Religious Service Attendance and Lower Depression Among Women-a Prospective Cohort Study

Is religion beneficial for mental health? A 9-year longitudinal study

Background/Objective

This study aimed to investigate the within-person and between-person effects of religious variables on mental health and vice versa.

Method

Using a large sample of adults residing in Germany from the GESIS Panel study (N = 8146), the random intercept cross-lagged panel model was used. Data on six dimensions of religion (i.e., membership in a religious community; attendance at a place of worship; frequency of prayers; importance of religion in life; and participation in a religious organization) and three indicators of mental health (i.e., depression symptoms, happiness, and life satisfaction) were collected.

Results

The findings revealed that there is almost no evidence of lagged effects of religion on mental health and limited evidence regarding the role of mental health in influencing the dimensions of religion. Moreover, at the between-person level, there was some evidence of significant covariance between the trait-like components, indicating stable, trait-like differences between persons on religion and mental health.

Conclusions

The beneficial effect of religion on mental health may have been exaggerated in previous research.

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the offspring generation

Background

We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the offspring generation of the Avon Longitudinal Study of Parents and Children (ALSPAC).

Methods

We examined approximately 4,450 offspring aged 28 years with RSBB data from a prospective birth cohort study (ALSPAC) in Southwest England. Three RSBB outcome measures were assessed: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). We explored age- and sex-adjusted associations between 35 demographic and socioeconomic exposures and each of the three RSBB outcomes using multinomial regression. Exposure-sex interactions were also examined.

Results

Some sociodemographic factors were associated with RSBB in this cohort; for instance, being female and from an ethnicity other than White were associated with increased religiosity across all domains. For many other exposures, however, associations were frequently null or inconsistent, often depending on the specific exposure and outcome combination. As an example, higher educational attainment was associated with higher rates of religious attendance, but not with religious belief or affiliation; in contrast, higher income was associated with lower levels of religiosity. No consistent interactions between sex and the exposures on RSBB were found. Effect sizes were also rather weak, with most pseudo- R 2 values below 0.5% and a maximum of 1.2%.

Conclusions

The results highlight that several demographic and socioeconomic factors are associated with RSBB in this cohort. However, the number of these associations, and their magnitude, is smaller than comparable results from the parental generation of these offspring, suggesting that patterns of sociodemographic factors associated with RSBB differ between these generations. In addition to describing these associations, this paper will help inform future studies using these data, particularly regarding the choice of potential sociodemographic confounders.

Health trajectories of individuals who quit active religious attendance: analysis of four prospective cohort studies in the United States

PURPOSE

To examine whether trajectories of health (depressive symptoms, psychological wellbeing, self-rated health, and body mass index) and health behaviors (smoking, heavy alcohol consumption, physical inactivity, and cannabis use) changed for individuals who first reported at least monthly religious attendance and then in subsequent study waves reported no active religious attendance.

METHODS

Data were from four cohort studies from the United States collected between 1996 and 2018: National Longitudinal Survey of 1997 (NLSY1997); National Longitudinal Survey of Young Adults (NLSY-YA); Transition to Adulthood Supplement of the Panel Study of Income Dynamics (PSID-TA); and Health and Retirement Study (HRS) with a total n = 6592 individuals and 37,743 person-observations.

RESULTS

None of the 10-year trajectories of health or health behaviors changed for the worse after the change from active to inactive religious attendance. Instead, the adverse trends were observed already during the time of active religious attendance.

CONCLUSION

These results suggest that religious disengagement is a correlate-not a cause-of a life course characterized by poorer health and health behaviors. The religious decline caused by people leaving their religion is unlikely to influence population health.

The Association between Dental Pain and Psychological Symptoms: Evidence from a Population-Based Study in Indonesia

OBJECTIVES

 This study aimed to determine the prevalence and distribution of dental pain and its association with psychological symptoms: stress and depression.

MATERIALS AND METHODS

 The 2014 Indonesia Family Life Survey data were used for the abovementioned purposes. Records of self-reported dental pain and stress as well as the occurrence of depression based on the 10-item Center for Epidemiologic Studies-Depression scale were analyzed. Multivariable ordinal regression models were fitted to test the hypothesized associations between dental pain and each of the psychological symptoms, controlling for age, sex, education, wealth, and religiosity.

RESULTS

 Dental pain prevalence among Indonesian population was approximately 15%. The adjusted odds ratios (ORs) from the ordinal regression models indicated that dental pain was related to the increase of the stress and depression level (OR: 1.31, 95% confidence interval [CI]: 1.14-1.49 and OR: 1.59, 95% CI: 1.41-1.79, respectively). Higher education, higher wealth, and being male are risk factors for stress. However, higher wealth and being male are protective factors for depression. Furthermore, higher religious level was a protective factor for both stress and depression.

CONCLUSION

 Dental pain was associated with a higher level of stress and a higher score of depression, even after being adjusted with age, sex, education, wealth, and religiosity.

"So, Do Not Fear": Religion and the prevalence, persistence, and severity of anxiety disorders among Black Americans

BACKGROUND

There is a dearth of scholarship that explicates the effects of religious participation on anxiety disorders among Black Americans. A better understanding of the links between religious participation, a coping resource, and anxiety disorders among Black Americans remains essential, given Black Americans are less likely than their white counterparts to seek professional treatment for mental health problems, leading to greater unmet mental health needs. The aim of this study was to investigate whether religious participation is associated with the prevalence, persistence, and severity of anxiety disorders among Black adults.

METHODS

We used a national sample of Black adults (N = 4999) from the National Survey of American Life, a cross-sectional study conducted from 2001 to 2003. Five anxiety disorders were assessed: posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, and agoraphobia. Three dimensions of religious participation were assessed: organizational, non-organizational, and subjective religious participation. Weighted logistic and linear regressions were estimated to examine the associations between religious participation and anxiety disorders.

RESULTS

Findings indicate that organizational religious participation and subjective religiosity were associated with lower odds of anxiety disorders and decreased severity. Findings for non-organizational religious participation in relation to the prevalence, persistence, and severity of anxiety disorders were mixed.

LIMITATIONS

The study limitations include the utilization of self-reported measures, cross-sectional study design, and age of the data set.

CONCLUSIONS

Different dimensions of religious participation have differing effects on anxiety disorders. Religious participation may be an important resource for Black Americans in coping and preventing anxiety disorders.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Pandemic-Induced Depression Among Older Adults with a History of Cancer During the COVID-19 Pandemic: Findings from the Canadian Longitudinal Study on Aging

Purpose

The objectives of this study were to identify the prevalence of, and factors associated with, incident and recurrent depression in a sample of older adults with a history of cancer during the COVID-19 pandemic.

