Religion,
Spirituality, and Depression
Religious Service Attendance and Depression Among U.S. Women: Assessing Causation and Feedback
Tyler J. VanderWeele, PhD, Harvard School of Public Health
Shanshan Li, National Institute of Child Health and Human Development
Abstract:
Importance: The association between religious service attendance and depression has been reported previously. However, previous studies were mainly cross-sectional, subject to reverse causation and did not account for the potential feedback between religious service attendance and depression. To our knowledge, no previous study has repeated measurements of both depression and religious service attendance, or has been able to take into account the potential feedback between religious service attendance and depression.
Objective: The objective of this study is to prospectively evaluate the association between self-reported religious service attendance with subsequent onset of incident depression and to explicitly account for feedback with potential effects in both directions.
Design, setting, participants, and outcome measures: We included a total of 49,560 U.S. nurses who were participants of the Nurses’ Health Study with mean age 58 years and followed up from 1996 to 2008. Religious services attendance was self-reported in 1992, 1996, 2000, 2004 and 2008. Depression was self-reported as being physician-diagnosed clinical depression or anti-depressant use in 1992, 1996, 2000, 2004 and 2008. Depressive symptom was measured by the Center for Epidemiologic Studies Depression scale in 2004 and by Geriatric Depression Scale in 2008. Multivariate logistic regression models and marginal structural models were used to estimate the relative risk of developing incident depression, adjusted for baseline religious service attendance level, baseline depression and time varying covariates.
Results: During 12 years of follow-up, 9,659 women self-reported as having onset of incident clinical depression. Compared with women who never attended religious services, women who had most frequent and recent religious service attendance had the lowest risk of developing depression (relative risk [RR] =0.71, 95% confidence interval [CI]:0.62-0.82, p value=0.0004). Compared with women who were not depressed, women with depression were less likely to subsequently attend religious service attendance once or more per week (RR=0.84, 95% CI: 0.75-0.95, p value <0.0001).
Conclusions and relevance: In this study of U.S. women, higher frequency of religious service attendance was associated with lower risk of incident depression. Women who had depression were less likely to attend religious services frequently. The research has important implications for the pastoral response of religious communities to incident depression.
Effects of Spirituality & Religiosity on Stress, Anxiety, Depression: Moderation, Mediation, or Moderated Mediation?
Kirby Reutter, PhD, LMHC, Gateway Woods Family Services
Abstract:
The extant literature demonstrates a modestly positive association between religion and psychological adjustment. However, the role that spirituality plays in wellbeing relative to both high and low levels of religiosity is not well known. The purpose of this study was to examine the extent to which daily spiritual experiences mediate the association between perceived stress and symptoms of anxiety / depression, and to further examine the extent to which religious commitment moderates this relationship. This study utilized a quantitative, cross-sectional, moderated-mediation design and comprised 343 research participants. Subjects ranged from California to Connecticut to China and comprised a wide variety of religious and non-religious traditions (e.g., Agnostic, Atheist, Buddhist, Hindu, Islam, Jewish, Pagan, undecided, and none) in addition to various forms of Christianity (e.g., Protestant, Anabaptist, Eastern Orthodox, Christian Gnostic, Roman Catholic, and non-denominational). Lazarus’ Transactional Model of stress provided the theoretical framework for this research. The following instruments were utilized to measure the four variables involved in this study: Daily Spiritual Experiences Scale, Hospital Anxiety and Depression Scale, Religious Commitment Inventory, and Perceived Stress Scale. According to the outcomes of this research, spirituality acted as a partial mediator between perceived stress and psychological adjustment, and both spirituality and religiosity acted as moderators between stress and psychological symptoms. However, religiosity did not act as a significant mediator between stress and psychological adjustment. In addition, religiosity did not seem to significantly moderate the mediating effects of spirituality. Overall, this study confirmed the role of both religiosity and spirituality as effective coping resources. Based on these results, religious and spiritual coping should be acknowledged by mental health professionals as personal resiliency factors, and should be incorporated within the therapeutic process. Given the prevalence of religious and spiritual practices in this country, it is puzzling that symptoms of depression remain at epidemic levels. Is religious / spiritual coping more effective for some individuals than for others? Are some forms of religious / spiritual coping more beneficial than other forms? Are there cultural / societal phenomena which supersede individual attempts to cope? Future research should further corroborate the role of spirituality as a mediator; further examine both religiosity and spirituality as distinct variables; and further explore more complex analyses, such as moderated mediation and mediated moderation.
KKR (2014). Effects of Spirituality & Religiosity on Stress, Anxiety, Depression: Mediation, Moderation, or Moderated Mediation. Lambert Academic Publishing.
KKR & SMB (2014). Religiosity and Spirituality as Resiliency Resources: Moderation, Mediation, or Moderated Mediation? Journal for the Scientific Study of Religion, 53(1): 56-72.
