,
Chile); Roxana Sepúlveda-Morales (Universidad de La Frontera, Chile); Gabriel
Abudinén A (Universidad San Sebastián, Chile); Patricio Alfaro-Toloza (Universidad
Católica de la Santı́sima Concepción, Chile); Romina Olmos-de-Aguilera (Universidad
Católica de la Santı́sima Concepción, Chile); Juan Pablo Sánchez-González (Universidad
Austral de Chile, Chile); Ignacio Navarro-Brito (Universidad de Valparaı́so, Chile); Jairo A.
Sierra-Avendaño (Universidad Industrial de Santander, Colombia); Fabián Carreño
(Universidad Industrial de Santander, Colombia); Jennifer Gomez-Alhach (Universidad
San Martı́n de Cali, Colombia); Francisco Bonilla-Escobar (Universidad del Valle,
Colombia); Omar-Javier Calixto (Universidad Militar Nueva Granada, Colombia);
Álvaro Mondragón-Cardona (Universidad Tecnológica de Pereira, Colombia); Jorge
Ortega-Arias (Universidad de Cartagena, Colombia); Laura Agudelo-Cifuentes
(Universidad del Quindio, Colombia); Kevin Acosta (Universidad de Tolima, Colombia);
Martha Ospina (Universidad de Tolima, Colombia); Germán D. Londoño Ruı́z
(Universidad Surcolombiana, Colombia); Andrés Felipe Quimbayo-Cifuentes
(Universidad de Caldas, Colombia); Ingrid Benı́tez-Ortega (Universidad del Sinú—Elı́as
Bechara Zainúm, Colombia), Christian D. Valverde-Lozano (Universidad
Hispanoamericana, Costa Rica); Jorge Barrezueta-Fernández (Universidad de Guayaquil,
Ecuador); Luis Cerna-Urrutia (Universidad Dr. José Matı́as Delgado, El Salvador);
Geovanna Moya (Universidad Nacional Autónoma de Honduras, Honduras); Gilberto
Yescas (Universidad de Montemorelos, México); Maribel Vizárraga-León (Universidad
14 Transcultural Psychiatry 0(0)

Juarez del Estado de Durango, México); Erick Gutierrez-Quezada (Universidad Autónoma

de Nayarit, México); Rita Azucas-Peralta (Universidad Nacional de Asunción, Paraguay);
Roy R. Vasquez-Sullca (Universidad Nacional San Antonio Abad, Perú); José Antonio
Grandez-Urbina (Universidad Ricardo Palma, Perú); Franco León-Jiménez (Universidad
Catolica Santo Toribio de Mogrovejo, Perú); Cristian Diaz-Velez (Universidad San Martin
de Porres Filial Norte y Universidad de Chiclayo, Perú); John Cabrera-Enriquez
(Universidad Nacional Pedro Ruiz Gallo, Perú); Fiorella Inga-Berrospi (Universidad de
San Martı́n de Porres, Perú); Katia Montalván-Muñoz (Universidad Nacional de Trujillo,
Perú); Oscar Moreno-Loaiza (Universidad Nacional de San Agustı́n, Perú); Marı́a Molina-
Torres (Universidad Nacional del Centro del Perú, Perú); Johana Ávila-Figueroa
(Universidad Nacional del Altiplano); Martha Torres-Dextre (Universidad Nacional José
Faustino Sánchez Carrión, Perú); Nelson Purizaca-Rosillo (Universidad Nacional de Piura,
Perú); Omar Raraz-Vidal (Universidad Nacional Hermilio Valdizán, Perú); Diego Ernesto
Valencia-Chambi (Universidad Particular Católica de Santa Marı́a, Perú); Mónica Alfonso
(Asociación Universidad Privada San Juan Bautista, Perú); Diego Lizarzaburu-Castagnino
(Universidad Cientı́fca del Sur, Perú); Cesar A. Mogollón (Universidad Nacional de
Cajamarca, Perú); Julio Maquera-Afaray (Universidad Privada de Tacna, Perú); Mario
Johnson-Franco (Universidad Peruana Cayetano Heredia, Perú); Gerardo Florián-Gómez
(Universidad Cesar Vallejo—Sede Trujillo, Perú); Jimmy Jeison Castro (Universidad San
Pedro, Perú); Erik J. Jhonston (Universidad de la Amazonı́a Peruana, Perú); Miguel Odar-
Sampé (Universidad Privada Antenor Orrego, Perú); Gelsing Richard Vásquez-Garcı́a
(Universidad Nacional de Ucayali, Perú); Kelly Herencia-Anaya (Universidad Nacional
San Luis Gonzaga, Perú); Felix Ancalli-Calizaya (Universidad Nacional Jorge Basadre,
Perú); Lizeth Guzmán (Universidad Nacional Federico Villareal, Perú); Carlos E. Muñoz-
Medina (Universidad del Oriente Núcleo Bolı́var, Venezuela); Manuel A. Rodrı́guez
(Universidad de Los Andes, Venezuela); and Adrián DaSilva-DeAbreu (Universidad
Central de Venezuela, Venezuela).