Materials and Methods

Data were drawn from four waves of the Canadian Longitudinal Study on Aging Comprehensive Cohort (n=2486 with cancer). The outcome of interest was a positive screen for depression based on the CES-D-10 during the autumn of 2020.

Results

Among older adults with cancer and no pre-pandemic history of depression (n=1765), 1 in 8 developed first onset depression during the pandemic. Among respondents with cancer and a history of depression (n=721), 1 in 2 experienced a recurrence of depression. The risk of both incident and recurrent depression was higher among those who were lonely, those with functional limitations, and those who experienced an increase in family conflict during the pandemic. The risk of incident depression only was higher among older women, those who did not engage in church or religious activities, those who experienced a loss of income during the pandemic, and those who became ill or had a loved one become ill or die during the pandemic. The risk of recurrent depression only was higher among those who felt isolated from others and those whose income did not satisfy their basic needs.

Conclusion

Health care providers should continue to screen and provide mental health support to their cancer patients and those with a lifetime history of cancer, with consideration for those with the aforementioned vulnerabilities.

Religious service attendance and mortality: A population-based prospective cohort study in southern Sweden

Aims

The aim is to investigate associations between attendance in religious service during the past year and all-cause, cardiovascular (CVD), cancer and other cause mortality.

Study design

Prospective cohort study.

Methods

A public health survey with three reminders was sent to a stratified random sample of the adult 18-80 population in southernmost Sweden in 2008. The response rate was 54.1%, and 24,855 participants were included in this study. The cross-sectional baseline survey was connected to mortality data with 8.3-year follow-up. Analyses were conducted in Cox regression models.

Results

13.9% had attended religious service at least once during the past year, and 86.1% had not attended. The group with religious attendance contained significantly higher proportions of women, high and medium position non-manual employees, participants born abroad, never alcohol consumers, respondents with high trust in others and respondents with high social participation. It also contained significantly lower proportions with low leisure-time physical activity (LTPA) and daily smokers. Religious service attendance during the past year was significantly associated with lower hazard rate ratios (HRRs) of all-cause mortality compared to non-attendance until social participation items were introduced in the final model. HRRs of CVD mortality were significantly lower for religious attendance in the multiple models until BMI and health-related behaviors were introduced. No significant results were observed for cancer and other cause mortality.

Conclusions

The results suggest that religious service attendance in a highly secularized country such as Sweden is significantly associated with lower all-cause mortality, which may be explained by a social network pathway in this highly secularized population.

Exploring causality from observational data: An example assessing whether religiosity promotes cooperation

Causal inference from observational data is notoriously difficult, and relies upon many unverifiable assumptions, including no confounding or selection bias. Here, we demonstrate how to apply a range of sensitivity analyses to examine whether a causal interpretation from observational data may be justified. These methods include: testing different confounding structures (as the assumed confounding model may be incorrect), exploring potential residual confounding and assessing the impact of selection bias due to missing data. We aim to answer the causal question 'Does religiosity promote cooperative behaviour?' as a motivating example of how these methods can be applied. We use data from the parental generation of a large-scale (n = approximately 14,000) prospective UK birth cohort (the Avon Longitudinal Study of Parents and Children), which has detailed information on religiosity and potential confounding variables, while cooperation was measured via self-reported history of blood donation. In this study, there was no association between religious belief or affiliation and blood donation. Religious attendance was positively associated with blood donation, but could plausibly be explained by unmeasured confounding. In this population, evidence that religiosity causes blood donation is suggestive, but rather weak. These analyses illustrate how sensitivity analyses can aid causal inference from observational research.

Associations of Religious Service Attendance With Cognitive Function in Midlife: Findings From The CARDIA Study

OBJECTIVES

Growing evidence suggests that religiosity is an important social determinant of health, including cognitive health. Yet most prior work focused on older adults or was conducted in racially and denominationally homogeneous regional samples. This study investigates the association of religious service attendance in midlife with cognitive function later in midlife.

METHODS

Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a racially and geographically diverse prospective cohort study, we explored the association of religious service attendance in midlife with cognitive function 5 years later. Cognitive function was measured using four cognitive tests administered by CARDIA technicians. Multivariable linear regression was used for analyses. Primary analyses controlled for sociodemographics, physical health, depression, and prior religious involvement. Sensitivity analyses additionally controlled for baseline cognition and social support.

RESULTS

Our study population included 2,716 participants (57.2% female, 44.9% Black, and mean age 50). In primary analyses, attending services more than weekly (compared to never) in midlife was associated with better global cognition (β = 0.14 standard deviations, 95% [confidence interval] CI = 0.02, 0.26) and verbal memory (β = 0.17 standard deviations, 95% CI = 0.04, 0.30), but not with processing speed (β = 0.04 standard deviations, 95% CI = -0.08, 0.16). A reverse association was observed with executive function (β = -0.16 standard deviations, 95% CI = -0.30, -0.02). Most findings persisted in analyses accounting for loss to follow-up via inverse probability weighting.

DISCUSSION

Our findings suggest that frequent involvement in religious services at midlife is associated with better global cognition and verbal memory but worse executive function. There was no association with processing speed.

COVID-19 Stress, Religious Affiliation, and Mental Health Outcomes Among Adolescents

PURPOSE

To examine the relationship between religious affiliation, stressors due to the COVID-19 pandemic, and mental health challenges in a representative sample of adolescents.

METHODS

The sample was composed of 71,001 Utah adolescents who participated in a survey by the Utah Department of Health in 2021. Data are representative of all Utah adolescents in grades 6, 8, 10, and 12. Bootstrapped mediation was used to test indirect effects of religious affiliation on mental health challenges through COVID-19 stressors.

RESULTS

Religious affiliation was related to significantly lower rates of teen mental health challenges as measured by suicidal thoughts, suicide attempts, and depression. For religiously affiliated adolescents, the rate of considering and attempting suicide was nearly half of that of unaffiliated adolescents. In mediation analyses, affiliation was indirectly related to mental health challenges (suicide ideation, suicide attempt, and depression) through stressors from COVID-19, including affiliated adolescents experiencing the following: less anxiety, fewer family fights, fewer school difficulties, and fewer skipped meals. However, affiliation was positively related to becoming sick with COVID-19 (or having COVID-19 symptoms), which was related to more suicidal thoughts.

