Multidimensional understanding of religiosity/spirituality: relationship to major depression and familial risk

Religious and secular spirituality: Methodological implications of definitions for health research

The importance of spirituality as a research topic has been increasingly recognized, which has led to several studies on the topic. Areas including psychology, medicine, and nursing have produced studies on spirituality under a plurality of definitions and methods, which reveals the complexity of the theme. However, this has resulted in a range of potential problems, including: (1) the use of overlapping and contradictory terms between studies, or even within the same study, (2) research methodologies that do not fit the definitions (sometimes unreflectively) assumed by the authors, (3) difficulties, or even the impossibility, of comparing the results of studies, (4) controversies in respect of the inclusion/exclusion of secular groups in research on spirituality, and (5) ambiguous measurements, often being exclusively dependent on each participant's individual interpretation of what spirituality means. This article discusses these problems, recommends theoretical and methodological alternatives and presents taxonomy of definitions of spirituality.

Pursuing the epidemiology and familial risks of depression and developing an evidence based psychotherapy

This commentary, as requested, presents the highlights of my research career. The epidemiology of psychiatric disorders study, challenged in a small study, the notion that diagnosis for psychiatric disorders could be made in a community survey. This pilot study was the basis for the Epidemiology Catchment Area Study (ECA) with 18,000 participants and the many more updated surveys, which followed. The families at High and Low Risk for Depression study in its 40th year challenged the notion that children didn't get depressed and showed that parental depression was the major risk for depression, which began in youth and reoccurred over the lifespan. Interpersonal psychotherapy (IPT), now has been tested in over 150 clinical trials, recommended by the World Health Organization (WHO), globally in China, Germany, Ukraine, and many more countries.

Exploring the meaning of life from the perspective of patients with depression: A phenomenological study

This study explored the perceptions of meaning of life for patients with depression. A qualitative phenomenology approach was used. Patients with depression (n = 20) were recruited until data saturation occurred. Findings revealed four themes all related to their value of: (1) accepting depression; (2) appreciating work (paid and non-paid); (3) embodying love and taking on responsibilities; (4) receiving spiritual comfort. Healthcare professionals could facilitate patients with depression to explore their meaning of life while enduring and transforming the emotional pain that accompanies depression, hence, perhaps, decreasing their suicidal ideations.

Altruism and "love of neighbor" offer neuroanatomical protection against depression

We prospectively investigate protective benefits against depression of cortical thickness across nine regions of a Ventral Frontotemporal Network (VFTN), previously associated with spiritual experience. Seventy-two participants at high and low risk for depression (Mean age 41 years; 22-63 years; 40 high risk, 32 low risk) were drawn from a three-generation, thirty-eight year study. FreeSurfer estimated cortical thickness over anatomical MRIs of the brain (Year 30) for each of the nine ROIs. Depression (MDD with SAD-L; symptoms with PHQ; Years 30 and 38) and spirituality (self-report on five phenotypes; Year 35), respectively, were associated with the weighted average of nine regions of interest. VFTN thickness was: 1) positively associated (p<0.01) with two of five spiritual phenotypes, altruism and love of neighbor, interconnectedness at a trend level, but neither commitment nor practice, 2) inversely associated with a diagnosis of MDD (SADS-L Year 30, for any MDD in the past ten years), and 3) prospectively neuroanatomically protective against depressive symptoms (PHQ-9 Year 38) for those at high familial risk.

The Relationship Between Four Measures of Religiosity and Cross-National Variations in the Burden of Dementia

Background

Several researchers have identified a possible protective effect of religiosity on the risk of dementia. Specific aspects of religiosity may be associated with this attenuation of risk, and it may be partially mediated through an effect on depressive symptoms or social support. However, this effect has only been demonstrated in selected cohorts to date.

Methods

This study was based on a cross-national analysis of associations. Correlations between World Health Organization estimates of the burden of dementia and four survey-derived measures of religiosity were examined across 101 countries, while controlling for estimates of late-life depression and social capital.

Results

Specific aspects of religiosity, such as attendance at religious services (Pearson’s r= -0.57), daily prayer (r = -0.58), and perception of religion as very important (r = -0.65), were associated with lower national levels of Alzheimer’s and other dementias (p< 0.01 for all correlations). This effect was partially mediated through an inverse relationship between religiosity and depression, but remained significant even after controlling for it and on multivariate analyses (β = -0.38 to -0.57, p< 0.01 for all measures). There was no evidence for a mediating effect of social capital.

Conclusions

Specific religious beliefs and practices may have a protective effect on dementia risk at the population level. These may involve group effects that require further study, such as reductions in depression in the elderly, or may involve beneficial effects on the stress response and cellular ageing in vulnerable individuals; however, the latter cannot be inferred with certainty from a group-level analysis. These results are consistent with earlier research and suggest a potential role for religious-based preventive strategies at the population level.

Predicting Depression Symptoms in Families at Risk for Depression: Interrelations of Posterior EEG Alpha and Religion/Spirituality

BACKGROUND

Posterior EEG alpha has been identified as a putative biomarker of clinical outcomes in major depression (MDD). Separately, personal importance of religion and spirituality (R/S) has been shown to provide protective benefits for individuals at high familial risk for MDD. This study directly explored the joint value of posterior alpha and R/S on predicting clinical health outcomes of depression.