Screening for Depression in African American Churches
Sidney Hankerson, MD, Columbia University
Priya J. Wickramaratne, PhD, Columbia University Medical Center
Young A. Lee, BS, New York State Psychiatric Institute
David K. Brawley, St. Paul Community Baptist Church
Kenneth Braswell, Fathers Incorporated
Myrna Weissman, PhD, Columbia University
Abstract:
Objectives: Faith-Based Health Promotion (FBHP) has received growing interest as a way to reduce disparities in depression care. African Americans have the highest rates of church attendance among all racial/ethnic groups in the U.S. and are three times more likely than Caucasian Americans to cite intrinsic spirituality as an extremely important part of depression management. However, the literature on church-based programs for depression is sparse. Thus, the purpose of this study was to examine the feasibility of screening for depression with a validated instrument in African American churches.
Methods: Participants were recruited between October and November 2012 from convenience samples at three predominantly African American churches in New York City. A participatory research approach, in which academicians and clergy collaborated as equitable partners, was used to determine screening days at each church. The Patient Health Questionnaire-9 (PHQ-9) was administered to a total of 122 participants. Clinical depression was defined as a PHQ-9 score ≥ 10. Descriptive statistics were used to report sample characteristics, depression prevalence, and treatment history. Logistic regression analyses were conducted to determine the association of depression prevalence and sociodemographic characteristics.
Results: The mean age of participants was 53.7 years (SD = 13.33), and the majority were women (55.9%). In terms of racial self-identification, 116 participants were black, two were Hispanic, one was Asian/Pacific Islander, and two were “other.” There was slightly greater percentage of divorced/separated (36.9%) participants compared to those widowed or currently married. There were nearly identical numbers of at least high school graduates (47.5%) and college attendees (46.7%). The most common income category was $35,000–69,999 (33.3%).
The depression prevalence estimate for the total sample was 19.7%. A slightly greater percentage of men (22.5%) were clinically depressed compared to women (17.7%). Total household income was inversely related to depression prevalence. A majority of the sample (63.9%) had previously sought help for a mental health problem. A similar percentage of men (53.1%) and women (53.8%) sought help from a minister or priest.
Conclusions: It was feasible to screen for depression with a validated instrument in African American churches, which lays the groundwork for expanding access to depression case-finding and management in other religious settings. The rates of depression were high, especially among black men, suggesting that churches may be a source of recruiting this under-served population. Future research is needed to assess the feasibility of screening for depression in churches with more representative samples and to identify how to engage African American religious communities in the conceptualization and delivery of mental health services.
Tyler J. VanderWeele, PhD, Harvard School of Public Health
Shanshan Li, National Institute of Child Health and Human Development
Abstract:
Importance: The association between religious service attendance and depression has been reported previously. However, previous studies were mainly cross-sectional, subject to reverse causation and did not account for the potential feedback between religious service attendance and depression. To our knowledge, no previous study has repeated measurements of both depression and religious service attendance, or has been able to take into account the potential feedback between religious service attendance and depression.
Objective: The objective of this study is to prospectively evaluate the association between self-reported religious service attendance with subsequent onset of incident depression and to explicitly account for feedback with potential effects in both directions.
Design, setting, participants, and outcome measures: We included a total of 49,560 U.S. nurses who were participants of the Nurses’ Health Study with mean age 58 years and followed up from 1996 to 2008. Religious services attendance was self-reported in 1992, 1996, 2000, 2004 and 2008. Depression was self-reported as being physician-diagnosed clinical depression or anti-depressant use in 1992, 1996, 2000, 2004 and 2008. Depressive symptom was measured by the Center for Epidemiologic Studies Depression scale in 2004 and by Geriatric Depression Scale in 2008. Multivariate logistic regression models and marginal structural models were used to estimate the relative risk of developing incident depression, adjusted for baseline religious service attendance level, baseline depression and time varying covariates.
Results: During 12 years of follow-up, 9,659 women self-reported as having onset of incident clinical depression. Compared with women who never attended religious services, women who had most frequent and recent religious service attendance had the lowest risk of developing depression (relative risk [RR] =0.71, 95% confidence interval [CI]:0.62-0.82, p value=0.0004). Compared with women who were not depressed, women with depression were less likely to subsequently attend religious service attendance once or more per week (RR=0.84, 95% CI: 0.75-0.95, p value <0.0001).
Conclusions and relevance: In this study of U.S. women, higher frequency of religious service attendance was associated with lower risk of incident depression. Women who had depression were less likely to attend religious services frequently. The research has important implications for the pastoral response of religious communities to incident depression.
Effects of Spirituality & Religiosity on Stress, Anxiety, Depression: Moderation, Mediation, or Moderated Mediation?