CONCLUSIONS

Findings suggest that adolescent religious affiliation may be a promotive factor that decreases mental health challenges through a reduction in COVID-19-related stressors, except religious individuals may be more likely to become sick. To increase positive mental health outcomes among adolescents during pandemic times, consistent and clear policies that facilitate religious connections that also align with good physical health measures will be critical.

Religiosity and Stigmatization Related to Mental Illness Among African Americans and Black Immigrants: Cross-Sectional Observational Study and Moderation Analysis

ABSTRACT

Stigma about mental illness is a known barrier to engagement in mental health services. We conducted an online cross-sectional study, aiming to estimate the associations between religiosity and mental illness stigma among Black adults ( n = 269, ages 18-65 years) in the United States. After adjusting for demographic factors (age, education, and ethnicity), respondents with higher attendance at religious services or greater engagement in religious activities ( e.g. , prayer, meditation, or Bible study) reported greater proximity to people living with mental health problems (rate ratio [RR], 1.72; 95% confidence interval [CI], 1.14-2.59 and RR, 1.82; 95% CI, 1.18-2.79, respectively). Despite reporting greater past or current social proximity, respondents with higher religiosity indices also reported greater future intended stigmatizing behavior (or lower future intended social proximity) (RR, 0.92-0.98). Focusing specifically on future intended stigmatizing behavior and the respondent's level of religiosity, age, and ethnicity may be critical for designing effective stigma-reducing interventions for Black adults.

Palliative Care in Heart Failure: An Integrative Review of Nurse Practice

Introduction: Because it is a chronic disease of progressive evolution, heart failure requires nursing attitudes and practices that are articulated with palliative care, implemented in an interdisciplinary team along with patients and their families. Objective: Identifying nurses' attitudes and practices in palliative care in cardiology. Method: Integrative literature review. The searches were carried out in the following bases: Google Scholar, Virtual Health Library, LILACS, SciELO, Embase, MEDLINE, CINAHL, and Scopus; through the terms Palliative Care AND Cardiology AND Nursing. Results: We identified 1298 studies published in the last five years, 14 of which have been selected for the scope of this review. Nurse attitudes and practices were characterized as: approach to symptom control; promotion of comfort and well-being; integrality of care and family orientation; effective communication among patients, family members and nursing team; timely evaluation for palliative care. Most of the studies included in this review have evidence level 2C (n = 7) and 2B (n = 4). Therefore, the results can be interpreted as reliable. Conclusions: This study makes important contributions to the practice of nurses in palliative care for heart failure. Based on the evidence collected, nurses can develop actions with the nursing team and with the interdisciplinary team related to direct patient and family care, as well as professional training. However, the field lacks studies showing the practices and actions implemented by the nursing team.

A “random group of misfits” or being “part of something bigger”? Exploring experiences of attending a non-religious congregation

Purpose

Religion is an important part of many people’s lives and there is some evidence that attending church or other religious congregations is positively associated with psychological well-being. However, religious participation is declining in Western Europe and North America. Sunday Assembly is a non-religious gathering that intends to provide a similar communal experience and a sense of spirituality to the church, but without the religious element. In the current study, we aimed to explore the experiences of and motivations for attending a non-religious congregation in relation to well-being.

Methods

A qualitative approach was taken, gathering data through semi-structured interviews with participants from Sunday Assembly congregations across England.

Results

Thematic analysis was used and three key themes were found: (1) searching for meaning and community, (2) Sunday Assembly as protective of mental health, and (3) loneliness in a crowd.

Conclusions

Sunday Assembly can provide a sense of belonging and improvement in mental health through shared experience and spirituality, and it can act as a coping mechanism during difficult times. Further research could explore the benefits of Sunday Assembly upon attendee’s mental health, test the effectiveness of Sunday Assembly as a coping mechanism, and whether continued attendance improves mood over time.

Demographic and socioeconomic predictors of religious/spiritual beliefs and behaviours in a prospective cohort study (ALSPAC) in Southwest England: Results from the offspring generation

Background: We explored associations between possible demographic and socioeconomic causes of religious/spiritual beliefs and behaviours (RSBB) in the offspring generation of the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: We examined approximately 4,450 offspring aged 28 years with RSBB data from a prospective birth cohort study (ALSPAC) in Southwest England. Three RSBB outcome measures were assessed: religious belief (belief in God/a divine power; yes/not sure/no), religious affiliation (Christian/none/other) and religious attendance (frequency of attendance at a place of worship). We explored age- and sex-adjusted associations between 35 demographic and socioeconomic exposures and each of the three RSBB outcomes using multinomial regression. Exposure-sex interactions were also examined. Results: Some sociodemographic factors were associated with RSBB in this cohort; for instance, being female and from an ethnicity other than White were associated with increased religiosity across all domains. For many other exposures, however, associations were frequently null or inconsistent, often depending on the specific exposure and outcome combination. As an example, higher educational attainment was associated with higher rates of religious attendance, but not with religious belief or affiliation; in contrast, higher income was associated with lower levels of religiosity. No consistent interactions between sex and the exposures on RSBB were found. Effect sizes were also rather weak, with most pseudo-R2 values below 0.5% and a maximum of 1.2%. Conclusions: The results highlight that several demographic and socioeconomic factors are associated with RSBB in this cohort. However, the number of these associations, and their magnitude, is smaller than comparable results from the parental generation of these offspring, suggesting that patterns of sociodemographic factors associated with RSBB differ between these generations. In addition to describing these associations, this paper will help inform future studies using these data, particularly regarding the choice of potential sociodemographic confounders.

Protocol for EXICODE: the EXIstential health COhort DEnmark-a register and survey study of adult Danes

INTRODUCTION

We established the EXIstential health COhort DEnmark (EXICODE) to examine how existential and spiritual needs, practices and orientations in a secular culture are linked to health outcomes, illness trajectory and overall cost of care in patients. Substantial literature demonstrates that existential and spiritual well-being has positive effects on health. While people turn to existential and spiritual orientations and practices during ageing, struggle with illness and approaching death, patients with severe illnesses like, for example, cancer similarly experience existential and spiritual needs. These needs are often unmet in secular societies leading to spiritual pain, unnecessary suffering, worse quality of life and higher medical costs of care.

METHODS AND ANALYSIS

EXICODE is a national cohort comprising a 10% random sample of the adult Danish population with individual-level register and survey data. Specific patient subgroups are oversampled to ensure diseased respondents. The questionnaire used in the survey consists of a collection of validated instruments on existential and spiritual constructs suited for secular culture as well as some ad hoc questions compiled in the comprehensive EXICODE Questionnaire.

