Re: "Religious service attendance and major depression: a case of reverse causality?"

Parent and Peer Attachments in Adolescence and Paternal Postpartum Mental Health: Findings From the ATP Generation 3 Study

Background: When adolescent boys experience close, secure relationships with their parents and peers, the implications are potentially far reaching, including lower levels of mental health problems in adolescence and young adulthood. Here we use rare prospective intergenerational data to extend our understanding of the impact of adolescent attachments on subsequent postpartum mental health problems in early fatherhood.

Methods: At age 17–18 years, we used an abbreviated Inventory of Parent and Peer Attachment to assess trust, communication, and alienation reported by 270 male participants in their relationships with mothers, fathers, and peers. More than a decade later, we assessed the adult males, now fathers, at 12 months postpartum (N = 409 infant offspring) for symptoms of depression, anxiety, and stress. Logistic regression was used to examine the extent to which attachment dimensions predicted paternal postpartum mental health, adjusting for potential confounding, and with assessment for interactions between parent and peer attachments.

Results: Trust in mothers and peers, and good communication with fathers during adolescence, were associated with 5 to 7 percentage point reductions in postpartum mental health symptoms in early fatherhood. Weak evidence of parent-peer interactions suggested secure attachments with either parent or peer may compensate for an insecure attachment with the other.

Conclusions: Our results suggest that fostering trust and communication in relationships that adolescent boys have with parents and peers may have substantial effects on rates of paternal postpartum mental health problems. The protective benefits may be preventative in intergenerational cycles of risk for mental health problems.

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

BACKGROUND

Previous research has shown prospectively that religiosity/spirituality protects against depression, but these findings are commonly critiqued on two grounds, namely: (1) apparent religiosity/spirituality reflects merely an original absence of depression or elevated mood and (2) religiosity/spirituality too often is measured as a global construct. The current study investigates the relationship between depression and religiosity/spirituality by examining its multidimensional structural integrity.

METHOD

Confirmatory factor analyses with a previously observed cross-cultural factor structure of religiosity/spirituality variables were conducted on an independent sample, diagnostic and familial risk subgroups from this sample, and a subsample of the original cross-cultural sample. Linear regressions onto a previous diagnosis of major depressive disorder (MDD) 5 years prior to assess the potential attenuating impact of a previous depression was explored.

RESULTS

Across familial risk groups and clinical subgroups, each of the previously validated religiosity/spirituality domains was confirmed, namely: religious/spiritual commitment, contemplative practice, sense of interconnectedness, the experience of love, and altruistic engagement. Previous MDD diagnosis was associated with a lower religious/spiritual commitment among high-risk individuals, higher contemplation among low-risk individuals, and lower importance of religion or spirituality regardless of risk group.

CONCLUSIONS

Structural integrity was found across familial risk groups and diagnostic history for a multidimensional structure of religiosity/spirituality. Differential associations between a previous diagnosis of MDD and level of religiosity/spirituality across domains suggest a complex and interactive relation between depression, familial risk, and religiosity/spirituality. Accounting for an empirically valid, multidimensional understanding of religiosity/spirituality may advance research on mechanisms underlying the relationship between religiosity/spirituality and mental health.

Is religiousness really helpful to reduce depressive symptoms at old age? A longitudinal study

Background

Higher levels of religiousness are associated with better mental health outcomes, but most of previous research is cross-sectional, failing to address issues of selection and reverse causation.

Methods

We assessed the longitudinal association between both public and private religiousness and depressive symptoms, drawing on data from 7,719 persons aged 65 and older of the Survey of Health, Ageing and Retirement in Europe (SHARE). Repeated measurements of different aspects of religiousness and depressive symptoms were used in random and fixed-effects models in order to assess the effect of changes in religious behavior on changes in depressive symptoms.

Results

Praying more than once a day was associated with more depressive symptoms (β = 0.150, 95% CI: 0.003, 0.298) relative to individuals who never pray, adjusted for socio-demographic characteristics, physical health covariates and history of depression, but the comparison with the fixed effects model suggests that this is the result of a selection effect. Participating weekly or more in a religious organization was associated with fewer depressive symptoms (β = -0.219, 95% CI: -0.344, -0.094), but this appeared to be spurious after taking due account of possible confounders (β = -0.092, 95% CI: -0.223, 0.038). Focusing on within-persons changes, we found that participating in religious organizations weekly or more was associated with more depressive symptoms (β = 0.275, 95% CI: 0.075, 0.475).

Conclusion

Our findings do not support that religious behavior, both public or private, may be beneficial for the mental health of older Europeans.