Kirby Reutter, PhD, LMHC, Gateway Woods Family Services
Abstract:
The extant literature demonstrates a modestly positive association between religion and psychological adjustment. However, the role that spirituality plays in wellbeing relative to both high and low levels of religiosity is not well known. The purpose of this study was to examine the extent to which daily spiritual experiences mediate the association between perceived stress and symptoms of anxiety / depression, and to further examine the extent to which religious commitment moderates this relationship. This study utilized a quantitative, cross-sectional, moderated-mediation design and comprised 343 research participants. Subjects ranged from California to Connecticut to China and comprised a wide variety of religious and non-religious traditions (e.g., Agnostic, Atheist, Buddhist, Hindu, Islam, Jewish, Pagan, undecided, and none) in addition to various forms of Christianity (e.g., Protestant, Anabaptist, Eastern Orthodox, Christian Gnostic, Roman Catholic, and non-denominational). Lazarus’ Transactional Model of stress provided the theoretical framework for this research. The following instruments were utilized to measure the four variables involved in this study: Daily Spiritual Experiences Scale, Hospital Anxiety and Depression Scale, Religious Commitment Inventory, and Perceived Stress Scale. According to the outcomes of this research, spirituality acted as a partial mediator between perceived stress and psychological adjustment, and both spirituality and religiosity acted as moderators between stress and psychological symptoms. However, religiosity did not act as a significant mediator between stress and psychological adjustment. In addition, religiosity did not seem to significantly moderate the mediating effects of spirituality. Overall, this study confirmed the role of both religiosity and spirituality as effective coping resources. Based on these results, religious and spiritual coping should be acknowledged by mental health professionals as personal resiliency factors, and should be incorporated within the therapeutic process. Given the prevalence of religious and spiritual practices in this country, it is puzzling that symptoms of depression remain at epidemic levels. Is religious / spiritual coping more effective for some individuals than for others? Are some forms of religious / spiritual coping more beneficial than other forms? Are there cultural / societal phenomena which supersede individual attempts to cope? Future research should further corroborate the role of spirituality as a mediator; further examine both religiosity and spirituality as distinct variables; and further explore more complex analyses, such as moderated mediation and mediated moderation.
KKR (2014). Effects of Spirituality & Religiosity on Stress, Anxiety, Depression: Mediation, Moderation, or Moderated Mediation. Lambert Academic Publishing.
KKR & SMB (2014). Religiosity and Spirituality as Resiliency Resources: Moderation, Mediation, or Moderated Mediation? Journal for the Scientific Study of Religion, 53(1): 56-72.
Screening for Depression in African American Churches
Sidney Hankerson, MD, Columbia University
Priya J. Wickramaratne, PhD, Columbia University Medical Center
Young A. Lee, BS, New York State Psychiatric Institute
David K. Brawley, St. Paul Community Baptist Church
Kenneth Braswell, Fathers Incorporated
Myrna Weissman, PhD, Columbia University
Abstract:
Objectives: Faith-Based Health Promotion (FBHP) has received growing interest as a way to reduce disparities in depression care. African Americans have the highest rates of church attendance among all racial/ethnic groups in the U.S. and are three times more likely than Caucasian Americans to cite intrinsic spirituality as an extremely important part of depression management. However, the literature on church-based programs for depression is sparse. Thus, the purpose of this study was to examine the feasibility of screening for depression with a validated instrument in African American churches.
Methods: Participants were recruited between October and November 2012 from convenience samples at three predominantly African American churches in New York City. A participatory research approach, in which academicians and clergy collaborated as equitable partners, was used to determine screening days at each church. The Patient Health Questionnaire-9 (PHQ-9) was administered to a total of 122 participants. Clinical depression was defined as a PHQ-9 score ≥ 10. Descriptive statistics were used to report sample characteristics, depression prevalence, and treatment history. Logistic regression analyses were conducted to determine the association of depression prevalence and sociodemographic characteristics.
Results: The mean age of participants was 53.7 years (SD = 13.33), and the majority were women (55.9%). In terms of racial self-identification, 116 participants were black, two were Hispanic, one was Asian/Pacific Islander, and two were “other.” There was slightly greater percentage of divorced/separated (36.9%) participants compared to those widowed or currently married. There were nearly identical numbers of at least high school graduates (47.5%) and college attendees (46.7%). The most common income category was $35,000–69,999 (33.3%).
The depression prevalence estimate for the total sample was 19.7%. A slightly greater percentage of men (22.5%) were clinically depressed compared to women (17.7%). Total household income was inversely related to depression prevalence. A majority of the sample (63.9%) had previously sought help for a mental health problem. A similar percentage of men (53.1%) and women (53.8%) sought help from a minister or priest.
Conclusions: It was feasible to screen for depression with a validated instrument in African American churches, which lays the groundwork for expanding access to depression case-finding and management in other religious settings. The rates of depression were high, especially among black men, suggesting that churches may be a source of recruiting this under-served population. Future research is needed to assess the feasibility of screening for depression in churches with more representative samples and to identify how to engage African American religious communities in the conceptualization and delivery of mental health services.