ETHICS AND DISSEMINATION

The project is registered for legal and GDPR concerns by the University of Southern Denmark, journal number: 10.367. Ethical approval was not required by Danish law since EXICODE collects only interview, survey and register data, but due to institutional best-practice policy an ethical evaluation and approval were nevertheless obtained from the University of Southern Denmark Research Ethics Committee (institutional review board), journal number: 20/39546. The project follows The Danish Code of Conduct for Research Integrity and is carried out in accordance with the Helsinki Declaration. Results will be disseminated widely through publications in peer-reviewed scientific journals, international conferences, patient societies as well as mass and social media.

Associations of Changes in Religiosity With Flourishing During the COVID-19 Pandemic: A Study of Faith Communities in the United States

This study explored the extent to which perceived changes in religiosity from before to during the COVID-19 pandemic are associated with flourishing. Participants from a diverse set of faith communities in two United States metropolitan regions (N = 1,480) completed an online survey between October and December 2020. The survey included items capturing perceived changes in four dimensions of religiosity (i.e., importance of religion, frequency of prayer, frequency of religious service attendance, and sense of connectedness to one's faith community) and a multidimensional measure of flourishing. Based on multilevel regressions, results indicated that self-reported decreases in each dimension of religiosity were associated with lower overall flourishing. This pattern of findings was largely similar for the domains of flourishing, with some variation in the strength of associations that emerged. An increase in frequency of religious service attendance was associated with lower overall flourishing and lower scores on selected domains of flourishing (e.g., mental and physical health), indicating possible evidence of religious coping. Faith communities might have to find ways of supporting members during the challenging COVID-19 period to prevent long-term declines in flourishing.

"God Doesn't Make Mistakes": Memorable Messages, Adjustment, and Grief following Family Death

Communicating in the wake of family death is complicated. Family members can vary in their expectations for support, their understandings of appropriate topics, and their approaches to coping. Using data collected from 172 individuals who experienced a family death in the last five years, this study explored family communication about loss with an eye toward identifying connections between specific communicative moments and reports of grief and adjustment. Framed within the theory of memorable messages (ToMM), five distinct memorable message types were identified and findings revealed that the type of message a bereaved individual received had direct implications for their reported amount of grief and adjustment. Messages centered on justifying or explaining the death were linked to greater grief, as compared to those that offered advice, shared a memory, or provided a sense of availability. Moderation analyses revealed that attendance to religious service impacted the relationship between message type and reports of grief and adjustment, particularly for rationale-based messages, which were more positively received by participants who attended religious service regularly. This piece supports the ToMM and extends knowledge of family communication about death, ultimately providing solace to those struggling to find the appropriate words to say to a grieving loved one.

Religion and Spirituality in Oncology: An Exploratory Study of the Communication Experiences of Clinicians in Poland

Communication with patients regarding oncology-related aspects is a challenging experience and requires a high level of skill from the interlocutors. The aim of this study was to verify the influence of religion/spirituality in oncological settings from the health professionals' perspectives in Poland. It assessed the role of religion/spirituality in patient-clinician communication, death or stress self-management, empathy, and breaking bad news skills. Data collection was carried out through a standardized self-administered questionnaire with varying scales. The study cohort consisted of 60 medical practitioners specializing in oncological radiotherapy treatments. It was observed that strategies used for coping with patients' death, stress reduction, empathy, communication with patients and/or their relatives, or breaking bad news skills, may be gender-specific or may depend on the length of time employed, as well as experience in a cancer-related work environment. This study shows that spirituality and religiousness can support clinicians in managing challenging or negative emotions related to their work in cancer settings. Religiousness and spirituality can also serve as a potential therapeutic strategies for those exposed to patient suffering and death.

Is Religiousness Associated with Better Lifestyle and Health Among Danes? Findings from SHARE

Evidence of a possible association between religion and health in secular societies is sparse. We therefore conducted a nationwide study using data from 1596 Danes aged 50 + who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 1 (2004-2005) and were followed up between 2006 and 2015, to investigate the association between religiousness and health including a lifestyle index. Results from the longitudinal models adjusted for age and gender showed that being religiously educated by parents, taking part in a religious organization, and praying were factors associated with fewer risk factors of unhealthy lifestyle. Furthermore, being religiously educated was associated with lower odds of self-rated poor health and depressive symptoms. Results were overall consistent across the cross-sectional and longitudinal models and persisted after further adjustment for education and marital status. These findings provide support for a positive relationship between religiousness and health among Danes, particularly for those being religiously educated by their parents.

Explaining US Adolescent Depressive Symptom Trends Through Declines in Religious Beliefs and Service Attendance

Over the past decade, US adolescents' depressive symptoms have increased, and changing religious beliefs and service attendance may be contributing factors. We examined the contribution of religious factors to depressive symptoms among 417,540 US adolescents (grades: 8, 10, 12), years:1991-2019, in survey-weighted logistic regressions. Among adolescents who felt religion was personally important, those who never attended services had 2.23 times higher odds of reporting depressive symptoms compared to peers attending weekly. Among adolescents who did not feel that religion was important, the pattern was reversed. Among adolescents, concordance between importance of religion and religious service attendance may lower risk of depressive symptoms. Overall, we estimate that depressive symptom trends would be 28.2% lower if religious factors had remained at 1991 levels.

Bi-directional associations between religious attendance and mental health: findings from a British birth cohort study

BACKGROUND

There is evidence that religious attendance is associated with positive outcomes for mental health; however, there are few longitudinal studies, and even fewer, which take into account the possibility of bi-directional associations. This study aimed to investigate bi-directional associations between religious attendance and mental health.

METHODS

Participants were 2125 study members who provided data at age 68-69 from the Medical Research Council National Survey of Health and Development (1946 British birth cohort study). Mental health was assessed using the 28-item General Health Questionnaire at ages 53, 60-64 and 68-69. Religious attendance was measured using a 4-point scale (weekly=3, monthly=2, less than monthly=1 or never=0) at ages 43, 60-64 and 68-69. Cross-lagged path analysis was used to assess reciprocal associations between mental health and religious attendance, adjusting for gender and education.

RESULTS

Previous religious attendance was strongly related to later attendance (r=0.62-0.74). Similarly, mental health at baseline was strongly associated with subsequent mental health scores (r=0.46-0.54). Poor mental health at age 53 and 60-64 was associated with more frequent religious attendance at age 60-64 (b=0.04; 95% CI: 0.02 to 0.06; p<0.05), and 68-69 (b=0.03; 95% CI: 0.02 to 0.06; p<0.05), respectively. There was no evidence that religious attendance at age 43, 60-64 or 68-69 was associated with later or concurrent mental health.