Religious service attendance, divorce, and remarriage among U.S. nurses in mid and late life

Prior research has suggested religious participation can promote marital satisfaction and stability. However, current literature has mainly focused on early life divorce, and used cross-sectional data, leaving open the question of the directionality of effects. We evaluated the prospective associations between service attendance and marital stability in mid and late life considering either 1) divorce or separation; or 2) remarriage, as separate outcomes. Data were drawn from the Nurses' Health Study, a large prospective cohort study that consisted of US female nurses in their 50s at study enrollment, with repeated measures of service attendance and marital status over 14 years of follow-up from 1996-2010. During follow up, among 66,444 initially married nurses who were mainly Christians, frequent service attendance was associated with 50% lower risk of divorce (95% CI: 32%, 63%), and 52% lower risk of either divorce or separation (95%CI: 37%, 63%). Among initially divorced or separated women, frequent service attendance was not associated with subsequent likelihood of remarriage; however, among widowed women, women who attended services frequently had 49% increased likelihood of remarriage (95% CI: 13%, 97%) compared to those women who did not. The study provides evidence that in this cohort of US nurses, frequent service attendance is associated with lower risk of becoming divorced in mid- and late- life, and increased likelihood of remarriage among widowed nurses, but not among divorced or separated nurses.

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

OBJECTIVE

Previous studies on the association between religious service attendance and depression have been mostly cross-sectional, subject to reverse causation, and did not account for the potential feedback between religious service attendance and depression. We prospectively evaluated evidence whether religious service attendance decreased risk of subsequent risk of depression and whether depression increased subsequent cessation of service attendance, while explicitly accounting for feedback with potential effects in both directions.

METHOD

We included a total of 48,984 US nurses who were participants of the Nurses' Health Study with mean age 58 years and who were followed up from 1996 to 2008. Religious service attendance was self-reported in 1992, 1996, 2000, and 2004. Depression was defined as self-reported physician-diagnosed clinical depression, regular anti-depressant use, or severe depressive symptoms. Multivariate logistic regression and marginal structural models were used to estimate the odds ratio of developing incident depression, adjusted for baseline religious service attendance, baseline depression, and time-varying covariates.

RESULTS

Compared with women who never attended services, women who had most frequent and recent religious service attendance had the lowest risk of developing depression (odds ratio [OR] = 0.71, 95 % confidence interval [CI] 0.62-0.82). Compared with women who were not depressed, women with depression were less likely to subsequently attend religious services once or more per week (OR = 0.74, 95 % CI 0.68-0.80).

CONCLUSIONS

In this study of US women, there is evidence that higher frequency of religious service attendance decreased the risk of incident depression and women with depression were less likely to subsequently attend services.

Religion and health in Europe: cultures, countries, context

Much of the research on the relationships between religious participation and health comes from the United States. Studies in other geographic regions or cultural contexts is more sparse. Evidence presented by Ahrenfelt et al., and that from other research studies, is reviewed concerning the associations between religion and health within Europe and world-wide. The evidence within Europe suggests protective associations between various forms of religious participation and lower depression, lower mortality, and better self-rated health. Methodological challenges in such research are reviewed, and discussion is given as to whether a person-culture-fit explanation suffices to account for the existing data and to what other mechanisms might be operative.

Religiousness and health in Europe

Recent research suggests that epidemiological forces in religion and health can have opposed effects. Using longitudinal data of people aged 50+ included in wave 1 (2004-2005) of the Survey of Health, Ageing and Retirement in Europe (SHARE), and followed up through waves 2 (2006-2007), 4 (2011) and 5 (2013), we examined two forms of religious internalization and their association with health. Multivariate logistic regressions were used to examine all associations. Taking part in a religious organization was associated with lower odds of GALI (global activity limitation index) (OR = 0.86, 95% CI 0.75, 0.98) and depressive symptoms 0.80 (95% CI 0.69, 0.93), whereas being religiously educated lowered odds of poor self-rated health (SRH) 0.81 (95% CI 0.70, 0.93) and long-term health problems 0.84 (95% CI 0.74, 0.95). The more religious had lower odds of limitations with activities of daily living 0.76 (95% CI 0.58, 0.99) and depressive symptoms 0.77 (95% CI 0.64, 0.92) than other respondents, and compared to people who only prayed and did not have organizational involvement, they had lower odds of poor SRH 0.71 (95% CI 0.52, 0.97) and depressive symptoms 0.66 (95% CI 0.50, 0.87). Conversely, people who only prayed had higher odds of depressive symptoms than non-religious people 1.46 (95% CI 1.15, 1.86). Our findings suggest two types of religiousness: 1. Restful religiousness (praying, taking part in a religious organization and being religiously educated), which is associated with good health, and 2. Crisis religiousness (praying without other religious activities), which is associated with poor health.

Causal inference and longitudinal data: a case study of religion and mental health

PURPOSE

We provide an introduction to causal inference with longitudinal data and discuss the complexities of analysis and interpretation when exposures can vary over time.

METHODS

We consider what types of causal questions can be addressed with the standard regression-based analyses and what types of covariate control and control for the prior values of outcome and exposure must be made to reason about causal effects. We also consider newer classes of causal models, including marginal structural models, that can assess questions of the joint effects of time-varying exposures and can take into account feedback between the exposure and outcome over time. Such feedback renders cross-sectional data ineffective for drawing inferences about causation.

RESULTS

The challenges are illustrated by analyses concerning potential effects of religious service attendance on depression, in which there may in fact be effects in both directions with service attendance preventing the subsequent depression, but depression itself leading to lower levels of the subsequent religious service attendance.

CONCLUSIONS

Longitudinal designs, with careful control for prior exposures, outcomes, and confounders, and suitable methodology, will strengthen research on mental health, religion and health, and in the biomedical and social sciences generally.