METHODS

Using a mixed-effects model approach, we obtained virtual estimates of R/S at age 21 using longitudinal data collected at 5 timepoints spanning 25 years. Current source density and frequency principal component analysis was used to quantify posterior alpha in 72-channel resting EEG (eyes open/closed). Depression severity was measured between 5 and 10 years after EEG collection using PHQ-9 and IDAS-GD scales.

RESULTS

Greater R/S (p = .008, η²_p = 0.076) and higher alpha (p = .02, η²_p = 0.056) were separately associated with fewer symptoms across scales. However, an interaction between alpha and R/S (p = .02, η²_p = 0.062) was observed, where greater R/S predicted fewer symptoms with low alpha but high alpha predicted fewer symptoms with lower R/S.

LIMITATIONS

Small-to-medium effect sizes and homogeneity of sample demographics caution overall interpretation and generalizability.

CONCLUSIONS

Findings revealed a complementary role of R/S and alpha in that either variable exerted protective effects only if the other was present at low levels. These findings confirm the relevance of R/S importance and alpha oscillations as predictors of depression symptom severity. More research is needed on the neurobiological mechanism underlying the protective effects of R/S importance for MDD.

Varieties of Religious (Non)Affiliation: A Primer for Mental Health Practitioners on the "Spiritual but Not Religious" and the "Nones"

Given changing demographics of religiosity and spirituality, this article aims to help clinicians understand contemporary trends in patient religious and spiritual orientation. It first identifies and describes the evolving varieties of religio-spiritual orientation and affiliation, as identified in survey studies. Particular attention is given to the examination of those who identify as spiritual but not religious (SBNR) and None (i.e., no religious affiliation), which is important to mental health practice because many patients now identify as SBNR or None. Next, empirical data are considered, including what the literature reveals regarding mental health outcomes and SBNRs and Nones. We conclude with a summary of the main points and five recommendations that mental health practitioners and researchers need to consider regarding this increasingly large portion of the population.

Understanding self-reported importance of religion/spirituality in a North American sample of individuals at risk for familial depression: A principal component analysis

Several studies have shown protective effects between health outcomes and subjective reports of religious/spiritual (R/S) importance, as measured by a single self-report item. In a 3-generation study of individuals at high or low familial risk for depression, R/S importance was found to be protective against depression, as indicated by clinical and neurobiological outcomes. The psychological components underlying these protective effects, however, remain little understood. Hence, to clarify the meaning of answering the R/S importance item, we employed a comprehensive set of validated scales assessing religious beliefs and experiences and exploratory factor analysis to uncover latent R/S constructs that strongly and independently correlated with the single-item measure of R/S importance. A Varimax-rotated principal component analysis (PCA) resulted in a 23-factor solution (Eigenvalue > 1; 71.5% explained variance) with 8 factors that, respectively, accounted for at least 3% of the total variance. The first factor (15.8%) was directly related to the R/S importance item (r = .819), as well as personal relationship with the Divine, forgiveness by God, religious activities, and religious coping, while precluding gratitude, altruism, and social support, among other survey subscales. The corresponding factor scores were greater in older individuals and those at low familial risk. Moreover, Spearman rank-order correlations between the R/S importance item and other subscales revealed relative consistency across generations and risk groups. Taken together, the single R/S importance item constituted a robust measure of what may be generally conceived of as "religious importance," ranking highest among a diverse latent factor structure of R/S. As this suggests adequate single-item construct validity, it may be adequate for use in health studies lacking the resources for more extensive measures. Nonetheless, given that this single item accounted for only a small fraction of the total survey variance, results based on the item should be interpreted and applied with caution.

The Role of Religiosity in Families at High Risk for Depression

BACKGROUND

About forty years ago we began a study of the offspring of depressed (high-risk) and not depressed (low-risk) parents, matched for age and gender, from the same community. We interviewed all of their biological children, blind to the clinical status of the parents. Over the years, we returned to re-interview the families at baseline, 2, 10, 20, 25 30, and 35 years. As the years went by and the sample grew up, we also interviewed the third generation, the grandchildren. As technology became available, we included measures of electrophysiology and magnetic resonance imaging in order to better understand the mechanisms of risk. At the 10-year follow up, we included measures of religion and spirituality - namely, personal religious/spiritual importance and frequency of religious service attendance. We included these measures in all subsequent waves including a more extensive follow up of religious beliefs at the 35-year follow up.

ISSUES OF FOCUS

This paper describes the study design and highlights the key findings of the role of religious/spiritual belief in the transmission and endurance of depression using clinical and biological approaches.

METHODS

We describe study findings based on clinical measures, as well as physiological measures that employed electrophysiology and magnetic resonance imaging.

RESULTS

Taken together, the findings suggest that religiosity/spirituality is protective against depression in high-risk individuals at both clinical and physiological levels.

IMPLICATIONS

The findings suggest religiosity interacts with both culture and biology in its impact on depression.