CONCLUSION

Using birth cohort data from the UK, it was found that poor mental health was associated with later religious attendance but not vice versa. Future research should confirm these novel findings and explore the underlying mechanisms between religious attendance and mental health.

Religiosity and Mental Wellbeing Among Members of Majority and Minority Religions: Findings From Understanding Society: the UK Household Longitudinal Study

It is unclear whether links between religiosity and mental health are found in contexts outside the United States or are causal. We examined differences in mental wellbeing and associations between mental wellbeing and religiosity among the religiously unaffiliated, White and non-White Christians, Muslims of Pakistani, Bangladeshi, and other ethnicities, and other minority ethnoreligious groups. We used 4 waves of Understanding Society: the UK Household Longitudinal Study (2009-2013; n = 50,922). We adjusted for potential confounders (including socioeconomic factors and personality) and for household fixed effects to account for household-level unobserved confounding factors. Compared with those with no religious affiliation, Pakistani and Bangladeshi Muslims and members of other minority religions had worse wellbeing (as measured using the Shortened Warwick-Edinburgh Mental Wellbeing Scale and General Health Questionnaire). Higher subjective importance of religion was associated with lower wellbeing according to the General Health Questionnaire; associations were not found with the Shortened Warwick-Edinburgh Mental Wellbeing Scale. More frequent religious service attendance was associated with higher wellbeing; effect sizes were larger for those with religious affiliations. These associations were only partially attenuated by adjustment for potential confounding factors, including household fixed effects. Religious service attendance and/or its secular alternatives may have a role in improving population-wide mental wellbeing.

Invited Commentary: Religious Service Attendance and Implications for Clinical Care, Community Participation, and Public Health

In this commentary, we review the evidence concerning associations between religious service attendance and subsequent health and wellbeing outcomes. The evidence base for a link between religious service attendance and health has increased substantially over the past 2 decades. The interpretation and implications of this research require careful consideration (Am J Epidemiol. 2022;191(1):20-30). It would be inappropriate to universally promote service attendance solely on the grounds of the associations with health. Nevertheless, a more nuanced approach, within both clinical care and public health, may be possible-one that encouraged participation in religious community for those who already positively self-identified with a religious or spiritual tradition and encouraged other forms of community participation for those who did not. Discussion is given to potential future research directions and the challenges and opportunities for promotion efforts by the public health community.

Religiosity and Depression at Midlife: A Prospective Study

Objectives:

Previously, authors found high personal importance of religion/spirituality (R/S) in early adulthood to predict a 75% decreased risk of recurrence of major depression in middle adulthood. Here, the authors follow up the original study sample to examine the association between R/S and major depression from middle adulthood into midlife.

Method:

Participants were 79 of 114 original adult offspring of depressed and non-depressed parents. Using logistic regression analysis, three measures of R/S from middle adulthood (personal importance, frequency of religious service attendance, and denomination) were used to predict Major Depressive Disorder (MDD) in midlife.

Results:

High R/S importance in middle adulthood was prospectively associated with risk for an initial onset of depression during the period of midlife. Frequency of attendance in middle adulthood was associated with recurrence of depression at midlife in the high-risk group for depression, as compared to the low-risk group.

Conclusion:

Findings suggest that the relation between R/S and depression may vary across adult development, with risk for depression associated with R/S at midlife potentially revealing a developmental process.

Stress and spirituality in relation to HPA axis gene methylation among US Black women: results from the Black Women's Health Study and the Study on Stress, Spirituality and Health

Background: Few epigenetics studies have been conducted within the Black community to examine the impact of diverse psychosocial stressors and resources for resiliency on the stress pathway (hypothalamus-pituitary-adrenal axis). Methods: Among 1000 participants from the Black Women's Health Study, associations between ten psychosocial stressors and DNA methylation (DNAm) of four stress-related genes (NR3C1, HSDB1, HSD11B2 and FKBP5) were tested. Whether religiosity or spirituality (R/S) significantly modified these stress-DNAm associations was also assessed. Results: Associations were found for several stressors with DNAm of individual CpG loci and average DNAm levels across each gene, but no associations remained significant after false discovery rate (FDR) correction. Several R/S variables appeared to modify the relationship between two stressors and DNAm, but no identified interaction remained significant after FDR correction. Conclusion: There is limited evidence for a strong signal between stress and DNAm of hypothalamus-pituitary-adrenal axis genes in this general population cohort of US Black women.

Spirituality and Well-Being: Theory, Science, and the Nature Connection

The links between spirituality and eudaimonic well-being are examined, beginning with a look at theoretical issues as to whether spirituality is best construed as part of well-being, or as a possible influence on well-being. A brief review of scientific findings from the MIDUS study linking religion and spirituality to well-being and other outcomes is then provided to show recent empirical work on these topics. Suggestions for future work are also provided. The third section is forward-thinking and addresses the power of nature to nurture spirituality and well-being, beginning with a look at how current research has linked nature to human flourishing. Issues of spirituality are rarely mentioned in this literature, despite evidence that nature has long been a source of inspiration in poetry, literature, art, and music. These works reveal that the natural world speaks to the human soul. To explore such ideas, parts of Jungian psychology are revisited: the soul's longing for poetry, myth, and metaphor; the importance of animism, which sees nature as a field inhabited by spirit; and the devaluing of ancient cultures. The final section considers the wisdom of the indigenous peoples who saw spirit in everything. Their inputs, exemplified with "Two-Eyed Seeing", offer new visions for thinking about the interplay of spirituality, well-being, and the natural world.

R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health

OBJECTIVE

Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014.

DESIGN

An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018.

RESULTS

Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data).

CONCLUSIONS

R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.

Race, Flourishing, and All-Cause Mortality in the United States, 1995-2016

We assessed whether race moderates the association between flourishing and all-cause mortality. We used panel data from the Midlife in the United States Study (MIDUS) (1995-2016; n = 2,851). Approximately 19% of White respondents and 23% of Black respondents in the baseline sample died over the course of the 21-year study period (n = 564). Cox proportional hazard models showed that Blacks had a higher mortality rate relative to Whites and higher levels of flourishing were associated with a lower mortality rate. Furthermore, a significant interaction between flourishing and race in predicting death was observed. Blacks with higher levels of flourishing had a mortality rate that was not significantly different from that of Whites. However, Blacks, but not Whites, with low flourishing scores had a higher mortality rate. As such, health-promotion efforts focused on enhancing flourishing among Black populations may reduce the Black-White gap in mortalityrate.

Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence

The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.