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, author-
ship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication
of this article.

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Carlo Calizaya-Gallegos, MD, earned his medical degree from Universidad Peruana
de Ciencias Aplicadas (Lima, Peru) in 2015, after the successful defense of this
study as his thesis.
Calizaya-Gallegos et al. 17

Percy Mayta-Tristán, MD, PhD(c), was Calizaya-Gallegos’ thesis advisor, as well as

the Principal Investigator of the Grupo Colaborativo Latinoamericano para la
Investigación en Recursos Humanos en Salud (Red-LIRHUS). He is currently
Head of the Directorate of Project Management and Research Promotion at
Universidad Cientı́fica del Sur (Lima, Peru).

Reneé Pereyra-Elı́as, MD, is a Red-LIRHUS research coordinator, Universidad

Peruana de Ciencias Aplicadas (Lima, Peru).

Juan José Montenegro-Idrogo, MD, is a Red-LIRHUS research coordinator,

Universidad Nacional Mayor de San Marcos (Lima, Peru).

Johana Avila-Figueroa, MD, is a member of Red-LIRHUS at Universidad Nacional

del Altiplano (Puno, Peru).

Ingrid Benı́tez-Ortega, MD, is a member of Red-LIRHUS at Universidad

Universidad del Sinú (Cartagena, Colombia).

John Cabrera-Enriquez, MD, is a member of Red-LIRHUS at Universidad Nacional

Pedro Ruiz Gallo (Chiclayo, Peru).

Omar-Javier Calixto, MD, is a member of Red-LIRHUS at Universidad Militar

Nueva Granada (Bogotá, Colombia).

Juan Pablo Cardozo-López, MD, is a member of Red-LIRHUS at Universidad San

Francisco Xavier de Chuquisaca (Sucre, Bolivia).

José Antonio Grandez-Urbina, MD, is a member of Red-LIRHUS at Universidad

Ricardo Palma (Lima, Peru).

Oscar Moreno-Loaiza, MD, is a member of Red-LIRHUS at Universidad Nacional

de San Agustı́n (Arequipa, Peru).

Manuel A. Rodriguez, MD, is a member of Red-LIRHUS at Universidad de Los

Andes (Mérida, Venezuela).

Roxana Sepúlveda-Morales, MD, is a member of Red-LIRHUS at Universidad de la

Frontera (Temuco, Chile).

Jairo A. Sierra-Avendaño, MD, is a member of Red-LIRHUS at Universidad

Industrial de Santander (Bucaramanga, Colombia).
18 Transcultural Psychiatry 0(0)

Fabian Carreño, MD, is a member of Red-LIRHUS at Universidad Industrial de

Santander (Bucaramanga, Colombia).

Gelsing Richard Vásquez-Garcı́a, MD, is a member of Red-LIRHUS at Universidad

Nacional de Ucayali (Pucallpa, Peru).

Roy R. Vasquez-Sullca, MD, is a member of Red-LIRHUS at Universidad

Universidad San Antonio Abad (Cuzco, Peru).

Gilberto Yescas, MD, is a member of Red-LIRHUS at Universidad, Universidad de

Montemorelos (Nuevo León, Mexico).