Late-Life Depression: A Narrative Review on Risk Factors and Prevention

After participating in this activity, learners should be better able to:• Identify risk factors for late-life depression• Evaluate strategies to prevent late-life depression ABSTRACT: Late-life depression (LLD) is one of the major sources of morbidity and mortality in the world. Because LLD is related to increased public health burden, excess health care costs and utilization, reduced quality of life, and increased mortality, prevention is a priority. Older adults differ from younger adults with respect to key features, such as their chronicity and lifetime burden of depression and their constellation of comorbidities and risk factors. LLD likely arises from a complex interplay of risk factors, including medical, physiologic, psychosocial, behavioral, and environmental factors. Thus, a comprehensive understanding of LLD risk factors is necessary to inform prevention strategies. In this narrative literature review, we address both the risk architecture of LLD and several potential strategies for prevention. Our description of LLD risk factors and prevention approaches is informed by the framework developed by the National Academy of Medicine (formerly, Institute of Medicine), which includes indicated, selective, and universal approaches to prevention.

Association of depression symptom severity with short-term risk of an initial hospital encounter in adults with major depressive disorder

BACKGROUND

Despite the availability of pharmacologic and nonpharmacologic treatment options, depression continues to be one of the leading causes of disability worldwide. This study evaluated whether depression symptom severity, as measured by PHQ-9 score, of patients diagnosed with MDD is associated with short-term risk of a hospital encounter (ER visit or inpatient stay).

METHODS

Adults with ≥1 PHQ-9 assessment in an outpatient setting (index date) and ≥ 1 MDD diagnosis within 6 months prior were included from the de-identified Optum Electronic Health Record database (April 2016-June 2019). Patients were categorized by depression symptom severity based on PHQ-9 scores obtained by natural language processing. Crude rates, adjusted absolute risks, and adjusted relative risks of all-cause and MDD-related hospital encounters within 30 days following assessment of depression severity were determined.

RESULTS

The study population consisted of 280,145 patients with MDD and ≥ 1 PHQ-9 assessment in an outpatient setting. Based on PHQ-9 scores, 26.9% of patients were categorized as having none/minimal depression symptom severity, 16.4% as mild, 24.7% as moderate, 19.6% as moderately severe, and 12.5% as severe. Among patients with none/minimal, mild, moderate, moderately severe, and severe depression, the adjusted absolute short-term risks of an initial all-cause hospital encounter were 4.1, 4.4, 4.8, 5.6, and 6.5%, respectively; MDD-related hospital encounter adjusted absolute risks were 0.8, 1.0, 1.3, 1.6, and 2.1%, respectively. Compared to patients with none/minimal depression symptom severity, the adjusted relative risks of an all-cause hospital encounter were 1.60 (95% CI 1.50-1.70) for those with severe, 1.36 (1.29-1.44) for those with moderately severe, 1.18 (1.12-1.25) for those with moderate, and 1.07 (1.00-1.13) for those with mild depression symptom severity.

CONCLUSIONS

These study findings indicate that depression symptom severity is a key driver of short-term risk of hospital encounters, emphasizing the need for timely interventions that can ameliorate depression symptom severity.

United on Sunday: The effects of secular rituals on social bonding and affect

Religious rituals are associated with health benefits, potentially produced via social bonding. It is unknown whether secular rituals similarly increase social bonding. We conducted a field study with individuals who celebrate secular rituals at Sunday Assemblies and compared them with participants attending Christian rituals. We assessed levels of social bonding and affect before and after the rituals. Results showed the increase in social bonding taking place in secular rituals is comparable to religious rituals. We also found that both sets of rituals increased positive affect and decreased negative affect, and that the change in positive affect predicted the change in social bonding observed. Together these results suggest that secular rituals might play a similar role to religious ones in fostering feelings of social connection and boosting positive affect.

Religious-service attendance and subsequent health and well-being throughout adulthood: evidence from three prospective cohorts

BACKGROUND

Religious-service attendance has been linked with a lower risk of all-cause mortality, suicide and depression. Yet, its associations with other health and well-being outcomes remain less clear.

METHODS

Using longitudinal data from three large prospective cohorts in the USA, this study examined the association between religious-service attendance and a wide range of subsequent physical health, health behaviour, psychological distress and psychological well-being outcomes in separate cohorts of young, middle-aged and older adults. All analyses adjusted for socio-demographic characteristics, prior health status and prior values of the outcome variables whenever data were available. Bonferroni correction was used to correct for multiple testing.

RESULTS

Estimates combining data across cohorts suggest that, compared with those who never attended religious services, individuals who attended services at least once per week had a lower risk of all-cause mortality by 26% [95% confidence interval (CI): 0.65 to 0.84], heavy drinking by 34% (95% CI: 0.59 to 0.73) and current smoking by 29% (95% CI: 0.63 to 0.80). Service attendance was also inversely associated with a number of psychological-distress outcomes (i.e. depression, anxiety, hopelessness, loneliness) and was positively associated with psychosocial well-being outcomes (i.e. positive affect, life satisfaction, social integration, purpose in life), but was generally not associated with subsequent disease, such as hypertension, stroke, and heart disease.

CONCLUSIONS

Decisions on religious participation are generally not shaped principally by health. Nevertheless, for individuals who already hold religious beliefs, religious-service attendance may be a meaningful form of social integration that potentially relates to greater longevity, healthier behaviours, better mental health and greater psychosocial well-being.

Religiosity, spirituality, suicide risk and remission of depressive symptoms: a 6-month prospective study of tertiary care Brazilian patients

Religiosity and spirituality (R/S) are increasingly recognized as significant aspects in the evaluation of depressed patients. Limited research, however, has investigated the impact of R/S on outcomes of more severe or chronic depressed patients. The present study investigated the impact of different religiosity dimensions in tertiary care Brazilian depressed patients over suicide risk scores measured at baseline and remission of depressive symptoms in a 6-month prospective follow-up. In 277 individuals interviewed, 226 presented a diagnosis of depressive episode and 192 were assessed in the follow-up. Religiosity was evaluated using the Duke University Religion Index, comprising three dimensions of religiosity (organizational religiosity, non-organizational religiosity, intrinsic religiosity). Other potential predictors of outcomes included the Childhood Trauma Questionnaire (CTQ), Maudsley Staging of illness (MSM), Medical Outcomes Study Social Support Survey (MOS), World Health Organization Spirituality, Religiousness and Personal Beliefs instrument (WHOQOL-SRPB) and Hamilton Depression Scale (HAM-D). Results showed that almost half (46.1%) of the patients reported previous suicide attempts. Linear regression models identified that religious attendance (t-statistic -2.17, P=0.03), intrinsic religiosity (t-statistic -2.42, P=0.01) and WHOQOL-SRPB (t-statistic -3.67, P=0.00) were inversely correlated to suicide risk scores. In a prospective follow-up 16.7 % of patients (n=32/192) achieved remission of depressive symptoms (HAM-D scores ≤7). Religious attendance (OR 1.83, P=0.02) was identified as the main predictor of remission. Findings reinforce the importance of attending to religiosity/spirituality in order to improve outcomes and promote the recovery especially among severely depressed patients with increased suicide risk.

Influence of Religiousness and Spirituality on Remission Rate, Mental Health, and Quality of Life of Patients With Active Crohn's Disease: A Longitudinal 2-Year Follow-up Study

BACKGROUND AND AIMS

Studies on inflammatory bowel disease [IBD] have shown that religiousness and spirituality [R/S] were associated with better mental health and quality of life [QOL]. However, longitudinal studies assessing the impact of R/S on long-term clinical outcomes of Crohn's disease [CD] are scarce. The aim of this study was to assess the influence of R/S on the course of CD after a 2-year follow-up and to determine whether these R/S beliefs were associated with mental health and QOL.

METHODS

A longitudinal 2-year follow-up study was conducted at a referral centre for IBD, including patients with moderately to severely active CD. Clinical data, disease activity [Harvey-Bradshaw Index], QOL [Inflammatory Bowel Disease Questionnaire-IBDQ], depression and anxiety [Hospital Anxiety and Depression Scale-HADS], and R/S [Duke Religion Index-DUREL, Spirituality Self-Rating Scale-SSRS, and Spiritual/Religious Coping-SRCOPE scale] were assessed at baseline and at the end of the 2-year follow-up. Linear and logistic regression models were employed.

RESULTS

A total of 90 patients [88.2%] were followed up for 2 years. On logistic regression, baseline levels of spirituality (odds ratio [OR] = 1.309; 95% confidence interval [CI]= 1.104-1.552, p = 0.002) and intrinsic religiousness [OR = 1.682; 95% CI = 1.221-2.317, p = 0.001] were predictors of remission at 2 years. On linear regression, the different dimensions of R/S did not significantly predict IBDQ or anxiety and depression scores after 2 years.

CONCLUSIONS

R/S predicted remission of CD patients after a 2-year follow-up. However, these beliefs failed to predict mental health or QOL. Health professionals who treat CD should be aware of the religious and spiritual beliefs of their patients, given these beliefs may impact on the disease course.

Plasma protein expression profiles, cardiovascular disease, and religious struggles among South Asians in the MASALA study

Blood protein concentrations are clinically useful, predictive biomarkers of cardiovascular disease (CVD). Despite a higher burden of CVD among U.S. South Asians, no CVD-related proteomics study has been conducted in this sub-population. The aim of this study is to investigate the associations between plasma protein levels and CVD incidence, and to assess the potential influence of religiosity/spirituality (R/S) on significant protein-CVD associations, in South Asians from the MASALA Study. We used a nested case–control design of 50 participants with incident CVD and 50 sex- and age-matched controls. Plasma samples were analyzed by SOMAscan for expression of 1305 proteins. Multivariable logistic regression models and model selection using Akaike Information Criteria were performed on the proteins and clinical covariates, with further effect modification analyses conducted to assess the influence of R/S measures on significant associations between proteins and incident CVD events. We identified 36 proteins that were significantly expressed differentially among CVD cases compared to matched controls. These proteins are involved in immune cell recruitment, atherosclerosis, endothelial cell differentiation, and vascularization. A final multivariable model found three proteins (Contactin-5 [CNTN5], Low affinity immunoglobulin gamma Fc region receptor II-a [FCGR2A], and Complement factor B [CFB]) associated with incident CVD after adjustment for diabetes (AUC = 0.82). Religious struggles that exacerbate the adverse impact of stressful life events, significantly modified the effect of Contactin-5 and Complement factor B on risk of CVD. Our research is this first assessment of the relationship between protein concentrations and risk of CVD in a South Asian sample. Further research is needed to understand patterns of proteomic profiles across diverse ethnic communities, and the influence of resources for resiliency on proteomic signatures and ultimately, risk of CVD.

Religion and Faith Perception in a Pandemic of COVID-19

The COVID-19 pandemic has impacted religion and faith in different ways. Numerous restrictions have been implemented worldwide. Believers are in conflict with authorities' warnings that gatherings must be limited to combat the spread of the virus. Religion has always played a role of the balm for the soul, and the regular religious participation is associated with better emotional health outcomes. In our study, we examined whether the exposure to COVID-19 enhances the faith. The instrument used was a survey verifying the power of spirituality in the face of the coronavirus pandemic.

Religious Attendance and Physical Health in Later Life: A Life Course Approach

Existing research on the life course origins of adult health has extensively examined the influence of childhood socioeconomic conditions, family structure, and exposure to trauma. Left unexplored are the potential long-term health effects of sociocultural exposures, such as religiosity at earlier phases of the life course. Integrating life course models of health with literature on the health-protective effects of adult religiosity, we consider how adolescent and midlife religiosity combine to structure the physical health profiles of adults past age 50. Using more than 35 years of representative data from the National Longitudinal Survey of Youth 79 (NLSY79), we found that the stability of frequent religious practice over time was associated with better health composite scores and lower disease burden. Causal mediation analyses revealed that part of this association is driven by a lower risk of smoking for consistent, frequent attenders. Adulthood religiosity also mediated the relationship between frequent early-life religious attendance and health.

Religiosity and depressive symptoms among older adults in Colombia

Objective: The objective of this study was to examine the relationship between depressive symptoms and religiosity among older adults in Colombia.Methods: Data are drawn from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study, a cross-sectional survey conducted in 2015 involving 19,004 community-dwelling adults aged 60 years and older living in urban and rural areas of Colombia. Depressive symptoms were measured using the Geriatric Depression scale (GDS; range 0-15), examined both as a continuous and categorical variable. Religiosity was assessed by self-rated religiosity and comfort derived from religion. Logistic and linear regression analyses were used to assess the association adjusting for confounders.Results: Multivariate logistic regression analyses demonstrated that being more religious (OR = 0.90, 95% CI = 0.85-0.95, p < .001) or perceiving greater strength or comfort from religion (OR = 0.88, 95% CI = 0.82-0.93, p < .001) was associated with a lower likelihood of scoring above the cutoff on the GDS for significant depressive symptoms (≥6). Similarly, linear regression analyses indicated that being more religious (unstandardized beta coefficient B = -0.16, p < .001) or perceiving greater strength or comfort from religion (B = -0.20, p < .001) was associated with a significantly lower score on the GDS assessed on a continuous scale.Conclusion: Being more religious or perceiving greater strength or comfort from religion is associated with fewer depressive symptoms among older adults in Colombia.

Religious service attendance, health behaviors and well-being-an outcome-wide longitudinal analysis

BACKGROUND

Previous studies of relationship between religiosity, health behaviors and well-being have showed mainly positive relationships, however, are very often limited to results of associative nature and subject to unmeasured confounding. This study focused on evaluating evidence for a positive association between religious service attendance (RSA), health behaviors and well-being in a longitudinal setting and robustness of these associations to unmeasured confounding.

METHODS

Three waves (2009, 2011 and 2015) of the biennial longitudinal Polish household panel study with response from 6400 respondents were analyzed. Evidence for a positive and robust association between RSA and outcome variables was evaluated using outcome-wide regression analysis with control of all variables temporally prior to the exposure and sensitivity measures (E-values) to give information on the extent to which an unmeasured confounder would need to be associated with both the exposure and the outcomes.

RESULTS

RSA is associated with reduced risk of unhealthy behaviors (smoking, alcohol use) and higher emotional well-being. These relationships are robust to substantial unmeasured confounding and difficult to explain by reference to other, unknown, variables. Evidence for a positive relationship between RSA and other well-being variables (social, physical) was less clear.

CONCLUSIONS

Religiosity may play an important role in public health, particularly in prevention of non-communicable diseases. The strong and robust associations between RSA and some health behaviors (i.e. tobacco use, alcohol abuse) and emotional well-being should arguably be taken into account in health education, health promotion programs, health prevention policy and psychotherapeutic approaches, particularly in more religious populations.

Psychological Climate for Caring and Work Outcomes: A Virtuous Cycle

The current literature’s focus on unidirectional effects of psychological and organizational climates at work on work outcomes fails to capture the full relationship between these factors. This article examines whether a psychological climate for caring contributes to specific work outcomes and investigates whether work outcomes support the climate for caring, creating a feedback loop. Results confirm a bi-directional, temporal association between perceived climate for caring and two of the four explored work outcomes: self-reported productivity and self-reported work quality. The effect of a perceived caring climate on these work outcomes was stronger than the effect in the opposite direction. The perception that the work climate was caring was also found to affect work engagement, but the reverse relationship was not identified. We did not find any evidence for a link between job satisfaction and a climate for caring at work in either direction.

Trauma exposure, PTSD symptoms, and tobacco use: Does church attendance buffer negative effects?

Traumatic stress and posttraumatic stress disorder (PTSD) are overrepresented in urban African American communities, and associated with health risk behaviors such as tobacco use. Support and resources provided by churches may reduce trauma-related health risks. In the current study, we assessed weekly church attendance as a moderator of relations between (a) traumatic event exposure and probable PTSD, and (b) probable PTSD and tobacco use. Data were drawn from a health surveillance study conducted in seven churches located in Chicago's West Side. Participants (N = 1015) were adults from churches as well as the surrounding community. Trauma exposure was reported by 62% of participants, with 25% of those who experienced trauma reporting probable PTSD. Overall, more than one-third of participants (37.2%) reported current tobacco use. As compared with non-weekly church attendance, weekly church attendance was associated with a lower likelihood of PTSD (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.26-0.62; p < .0001) and lower tobacco use overall (OR = 0.22; 95% CI = 0.16-0.30; p < .0001), but did not moderate the effect of trauma exposure on risk of PTSD, or the effect of PTSD on tobacco use. Findings support church attendance as a potential buffer of trauma-related stress.

Religious Service Attendance and Deaths Related to Drugs, Alcohol, and Suicide Among US Health Care Professionals

IMPORTANCE

The increase in deaths related to drugs, alcohol, and suicide (referred to as deaths from despair) has been identified as a public health crisis. The antecedents associated with these deaths have, however, seldom been investigated empirically.

OBJECTIVE

To prospectively examine the association between religious service attendance and deaths from despair.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study used data extracted from self-reported questionnaires and medical records of 66 492 female registered nurses who participated in the Nurses' Health Study II (NHSII) from 2001 through 2017 and 43 141 male health care professionals (eg, dentist, pharmacist, optometrist, osteopath, podiatrist, and veterinarian) who participated in the Health Professionals Follow-up Study (HPFS) from 1988 through 2014. Data on causes of death were obtained from death certificates and medical records. Data analysis was conducted from September 2, 2018, to July 14, 2019.

EXPOSURE

Religious service attendance was self-reported at study baseline in response to the question, "How often do you go to religious meetings or services?"

MAIN OUTCOMES AND MEASURES

Deaths from despair, defined specifically as deaths from suicide, unintentional poisoning by alcohol or drug overdose, and chronic liver diseases and cirrhosis. Cox proportional hazards regression models were used to estimate the hazard ratio (HR) of deaths from despair by religious service attendance at study baseline, with adjustment for baseline sociodemographic characteristics, lifestyle factors, psychological distress, medical history, and other aspects of social integration.

RESULTS

Among the 66 492 female participants in NHSII (mean [SD] age, 46.33 [4.66] years), 75 incident deaths from despair were identified (during 1 039 465 person-years of follow-up). Among the 43 141 male participants in HPFS (mean [SD] age, 55.12 [9.53] years), there were 306 incident deaths from despair (during 973 736 person-years of follow-up). In the fully adjusted models, compared with those who never attended religious services, participants who attended services at least once per week had a 68% lower hazard (HR, 0.32; 95% CI, 0.16-0.62) of death from despair in NHSII and a 33% lower hazard (HR, 0.67; 95% CI, 0.48-0.94) of death from despair in HPFS.

CONCLUSIONS AND RELEVANCE

The findings suggest that religious service attendance is associated with a lower risk of death from despair among health care professionals. These results may be important in understanding trends in deaths from despair in the general population.

Building towards common psychosocial measures in U.S. cohort studies: principal investigators' views regarding the role of religiosity and spirituality in human health

BACKGROUND

The goal of this study was to understand prospective cohort study Principal Investigators' (PIs') attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research.

METHODS

One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation.

RESULTS

The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of religiosity. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates for the outcome under study; (2) studies that posit a plausible biological mechanism of effect; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research among investigators; and (5) NIH funding for R/S research.

CONCLUSIONS

Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide new leverage points for reducing health disparities.